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Take calcium, exercise and be in the sun protect against osteoporosis

"The remarkable drop in estrogen during menopause makes women more prone to this disease"

"Osteoporosis: diagnosis and prevention of morbidity and mortality" is the title of the talk that yesterday offered the doctor Salamanca Arias Patience in the auditorium of the University College, within the forum of the newspaper. A conference where the keys were given to prevent this disease that affects women in most cases.



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-What people are more likely to suffer from osteoporosis?

-The most prone patients are established universally that are women over 40 years, those who have already reached menopause.

- Does this disease affect men less?

-It is also a disease of men, but just as in women it appears in that period of life, in men it happens later. The deterioration is slower because one of the important factors is the loss of estrogen. Women are markedly diminished during menopause, but loss in men, who also have estrogen, does not occur so quickly. That is why osteoporosis appears after 65 years of age.

-What are the alarm symptoms?

-There are no symptoms, but risk factors that must be taken into account. One of the most important is the genetic, for example if the parents of the person we are evaluating have had a hip fracture. You also have to know if this person has had some toxic habits, especially tobacco. Another factor is that you have had a fracture before, a disease that favors the loss of bone mass or a treatment that is favoring the fragility of the bone.

- Is there any form of prevention?

There is an English research group that has determined a program called FRAX, where twelve risk factors are introduced. Through a mathematical calculation two data are obtained to know if you will have hip fracture or osteoporotic fracture of another bone. What is usually done to avoid these risks is to make an assessment according to this calculation and the risk factors, along with bone densitometry, to obtain a high, medium and low risk. And this is the way to know who to treat: always when it is maximum risk or has had a fracture, if it is medium risk too and when it is low risk only will have to take preventive measures.

- What are those measures?

-That they exercise, that they take an adequate amount of calcium and the sun a little a day. They are very easy measures to comply with and, if done well, during the adolescence stage and the first part of adulthood they get a high peak of bone mass that will later have less chance of having loss and osteoporosis. To keep it, you have to keep doing the same so that the loss is less. We must also know that certain minerals and vitamins such as D not only get this type of action on the bone, but also has other effects on biological processes that until now were not very clear and that get some protection against cancer and autoimmune diseases or infectious. This type of actions are very important for health, not only bone, but general.

- What do you think of the products that provide extra calcium, like some milks?

- They provide more calcium, although perhaps not as much as explained in the packaging. But neither is it necessary to resort to these products because there are many foods that have calcium other than dairy, such as almonds and hazelnuts, chickpeas, sardines in oil, some cheeses? The amount of calcium is easy to get, what is not so much is the adequate level of vitamin D. Although in Spain we think we have a wonderful sun, more than 50% of the population have it low, even in the south of the country . This vitamin is very important, because it helps calcium to be absorbed and deposited in the bone so that it can then be distributed to all other organs when necessary.

- Is it true that playing certain sports, such as football or handball, during puberty, prevents the disease, as a recent study has confirmed?

-It is a protective factor, along with taking a calcium intake of about a gram a day and sunbathing for twenty or thirty minutes. These are the three actions that help the bone stay healthy.

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Calcium is a weapon to fight diseases

Calcium , besides being the most valuable weapon to alleviate the effects of osteoporosis , is a very effective mineral to prevent the possible development of periodontal disease, colon cancer, kidney stones or to control blood pressure.

Osteoporosis

Osteoporosis is a disease that causes a progressive decrease in bone mass , reducing the strength of the bone that can be broken by small traumas and even spontaneously.

To prevent this disease is necessary an adequate intake of calcium , especially in adolescence, which is where most of our bone capital is acquired. Along with the consumption of calcium, a healthy lifestyle in which there is room for regular exercise, a prudent exposure to the sun (necessary for the synthesis of vitamin D) and an abandonment of the use of tobacco, alcohol and caffeine (which they have a negative effect on bone remodeling), they will be the best allies in the fight against osteoporosis.



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Kidney stones

90% of kidney stones are made of calcium oxalate and in most patients with stones a high level of calcium is detected in the urine. This suggested that if calcium consumption were reduced, this pathology would be mitigated. However, it has been proven that calcium is not the cause of kidney stones and that a limitation of its consumption can increase the risk of it occurring. This protective function is carried out thanks to its ability to bind oxalate in the intestine, preventing it from being absorbed and causing kidney stones.

Periodontal disease

The bone that is the cause of the loss is the jaw . Increasing calcium intake has found improvements in inflammatory processes and dental mobility. Therefore it is especially convenient to increase the calcium intake in people suffering from periodontal disease.

Blood pressure

The increase in calcium intake can be positive to avoid the increase in blood pressure , which is especially important during pregnancy, since hypertension can pose a danger to the health of the mother and child. During pregnancy the calcium needs increase . Epidemiological studies suggest an inverse relationship between dietary calcium and the incidence of hypertension induced by pregnancy, so the risk of blood pressure problems during this period can be reduced by an adequate intake of calcium.

Colon cancer

The consumption of calcium and dairy products exerts a protective effect against colon cancer . Several studies show the correlation between calcium intake (1,200-1,400 mg per day) and the significant decrease in the risk of this type of cancer. It has also been found that higher levels of circulating vitamin D in the blood reduce the risk of colon cancer by up to 40% compared to people with the lowest levels.

Although the results confirm the relationship between vitamin D and the etiology of colon cancer, experts do not recommend taking vitamin D supplements to prevent the tumor. There are also no studies that recommend the use of calcium supplements to prevent colon cancer.

Know more

Scientific evidence shows that the best way to reduce the risk of colon cancer is to stop smoking, increase physical activity, reduce obesity and abdominal fat and limit the consumption of alcohol and red meat.

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Calcium (citrate) and Vitamin D3 prevents osteoporosis

Calcium, the most abundant mineral in the human body, plays an essential role in the construction and strength of bone mass , as well as in the prevention of osteoporosis.

Present in almost all the cells of the organism, it intervenes in the numerous biochemical reactions indispensable for its functioning.

Calcium citrate is associated with vitamin D3 (cholecalciferol) which allows assimilating the ingested calcium . However, the ingestion of this vitamin - usually carried by food or produced by the body after sun exposure - is especially necessary in adults with deficiencies and, in particular, in the elderly.



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In addition, it participates in the prevention of colon cancer: during digestion, excess calcium neutralizes fatty acids, a source of irritation of the intestinal mucosa.

Of organic origin, calcium citrate is the source of calcium that the body better absorbs, better assimilates and better tolerates. Powered by vitamin D3, it is also the most effective in the prevention and treatment of osteoporosis.

Calcium (citrate) + vit. D3: Detailed information

Calcium is the most abundant mineral in the human body. It plays an essential role in the acquisition and consolidation of bone mass by preventing osteoporosis.

Present in very low concentrations in almost all the cells of the organism, it intervenes in many biochemical reactions indispensable for its functioning: the contraction of the muscles, the heartbeat, the regulation of the blood pressure in the blood vessels, the communication between the cells nervous and blood clotting.

In addition, it performs a preventive action of colon cancer: after digestion, excess calcium neutralizes fatty acids that cause irritation of the intestinal mucosa.

According to the experts, the calcium intake is often insufficient, especially in the elderly, who assimilate the calcium of intestinal origin worse and meet their needs for this mineral from an aged bone.

Bone is a dynamic tissue that is destroyed and re-forms continuously. With age, bone destruction (reabsorption) predominates and osteoporosis appears, a risk factor for fractures and vertebral crushing. This mechanism is further aggravated when the organism, not receiving an insufficient external input, is forced to obtain from its bone reserves the calcium essential for many of its functions, further weakening the skeleton.

The supply of calcium can be guaranteed with natural supplements that contain a source of calcium. Most often, add calcium carbonate or calcium citrate.

Calcium carbonate is obtained from sea shells, bone powder, coral or dolomite. The "raw materials" are of natural origin but may be contaminated with toxic materials (heavy metals) or other contaminants. They can also be poorly tolerated by some people suffering from gastric acid causing constipation and distension.

We use calcium citrate of organic origin. Perfectly tolerated, calcium citrate is the source of calcium that best absorbs and assimilates the body. It does not interfere with the absorption of other minerals (iron, magnesium, zinc) or vitamins (A, D, C).

Calcium citrate is associated with vitamin D3 (cholecalciferol) which allows assimilating the ingested calcium . However, the ingestion of this vitamin - usually carried by food or produced by the body after sun exposure - is especially necessary in adults with deficiencies and, in particular, in the elderly.

Calcium is produced according to the Standards of Proper Manufacturing of the European Pharmaceutical Industry. It also complies with the ISO-9001 standard of international quality.

INGREDIENTS:

For 2 tablets: 800 mg of calcium (calcium salts of citric acid) (100% VRN *), 2.5 μg of vitamin D3 (Colecalciferol 110000 IU / g max) (50% NRV).

* VRN: Nutrient Reference Values.

OTHER INGREDIENTS:

Dextrose, sweetener (E420): sorbitol, bulking agent (E460ii): microcrystalline cellulose, orange flavor, anti-caking agent (E470b): magnesium salts of fatty acids.

ALLERGENS:

This product does not contain allergens (according to Regulation (EU) No. 1169/2011) or genetically modified organisms.

MANUFACTURE AND QUALITY GUARANTEE:

This food supplement is manufactured by a laboratory following the BPF standards. The GMP are the Good Manufacturing Practices in force in the European pharmaceutical sector (in English GMP, Good Manufacturing Practice).
The content of the active principle is guaranteed by regular analyzes that can be consulted online.

USE TIPS:

2 tablets a day to chew or suck, during meals.

PRECAUTIONS:

Contraindicated in case of renal failure. It is recommended for pregnant or lactating women. Do not exceed the recommended daily dose.

WARNINGS:

Food supplements should not be used as substitutes for a varied and balanced diet and a healthy lifestyle. In case of medical treatment, consult with your therapist. Only for adults. Keep out of the reach of little kids.

STORAGE INSTRUCTIONS:

Store in a cool, dry place and out of reach of light.

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How to assimilate well the calcium that we need?

Our readers already know that the best source of calcium is not milk, not only because advertising has exaggerated the content of this mineral, and especially absorption, but because of its low quality, as Paul Pichford points out in the "Bible" Healing with Whole foods , which publishes official data on the number of cases of Americans with osteoporosis, arthritis and calcium deficit with delicious diets of milk and derivatives.



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WHAT IS CALCIUM?

Calcium is crucial for the organism and is involved in almost all biological and metabolic functions.

•     Combined with phosphorus forms the mineral salts of bones and teeth
•     It is essential for the blood to coagulate correctly
•     Prevents cramps
•     Reduces blood pressure
•     Prevents osteoporosis
•     Maintains the permeability of cell membranes
•     Helps neuromuscular activity
•     Involved in the maintenance of heart rhythm
•     Maintains healthy skin
•     Maintains PH balance, protecting the body from other diseases such as cancer
•     During pregnancy reduces the incidence of preeclampsia (gestational hypertension or increased blood pressure)

MAGNESIUM, VITAMIN D AND MORE

The absorption of calcium, says Pichford, "requires an adequate amount of magnesium, phosphorus, and vitamin A, C and D. The body must have a good absorption of these minerals and vitamins so that their calcium is well assimilated."

Magnesium stimulates the production of calcitonin and, therefore, increases the calcium in the bones at the same time that it extracts it from the tissues. Many forms of arthritis are characterized by excess calcium in the tissues, while calcium is lacking in the bones, says Pichford.

Chlorophyll is in magnesium, so most green vegetables (full of chlorophyll) are valuable sources of phosphorus and vitamin A, so that calcium is metabolized well. And another essential source is the sun, vitamin D, the well-known vitamin of light. People who spend the day locked up in an office or who, in winter, do not leave metropolitan cities where the sun touches them in a flash has more calcium deficit.

But there is still more. Isabel Fernández , gynecologist and expert in orthomolecular nutrition and homeopathy, discovered in a study three years ago that the calcium that we usually eat in the diet is often neither well absorbed nor well used but there is a very rich source of calcium, the marine coral, which is absorbed practically in its entirety and also the body accepts very well. Besides being very rich in calcium, marine coral contains magnesium and more than seventy trace elements in a proportion very similar to that of the human body and which are fundamental for the body's enzymatic processes. It was seen that the intake of marine coral by the women analyzed, all selected in the menopausal stage, strengthened and recovered their bone structure, and after three months taking marine coral morning and night, there was evidence of a decreased risk of osteoporosis, as well as arterial problems, an improvement of its adrenal function and thyroid function. With the improvement of calcium metabolism, it also improved the metabolism of magnesium and other essential minerals.

Marine coral

WHAT IS EXACTLY THE MARINE CORAL?

The Natural Coral is fossil marine coral, purified and crushed. It is mined from fossil coral mines, on islands created by reefs that have been out of the sea for many thousands of years. "In this way we achieve two important objectives, firstly that no harm is done to the living reefs, so our marine coral is produced in a sustainable manner and has been awarded with the EcoSafe and Friends of the Sea stamps", says Per Bjork, responsible for Cien por Cien Natural, who commercializes the Coral Natural product, which respects the fragility of the reefs and the environment of the oceans. Fossil corals are used for its elaboration. Another very important aspect is that it has not suffered the current pollution of the oceans, having been out of the sea since long before human activity began to pollute the seas. It should also be noted that the Natural Coral is packaged without additives (additives that only serve to reduce the wear of the filling machinery), which allows dissolving the ground powder in water or, why not, as an alternative to milk to cut the coffee.

Fernandez confirmed that " the coral recovers the biological rhythms, produces more energy, deacidifies the body, vital for health in general. In fact it is a very alkaline mineral, the most alkaline mineral in the body.

The coral recovers the biological rhythms, produces more energy, deacidifies the body

The increase in vitality also means that the body does not have to extract calcium from the bones to balance its PH, which is why, over time, osteoporosis and other pathologies such as alopecia appear.

In fact, there is a very novel test known as HMS or Hair Metabolic System, a laboratory analysis that determines the mineral content of hair and that allows, among other parameters, to know the proportions of calcium with respect to other minerals that we have in the body (What shows us how we are in its absorption and metabolism, according to Jesus Dominguez, physiotherapist and naturopath specialist in functional naturopathy and often carries out this test. "It is a very valuable information because the content of minerals in the hair is the same as the mineral content of the cells of our body, "adds Dominguez.



Dominguez adds that, as far as calcium is concerned, it is very important to know that one of the most common findings in a mineralogram is the presence of excessive levels of intracellular calcium. This is mainly due to a decreased efficacy of the action of thyroid hormone at the cellular level.

"The mineralogram allows to see that there are also cases of excess calcium."

It is surprising how this elevation of intracellular calcium levels conditions, in addition to a diminished efficacy of thyroid hormone, tendency to hypotension, tendency to insulin resistance situations compatible with a slow metabolism.

Lilián Dous is a regular consumer of Coral Natural. "I started to consume it because it was recommended to me as a very simple option to maintain my health. At first I did not notice anything, I thought I had an iron health, but after a while I saw that it was not like that, although I did not perceive it, I had a lot of health problems, that although they did not make me impossible, they were there. Every two years I had a few weeks of terrible pain because kidney stones were forming, I was very prone to colds, I had backaches more often than I realized, etc. Little by little Lilian was realizing that all this had disappeared. The colds were reduced, the back no longer hurt, and over the years was seeing that he has not returned to have nephritic colic. And if that was not enough, a year later "I was forced to undergo surgery to remove the uterus and ovaries. I started to worry about my bones, since I do not drink milk, but the following year I did a densitometry and my bones were perfect . Two years later I had another densitometry and my bone mass had increased. Today I still have some bones in a state that surprises my gynecologist because according to him they do not correspond to my age. It shows me that when they recommended me to take Coral Natural they did me a favor.

Select your pathology and get fully informed

• Osteoporosis
• Arthritis

HOW MUCH CALCIUM DO WE NEED EVERY DAY?

Once we know all that, we should worry about absorbing it well and knowing the recommended amount of calcium we need to ingest, which is about 1000 mg a day in adults and a little more in periods of growth (childhood and adolescence), pregnancy and lactation, advanced age (because less is assimilated), when there are heart and vascular diseases including hypertension, bone diseases and most disorders of the nervous system. And then there are calcium-inhibiting foods : refined sugars, alcohol, coffee, drugs and drugs, very little exercise, too much salt and too much protein.

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Calcium : a summary of the evidence

Summary : The consumption of calcium helps to reduce the risk of suffering from osteoporosis, hypertension, cancer, kidney stones and obesity. Studies have shown that calcium supplementation increases or prevents the loss of bone mass, which is vital for the prevention of osteoporosis. Studies have also shown the positive impact of calcium in the regulation of blood pressure and in the prevention of colon, breast and ovarian cancer, possibly through its participation in cell division. A diet high in calcium helps prevent kidney stones by decreasing oxalate absorption and recently, it has been suggested that it can also help in weight control, decreasing lipogenesis and increasing lipolysis. The protective effect of calcium is evident in the recommended levels of calcium intake for most of the population, that is, between 1000 and 1300 mg of calcium per day.



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Summary : Intake of dietary calcium decreases the risk of osteoporosis, hypertension, cancer, kidney stones, and obesity. Studies have shown that calcium supplementation increases bone mass and prevents its loss, which is crucial in the prevention of osteoporosis. Likewise, studies have confirmed the impact of calcium in the regulation of blood pressure and in the prevention of colon, mammary and ovary cancer, possibly through its action in cellular division. A diet rich in calcium can also help against kidney stones by reducing oxalate absorption, and recently, it has been suggested that a diet rich in calcium can help in weight management, reducing lipogenesis and increasing lipolysis. The protective effects of calcium are seen within the levels actually recommended for the population, which are between 1000 and 1300 mg per day of calcium.

Introduction

Calcium is a nutrient that is involved in the prevention of chronic diseases, such as osteoporosis, high blood pressure, colon, breast and ovarian cancer, kidney stones and obesity. The association between calcium and these diseases has its explanation in the variety of functions that this nutrient fulfills in the organism. Calcium is the most abundant mineral in the human body where it forms part of the teeth and bones, where it represents up to 40% of the mineral content. Calcium is also considered a second messenger, because it acts both as a signal transmitter from outside the cell inward, as an activator of proteins involved in this process. In this way, calcium is found involved in the secretion of hormones, in the mediation of dilation and muscular and vascular contraction, as well as in neural conduction.

The following is a review of the evidence of the role of calcium in chronic diseases such as osteoporosis, arterial hypertension, cancer, renal lithiasis, and obesity.

Calcium and osteoporosis

99% of calcium is found in bones and only 1% in blood, muscle, and other tissues. However, this small fraction has priority and the calcium contained in the bones constitutes a great reservoir from which it can be extracted at any time to keep the serum level of calcium constant if the dietary intake is low. If calcium intake is persistently low, the bones become increasingly fragile, which can lead to osteoporosis.

Osteoporosis is a chronic, multifactorial disease that can progress silently for decades until a fracture occurs. It is characterized by a low bone density and by a deterioration of the bone microarchitecture (1), which produces a greater vulnerability to suffer fractures, mainly in the wrist, hip and spine (2,3).

In the world more than 200 million people have osteoporosis, and according to projections, the number of hip fractures a year will increase from 1.66 million in 1990 to 6.26 million in 2050 (4). In Venezuela, the magnitude of the problem is not well known. According to a report in 1980, the incidence of hip fractures in> 45 years was 348 and 834 (5), and in 1988 the incidence in> 80 years was 193 and 381 (6), per 100,000 inhabitants, in men and women, respectively (5).

Osteoporosis is a juvenile disease, since it is in adolescence when most of the bone mass is acquired, which will determine if the person will be at risk of fractures in the coming years. Thus, at 17 years of age the female adolescent has acquired 90% of her bone mass, at 19.8 years 95% and at 22.1 years 99% of her bone mass (7). That is to say, after the age of 22, the woman basically has already formed her bone mass. Although the process of bone mass acquisition is 60-80% determined by the genetics of the individual, there are modifiable factors that affect this process, such as calcium intake, physical activity and lifestyle, among which, the Calcium intake is the one that has the greatest effect (8). If in adolescence the individual does not consume an adequate intake of calcium, it will not reach the maximum peak of bone mass and the individual will enter the adult stage with a bone density lower than its genetic potential (dotted line, Figure 1 ). When the period of rapid loss of bone mass begins, which corresponds to menopause, this individual could have fractures. The development of bone mass up to the maximum peak potential protects against osteoporosis, since there is an inverse relationship between bone mineral density and the incidence of fractures (9,10).

Studies in adolescents and children (11-14) and adults (15-18) have shown that calcium supplementation increases bone mass. Supplementation in identical twins (6-14 years) with 1612 mg / d of calcium significantly increased bone density compared to the group with a 908 mg / d calcium intake (12). Studies in American girls and Chinese children showed that calcium supplementation for 18 months resulted in a significant additional increase in density and total bone content over the control group (11,13). In adolescent girls, an increase of 35 g more in bone mineral content was observed with the supplementation of dairy products during one year compared with the control group (14). These effects are maintained only if the high calcium intake is constant, and not as a short intervention, since after one year of the intervention, the differences in bone density disappeared (19). It has been observed that if daily calcium intake remains high throughout childhood and adolescence, this results in high bone density of the radius in post-menopausal women.

Transversal and intervention studies in adults report a positive relationship between calcium intake and bone mass. A meta-analysis of 33 studies evidenced a significant correlation between calcium intake and bone density (21). It was concluded that the intake of 1 g / d of calcium can prevent the loss of 1% of bone / year in most regions of the body. In the first years of post-menopause, bone mass does not respond as much to calcium supplementation, since it is a stage of rapid bone resorption, however, if it favors those women with more than 5 years postmenopausal (22). In the elderly it has also been observed that the intervention with calcium favors the reduction of the fracture index (18).

Calcium and high blood pressure

High blood pressure is a public health problem that affects 20% -23% of adults in Venezuela (23). Blood pressure levels predict the mortality and morbidity of cardiovascular diseases (CVD), so any factor that lowers blood pressure is important at the population level.

After 20 years of controversy, the evidence confirms the positive impact of calcium and calcium-rich foods in the regulation of blood pressure, through 2 lines of research:

1. Epidemiological studies: The first study that systematically investigated the relationship between calcium and blood pressure was an epidemiological analysis of the relationship of 17 nutrients with blood pressure in Americans (24). Low calcium intake was the most consistent factor in individuals with hypertension and it was determined that high calcium intake was associated with low blood pressure and a low absolute risk of hypertension. Several meta-analyzes have shown a significant decrease in blood pressure with a high calcium intake (25-28). One of these analyzes showed that calcium from food was more effective in reducing blood pressure compared to supplements (29). In children this protective effect has also been seen, and it was determined that for each 100 mg increase in calcium intake, the systolic pressure was decreased by 2.27 mm Hg (30).

2. Clinical studies: There have been numerous studies, some have used calcium supplements as the source of the nutrient and other foods. Supplementation of 1 g / d of calcium for several weeks (31) or days (32) resulted in a significant decrease in blood pressure. It was recently observed that those with low habitual calcium intake benefited more from calcium supplementation (33), although not all studies show this (34,35). The results with the use of supplementation are not consistent, possibly to the use of a single isolated nutrient. This is why several studies have investigated the impact of calcium-rich foods, which are also good sources of magnesium and potassium, in blood pressure. In hypertensive patients, a 9-8% decrease in blood pressure was observed with the consumption of dairy products and calcium fortified juice for 6 weeks, compared with the control group. The "DASH" study (37) investigated the effect of 3 diets on blood pressure: 1) diet high in saturated fat and low in calcium (450 mg / d calcium); 2) diet rich in fruits and vegetables but low in calcium (450 mg / d calcium); and 3) diet rich in fruits and vegetables and dairy products low in saturated fat "combined diet" (1240 mg / d calcium). The combined diet significantly reduced blood pressure compared to the other two diets.

The interaction of calcium with other nutrients seems to be important in the control of blood pressure, such as the salt-calcium interaction. In black hypertensive patients consuming a diet low / high in calcium / sodium, an increase in blood pressure and in the levels of parathyroid hormone (PTH) was observed, especially in black individuals, which was abolished with the high diet in calcium (38). This racial difference was also found in girls when consuming a diet low (800 mg / d) or high (> 1300 mg / d) in calcium and low (1 g / d) or high (3.86 g / d) in sodium for 3 weeks (39). The urinary excretion of sodium ( Figure 2 ) and calcium excretion ( Figure 3 ) was significantly lower in black girls in the high sodium / low calcium combination, but when calcium was added to the diet, the racial differences disappeared. These racial differences may be the result of some mutation in the channels of calcium and sodium regulation at the renal level, which may be present in other groups with a high incidence of hypertension (40-42).

The mechanism by which calcium and sodium affect blood pressure is altering their regulatory systems (43). In the case of sodium, the renin-aldosterone system and in the case of calcium, vitamin D and PTH. These hormones in turn regulate free calcium in the cytosol, which participates as a second messenger in various reactions. A high level of free calcium in the cytoplasm increases smooth muscle contraction, catecholamine secretion and central nervous system activity and therefore increases blood pressure. A high intake of calcium keeps low free calcium in the cytoplasm because vitamin D and PTH do not increase, so blood pressure does not increase either.

Calcium is also involved in the prevention of pregnancy-induced hypertension (HIE). In Guatemala, a low incidence of eclampsia has been found and is explained by the high calcium intake (44). However, in Colombia and India a high incidence of eclampsia has been observed and in these populations it has been determined that the calcium intake is 250-350 mg / d. In Ecuador it was observed that supplementation with 2 g / d of calcium reduced blood pressure in pregnant adolescents (45). In a meta-analysis of 14 randomized studies with calcium supplementation in 2459 pregnant women, a significant decrease in blood pressure was observed (26).

Calcium and cancer

Cancer is the third cause of death worldwide. In the year 2000, around 7 million people died of cancer, which represents 12% of all deaths (46). Among the different types of cancer, colon cancer is the third cause of death and breast cancer is the fifth cause. In Venezuela in 2000 there were 922 cases and 499 people died of colon cancer, 442 cases and 282 people died of ovarian cancer, and 3400 cases and 1068 people died of breast cancer (47).

Epidemiological studies have shown that a high calcium intake decreases the risk of colon cancer and its recurrence. In studies with more than 100 thousand subjects it was determined that the intake of 1200 mg / d of calcium was associated with a lower risk and incidence of colon cancer (48), both in men (49) and in women (50). Longitudinal studies with numerous subjects with or without a history of colon cancer show that the consumption of more than 2 daily servings of calcium protects against recurrent colon cancer (51), especially if low-fat dairy products are consumed (52). which results in a low relative risk of colon cancer (53). However, not all studies have found this relationship (54,55).

Clinical studies have found a decrease in the proliferative activity of colonic cells with calcium intake (56,57). In subjects with a history of colorectal adenoma, supplementation with 1200 mg / d of calcium decreased the risk of recurrence by 19% (58).

The mechanism by which calcium seems to protect against colon cancer lies in the participation of calcium in cell division and in the regulation of cell proliferation and differentiation. A low level of intracellular ionized calcium contributes to cell proliferation while high concentrations decrease the proliferation of colonic cells (59). Alternatively, calcium precipitates bile and fatty acids in faeces (60), which are potentially toxic, whereas insoluble calcium salts are less toxic to the colonic mucosa. Calcium supplementation reduces the concentration of faecal bile acids (61). However, not all studies have shown these benefits (62-64).

Regarding breast cancer, it was found that a high consumption of dairy products was related to a low relative risk in young women (65), but not in post-menopausal women (66). In Uruguay it was found that low-fat dairy products, especially fermented products (yogurt), were linked to a lower risk of cancer, while high-fat dairy products (chocolate and yellow cheese) were at higher risk (67) .

Calcium intake has also been associated with the prevention of ovarian cancer. In women, a low relative risk was observed with a high consumption of low-fat dairy products versus those with low consumption (68), although others did not achieve this effect (69).

To observe the protective effect of calcium in cancer, it is not necessary to consume levels higher than those recommended for the general population, since studies have shown that higher levels of calcium (> 1200 mg / d) do not produce additional benefits (48 ).

Calcium and kidney stones

The incidence of renal lithiasis varies by region, being low in Asia (1% -5%), average in Europe (5% -9%) and North America (12% -13%) and high in the Middle East (20%) ) (70). In Venezuela, there are no national data on the incidence of kidney stones.

Kidney stones are formed when the urine is concentrated and the substances that normally are in it crystallize, such is the case of oxalate and calcium; so the first therapeutic measure against kidney stones would involve a reduction in calcium intake, however, there is evidence to the contrary. A study with more than 45 thousand men showed that high calcium intake decreased the risk of presenting kidney stones in 34% (2), with a low relative risk in those with a high calcium intake compared with those who consumed <850 mg / d of calcium. In women it was also observed that a high calcium intake decreased the risk of kidney stones, but only if calcium came from food, since the use of calcium supplements was positively associated with the risk of kidney stones, especially those who consumed calcium. supplement without food (71). Foods rich in calcium (dairy products) may contain other substances that help reduce the risk.

It has been suggested that the mechanism by which calcium prevents kidney stones is in the interference of intestinal absorption of oxalate (72). Clinical studies show that calcium binds to oxalate at the intestinal level, making it less available for absorption, which leads to a lower oxalate content in the body and therefore to a lower excretion of oxalate in the urine (73,74 ). The high concentration of oxalate in the urine is what causes the calculation.

Calcium and obesity

Obesity is an epidemic worldwide. It is estimated that more than 1 billion people are overweight and at least 300 million people are obese (75). Recently, high calcium intake has been related to a decrease in body weight due to its relationship with the control of fat metabolism. The first study to demonstrate this association was an epidemiological study in women, where those with a high calcium intake (> 1300 mg / d calcium), presented a low relative risk (0.16) of having high body fat compared to those with an intake less than 300 mg / d of calcium (76). In young women it was observed that a high calcium intake with respect to total calories significantly decreased body fat (> 3 kg) compared to women with a low calcium / kcal intake (77). In children aged 5 to 6 years, there was also a significant decrease in body fat (2 kg) consuming 1200 mg / d versus those who consumed 500 mg / d (78) and in children aged 7 to 10 years it was determined that the low Ingestion in calcium was found to be one of the predictors of obesity (79).

Clinical studies have also shown this effect. The consumption of 2 cups of yogurt per day for 12 months resulted in a total decrease of 4.9 kg of body fat at the end of this period in obese (76). Obese subjects assigned to a diet exclusively based on dairy products lost 7.4 kg, while those with a mixed diet lost only 1.4 kg in 4 weeks (80). In a re-analysis of several studies in women it was determined that for every 1000 mg of difference in calcium intake there was 8 kg of difference in body weight (81).

The effect of calcium on weight control seems to be more effective with the consumption of dairy products compared to the use of calcium supplements, possibly due to the presence of other bioactive compounds, although there are no studies in humans (82). In obese mice, a greater decrease in body weight and fat mass was observed with a mixed diet based on dairy products versus the diet with calcium supplement (83).

The mechanism by which calcium influences weight control and body fat lies in the regulation of intracellular fat metabolism. Apparently, a diet low in calcium leads to a decrease in serum calcium, which increases intracellular calcium in the adipocytes, resulting in an increase in lipogenesis and decreased lipolysis, and therefore, fat accumulation. Conversely, a diet high in calcium suppresses intracellular calcium, increasing thermogenesis and reducing fat accumulation.

In conclusion, dietary calcium helps protect against chronic diseases such as osteoporosis, high blood pressure, cancer, kidney stones and obesity. Calcium from food, especially dairy products, seems to be more effective in preventing these diseases, possibly due to the interaction with other nutrients present in these foods. To observe the protective effect of calcium against these diseases, it is not necessary to recommend high calcium intakes, since its protective effect is evident at the levels recommended for most of the population, that is, between 1000 and 1300 mg of calcium per day. However, adequate calcium intake for preventive purposes should be maintained over time and not as a punctual intervention.

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One thousand milligrams of calcium per day to prevent osteoporosis

In order to prevent osteoporosis, foods that provide one thousand milligrams of calcium per day should be consumed in general. The specialist José Zanchetta affirms that the epidemiological studies allow the understanding of this disease that weakens the bones and the awareness of the importance of the campaigns of prevention and diagnosis.

(CyTA Agency - Leloir Institute) -. The early care of our bones from childhood prevents the development of osteoporosis in adult life, a disease characterized by a decrease in the density and quality of bones.



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"Although the population's awareness of the measures that can prevent this disease is greater today, there are still many details that the population does not know," Dr. José Zanchetta, president of the Argentine Society of Health Sciences, told the CyTA Agency. Osteoporosis and member of the steering committee of the International Osteoporosis Foundation. He adds: "There is a lot that we can do daily to take care of our bones and those of our children. Care must start from early childhood. The proper diet in calcium, regular exercise, adequate sun exposure, healthy life without excessive tobacco and alcohol (both elements are toxic to the skeleton) favor the development, strengthening and maintenance of healthy and strong bones. On the other hand, the early detection of the disease plays a fundamental role in its future management ".

Calcium and vitamin D

When sufficient calcium is not supplied to the organism, the skeleton is decalcified and in the long term it becomes fragile in the face of minor traumas that can cause fractures, stresses Dr. Zanchetta who also works as a medical director of the Metabolic Research Institute.

Parallel vitamin D consumption is key to bone fortification. "This type of vitamin favors the absorption and utilization of calcium, and although it can be provided by some fortified foods, such as dairy products, the main source of vitamin D is our own body, since our skin exposed to the sun starts its production", explains Zanchetta. And he continues: "The main function of vitamin D is to help calcium to be absorbed in the intestine. In extreme situations of absolute lack of sun exposure in children, it can cause rickets, and malformation of the bones. It is recommended the solar exposure of 15 minutes in arms and legs per day (walks, shopping) avoiding the hours not recommended (11 to 16 hours). If there are contraindications for sun exposure (as in people with a history of skin cancer) it can also be easily replaced with medication droplets. "

According to the specialist, it is advisable to incorporate the calcium in the food and the most suitable are the dairy products. "The needs can vary in different moments of life but in general lines are 1000 milligrams (mg) of calcium per day," he says.

In this sense, Dr. Zanchetta states that it is useful to know how much calcium the different dairy products contain to make the daily menu. As an example, point out that a portion of semi-soft cheese provides 700 mg of calcium, a yogurt of 250 between 350-400 mg, a fortified yoghurt 450-500 mg, a glass of milk of 200 ml contains 200 mg and a glass of milk Fortified about 250-300 mg.

"If you can not meet the daily requirements for some reason such as intolerance can be supplemented with supplements in tablets," says the specialist.

Higher prevalence in women

Although osteoporosis is suffered by both sexes, this disease affects women more, especially after menopause. In order to know its prevalence in this population, Dr. Zanchetta and a team of colleagues conducted an epidemiological study in which 4 thousand Argentine postmenopausal women were evaluated.

The results of the work, presented at the 7th Congress of the Ibero-American Society of Osteology and Mineral Metabolism in 2007, showed that 35 percent of postmenopausal women over 50 have osteoporosis according to the classification set by the World Health Organization. According to Zanchetta, these results would be valid to date and can be extrapolated to the group of women of that age group in the country. And she says that at this stage in women's lives it is crucial to maintain optimal levels of calcium.

On the other hand, the specialist warns that in the case of the elderly where calcium levels tend to decrease it is critical to avoid falls to prevent fractures. "You have to take care of your eyesight, train your balance and muscular strength, wear comfortable footwear and free the house from obstacles that make it easier to get stuck, among many other measures," he says.

"Thanks to epidemiological studies we can have a more concrete idea of ​​this problem, which can help society in general to become aware of the importance of prevention and diagnosis campaigns and thus be able to identify patients at risk", Dr. Zanchetta emphasizes. And he concludes: "Prevention plays an important role, food, nutrition and exercise favor the development, strengthening and maintenance of healthy and strong bones and early detection of the disease plays a key role in its future management. Consultation with the doctor about bone health is fundamental. "

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Calcium overdose to have strong bones?

Increasing calcium intake does not prevent fractures, nor are supplements useful for bone remineralization .



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Tell me three truths about bone health:

• - It is necessary to take a lot of calcium to have strong bones.
• - Dairy products are essential and protect us from osteoporosis.
• - If, despite having a high consumption of dairy products (ergo, calcium), our bone density suffers, it will be fixed by taking calcium in supplements or calcium-fortified foods.

Many will think that these three statements are obvious, everyone knows them and you do not have to be a nutritionist ... These messages come to us continuously through advertising, food marketing and the advice of some experts. Nothing new. Dairy = calcium = strong bones.

Although the truth is that it may not be so true.

    It is encouraged not to leave the dairy products even if they are not tolerated, without much pausible evidence and with economic interests behind

Maybe the dairy industry has an interest in these messages and strives to reach us, especially when the trend indicates that sales fall. Maybe calcium intake is not directly proportional to bone mineralization . Perhaps there are preventive strategies for osteoporosis that are not prioritized because they do not report any economic benefit to any industry. Perhaps professional advice is often outdated or biased by interests, or poorly updated.

Yes, we started strong. Let's reduce the tension by talking a little about the recommended calcium intakes:

How much calcium?

Calcium intake recommendations are very variable among countries with similar conditions; we went from 900mg per day for adults in Spain to 1,000mg in the US or 700mg in the United Kingdom for the same age range. 30% less for the British than for the Americans, yes. The EFSA (European Food Safety Authority) for its part indicates a reference intake of 1,000 mg / day from 18 to 24 years and 950 mg / day for people over 25 ( PDF ). No changes in pregnancy or breastfeeding (Spain rises to 1,200mg in breastfeeding and the United Kingdom to 1,250mg) Do I need less calcium in London than in Madrid? If I breastfeed, do I increase my calcium intake by more than 60% as advised by the UK or do I keep it the same as the EFSA states? Or are the recommendations very dependent on other variables such as the type of diet, the bioavailability of the mineral and the interests of the person who formulates them? It is difficult to answer. But it is worth sowing the doubt and highlight that things are far from clear.

Do we take enough calcium?

Yes, we have enough, according to the Spanish Nutrition Foundation ( PDF ) and according to a study by Eduard Baladia, Julio Basulto and María Manera ( PDF ). Is media bombing with the issue needed then? Even if the intake is low ( as suggested by other sources ), is consuming more calcium the best strategy for good bone health? No: neither increase the intake prevents fractures , nor supplements are useful for bone remineralization . To these conclusions came two reviews published in the British Medical Journal in 2015.

It seems that the affirmations that opened the article begin to not be so clear.

The population is pressured to achieve a high calcium intake, especially in childhood and in postmenopausal women. All kinds of products focused on these objectives are designed: yogurts with twice as much calcium, milk enriched with even more calcium, children's products that outline in the package its content in such a heavy mineral ... It is encouraged not to leave dairy products even though they are not tolerated , because the industry gives solutions, launching government campaigns ... All without much pausible evidence and economic interests behind.

Meanwhile, one in four postmenopausal women have osteoporosis (according to the Spanish Society of Rheumatology in 2015 ), and the trend is increasing. It does not seem that the strategy is working at the level of population health.

Leaving aside economic interests, it can be said that insisting on increasing calcium intake lacks justification, from a health point of view. On the other hand, they are remarkably more effective indications to prevent osteoporosis and take care of bone health: recommend physical activity (especially strength exercises), an adequate protein intake (especially in the elderly), maintain a good level of vitamin D, moderate consumption of salt, get enough magnesium and vitamin K consuming vegetables, do not drink and do not smoke. And in the prevention of non-communicable diseases in general, incidentally.

But the message that the population receives is only to increase the calcium intake. And based on dairy, even if you do not like them or do not tolerate them. Dairy products that are frequently accompanied by huge amounts of sugar, especially those intended for children. You could even say that these sugary dairy products are a product to avoid and not to recommend.

Can economic interests have more weight in public health guidelines than the evidence itself? Maybe it's not just happening with dairy and calcium?

Lucía Martínez Argüelles , is a dietitian-nutritionist, master in nutrigenomics and personalized nutrition, TSD.

NUTRIR CON SCIENCIA is a section on nutrition based on scientific evidence and knowledge contrasted by specialists. Eating is much more than a pleasure and a necessity: diet and eating habits are now the public health factor that can most help us prevent many diseases, from many types of cancer to diabetes. A team of dieticians-nutritionists will help us to better understand the importance of food and to tear down, thanks to science, the myths that lead us to eat badly.

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The natural treatment of osteoporosis: Calcium

In Western culture, talking about the contribution of calcium is talking about milk and its derivatives. This is however another of the myths of modern nutrition promoted by the interests of the dairy industry.



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FIRST OF ALL SOME NOTIONS OF COMMON SENSE

• -We are the only mammal that continues to drink milk after teething.
• - We do not know of any other species within mammals that substitute breast milk for the milk of another species.
• -A calf is born and stands up as soon as possible, in the first year of life reaches a weight 180 Kg .; For this fabulous skeletal muscle development, nature has provided cow's milk with the appropriate nutrients: calcium and proteins in abundance. Precisely because of that, cow's milk has been exalted by modern nutrition; but human breeding does not need such a development in its first year of life, the priority is the maturation of its nervous system and its immune system, for this they are the mother's milk and lactation.

THE ADVANTAGES OF MILK AS A SOURCE OF CALCIUM

We can mention 3 reasons why milk has been exalted as a good source of calcium:

• 1) Milk contains important amounts of calcium: it provides 119mg per 100gr.
• 2) The calcium in the milk comes in the form of calcium salts (caseinates and phosphates) which makes it more absorbable.
• 3) Lactose (sugar) in milk improves the absorption of calcium.

For these reasons milk has been widely extolled as a good source of calcium. However, there are several evidences against this assertion.

THE DISADVANTAGES OF MILK AS A SOURCE OF CALCIUM

• 1) The calcium in milk is bound to its proteins, which makes it difficult to absorb it.
• 2) The milk protein generates blood acidification that must be neutralized by extracting alkalizing minerals from the bones, including calcium, which are then eliminated through the urine.
• 3) This process is regulated by the hormone thycalcalcin, which in turn inhibits the absorption of calcium.
• 4) Lactose in milk, in people with intestinal intolerance to it, generates intestinal irritation and absorption problems.
• 5) Calcium is best assimilated when the food containing it has a calcium / phosphorus ratio of 2: 1; milk and its derivatives have a relatively high phosphorus content in correlation with calcium: 119mg. of calcium / 93.4mg of phosphorus per 100gr.
• 6) Milk is poor in magnesium and vitamin C, which improves the absorption of calcium.

HIGH DAIRY CONSUMPTION AND HIGHER INCIDENCE OF OSTEOPOROSIS

The main effect of calcium deficiency in the diet is osteoporosis, but against all forecasts recent studies have shown that, paradoxically, osteoporosis is much more frequent among populations that have high milk and dairy consumption (and in general a high calcium intake in your diet).

For example, the Bantu, a South African ethnic group, which has a low protein diet and a discrete calcium intake (200/300 mg of calcium per day, about half or one third of what an average American consumes) does not They present almost osteoporosis, although women are usually multiparous and breastfeed for several years. But when these women migrate to the United States and adopt the American diet they develop osteoporosis, although not as much as Caucasian or Asian women.

Eskimos, on the other hand, have a diet rich in protein and calcium (2500mg per day) and yet have one of the highest levels of osteoporosis in the world.

lactros

Another well-known case is that of the Chinese: when the Chinese introduce milk into their diet, an increase in the incidence of osteoporosis is generated, this occurs even though Chinese people who drink milk have a higher calcium intake than those who drink milk. they do not drink milk

This paradox can be explained by the loss of calcium generated by the acidity produced by the intake of milk and meat proteins: the body counteracts the acidity by releasing minerals from the bones in the bloodstream and the kidney subsequently excretes them in the urine. This effect has been observed for all people who, without ever drinking milk, suddenly begin to drink it, as shown by the works of Drs Hsiu and Fun, from the universities of Taipei and Los Angeles.

On the other hand, studies with vegetarian populations have shown that meat consumers 65 years of age have 5 to 6 times more bone loss than vegetarians of that age. This may be due to both a high intake of animal protein (acidifier) ​​and a low intake of vegetables.

Dr. William Ellis, a North American physician, states based on the performance of more than 25,000 blood tests, that the lowest levels of calcium were found among those who consumed 4 or 5 glasses of milk per day.

Finally, let's say that babies fed with breast milk develop their bone structure better than those fed formulas based on cow's milk, although the diet of the latter is richer in calcium. The explanation lies in the calcium phosphorus ratio in human milk (2: 1), in comparison with that of cow's milk (2: 1.6), which makes absorption difficult, since phosphorus is linked to calcium and prevents the absorption of calcium.

The issue is therefore the metabolism of calcium and not simply the quantitative contribution of it. The concern for the contribution of calcium as a supposed determining vector for the prevention and / or treatment of osteoporosis, is a concept that has been applied in a mechanistic and erroneous way at present.

Currently, the real problem is not so much the contribution as the loss of calcium, that is, the modern diet provides calcium in abundance but it generates a poor absorption and a high loss of it .

THE ABSORPTION OF CALCIUM

Normally we absorb only 20 to 30% of the calcium in our food.

THE ABSORPTION OF CALCIUM IS DIFFICULTY WITH:

• -The antacids (inhibit stomach acid which decreases the absorption of calcium).
• - Excess fiber (fiber phytates trap calcium).
• -The phosphates of the chemical additives present in the sausages, melted cheeses, potato chips, cream of milk, canned fruits, carbonated drinks, etc. (The following additives contain phosphate: e-442, e450, e338 to e-343).
• -The carbonates (inhibit gastric acidity, which decreases the absorption of calcium).
• -The oxalates, present in some vegetables such as spinach, bind to calcium and prevent its absorption.
• -The prolonged use of laxatives worsens the absorption of calcium.

IMPROVES CALCIUM ABSORPTION:

• -Good heartburn that helps solubilize calcium.
• -The presence of vitamin D that helps absorb calcium (sunbathing improves vitamin D levels).
• -Vitamin C increases the absorption of calcium by 100%.
• -The magnesium improves the absorption of vitamin D, which in turn optimizes the absorption of calcium and its retention in the bones.
• -The consumption of calcium along with a wide range of minerals such as (magnesium, boron, manganese, fluoride, silica, copper, etc.) optimizes its absorption and use. To ensure an ample supply of minerals in the diet, the consumption of vegetables is fundamental.
• -The calcium supplements so usual now really do not solve the problem and can generate calcium deposits in the arteries, kidneys and other organs.

INCREASE THE EXCRETION OF CALCIUM BY RENAL AND OTHER ROUTES:

• -Foods containing refined (acidifying) sugar increase the urinary expulsion of calcium.
• - The acidifying diet (high consumption of animal proteins and low consumption of vegetables).
• -The elevated salt intake. The normal diet contains 10 to 20 times more sodium than necessary, which alters the calcium metabolism.

A study conducted with Dutch students, for example, observed that they eliminated 20% more calcium when they ate 6000mg. of sodium a day when they only ate 3000mg.

• -The high intake of phosphorus through bottled soft drinks, meats and agrochemicals hinders the intestinal absorption of calcium.
• -The coffee and alcoholic beverages: the consumption of alcoholic beverages hinders the absorption of calcium, and the excessive consumption of coffee (8 cups a day) generates loss of calcium.

WHAT TO DO THEN ABOUT CACIO TO AVOID AND / OR COMBAT OSTEOPOROSIS?

According to the above, it is clear that the common recommendation, currently dominant, to combat osteoporosis is wrong and harmful. In fact, consume many dairy products and take calcium supplements, not only does not solve the problem but can aggravate it, because as we saw a diet rich in dairy generates blood acidity and helps increase the expulsion of calcium and other minerals through the urine . For its part, the calcium in the supplements is poorly absorbed and can be fixed in the arteries or clog the kidneys.

The real issue is to understand calcium metabolism and act accordingly. The modern diet provides huge amounts of calcium but the osteoporosis epidemic continues to grow. Remember that milk provides 125mg of calcium per 100gr., And that in the long term the abundant consumption of dairy products generates a negative balance of calcium: the urinary loss of calcium generated by the blood acidification produced by dairy products is greater, than the contribution of calcium offered by them.

OTHER SOURCES OF CALCIUM

There are numerous sources of calcium, and many of them are better than milk:

The richest sources of calcium are seaweeds , which also contain little phosphorus, are rich in minerals, and contain almost all the trace elements that the body needs, which favors the absorption of calcium.

The hiziqui seaweed contains 1300mg of calcium, and the seaweed wakame 1250mg. per 100gr., which represents about 14 times more than milk. You can get them in stores selling Japanese products, and consume them soaked by adding them to salads, or cooked in soups or vegetable stews or other dishes.

Another interesting source of calcium are oilseeds :

The sesame contains 1000mg. of calcium per 100gr., almonds 266mg of calcium per 100gr. but they are rich in phosphorus which decreases the absorption of calcium.

Spirulina algae is also rich in calcium: 100 mg per 100 grams, although it is also rich in phosphorus. However, it also provides important amounts of magnesium, manganese, B complex and other valuable nutrients for bone health.

The other important source are green vegetables such as broccoli, parsley, watercress, nettle, dandelion, cabbage, all contain between 100 and 200 mg. of calcium per 100 grams and are rich in vitamin C and magnesium, which greatly improves the absorption of calcium (spinach and rhubarb because of their high content of oxalates hinder the absorption of calcium.)

On the other hand, green vegetables are the main nutritional source of vitamin K, of whose importance for bone health I spoke in a previous submission.

It is very important to point out that vitamin K does not have coagulant effects in people who do not have vitamin deficiency, that is, that you can consume important amounts of green vegetables without fearing that a high consumption of this vitamin will increase the risk of formation of blood clots.

Other sources of calcium (in parentheses its contribution of calcium x per 100gr.):

chard (119mg.), tortillas (175mg), beans (240mg), soybeans (277mg.), cane molasses (860mg), low-fat yogurt (199mg), sardines (240mg), camembert cheese (388mg), gruyere cheese ( 1.011mg).).

In this link, the previous installments of the series "The natural treatment of osteoporis", in addition to other collaborations of Andrés Sierra in Ecoofera.

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Vitamin D, calcium and bone health

Why is bone health important?

Bones are living tissues that constantly wear out and replace. Throughout life, the body seeks to compensate for the loss of bone tissue with the creation of new tissue. The highest bone mass (size and strength) is reached at approximately 30 years. Thereafter, bone mass begins to be lost.

Over time, the loss of bone tissue can cause osteopenia (lower bone mass) and then osteoporosis, a condition in which bones weaken and are more prone to breakage (fractures). Fractures can cause serious health problems, including disability and premature death. It is important to consume enough vitamin D and calcium to maintain healthy bones and reduce the risk of osteopenia or osteoporosis. Frequent exercise and the type in which weight is supported helps keep bones strong.



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Why is vitamin D and calcium important for bone health?

Vitamin D allows the body to absorb calcium. Calcium is necessary to have strong and healthy bones. Without enough vitamin D and calcium, bones may not form properly during childhood and may lose bone mass, weaken and break easily during adulthood. Even if you consume enough calcium in your diet, the body does not absorb that calcium if you do not consume enough vitamin D.

What is vitamin D?

Vitamin D is a fat-soluble vitamin, which means it is stored in the fatty tissue of the body. People normally get vitamin D when exposed to sunlight, which leads to the production of vitamin D in the skin.

Vitamin D is found naturally in very few foods. In the United States, it is added routinely to milk and baby formula. Other good food sources are egg yolks and some types of fish, such as salmon and mackerel. Vitamin D is also available in nutritional supplements.

Did you know?

Vitamin D is the only one that the body produces. Other vitamins such as A, B and C only come from food and supplements.

You probably do not get enough vitamin D if:

•     Spend little time in the sun or use a powerful sunscreen
•     He has very dark skin
•     is over 50 years of age, when the body has less capacity to produce and use vitamin D efficiently
•     have certain diseases of the digestive system that interfere with the absorption of fat and vitamin D
•     is overweight, because vitamin D can get "trapped" in body fat and be less available for the body's needs

Osteoporosis
What is calcium?

Calcium is a mineral with many functions. Most of the calcium in the body is stored in the bones and teeth, where it contributes to its structure. Calcium comes mainly from the foods you eat.

Among the good sources of calcium are dairy products (milk, cheese, yogurt); products fortified with calcium (foods and beverages with added calcium); fish canned with bones, and vegetables. Like vitamin D, calcium is also available in supplements.

You may need additional calcium if:

•     she is a postmenopausal woman
•     eat a few dairy products or do not eat them
•     have a digestive disease that interferes with the absorption of nutrients

Daily recommended level of vitamin D and calcium for adults

Vitamin D     Less than 50 years: 400 to 800 international units (UI)
More than 50 years: 800 to 1,000 IU


Calcium                  Less than 50 years old: At least 1,000 milligrams (mg)
More than 50 years: At least 1,200 mg

Questions to ask your doctor

•     How much calcium and vitamin D do I need?
•     How do I know if I am consuming enough?
•     Should I take a calcium or vitamin D supplement? How much should I take?
•     Should I have an analysis to determine if I have vitamin D deficiency?
•     What else can I do to keep my bones strong?

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Calcium and vitamin D: natural remedies to alleviate osteoporosis

The disease affects almost three million people in Spain
Adults up to 50 years, the population most affected, should ingest 1,000 milligrams of calcium daily .

Osteoporosis is a disease that causes a decrease in the density of bones , resulting in a worse resistance to shock and that, the same, fracture more easily. Almost three million people in Spain suffer from this disease, of which, in a few cases, the causes are known but it has a prevalence in the population over 50 years old; of 26.07% in women and 8.1% in men.



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To prevent a disorder that the World Health Organization (WHO) defines as: "a systemic disease , characterized by a decrease in bone mass and a deterioration of the microarchitecture of bone tissue that increases its fragility, with the consequent increase of fracture risk ", it is essential to consume calcium . In addition, it is also essential to take vitamin D , which improves the absorption of calcium for bone growth, delays the onset of disease and prevents fractures.

Why should calcium be consumed?

Calcium is essential for the blood to coagulate and the heart, muscles and nerves to function correctly. The insufficiency of this mineral contributes to the development of osteoporosis. Numerous studies have been published that indicate that inadequate calcium intake is directly related to a decrease in bone density and a high fracture rate.

Milk is the most traditional source of calcium. Its consumption is essential during the first years of life to ensure good development and growth, but that does not mean that, after this stage, you should stop taking it.

How much should be taken?

An article by Health.com , a magazine specializing in wellness, argues that adults up to 50 years old should consume 1,000 milligrams of calcium and 200 units of vitamin D per day . People who exceed this range would need 1,200 milligrams of calcium and 400 to 600 units of vitamin D. In adults it has been proven that those who follow a healthy diet have higher levels of bone mass than those who do not have healthy habits.

Children and adolescents must meet the recommendations of 1,300 milligrams daily to reach higher levels of bone mineral density.




Calcium, exercise and vitamin D, key factors in the prevention of osteoporosis

After 50 years of age, one in four women suffer from osteoporosis , three more than in the case of men. To prevent the disease, it is advisable to "maintain a diet that gives us the recommended amount of calcium , control vitamin D levels and, if necessary, take supplements," as indicated by Dr. Ángel Oteo, coordinator of the Unit Bone Fragility and Osteoporosis of the HM Madrid University Hospital.

Another key factor, according to this HM Hospitals specialist, is "to avoid a sedentary life that not only favors the appearance of osteoporosis, but also increases the risk of falls " . Therefore, it is advisable to perform physical exercise and maintain an active life, as well as correct visual and hearing problems, evaluate treatments that may cause sleep and eliminate barriers that pose an obstacle in the home.

It is necessary to take into account individual factors of each patient such as age, weight, the presence of previous fractures, the age of menopause in the case of women, the consumption of toxic substances such as alcohol or tobacco, diseases such as rheumatoid arthritis or treatment with corticosteroids.

Osteoporosis affects the entire skeleton , although the most frequent fractures occur in the vertebrae, hip, wrist, ribs and shoulder. The main problem of the pathology is that it does not give symptoms until the injury occurs and the fact of suffering the first fracture is associated with an increased risk of presenting new ones, as well as an increase in the mortality and a decrease in quality of the patient's life.

Mind acting before the first fracture

To avoid this first fracture and prevent the aggravation of the disease, it is necessary to make an early diagnosis . In this sense, Dr. Oteo recommends evaluations to discard osteoporosis "to all women and men between 50 and 70 years, according to whether or not they have risk factors, and also to all those who, above that age, They have suffered a fracture . "

The most common test is bone densitometry , although "complementary tests , such as imaging tests or laboratory tests are also performed , since the problem may appear as a consequence of other clinical situations , " says HM Hospitals specialist.

The evaluation is fundamental to be able to act before the first fracture occurs or to prevent future injuries, with the consequences that entail for the quality of life of the patient.

Once the disease is diagnosed, it is necessary to determine which patients need treatment . "According to the International Clinical Guidelines, those who have suffered a hip or vertebral fracture and those diagnosed with osteoporosis in the densitometry should receive it , " says Dr. Oteo . In case of osteopenia , bone loss less severe than that of osteoporosis, risk factors should be evaluated for whether it is necessary or not to receive treatment.

Currently there are treatments that allow both to prevent and treat osteoporosis in an optimal way. The Bone Fragility and Osteoporosis Unit of the HM Madrid University Hospital has clinical tools that allow calculating the risk of presenting a fracture if the patient does not receive treatment.

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Vitamin D and calcium prevent OSTEOPOROSIS

Osteoporosis, known as the silent epidemic, is considered one of the most common diseases in our country, as it affects women in a special way. It has emerged in recent years as a global public health problem that affects more than 200 million people in the world1. In Spain, it is estimated that osteoporosis affects 3.5 million people, which is why it is a public health problem of great magnitude due to its prevalence, the morbidity and mortality it causes and the consumption of health resources2.

The increase in life expectancy has led to the appearance of a series of bone disorders that have an important clinical impact, such as the development of osteoporosis. Factors such as aging, decreased sex hormones and inadequate lifestyle are the main risk factors that determine a low bone mass and, therefore, are in the genesis of a large part of osteoporotic fractures3. Physical inactivity, dietary changes and the hormonal changes that occur as you age lead, ultimately, to a marked reduction in bone mass2.



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In this sense, in order to prevent the appearance of this pathology and to minimize the associated complications, it is necessary to acquire a healthy lifestyle and carry out dietary measures, taking into account that the foods that are consumed usually contain a wide variety of foods. vitamins, minerals and other important nutrients for health.

In particular, and together with the treatment prescribed by the specialist, there are two essential nutrients in the management strategies of osteoporosis: calcium and vitamin D, since "an inadequate level of these two substances has serious consequences, such as bone loss, musculoskeletal pain, muscle weakness, falls and fractures, "says Dr. Manuel Díaz Curiel, of the Internal Medicine Service of the Jiménez Díaz Foundation in Madrid.

For that reason and with the objectives of facilitating the update on the global management of osteoporosis -which includes an adequate pharmacological treatment that helps the absorption of calcium that is acquired through the diet- and to present the role of the vitamin D and calcium for bone and general health, and insist on the importance of proper nutrition, Drs. Jose Manuel Quesada, Manuel Díaz Curiel and Gregorio Varela with the sponsorship of MSD, Danone and Grupo Ferrer have organized, in Madrid, the 'Symposium vitamin D and healthy life', aimed at health professionals, as primary care doctors, specialists in rheumatology , traumatology, rehabilitation, internal medicine, endocrinology and nutritionists.

"It has been shown that vitamin D and calcium supplements reduce the appearance of osteoporosis by up to 40%, which is why we must encourage healthy diets supplemented with calcium," says Dr. Díaz Curiel.

To this, adds Dr. José Manuel Quesada, of the Endocrinology and Nutrition Service of the Reina Sofía University Hospital of Córdoba, belonging to the Thematic Network of Salud , Farmacia , Psicología , Belleza, Medicamentos Cooperative Research on Aging and Fragility (RETICEF) and scientific coordinator of the Symposium, "that in order to have a good absorption of calcium, a good gastric function is also essential, since only in this way is it possible to dissociate calcium from its salts and that this calcium is absorbed correctly. Also, for a good absorption to take place, it is necessary that there be at least 20 nanograms per milliliter of vitamin D, which is very complicated to achieve ".

The sun, source of obtaining vitamin D
It is known that vitamin D, Achilles' heel in the approach to osteoporosis, is key in the prevention of fractures due to this disease, even more so if one takes into account that there is a deficit of this hormone in the elderly population and that associated to calcium decreases the risk of fracture4. Vitamin D is essential for the maintenance of muscle function, facilitating the absorption of calcium and phosphorus.

The main problem is that vitamin D present in food is scarce, so it must be obtained through other sources, such as solar energy. Once the sun comes into contact with the skin, the formation of vitamin D begins.

"90% of vitamin D should be synthesized by the skin through the sun. However, there is an inadequate level of vitamin D throughout the world, including in Spain. It is estimated that practically 70% of the population has an inadequate level of vitamin D and it has been shown that the levels in our country are even lower than those of the inhabitants of Nordic countries, such as Sweden, Finland and Norway "5, states Dr. Quesada.

Foods beneficial for obtaining calcium
Specialists stress the importance of supplementing the diet with a diet rich in calcium. "There are foods that help to present higher levels of this substance. These foods are mainly dairy products - milk cheese and yogurt - and others such as margarine, "says Dr. Díaz Curiel. In turn, Dr. Quesada states that "it is necessary to supplement vitamin D through drugs, while calcium can be acquired relatively easily through diet."

Additional benefits of vitamin D
"Currently, vitamin D is conceived as a true hormone, since it improves bone and mineral metabolism, and is also the calcium manager, keeps the bone compact and strong and reduces up to 49% the risk of falling and improves neuromuscular performance, "says Dr. Diaz Curiel.

But, beyond providing benefits in the management of osteoporosis and avoiding the risk of falls and fractures, it has been shown that "in light of the available evidence, it is critical to maintain optimal levels of vitamin D, since low vitamin levels D, are associated with a higher risk of developing cancer, of suffering from infections, autoimmune, cardiovascular diseases, such as acute myocardial infarction, metabolic syndrome and arterial hypertension, among others. The treatment with vitamin D, by its specific actions, diminishes those risks and that of death as a whole. These data, of great scientific importance, make that maintaining adequate levels of vitamin D is a public health objective "6, says Dr. Quesada.

For its part, Carmen Sánchez, president of the Spanish Association against Osteoporosis (AECOS), insists that "it is essential that women ask their doctor about the health of their bones, since among all it is possible to fight against osteoporosis" .

Update of Recommended Vitamin D Intakes
As indicated by Prof. Gregorio Varela, member of the Department of Nutrition, Bromatology and Food Technology of the Faculty of Pharmacy, University CEU San Pablo, "the intake of vitamin D is lower than recommended in a very high percentage of individuals, ranging between 50 and 100% of the cases studied. Of the entire population, the elderly are the group most at risk of having vitamin D deficiencies. "

Vitamin D plays a key role in the maintenance of bone mass and mineral metabolism, since it regulates the intestinal absorption of calcium. "Taking into account that one of the main consequences of presenting inadequate levels of vitamin D is the appearance of rickets and osteomalacia, it is necessary to redefine the reference values ​​of vitamin D," says Prof. Varela.

Therefore, "it is essential to call for the public health authorities to update the Recommended Intakes, which lead to improve nutritional status," concludes Prof. Varela.

Proper treatment
As explained by Dr. Diaz Curiel, it is essential to detect early those patients with risk factors for osteoporosis. "Preventive work is the best therapy, especially in those people who have
n risk factors. "

"Only half of patients suffering from osteoporosis have been diagnosed, and of this percentage, only 19% have been correctly treated. For this reason, and to ensure an adequate diagnosis, it is also important to know the risk factors of each person ", explains Dr. Díaz Curiel," there are factors that can and should be corrected, such as diet, lack of exercise , the abuse of tobacco and the consumption of alcohol, which can modify the peak of bone mass ".

For this reason, it is essential that "a treatment against osteoporosis be instituted, and that this be enhanced through an adequate and continuous supply of vitamin D, which avoids breaches in indicated supply8, enhancing the calcium intake through the diet ", concludes Dr. Quesada.

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Calcium and vitamin D prevent osteoporosis: how to increase your levels

Nutrition in osteoporosis
We give you the appropriate dietary guidelines that help change the modifiable risk factors of osteoporosis, in order to prevent or control your symptoms, especially with the intake of calcium or vitamin D.



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The main objective of the treatment of osteoporosis is to avoid bone fractures. For this, before the diagnosis of the disease, it is advisable to increase the calcium intake and adapt the vitamin D :

Increase calcium intake

For this, it will be necessary to increase the consumption of foods rich in calcium , such as dairy products and their derivatives . Other interesting foods to consider for their contribution in calcium are almonds, chickpeas, bivalve molluscs and green leafy vegetables such as Swiss chard and spinach. It is likely that the doctor also advises the use of calcium supplements, such as calcium carbonate or calcium citrate. Although the recommended intake of calcium in adulthood is between 800 and 1000 mg of calcium per day, it is advised that the postmenopausal woman consume between 1000 and 1300 mg of calcium daily.

The absorption of calcium can be altered in a positive way by a low intestinal pH, the intake of fats and lactose or an increase in calcitriol in the blood. Calcitriol is the active form in which vitamin D is found in the body, and is also used in the form of a drug to treat low calcium levels.

However, there are factors that can reduce the absorption of calcium, such as certain types of gastritis , vitamin D deficiency, high intestinal pH, excessive consumption of dietary fiber , presence of oxalates and phytates in the diet and excess phosphorus , among others. . For this, the consumption of between 2 and 4 daily servings of dairy products and derivatives (better skimmed) is basic.

Adequate intake of vitamin D

Vitamin D is essential in the absorption of dietary calcium. The recommended intake of vitamin D for the general population is between 400 and 800 IU daily. When it comes to people over 65, this recommendation increases to 800 IU. Food sources of vitamin D are scarce: whole milk products and blue fish are the main dietary sources to obtain it, along with eggs (yolk) and supplemented foods such as breakfast cereals, margarine and soy drinks.
Boquerones, pescado azul Blue fish is a rich source of vitamin D, essential for the absorption of dietary calcium.

However, this vitamin is able to form on our skin during sun exposure, so sun walks in older people with osteoporosis are fundamental to their bone health.

Below is the calcium and vitamin D content of some of the foods to be included in the diet for the prevention and treatment of osteoporosis:
   
     Calcium(mg)             Vitamin D(UI)

• 1 glass of milk (250ml)     282.5     traces
• 1 glass of milk enriched with calcium and vitamin D (250ml)     400     8
• 1 yogurt     171.25     traces
• 125g of cottage cheese     748.75     traces
• 40g semi-cheese     306     4.48
• 1 tablespoon of milk powder (10g)     94.3     one
• 20g of butter         10.4
• 20g of margarine         64
• Small blue fish        
• Canned anchovies (4-5 steaks)     54     112
• Herring (1 unit of 60g aprox)     30     456
• Sardines in tin (100g)     407     220
• Egg yolk (1 unit)     27.4     36
• Veal liver         9.6

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The role of Vitamin D prevent osteoporosis

We tell you how important it is for your bone health and how to acquire it

When it comes to bone health , most of us are aware of the importance of calcium intake, and we are not wrong. Calcium is essential to have strong bones, although it should be noted that there are other nutrients involved, and without a good contribution of all of them we can not enjoy good bone health and prevent a disease as widespread and silent as osteoporosis .



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Nutrients needed to prevent osteoporosis
On the one hand, calcium, phosphorus and vitamin D are necessary for bone development at a structural and functional level . On the other hand, magnesium, vitamin K and zinc are involved in its formation . Consuming sufficient amounts of all of them is important throughout life, both in the growing season, when the bone is developing, and in adulthood, to avoid excessive loss of bone mass that can end in osteoporosis .

The importance of Vitamin D for our bone health
After calcium, the most important nutrient for bone health is Vitamin D. This vitamin, which is found in the fat fraction of foods, has the function of facilitating the absorption of calcium and phosphorus from the diet , that is, consuming calcium along with Vitamin D favors the calcium that we are ingesting into the bloodstream .

For this reason, the calcium that dairy products contain is so good, because when accompanied by Vitamin D we can take better advantage of it. In addition, Vitamin D also causes less calcium to be eliminated and therefore also decreases its loss.

How can I get Vitamin D?
Vitamin D can be obtained through food , by eating fatty animal foods such as blue fish, mushrooms, egg yolks, fortified foods and dairy (if you take skimmed you will be losing part of this vitamin) .

There is another way to obtain Vitamin D without food intake, an alternative that is also our main source of this nutrient: the sun. The contact of sunlight with our skin stimulates the synthesis of Vitamin D. For this reason deficiencies of this type of vitamin usually occur in the winter months or in countries where they have fewer hours of sunshine.

It is estimated that in winter we would need around 130 daily minutes of sun exposure, with at least 10% of the body uncovered and in the central hours of the day and with 25% of the body exposed, to synthesize enough Vitamin D. Instead, in summer with 10 minutes (without protective cream) we would have enough.

Keep in mind that as we get older, our ability to synthesize Vitamin D through sunlight is lost and we will require more contact, in addition to strengthening our diet .
In summary, to provide a sufficient amount of Vitamin D, we advise you to take:

•     3 times a week blue fish (salmon, tuna, sardine, trout, bonito, jack mackerel, anchovy, mackerel, carp, anchovy, turbot ...).
•     2 or 3 times a serving of eggs.
•     Dairy daily or enriched vegetable drinks.

And do not forget to take a daily walk to facilitate sun exposure!






How can I prevent osteoporosis?

What is osteoporosis?

Osteoporosis is an alteration in the bone density that usually appears during the Third Age, but its origin is usually the cause of nutritional deficiencies that can begin in childhood. It is considered a silent disease, because it does not cause symptoms until fractures appear.

Characteristics of osteoporosis

By definition, osteoporosis is a decrease and deterioration of the bone mass , that is, the mineral density of the bone is reduced and a change in its structure is produced, converting it into a more porous tissue. The bone with osteoporosis , therefore, is more fragile and more susceptible to injury due to not being able to withstand normal stresses.

The incidence of osteoporosis is very high in women from the age of 50 , doubling between 50 and 60 years, and tripling from 60. In fact, it is estimated that half of women 50 years will suffer a fracture due to osteoporosis at some point in his life. The most frequent fractures are those of the ulna, vertebrae and ribs.

Classification

    Primary osteoporosis . It is due to physiological factors, without any associated disease . There are two kinds:

•     a) Due to low estrogen levels , especially in postmenopausal women.
•     b) Because of advanced age , both in men and women, from 70 years old.

    Secondary osteoporosis . There is a pathology or external cause that originates it . Four causes:

•     a) For diseases of the endocrine system.
•     b) For drugs.
•     c) For digestive diseases.
•     d) Due to nutritional deficit.

How does the formation and maintenance of bones work?

99% of calcium is stored in the bones, and only the remaining 1% circulates through the blood. The calcium in the blood will fulfill different functions, such as muscle contraction, coagulation or bone mineralization.

The body is responsible for maintaining the concentration of calcium in regular blood, controlling the absorption of calcium from the diet and its elimination from the body. If the body detects that the concentration of calcium in blood is low, activate mechanisms to increase it. These mechanisms involve, among others, obtaining the calcium from the bones, so that if it is not corrected, the mineral density of the bone decreases.

Bone remodeling is the process by which bone is formed and destroyed. During the growth the balance is positive (more is created than the one that is destroyed), during the adult phase there is usually a 0 balance and, after 40 years, the regulation mechanisms begin to fail and a negative balance is produced, that is, the bone is destroyed.

It is important to understand that with our habits we can improve the calcium accumulation and avoid excessive loss.

How to improve bone health?

To enjoy good bone health, we must begin to take care of young people and continue to do so throughout our lives. In the stages of bone formation we can achieve the maximum possible mineralization and in the adult phase minimize losses.

The factors most involved in bone health are:

Calcium

It is essential for the structural and functional development of bone. The best source of calcium that we have in the diet is that from dairy products. Throughout life is recommended to take between 2 and 4 servings of dairy every day to meet the needs of calcium. A dairy serving equals 1 glass of milk, 2 yogurts or 40 g of cheese.

Calcium also contributes pulses, nuts, broccoli or cabbage , and some enriched vegetable drinks, although its use is less.

The stages of life in which the requirements are greatest are childhood and adolescence, pregnancy and lactation, and also during the Third Age.

Vitamin D

Along with calcium, Vitamin D is essential for bone formation. Its role is to help the calcium in the diet absorb better. We can synthesize it when the sun hits us on the skin (10 minutes a day) or food: blue fish, mushrooms, cow's milk or eggs.

Physical activity

It has been observed that exercise has a protective role of bone health. The tensions that the skeleton receives when we practice exercise favor the quality of the bone. Exercises with impact are most stimulating and are especially important during puberty. In addition, there is a direct relationship between muscle mass and bone mass, so that maintaining a good muscle mass is preventive for bone health.

In summary, both to prevent and treat osteoporosis a balanced diet is recommended that covers all the needs of nutrients, especially calcium and vitamin D, and exercise on a regular basis.