CALCIUM GUIDELINE
1. Definition
Calcium is an essential mineral found in great abundance in the body. Ninety-nine percent of all the
calcium in the body is found in the bones and teeth. The remaining one percent is in the blood.
Role/Function Calcium plays important roles in nerve conduction/ nerve impulse transmission, ,
Bone Structure (99%), Regulator of Metabolism (1%), muscle contraction, and blood clotting,. Some
studies suggest that calcium, along with vitamin D, may have benefits beyond bone health, perhaps
protecting against cancer, diabetes and high blood pressure. But evidence about such health
benefits is not definitive.
Regulation of Blood Calcium10 mg/dl of blood
hypocalcemia & hypercalcemia
abnormal muscle cramping
nerve irritation
Controlled by: vitamin D, parathyroid hormone, calcitonin
2. Source of Calcium:
99% of the body’s calcium supply is stored in the bones and teeth where it supports their structure and
function
a) Calcium and diet
Your body doesn't produce calcium, so you must get it through other sources. Calcium can be found in a
variety of foods, including:

Dairy products, such as cheese, milk and yogurt

Dark green leafy vegetables, such as broccoli and kale

Fish with edible soft bones, such as sardines and canned salmon

Calcium-fortified foods and beverages, such as soy products, cereal and fruit juices
Even if you eat a healthy, balanced diet, you may find it difficult to get enough calcium if you:

Follow a vegan diet

Have lactose intolerance and limit dairy products
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
Consume large amounts of protein or sodium, which can cause your body to excrete calcium

Have osteoporosis

Are receiving long-term treatment with corticosteroids

Have certain bowel or digestive diseases that decrease your ability to absorb calcium, such as
inflammatory bowel disease or celiac disease
In these situations, calcium supplements may help you meet your calcium requirements.
Table: Selected Food Sources of Calcium
Food
Milligrams (mg) per serving
Percent DV*
Yogurt, plain, low fat, 8 ounces
415
42
Mozzarella, part skim, 1.5 ounces
333
33
Sardines, canned in oil, with bones, 3 ounces
325
33
313–384
31–38
Cheddar cheese, 1.5 ounces
307
31
Milk, nonfat, 8 ounces**
299
30
Soymilk, calcium-fortified, 8 ounces
299
30
Milk, reduced-fat (2% milk fat), 8 ounces
293
29
Milk, buttermilk, lowfat, 8 ounces
284
28
Milk, whole (3.25% milk fat), 8 ounces
276
28
Orange juice, calcium-fortified, 6 ounces
261
26
Tofu, firm, made with calcium sulfate, ½ cup***
253
25
Salmon, pink, canned, solids with bone, 3 ounces
181
18
Cottage cheese, 1% milk fat, 1 cup
138
14
Tofu, soft, made with calcium sulfate, ½ cup***
138
14
100–1,000
10–100
103
10
99
10
Kale, raw, chopped, 1 cup
100
10
Kale, fresh, cooked, 1 cup
94
9
Ice cream, vanilla, ½ cup
84
8
Chinese cabbage, bok choi, raw, shredded, 1 cup
74
7
Bread, white, 1 slice
73
7
Pudding, chocolate, ready to eat, refrigerated, 4 ounces
55
6
Tortilla, corn, ready-to-bake/fry, one 6” diameter
46
5
Tortilla, flour, ready-to-bake/fry, one 6” diameter
32
3
Yogurt, fruit, low fat, 8 ounces
Ready-to-eat cereal, calcium-fortified, 1 cup
Frozen yogurt, vanilla, soft serve, ½ cup
Turnip greens, fresh, boiled, ½ cup
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Table: Selected Food Sources of Calcium
Food
Milligrams (mg) per serving
Percent DV*
Sour cream, reduced fat, cultured, 2 tablespoons
31
3
Bread, whole-wheat, 1 slice
30
3
Broccoli, raw, ½ cup
21
2
b) Calcium RDA:
1998 RDA’s (AI)
1300 mg/d : children & teens
1000 mg/d : adults
1200 mg/d : older
Usual intakes are low
c)
Calcium and vitamin D
Your body needs vitamin D to absorb calcium. For this reason, some calcium supplements contain
vitamin D. A few foods naturally contain small amounts of vitamin D, such as canned salmon with bones,
and egg yolks. You can also get vitamin D from fortified foods and sun exposure. The RDA for vitamin D
is 600 international units (15 micrograms) a day for most adults .
d) calcium supplements:
Several different kinds of calcium compounds are used in calcium supplements. Each compound contains
varying amounts of the mineral calcium — referred to as elemental calcium.
The two main forms of calcium supplements are carbonate and citrate. Calcium carbonate is cheapest and
therefore often a good first choice. Other forms of calcium in supplements include gluconate and lactate.
In addition, some calcium supplements are combined with vitamins and other minerals. For instance,
some calcium supplements may also contain vitamin D or magnesium. Check the ingredient list to see
which form of calcium your calcium supplement is and what other nutrients it may contain. This
information is important if you have any health or dietary concerns.
3.
Calcium Deficiency
a) Groups at Risk of Calcium Inadequacy
Although frank calcium deficiency is uncommon, dietary intakes of the nutrient below recommended
levels might have negative health consequences over the long term. The following groups are among
those most likely to need extra calcium.
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Postmenopausal women
Menopause leads to bone loss because decreases in estrogen production both increase bone resorption
and decrease calcium absorption
Amenorrhea women and the female athlete triad
Amenorrhea, the condition in which menstrual periods stop or fail to initiate in women of childbearing
age, results from reduced circulating estrogen levels that, in turn, have a negative effect on calcium
balance.
Individuals with lactose intolerance or cow’s milk allergy
Lactose intolerance refers to symptoms (such as bloating, flatulence, and diarrhea) that occur when one
consumes more lactose, the naturally occurring sugar in milk, than the enzyme lactase produced by the
small intestine can hydrolyze into its component monosaccharides, glucose and galactose [37].
Cow’s milk allergy is less common than lactose intolerance, affecting 0.6% to 0.9% of the population [44].
People with this condition are unable to consume any products containing cow’s milk proteins and are
therefore at higher risk of obtaining insufficient calcium.
To ensure adequate calcium intakes, lactose-intolerant individuals and those with cow’s milk allergy can
choose nondairy food sources of the nutrient (such as kale, bok choy, Chinese cabbage, broccoli, collards
and fortified foods) or take a calcium supplement.
Vegetarians: Vegetarians might absorb less calcium than omnivores because they consume more plant
products containing oxalic and phytic acids
Osteoporosis
Risk Factors
Genetics
Family History
Ethnicity
Caucasian > Asian > Blacks
Risk Factors
b)

Chronic Calcium Deficiency

Lack of Exercise
Sings/Symptom
Inadequate intakes of dietary calcium from food and supplements produce no obvious symptoms in the
short term. Circulating blood levels of calcium are tightly regulated. Hypocalcemia results primarily from
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medical problems or treatments, including renal failure, surgical removal of the stomach, and use of
certain medications (such as diuretics). Symptoms of hypocalcemia include numbness and tingling in the
fingers, muscle cramps, convulsions, lethargy, poor appetite, and abnormal heart rhythms. If left
untreated, calcium deficiency leads to death.
Over the long term, inadequate calcium intake causes osteopenia which if untreated can lead to
osteoporosis. The risk of bone fractures also increases, especially in older individuals. Calcium deficiency
can also cause rickets, though it is more commonly associated with vitamin D deficiency [1].
4. Recommended Daily Allowance:
a) WHO recommendation for pregnant women
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b) Recommendation for other ages:…………………………………………………………………………
5. Guideline for Prevention and Treatment
……………………………………………………………………….
Calcuim dosage for differenct ages
‫مقدارتوصیه شده روزانه‬
‫عمربه سال‬
6
700 mg
1–3
1000 mg
4–8
1300 mg
9 – 18
1000 mg
19 – 50
1000 mg ( ‫ مردها‬M)
1200 mg (‫ زنها‬F)
51 – 70
1200 mg
> 70
1000 mg
‫مادران حامله وشیرده‬
‫ ساله‬۱۹‫باالتراز‬
6. calcium supplements Toxicity :
Calcium supplements aren't for everyone. For instance, if you have a health condition that causes excess
calcium in your bloodstream (hypercalcemia), you should avoid calcium supplements.
Dietary calcium is generally safe, but more isn't necessarily better, and excessive calcium doesn't provide
extra bone protection. In fact, if the calcium in your diet and from supplements exceeds the tolerable
upper limit, you could increase your risk of health problems, such as:

Kidney stones

Prostate cancer

Constipation

Calcium buildup in your blood vessels

Impaired absorption of iron and zinc
If you take calcium supplements and eat calcium-fortified foods, you may be getting more calcium than
you realize. Check food and supplement labels to monitor how much calcium you're getting a day and
whether you're achieving the RDA but not exceeding the recommended upper limit.
some images if you prefer to be add?
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References
1.
Committee to Review Dietary Reference Intakes for Vitamin D and Calcium, Food and Nutrition Board, Institute of
Medicine. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: National Academy Press, 2010.
2.
U.S. Department of Agriculture, Agricultural Research Service. 2011. USDA National Nutrient Database for Standard
Reference, Release 24. Nutrient Data Laboratory Home Page, http://www.ars.usda.gov/ba/bhnrc/ndl
.
3.
U.S. Department of Agriculture, Center for Nutrition Policy and Promotion. ChooseMyPlate.gov
, 2011.
4.
Straub DA. Calcium supplementation in clinical practice: a review of forms, doses, and indications. Nutr Clin Pract.
2007;22:286-96. [PubMed abstract]
5.
Andon MB, Peacock M, Kanerva RL, De Castro JAS. Calcium absorption from apple and orange juice fortified with
calcium citrate malate (CCM). J Am Coll Nutr 1996;15:313-6. [PubMed abstract]
6.
Bailey RL, Dodd KW, Goldman JA, Gahche JJ, Dwyer JT, Moshfegh AJ, Sempos CT, Picciano MF. Estimation of total
usual calcium and vitamin D intakes in the United States. J Nutr. 2010 Apr;140(4):817-22. [PubMed abstract]
7.
Ervin RB, Wang C-Y, Wright JD, Kennedy-Stephenson J. Dietary intake of selected minerals for the United States
population: 1999-2000. Advance Data from Vital and Health Statistics, number 341. Hyattsville, MD: National Center
for Health Statistics, 2004.
8.
Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, Durazo-Arvizu RA, Gallagher JC, Gallo RL, Jones G,
Kovacs CS, Mayne ST, Rosen CJ, Shapses SA. Clarification of DRIs for calcium and vitamin D across age groups. J Am
Diet Assoc. 2011 Oct;111(10):1467. [PubMed abstract]
9.
National Institutes of Health. Optimal calcium intake. NIH Consensus Statement: 1994;12:1-31. [PubMed abstract]
10. Heaney RP, Recker RR, Stegman MR, Moy AJ. Calcium absorption in women: relationships to calcium intake, estrogen
status, and age. J Bone Miner Res 1989;4:469-75. [PubMed abstract]
11. Weaver CM, Heaney RP. Isotopic exchange of ingested calcium between labeled sources: evidence that ingested
calcium does not form a common absorptive pool. Calcif Tissue Int 1991;49:244-7. [PubMed abstract]
12. Weaver CM, Heaney RP, Martin BR, Fitzsimmons ML. Human calcium absorption from whole-wheat products. J Nutr
1991;121:1769-75. [PubMed abstract]
13. Weaver CM, Proulx WR, Heaney RP. Choices for achieving adequate dietary calcium with a vegetarian diet. Am J Clin
Nutr 1999;70:543S-8S. [PubMed abstract]
14. Heaney RP. Bone mass, nutrition, and other lifestyle factors. Nutr Rev 1996;54:S3-S10. [PubMed abstract]
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