COMPLETE GUIDE OF MEDICAL COLLEGE & HOSPITAL

Berhampur University

M K C G Medical College, Berhampur

Utkal University

S C B Medical College, Cuttack

Sambalpur University

V S S Medical College, Burla, Sambalpur

Cash Safety: 

ENOUGH  VS. TOO MUCH

Health professionals are united in their opinion that people are not consuming enough calcium. The latest government health and nutrition study (NHANES III) documents that the great majority of people, especially women, are not consuming the Recommended Daily Allowance of calcium. Various health experts, including a National Institutes of Health panel, have even recommended consumption above the recently revised Recommended Daily Intake levels to optimize bone health and increase other potential health benefits.

 With the growing medical consensus that individual need to increase their dietary intake of calcium or, if that is not enough, take supplemental calcium, the question arises: how much is too much?

Calcium: Extremely Safe 

It is very hard to consume too much calcium. Most of the calcium absorbed by the body, and not used by bone, is excreted in the urine. The Handbook of Nonprescription Drugs notes that daily consumption of as much as 20 grams of calcium carbonate, or 8 grams of elemental calcium, causes few side effects in healthy people.¹ Much lower levels of calcium, in the range generally consumed, should cause few if any adverse experiences.

 Calcium has been tested extensively in women with osteoporosis, women at risk for osteoporosis, and pregnant and nursing women. These studies, using varying amounts of supplemental calcium, typically between 1,000 and 2,500 mg per day, provide meaningful evidence of what constitutes a safe daily amount of calcium.

Calcium supplementation is the mainstay of osteoporosis risk reduction and treatment. Studies of calcium related to fractures in post-menopausal osteoporotic women² and studies on the process of bone formation and loss in osteoporosis³ have found doses of 1.5 to 2.5 grams per day of elemental calcium to be safe.

Calcium supplementation is also increasingly being considered in the maintenance of healthy blood pressure in pregnant women. Increased calcium intake is already a standard recommendation for women who are pregnant or lactating to support the additional calcium needs of mother and baby at this time.  

A meta-analysis of 14 controlled trials of calcium was recently published in the Journal of the American Medical Association. Supplemental calcium between 1,000 and 2,000 mg per day was found to be safe in pregnant women.⁴

 In a recently completed trial, over 4,000 women were given 2 grams (2,000 mg) per day of elemental calcium . No significant adverse events or hypercalcemia (high calcium in the blood) were reported.⁵

 Calcium: Enough vs. Too Much 

Supplemental calcium up to 2,000 mg per day appears to be safe and effective in helping to prevent osteoporosis and may reduce the risk for pregnancy-induced high blood pressure. At present there is little evidence that higher doses provide any further health benefit in most healthy individuals, although selected individuals may require up to 2,500 mg.

 Calcium, like all minerals and vitamins, if consumed in great excess, can potentially produce adverse effects. A single incidence, or several days of excessive consumption, is unlikely to cause any harm. However, such patients should be monitored for signs of abuse.

 For example, studies have examined patients with hypocalcaemia, or excess calcium in the blood, and milk-alkali syndrome, a potentially dangerous and rare complication of hypocalcaemia. Antacid abuse in the range of 4 grams (4,000 mg) to 60 grams (60,000 mg) of elemental calcium daily for a prolonged period of time, usually combined with milk and for months or years, has been reported in patients with milk-alkali syndrome.

Calcium Safety: Expert Consensus 

The 1994 NIH Consensus Development Conference on Optimal Calcium Intake examined most of the published literature on dietary calcium and supplementation, and heard from experts on the effects of calcium on osteoporosis, heart disease, pregnancy and cancer.

 In their final report, the panel stated that most current evidence points to doses up to 1,500 mg per day as being helpful in preventing and treating osteoporosis. The panel’s report concluded that 2 grams, or 2,000 mg, of elemental calcium per day consumed regularly was safe for most people.⁷ Most recently, a report from the National Academy of Science’s Institute of Medicine evaluating the RDAs for various nutrients sets a "Tolerable Upper Intake Level" for calcium at 2,500 mg per day, which is an amount unlikely to pose risks of adverse health effects in most healthy individuals.⁸

 Individuals seeking to supplement their calcium intake should follow accepted therapeutic guidelines. If interested in more information about what’s right for them, they should consult a physician.