Vitamins with calcium: how to understand the variety of assortments

What calcium to buy to strengthen bones.

October 12, 2021
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Content

• Forms of calcium
• How to choose a calcium supplement
• How to take calcium tablets
• Top 10 calcium supplements
• Calcium-D3 Nycomed Forte
• Now Foods, Calcium Hydroxyapatite
• Calcemin Advance
• Doppelhertz Active Magnesium+Calcium+D3
• Calcium D3 Ultra
• Solgar Calcium-Magnesium with Vitamin D3
• Calcium-Active Citrate
• Mountain calcium D3
• Complivit Calcium D3 Forte
• Calcium gluconate
• Foods High in Calcium

Calcium is a very important macronutrient, without which the body cannot function properly. Calcium is not only about strong bones and teeth. It is also responsible for muscle contraction, blood clotting, heart and vascular health, and the functioning of the nervous system.

To get your daily calcium requirement (about 1,000 mg) from food, you should drink a glass of milk, a glass of plain yogurt, and eat a block of cheddar cheese. But you can take a simpler route - and just buy calcium tablets. But here it is important to choose a drug that will be well absorbed by the body. These are the products on our list of the best calcium supplements.

Read also Vitamins for hair loss: 10 of the best Review of the best vitamins for hair.

Healthy Supplements at 40

The gradual decline of ovarian function can appear as early as 40 years of age. The condition of the skin noticeably deteriorates, it loses elasticity, and the hair turns grey. You can effectively maintain health during this period with the help of vitamin supplements combined into complexes for mature women. They must include the following components:

• B6 – to maintain the functioning of the nervous system, normalize sleep and reduce PMS symptoms;
• E – to slow down aging, improve skin condition;
• D- for the prevention of endometrial hyperplasia, cancer;
• A – to strengthen blood vessels, vision, for the prevention of gynecological pathologies;
• K – to normalize blood clotting, prevent uterine bleeding.

After forty years, due to a decrease in ovarian function, the body begins to decline. A good multivitamin will not stop this process, but will help support the body.

Forms of calcium

Calcium in preparations is presented in the form of various compounds. Let's talk about them in more detail.

1. Calcium citrate.
   Most often, such calcium costs an order of magnitude more than other calcium preparations. And all because calcium citrate is maximally absorbed by the body (even if there are problems with the gastrointestinal tract). This form of the drug is ideal for people over 60 years of age.
2. Calcium phosphate.
   This form of calcium has good bioavailability. Calcium phosphate, unlike other compounds, does not cause constipation. This calcium is usually prescribed to those who are prone to such problems.
3. Calcium chelate.
   This calcium is absorbed by the body by 90-98%, it is enriched with amino acids, is well tolerated, does not disturb the acid balance and is quickly absorbed by the body.
4. Calcium hydroxyapatite.
   This form of calcium is obtained from animal sources. Calcium hydroxyapatite is often enriched with collagen and phosphorus, making it ideal for strengthening bones and teeth.
5. Calcium carbonate.
   The cheapest and most common type of calcium. Its maximum digestibility is 22%. But if a person has low acidity, such calcium is not absorbed at all. Moreover, excess calcium can simply be deposited in the kidneys. Calcium carbonate has good bioavailability, plus the issue of price is important, so people often buy it.

Which type of calcium should you choose?

Among the abundance of calcium-containing preparations, we are offered “natural”, “natural origin”, “coral”, “pearl”, “in an easily digestible form” and even “soluble”. Although we all know that calcium does not dissolve in water!

So, let's try to figure it out.

The sources of calcium included in calcium preparations are divided into two classes: calcium of natural origin and “synthetic”.

Calcium from Natural Sources

Obtained from limestone, dolomite, oyster shells, corals, and animal bones. Almost all sources of calcium of natural origin are calcium carbonate, which, despite the high calcium content in salt - about 40%, is very poorly absorbed by the body. Moreover, so-called “natural” calcium may contain dangerous impurities. After all, not all areas where shells and corals are mined are environmentally friendly, and it is often difficult to understand where the calcium comes from and how purified it is.

While studying natural sources of calcium, scientists discovered the presence of lead in them, the amount of which often exceeded the maximum permissible level. Avoiding such pollution is problematic in the conditions of our civilization. This is especially true for calcium from oyster shells and animal bones. Lead in living organisms accumulates precisely in places where calcium is deposited: bones, shells, shells. Once in the body, lead is difficult to remove, damaging the kidneys, brain, and blood cells. And in children, intellectual functions decrease, behavior changes, and unmotivated aggression appears.

Synthetic calcium

It represents purified substances in the form of calcium salts and, in terms of safety, is preferable to “natural” ones. However, there are some nuances here too.

Firstly , the calcium content in these salts is different: the maximum is in carbonate, and the minimum is in gluconate.

Secondly , they vary greatly in biological effect and digestibility.

Calcium phosphate.

Phosphorus is a component of many food products, so in modern conditions the human body is already experiencing a phosphorus load in order to additionally take in phosphates. Albeit with the goal of getting calcium.

Calcium phosphate does not “color” and its absorption is very low. Therefore, its use as a substance to replenish calcium requirements is not recommended.

Calcium
lactate and gluconate.
There is one big complaint about these salts: they contain little elemental calcium - 13% and 9%, respectively. Therefore, these compounds must be taken in large quantities. Depending on the dosage, this is 5-10 large gram tablets of children's ascorbic acid.

Calcium chloride.

This salt, when taken orally, irritates the stomach, causing pain and heartburn. It is used mainly in solutions.

Thus, in terms of effectiveness and safety, only two forms of calcium really compete with each other: calcium citrate and calcium carbonate. This is what we actually see on pharmacy shelves.

Calcium carbonate.

The most common and one of the cheapest forms of calcium. The share of carbonate preparations in the world market is about 85%. And although calcium carbonate is the leader in elemental calcium content - 400 mg, the absorption of calcium from this salt directly depends on the acidity of gastric juice. The higher the acidity, the better the absorption. With low acidity (typical for people over 45 years old), the absorption of calcium carbonate drops to 2-3%. That is, it is practically not absorbed.

Moreover, when calcium carbonate is absorbed, the hydrochloric acid of the gastric juice, which is necessary for the digestion of food and also serves as a barrier against the penetration of parasites into the body, is neutralized. Often, taking calcium carbonate is accompanied by gastrointestinal discomfort, a feeling of fullness and belching of carbon dioxide.

Calcium Citrate.

Calcium citrate is a safe and chemically pure product that is obtained from purified substances by reacting calcium carbonate from purified limestone with citric acid. Despite the fact that citrate contains only 21% calcium (calcium content in carbonate is 40%), the body receives 2.5 times more elemental calcium from citrate than from carbonate.

At the same time, calcium from citrate is absorbed regardless of the acidity of gastric juice. And with reduced gastric secretion, the body receives 10 times more calcium from calcium citrate than from carbonate. Therefore, this form of calcium is most optimal for people over 45 years of age.

Plus, calcium citrate has significantly fewer side effects than calcium carbonate. In addition, it promotes the absorption of vitamin C and other minerals.

The biggest problem with citrate is its price. Today, calcium citrate is a more expensive form than calcium carbonate.

How to choose a calcium supplement

Many factors influence how calcium is absorbed in the body. Let's look at the main ones.

1. Associated health problems.
   If you are over 60 years old or have gastrointestinal diseases, we recommend choosing calcium citrate preparations. If a person has a tendency to constipation, it is better to buy calcium phosphate. For older people (especially if there is coronary heart disease or congestive heart failure), calcium enriched with magnesium and potassium is suitable (but first consult a doctor). For anemia, it is better to choose Calcemin Advance (it does not affect the absorption of iron, like other calcium preparations).
2. Lifestyle and nutritional habits.
   Most people today are deficient in vitamin D, which is produced by exposure to the sun and found in fish. This vitamin is necessary for the absorption of calcium and phosphorus. Therefore, if you suspect you have a vitamin D deficiency, choose calcium supplements fortified with it.
3. Tendency to allergies.
   Before taking any vitamins and minerals (including calcium supplements), be sure to consult your doctor. An allergy can be either to the main component of the drug or to auxiliary components.
4. Age.
   Be sure to read the instructions before purchasing calcium to understand at what age a particular drug should be taken. By the way, many tablets cannot be broken, but taken only whole - this also needs to be taken into account.

IMPORTANT!

Any calcium supplements should not be taken with milk. Milk dissolves the tablet shell, and the active substance is quickly destroyed by stomach acid.

The role of diet in preventing osteoporosis

Because osteoporosis usually progresses to a clinically advanced stage before its effects become apparent, preventing bone loss is the single best way to avoid the possibility of fractures and resulting disability. Although increasing calcium in the diet is one of the strategies most often proposed, many studies have failed to show a clear relationship between dietary absorption of this mineral and bone density. Consumption of calcium and vitamin D-rich foods is likely more important during the bone-growing years before peak mass is reached rather than later in adulthood.

Dairy products contain more than 70% of the calcium in the diet of the “average” resident of our country. The calcium found in these foods is quickly absorbed because these foods contain lactose and some are fortified with vitamin D.

Vegetarians who avoid animal foods can get calcium from soy milk, tofu (soy curd) processed with calcium sulfate, grains (especially unrefined or slightly refined grains), some green leafy vegetables (cabbage, turnips), beans and nuts. Some types of currently popular mineral drinks and tap water also contain calcium, the amount of calcium varies depending on the source.

Supplement Efficacy

Due to widespread and questionable advertising linking dietary calcium to osteoporosis, this mineral has been added to many products, including orange juice, soda, and bread products.

Calcium supplements have also become popular, but their value as a source of calcium remains controversial. Supplements vary in absorption capacity, and many people take them incorrectly. For example, until recently, calcium supplements came in the form of large, difficult-to-take pills. Supplement manufacturers have reduced the size of the pills to make them easier to swallow, but they may have compressed the pills so much that they do not dissolve in the stomach and pass intact through the gastrointestinal tract.

Calcium supplements vary in the percentage of the mineral in each dose and their effect on the body. Among the most commonly used compounds are calcium carbonate (Kalmagin, Calcium D3 Nycomed, etc.) and calcium citrate (Citrical, etc.). Calcium carbonate contains up to 40% pure calcium. It reacts with hydrochloric acid in the stomach to form calcium chloride, a highly soluble and available compound.

Undesirable effects of large amounts of calcium carbonate include flatulence, nausea and constipation. Excessive use of supplements may also cause excess hydrochloric acid due to stimulation of gastric secretion; The possibility of developing kidney stones has also been reported. Calcium carbonate may reduce the absorption of medications such as aspirin, tetracycline, atenolol, and ferrous sulfate if the supplement and these medications are taken together. Antacids containing both calcium carbonate and aluminum actually block calcium absorption.

Calcium citrate contains less calcium, approximately 24%. This compound does not require hydrochloric acid to dissolve, making it more suitable for those who are deficient in this component of gastric juice. This condition, known as achlorhydria, is quite common in old age.

In addition to the evidence regarding the potential of calcium supplements to cause gastrointestinal problems, there is other evidence that casts doubt on their value. Calcium supplements alone have little beneficial effect on postmenopausal bone mineral loss. They may slow compact bone loss but are not very effective in preventing trabecular bone loss.

Additionally, medications that also contain vitamin D may cause toxic accumulation of this fat-soluble vitamin if taken in excess amounts. Bone meal and dolomite contain calcium and are relatively inexpensive, but they also contain toxins such as lead and should be avoided.

Typical mistakes in the diet of patients with osteoporosis:

• insufficient calcium in the diet;
• excessive amounts of dietary fiber, phytic and oxalic acid, which impair the absorption of calcium;
• protein deficiency in the diet, leading to a negative nitrogen balance and a decrease in reparative processes;
• too much protein in the diet, which contributes to increased excretion of calcium in the urine (for every 50 g of protein in excess of the norm, 60 mg of calcium is lost in the urine);
• excess carbohydrates in the diet, which also leads to increased loss of calcium in the urine;
• excess phosphorus in the diet, which impairs calcium absorption;
• abuse of alcohol and drinks with a high caffeine content (coffee, strong tea, cola, chocolate), which increases the loss of calcium in urine and feces;
• too much sodium, leading to loss of calcium in the urine;
• excessive (less often - insufficient) energy value of the diet;
• deficiency of vitamin D in the diet and insufficient insolation necessary for endogenous synthesis of the vitamin;
• lack of fat in the diet, which leads to impaired absorption of all fat-soluble vitamins, including vitamin D;
• underestimation of the role of dietary supplements and preparations containing calcium and vitamin D for the prevention and treatment of osteoporosis.

How to take calcium tablets

It is better to take calcium supplements with meals, since fats, proteins and bile acids are necessary for the absorption of the macroelement. It is also important to take into account circadian (daily) rhythms. The body has a hormone responsible for calcium metabolism - its maximum concentration is observed in the afternoon.

It is better to divide the daily calcium intake into two doses, because 600-1000 mg of calcium at one time will not be absorbed. You need to take calcium with enough water (one glass).

If you are taking antibiotics from the tetracycline group, the break between the antibiotic and calcium should be at least three hours, because they bind to each other and neutralize each other's effects.

If you are taking diuretics, monitor your blood creatinine and calcium levels at least once a month.

You should not take calcium if:

• tendency to thrombosis;
• severe atherosclerosis;
• hypercalciuria (metabolic problem when there is an excess of calcium in the urine);
• atrial fibrillation;
• sarcoidosis;
• multiple myeloma;
• metastases in the bones or spine;
• active form of tuberculosis;
• gout

Calcium supplements are prescribed very carefully to patients with uncontrolled hypertension, severe coronary heart disease, renal and liver failure.

Read also Top 5 non-hormonal drugs for menopause Non-hormonal drugs for menopause.

Calcium-D3 Nycomed Forte

This calcium supplement can easily be called one of the most popular in Russia. “Calcium D3 Nycomed Forte” is sold in the form of chewable tablets (1 tablet contains 500 mg of pure calcium and 400 IU of vitamin D3). Doctors recommend taking 2-3 calcium tablets per day. At first glance, it may seem that Calcium D3 Nycomed Forte contains too much vitamin D (compared to other drugs), but the daily dose of this vitamin is from 800 to 1200 mg. Among the undeniable advantages of this drug are the high calcium content and the presence of vitamin D. There is one minus - the price is not entirely affordable.

Calcium-D3 Nycomed Forte

Takeda Pharmaceutical Company, Japan

Calcium-D3 Nycomed Forte is a combination drug that regulates the metabolism of calcium and phosphorus.
Replenishes the lack of calcium and vitamin D3 in the body, which is required for the mineralization of teeth. Calcium takes part in the formation of bone tissue, mineralization of teeth, blood clotting, regulation of nerve conduction processes and muscle contractions, and maintaining stable nervous activity. from 223

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How much calcium should be added

Remember that you usually only need 1000-1200 mg of calcium each day. There is no point in getting more calcium. It might even be dangerous. There are recommendations that the maximum daily calcium intake should not be more than 2000-2500 mg per day. To avoid the danger of getting too much calcium and causing constipation, hypercalcemia, calcium accumulation in soft tissues, problems with the absorption of iron and zinc, it is not recommended to receive more than 1400 mg of calcium per day for a long time.

If you cannot supplement your diet with foods high in calcium (dairy products, leafy greens, nuts, beans and tofu), you can take up to 500-1000 mg of elemental calcium from supplements.

Now Foods, Calcium Hydroxyapatite

This is an American calcium preparation of animal origin, which means it is ideal for strengthening teeth (97% of our tooth enamel is calcium). Now Foods are powder capsules. This form of release allows you to protect calcium from the aggressive influence of the gastric environment, so calcium is absorbed almost completely. You can take Now Foods calcium from the age of 18, it reduces the amount of plaque on your teeth, makes them smoother, enamel defects become less noticeable, and the likelihood of developing caries is reduced.

Now Foods Calcium Hydroxyapatite

Now Foods, USA

Calcium hydroxyapatite contains macroelements, which is a balanced mixture of minerals necessary for the body.
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Calcemin Advance

Another calcium tablet made in the USA, which contains all the substances necessary for healthy bones. "Calcemin Advance" is suitable for women during menopause, the form of the drug is calcium citrate and calcium carbonate. Tablets are prescribed from the age of 12. This drug not only maintains the necessary level of calcium in the body, but also prevents it from being washed out of the bones. And all - thanks to the fact that it contains boron (it is this that inhibits the effect of the hormone that causes calcium loss). "Calcemin Advance" can be taken during breastfeeding and in case of chronic renal failure (as prescribed by a doctor). These calcium tablets do not cause the formation of kidney stones and are also compatible with iron supplements.

Calcemin Advance

Bayer AG, Germany; Contract Pharmacal Corporation, USA

Mineral and vitamin complex.
Calcium, which is part of the drug, is a building component for bone tissue, regulates the permeability of the vascular wall, is involved in the regulation of conductivity in synapses and neuromuscular junctions, is involved in the contractile activity of skeletal and smooth muscles, and is a necessary component for the blood clotting process. from 75

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Doppelhertz Active Magnesium+Calcium+D3

This calcium preparation is presented in the form of carbonate, available in the form of effervescent tablets, and is prescribed from the age of 14. “Doppelhertz Active Magnesium + Calcium + D3” is suitable for adults and adolescents, improves overall well-being, and perfectly replenishes calcium deficiency in the body. Effervescent tablets are well absorbed and practically do not irritate the gastric mucosa. In addition to calcium, the complex contains vitamin D3, which is responsible for the absorption of macronutrients, as well as magnesium, a building material for bones, which also has a positive effect on the cardiovascular system. “Doppelhertz Active Magnesium + Calcium + D3” improves sleep, calms the nervous system, improves memory, gives a surge of energy and stimulates metabolism.

Doppelhertz Active Magnesium+Calcium+D3

Queisser Pharma, Germany

An additional source of vitamins D3, B2, magnesium, calcium.
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Calcium D3 Ultra

This calcium preparation (in the form of carbonate) improves metabolism, strengthens bones and teeth, and supports the proper functioning of the cardiovascular system. "Calcium D3 Ultra" are chewable tablets with various fruit flavors. The tablets are enriched with vitamin D3, which helps calcium to be well absorbed. The drug not only strengthens bone tissue and mineralizes teeth, but also improves muscle contractions and improves the transmission of nerve impulses. You need to take 3 tablets per day with meals. The course of treatment or prevention is at least a month. "Calcium D3 Ultra" is inexpensive and has a pleasant taste. The disadvantages of the drug are that one tablet contains a low concentration of essential substances, so you need to take several per day, which is not very convenient. Well, not every pharmacy has this calcium supplement.

Calcium D3 Ultra

INAT-Pharma, Russia

A combined drug that regulates the exchange of calcium and phosphorus in the body (in bones, teeth, nails, hair, muscles).
Reduces resorption (resorption) and increases bone density, replenishing the lack of calcium and vitamin D3 in the body, necessary for the mineralization of teeth. from 145

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What tests to take

It is difficult to detect calcium deficiency using a blood test, because the body does everything possible to maintain a constant level of ionized calcium in the blood. But it’s easy to be deficient or deficient in vitamin D by taking a blood test for 25-OH vitamin D.

To identify contraindications and evaluate the effectiveness of treatment with calcium preparations, you should take tests:

• Calcium and phosphorus in the blood
• Calcium in daily urine
• Blood creatinine
• 25-OH vitamin D

In the Lab4U laboratory this can be done with a discount of up to 50%.

Solgar Calcium-Magnesium with Vitamin D3

Tablets made in the USA have a combined composition and completely cover the daily calcium requirement. The active ingredients in Solgar Calcium-Magnesium with Vitamin D3 vitamins are presented in the form of citrate. This drug is prescribed from the age of 18. The product not only strengthens bones and muscles, but also has a positive effect on the condition of hair and nails. “Solgar Calcium-Magnesium with Vitamin D3” helps the production of hormones, improves mood, is suitable for the prevention of osteoporosis, reduces cramps in the calf muscles, and strengthens the cardiovascular system. The positive effect of taking these calcium tablets is noticeable after 2 weeks.

Solgar Calcium-Magnesium with Vitamin D3

SOLGAR, USA

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What vitamins are needed at 30 years old?

At a young age, the need for vitamin substances differs from the period of maturity. The female body is actively functioning, eggs mature in the ovaries, and ovulation occurs. Even if you don’t want to get pregnant at thirty, you need products that will maintain a normal menstrual cycle.

The benefits come from the antioxidant complex, which includes A, E, C. Folic acid and B12 are required, they are involved in hematopoiesis and help restore hemoglobin levels along with iron medications. Those who suffer from heavy menstruation should take these drugs in a prophylactic dose before each menstruation.

A good vitamin complex helps strengthen nails and improves the condition of hair and skin. If it contains a sufficient dose of folic acid, it can be used when planning pregnancy.

Calcium-Active Citrate

This drug contains calcium citrate and vitamin D3. It is perfectly absorbed by the body, so it is suitable for people with gastrointestinal diseases (atrophic gastritis, surgical treatment of the digestive system). You can take “Calcium-Active Citrate” regardless of meals and stomach acidity. Therefore, doctors often prescribe this calcium to elderly patients and those with low acidity. The risks of kidney stones are minimal; it can be taken during pregnancy and lactation (in consultation with your doctor). "Calcium-Active Citrate" - inexpensive calcium tablets with high bioavailability. Among the disadvantages is that one package of the drug is not enough for the course.

Calcium-Active Citrate

DIODE, Russia

Calcium-Active Citrate is a biologically active food supplement containing calcium citrate (salt, which, according to scientific research, is the best source of calcium in terms of absorption and absence of adverse reactions) and the required daily dosage of vitamin D3.
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Mountain calcium D3

This is a complex preparation of calcium in the form of carbonate, enriched with vitamin D3 and mumiyo. “Mountain Calcium D3” from “Evalar” is perfectly absorbed, supplying the body with the daily requirement of necessary substances. Shilajit contains about 30 important elements that improve blood composition. The drug is prescribed from the age of 12, for pregnant and breastfeeding women - only after consultation with a doctor. “Mountain calcium D3” is maximally bioavailable, strengthens bones, teeth, hair and nails, is suitable for the prevention of osteoporosis, and is inexpensive. Among the disadvantages are the unpleasant taste and the large size of the tablets.

Mountain calcium D3

Evalar, Russia

The combination of tablets Mountain calcium D3 calcium, vitamin D3 and Altai mumiyo in 1 tablet 100% replenishes calcium deficiency in the body.
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Benefits of calcium for the body

Strong bones, nails and teeth, elastic skin, healthy hair - all this is the result of calcium in the human body[1]. In addition, the mineral is involved in the regulation of heart rate, in the processes of transmitting impulses along nerve fibers, excitation and contraction of muscle cells. Without calcium, various biochemical reactions at the cellular level, the effective functioning of the immune system and the proper functioning of the hemostatic system are impossible [2,3].

Important! The daily intake of calcium depends on the person’s age and state of health[4]. An adult 18–59 years old is recommended to take 1000 mg of the mineral every day, after 60 years - 1200 mg. Children up to three months require 400 mg of calcium per day, babies up to six months - 500 mg, and up to one year - 600 mg. The standards gradually increase: at one to three years of age, a child needs 800 mg of the mineral, in the next four years - 900 mg, at 7-11 years - 1100 mg, and then, until adulthood, about 1200 mg of calcium should be consumed daily.

How does calcium deficiency manifest itself in the body?

A decrease in calcium in the blood can go unnoticed for a long time. But over time, a person suffering from hypocalcemia begins to notice a decrease in working capacity, rapid fatigue, constant lethargy and weakness [5]. If you do not immediately respond to these symptoms, the calcium level in the body will likely continue to decline. In this case, the consequences may be more serious.

A lack of calcium can affect the functioning of the heart, muscles, nerves, skin, bones, teeth, and so on. Lack of calcium leads to disruption of the process of neuromuscular excitability of skeletal muscles, smooth muscles of internal organs, as well as dysfunction of cells that regulate the rhythm of heart contractions. The latter manifests itself in the form of arrhythmias of various types. Since calcium is involved in the formation of blood clots and stopping bleeding, its deficiency can disrupt the blood coagulation cascade[6].

A significant lack of the mineral over a long period leads to bone destruction: the mineral density of bone tissue decreases, which increases the likelihood of developing calcium deficiency diseases (osteoporosis, spondylosis, osteochondrosis, osteoarthritis) [7,8].

Calcium deficiency also affects the appearance: the skin becomes less elastic, dermatological problems may occur: dryness, peeling, and a tendency to inflammatory rashes. With a lack of calcium, teeth are more susceptible to caries. Since the health of nails and hair directly depends on the balance of the mineral, if it is deficient, hair becomes dull and split, and nails become brittle[9,10].

Why are vitamins with calcium prescribed?

Preventive intake of calcium-containing vitamin complexes can benefit any person, of course, with the exception of people whose levels of the mineral have crossed the upper limit of normal. For those who eat an unbalanced diet, and for adherents of certain diets (for example, if the diet does not include dairy and other foods rich in the element), taking calcium in tablet form will be an excellent measure to maintain overall health.

An additional source of calcium - in the form of dietary supplements or medications - is especially important for pregnant and breastfeeding women. In the first case, calcium is necessary for the intrauterine development of the fetus, and in the second, for the mineralization of the skeleton and the growth of the child [11]. Women during menopause need calcium no less. A profound restructuring of the body's hormonal regulation leads to demineralization of bone tissue, which increases the risk of osteopenia and osteoporosis. Therefore, the above groups are strongly recommended to take preventive courses of calcium supplements.

At the first signs of calcium deficiency, you should consult a doctor and undergo appropriate tests. If the diagnosis is confirmed, the doctor will probably prescribe vitamins containing calcium.

Important! The effect of calcium on the body is closely related to another important nutrient - vitamin D. In tandem with calciferol, the mineral more effectively penetrates bone tissue, promoting its mineralization and the building of a healthy and strong bone structure. According to the clinical recommendations of the Ministry of Health of the Russian Federation, vitamin D is used to increase the absorption of calcium[12].

Complivit Calcium D3 Forte

Calcium preparation in the form of chewable tablets (1 tablet contains 500 mg of calcium, 400 mg of vitamin D3). After a course of taking this drug, there is a thickening of bone tissue, mineralization of bones and teeth, and a stop in the process of leaching calcium from the body. Contraindications to the use of Complivit calcium D3 forte include pregnancy and breastfeeding. These calcium tablets with a high concentration of substances strengthen the immune system, stimulate the metabolism of calcium and phosphorus, serve as an excellent prevention of osteoporosis, have a pleasant taste, and are inexpensive. Among the disadvantages is the possible development of an allergic reaction.

Complivit Calcium D3

JSC Pharmstandard-UfaVITA, Russia

Regulates the exchange of calcium and phosphates, reduces resorption and increases bone density, compensates for the lack of calcium and vitamin D3 in the body, enhances the absorption of calcium in the intestines and the reabsorption of phosphates in the kidneys, promotes bone mineralization.
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A differentiated approach to the selection of second-generation soluble calcium preparations

Insufficient supply of the body with calcium ions is a risk factor for a number of chronic pathologies, including disorders of bone metabolism, muscle functioning, endothelium, immune and cardiovascular systems. According to the World Health Organization, calcium content in drinking water is one of the fundamental factors determining human health at the population level [1].

However, drinking water in the vast majority of geographic regions contains an amount of calcium that is obviously insufficient to compensate for the body's daily needs (1000 mg/day for adults). In addition, drinking water available to most people undergoes multiple purification cycles to remove organic impurities and toxic “heavy” metals - lead, mercury, cadmium. During cleaning, the already low calcium content is significantly reduced. For this reason, there is a need to saturate drinking water with macro- and microelements necessary for health, primarily calcium, using special preparations.

From a pharmacological point of view, the intake of calcium into the body in the form of an aqueous solution has a number of significant advantages. First, the calcium is already in a dissolved state (unlike, say, insoluble calcium carbonate tablets). Secondly, in the aqueous solution there are no ligands that interfere with the absorption of calcium (for example, food products contain a significant amount of phytic acid, which converts calcium ions into an insoluble and poorly digestible form). Thirdly, the supply of water with calcium ions in the drug solution helps solve the problem of insufficient fluid intake (an adult should drink at least 2–2.5 l/day of clean drinking water). Fourthly, an aqueous solution of calcium can be enriched with special synergistic micronutrients that improve the pharmacokinetics and pharmacodynamics of calcium.

This paper discusses the features of calcium preparations that must be taken into account when prescribing them so that their use is as effective and safe as possible. The results of studies of the calcium supply of various populations, the pharmacology of various calcium preparations and the intended purpose of soluble organic calcium preparations are consistently reviewed. Data from clinical and epidemiological studies and evidence-based medicine are presented.

Calcium supply in different populations

The recommended daily intake (RDI) of calcium in the Russian Federation is on average 1000 mg/day for adults, for people over 60 years old - 1200 mg/day. The physiological need for children is from 400 to 1200 mg/day [2]. RSPs in other countries lie in comparable ranges of values ​​(Table, Fig. 1).

Clinical and epidemiological studies conducted in different countries show that the average daily calcium intake among various segments of the population is 500–1000 mg/day and rarely exceeds the RDI.

Thus, available clinical and epidemiological data indicate that calcium intake is insufficient. Normalization of calcium intake can be carried out both by changing the composition of the consumed diet and by using special calcium supplements.

Clinical pharmacology of calcium preparations based on inorganic and organic salts

Compensation for calcium deficiency can be carried out both by changing the composition of the consumed diet and by using special calcium supplements.

A significant problem for carrying out the most effective and safe compensation for dietary calcium deficiency is the choice of pharmacological substance (calcium salt) and pharmaceutical form of calcium (tablets, dragees, drinking solution). This section provides prolegomena for a differentiated approach to the selection of safe and effective calcium preparations.

The absorption of calcium from drugs depends on factors such as 1) the calcium substance, 2) the dose of calcium, 3) the mode of administration, 4) the pH of the gastric juice and, of course, 5) combined use with other drugs. According to the substance, there are inorganic (1st generation) and organic (2nd generation) calcium preparations. The vast majority of 1st generation calcium preparations are calcium carbonate, which is insoluble in water and requires a certain pH range for absorption. Organic calcium preparations (2nd generation) are better soluble in water, significantly less dependent on the pH of gastric juice, and are characterized by higher bioavailability than tablet forms [4].

Inorganic calcium salts

Calcium carbonate

Calcium carbonate is the most common one of the cheapest forms of calcium, which is widely used in medicine as an antacid [5]. Antacids act on the surface of the gastric mucosa, neutralizing hydrochloric acid in gastric juice (HCl). When hydrochloric acid is neutralized, the calcium carbonate portion of the antacid dissolves according to the equation:

CaCO3 + 2HCl → CaCl2 + CO2↑+H2O

The resulting calcium chloride is absorbed by the epithelial cells of the stomach and enters the blood. Most of the calcium carbonate remains undissolved and moves through intestinal transit into the large intestine. Therefore, the absorption of calcium carbonate largely depends on the acidity of the stomach (better absorption is observed at lower pH [6]) - after all, calcium carbonate is insoluble in water and its absorption in the body occurs exclusively through interaction with HCl of gastric juice. Significant absorption of calcium from calcium carbonate should only be expected in patients with hyperacidity of the stomach.

Organic calcium salts

Calcium lactate

Calcium lactate is a characteristic component of mature cheeses. Calcium lactate can be absorbed at different pH levels, and this form of calcium can be taken without regard to meals. Calcium lactate successfully neutralizes the insufficient effects of estrogen-containing drugs on bone mineral density [7]. However, taking calcium lactate preparations alone cannot ensure complete satisfaction of calcium needs.

Calcium gluconate

Calcium gluconate is used as a topical agent or in the form of an injection solution [8, 9]. With a certain method of treatment, calcium gluconate is able to physiologically stimulate the release of the active form of the calcitonin molecule from parafollicular C-cells [10], and is characterized by a clear positive effect on renal function, exhibiting vasodilatory and natriuretic properties [11]. Calcium gluconate is also an effective and safe oral form of calcium for increasing bone mass density in preterm infants [12].

Calcium citrate

Calcium citrate is an exceptionally effective and safe form of calcium. First, calcium citrate is completely soluble in water. Secondly, calcium from citrate is absorbed regardless of food intake or the acidity of gastric juice. The chemical properties of calcium citrate make it the drug of first choice in patients with low gastric acidity, as well as in elderly patients and patients using antacids and proton pump inhibitors. Thirdly, the citrate anion itself has its own physiological significance, being the main substrate of the central energy cycle of each cell - the Krebs cycle. Fourth, the citrate anion helps reduce the risk of kidney stones and, moreover, promotes the dissolution of kidney stones [13].

The results of a comparison of the solubility of several calcium preparations of the 1st and 2nd generations in a wide pH range (from 1 to 7) showed that tablets of 1st generation preparations based on calcium carbonate disintegrate within 7–9 minutes and do not completely dissolve even at low pH values ​​(i.e. high acidity) [14]. On the contrary, the 2nd generation preparation studied (calcium carbonate mixed with citric acid and calcium lactogluconate) completely dissolves within 2–3 minutes, forming a clear solution of calcium citrate that does not contain sediment. The time for complete dissolution of the 2nd generation drug also increased slightly with increasing pH (i.e., a decrease in acidity), although not as pronounced (pH = 1.39 - 2 min 10 s, pH = 7.04 - 3 min, i.e. e. less than 1 minute, p < 0.002 (Fig. 2).

As noted above, an important factor in the absorption of calcium carbonate-based drugs is the acidity of gastric juice. The composition of gastric juice includes hydrochloric acid (providing a low pH value), gastric juice enzymes pepsin, gastrixin, mucus, minerals (potassium, ammonium and sodium chlorides, sulfates, phosphates), etc. A significant difference between 1st generation drugs based on calcium carbonate is that they almost completely (up to pH values ​​= 7) neutralize hydrochloric acid when simulating the pH of gastric juice. At the same time, a preparation based on calcium citrate forms a slightly acidic solution with a very stable pH value = 4.52 ± 0.15 at any initial pH (i.e., it can be absorbed both at high, normal and low acidity of the stomach). The 2nd generation drug based on calcium citrate formed a slightly acidic solution with pH values ​​lying in a very narrow range - pH = 4.52 ± 0.15 (Fig. 3) [14].

Calculations have shown that even at pH < 2.0, no more than 50% of calcium carbonate from tablets of 1st generation drugs passes into the solution, and the solubility of the tablet drops sharply with increasing pH (i.e. with a decrease in the acidity of gastric juice). From the 2nd generation drug, all 100% of calcium goes into solution, which contributes to a significant increase in the absorption of calcium in the body (Fig. 4) [14].

On the intended purpose of soluble organic calcium preparations

Available basic research and evidence-based medicine have shown a number of distinct benefits from the use of calcium lactate, gluconate and calcium citrate. The introduction of drugs based on the above organic salts corresponds to the basic principle of clinical pharmacology - maximum efficiency and maximum safety. This principle corresponds to the soluble calcium preparation based on organic salts Calcium Sandoz® Forte and dietary supplements (BAA) Calcium D3 Sandoz® Osteo and Calcium Sandoz® Beauty. They are available in the form of tablets (500 or 1000 mg of elemental calcium and 600 mg for Calcium D3 Sandoz® Osteo) for the preparation of an aqueous solution, which the patient receives. Taking these medications will also, in part, help compensate for insufficient drinking water consumption (Fig. 5).

Calcium Sandoz® Forte contains three calcium salts (calcium lactate, calcium gluconate and calcium carbonate). 1 tablet with 500 mg of calcium contains an equimolar mixture of calcium lactate and calcium gluconate in the amount of 1132 mg, calcium carbonate 875 mg (total 500 mg of elemental calcium) and 1662 mg of citric acid. It should be emphasized that the tablets of the drug are used to prepare a drinking solution, which the patient consumes. During the preparation of an aqueous solution, a chemical interaction of calcium carbonate with citric acid occurs with the formation of calcium citrate and the volatilization of the resulting carbon dioxide from the solution:

3CaCO3 + 2C6H8O7 → Ca3(C6H5O7)2 + 3CO2↑+ 3H2O

When a tablet of the drug is dissolved in water, the resulting solution contains calcium cations surrounded by anions of organic acids (lactate, gluconate and citrate), which stabilize calcium ions in the solution and ensure good bioavailability of the ionized form of calcium. For this reason, Calcium Sandoz® Forte is the drug of choice for the prevention of calcium deficiency.

Calcium D3 Sandoz® Osteo contains 600 mg/tablet. elemental calcium in the form of citrate, lactate and gluconate, 400 IU/table. vitamin D and is intended to reduce the risk of osteoporosis, including increasing bone mineral density and reducing the risk of fractures associated with calcium deficiency; to maintain normal levels of calcium and vitamin D in order to reduce the risk of developing osteoporosis in the pre- and postmenopausal period. As is known, risk factors for the development of osteoporosis and osteoporotic fractures are gender (female), age (over 65 years), body mass index less than or equal to 20 kg/m2, estrogen deficiency, sedentary lifestyle and diet deficient in calcium and vitamin D [15 ].

The synergy of the properties of the components of Calcium D3 Sandoz® Osteo, which offers both the consumption of highly digestible organic calcium salts and vitamin D, allows it to be taken to compensate for calcium deficiency and conditions associated with a deficiency of this element: to increase bone mineral density and reduce the risk of fractures, for reducing the risk of developing osteoporosis in the pre- and postmenopausal period.

Calcium citrate (1200 mg/day) in combination with vitamin D (800 mg/day) reduces the risk of fractures [16]. The meta-analysis included 17 placebo-controlled studies (n = 52,625) and showed that the combination of calcium salts with vitamin D reduced the risk of all types of fractures by 13% [17]. A comparative meta-analysis of 15 clinical studies that compared the bioavailability of calcium carbonate and calcium citrate included a total of 184 patients and showed better bioavailability of calcium citrate. According to the results of the meta-analysis, calcium absorption from calcium citrate was significantly higher than from calcium carbonate: by 20% on average in the sample, by 24% in category “A”, by 27% when taken on an empty stomach and by 22% when taken on an empty stomach. taken with meals [18].

Citrate anion itself helps normalize bone metabolism. A randomized study of elderly patients without osteoporosis (n = 201, 65 years and older) showed that long-term intake of potassium citrate (4.5 g/day for 2 years) increased bone mineral density (average 1.7 ± 1. 5%, 95% confidence interval (CI) 1.0–2.3, p < 0.001), and this effect apparently relates specifically to the effect of the citrate anion [19].

Among other things, calcium citrate in combination with vitamin D has a beneficial effect on the safety of teeth. In a study of a group of 145 older adults aged 65 years and older, patients were randomized to receive either calcium citrate 500 mg/day or 1000 mg/day (calculated as elemental calcium) and vitamin D (700 IU/day) within 2-year osteoporosis prevention program. Among patients receiving calcium 500 mg/day, 40 of 68 participants (59%) experienced at least one tooth loss over the 2-year follow-up period. At the same time, only 33 of 77 patients (40%) receiving calcium at a dose of 1000 mg/day. tooth loss was noted. Thus, taking calcium citrate in combination with vitamin D reduced the risk of tooth loss by 50% (OR 0.5, 95% CI 0.2–0.9) [20].

Conclusion

Correcting calcium deficiency is of vital importance to maintaining health. Replenishing dietary calcium deficiency to prevent metabolic disorders of bone tissue, skin, and hair can be done using various calcium salts. The significant difference between inorganic salts (calcium carbonate, calcium phosphate) and organic calcium salts (citrate, lactate, calcium gluconate) is their solubility and therefore the bioavailability of calcium.

Due to its low cost and relative effectiveness, calcium carbonate antacid has long been used not only for its intended purpose, but also to compensate for calcium deficiency. At the same time, the absorption of calcium from carbonate significantly depends on the state of the gastrointestinal tract and, above all, on the acidity of the stomach (since calcium carbonate is practically insoluble in water).

Calcium carbonate is contraindicated in patients with low stomach acidity, with polyps of the stomach and intestines. Taking calcium carbonate is obviously undesirable while taking estrogen-containing drugs. Data from pharmacology, experimental and clinical medicine indicate the effectiveness and safety of using organic calcium salts such as lactate, gluconate and citrate to correct calcium deficiency (Fig. 6). Among organic salts, calcium citrate is characterized by the highest solubility (the solubility line is as follows: calcium citrate > calcium lactate > calcium gluconate).

Soluble calcium preparations based on organic salts, produced, in particular, in the form of effervescent tablets, are completely soluble in water and therefore are much better absorbed than insoluble calcium carbonate or phosphate. Calcium Sandoz® Forte (1000 mg/table. elemental calcium in the form of organic salts) can be used for the prevention and treatment of calcium deficiency in a wide range of patients, including pregnant women, women during lactation and children after three years of age. Dietary supplement Calcium D3 Sandoz® Osteo (organic calcium salts in combination with vitamin D) is intended to reduce the risk of osteoporosis, including increasing bone mineral density and reducing the risk of fractures associated with calcium deficiency; to maintain normal levels of calcium and vitamin D in order to reduce the risk of developing osteoporosis in the pre- and postmenopausal period. Thus, in modern pharmacology there has been a transition to the most natural compensation of calcium deficiency in the form of the use of aqueous solutions of completely soluble and quickly digestible calcium citrate.

Literature

1. World Health Organization. Calcium and Magnesiumindrinkingwater, 2009, p. 194.
2. Norms of physiological needs for energy and nutrients for various groups of the population of the Russian Federation, MR 2.3.1.2432–08.
3. Maltsev S.V., Arkhipova N.N., Shakirova E.M. Vitamin D, calcium and phosphates in healthy children and in pathology. Kazan, 2012, 45 p.
4. Gromova O. A., Volkov A. Yu., Torshin I. Yu., Gromov A. N., Nosikov V. V., Gogoleva I. V. Comparative analysis of the solubility of various calcium preparations depending on the acidity of the medium // Doctor. 2013, 7, p. 18–24.
5. Richard W. Lime Kilns and Lime Burning. 2004. P. 4. ISBN 978–0-7478–0596–0.
6. Lieberman H. A., Leon Lachman, Joseph B. Schwartz (1990). Pharmaceutical Dosage Forms: Tablets. New York: Dekker. P. 153. ISBN 0–8247–8044–2
7. Mizunuma H., Okano H., Soda M., Tokizawa S., Kagami I., Miyamoto S., Honjo S., Ibuki Y. Calcium supplements increase bone mineral density in women with low serum calcium levels during long-term estrogen therapy // Endocr J. 1996; 43 (4): 411–415.
8. Yoshimura CA, Mathieu L., Hall AH, Monteiro MG, de Almeida DM Seventy per cent hydrofluoric acid burns: delayed decontamination with hexafluorine ® and treatment with calcium gluconate // J Burn Care Res. 2011; 32(4):e149–54 doi.
9. Capitani EM, Hirano ES, ZuimIde S., Bertanha L., Vieira RJ, Madureira PR, Bucaretchi F. Fingerburnscausedbyconcentratedhydrofluoricacid, treatedwithintra-arterialcalciumgluconateinfusion: casereport // Sao Paulo Med J. 2009; 127(6):379–381.
10. Giovanella L. Serum procalcitonin and calcitonin normal values ​​before and after calcium gluconate infusion // Exp Clin Endocrinol Diabetes. 2012; 120 (3): 169–70 doi.
11. Ruilope LM, Oliet A., Alcazar JM, Hernandez E., Andres A., Rodicio JL, Garcia-Robles R., Martinez J., Lahera V., Romero JC Characterization of the renal effects of an intravenous calcium gluconate infusion in normotensive volunteers // J Hypertens Suppl. 1989; 7(6):S170-S171.
12. Horsman A., Ryan SW, Congdon PJ, Truscott JG, Simpson M. Bone mineral accretion rate and calcium intake in preterm infants // Arch Dis Child. 1989; 64 (7) Spec: 910–918.
13. Torshin I. Yu., Gromova O. A. 25 moments of molecular pharmacology. A-griff, 2012. 695 p.
14. Gromova O., Volkov A., Torshin I., Gromov A., Nosikov V., Gogoleva I. Comparative analysis of the solubility of various calcium preparations depending on the acidity of the medium // Doctor. 2013. No. 7. pp. 18–24.
15. Toroptsova N.V., Benevolenskaya L.I. Osteoporosis: modern approaches in the prevention of osteoporosis and fractures // Breast Cancer. 2003, No. 7, p. 398
16. Quesada Gomez JM, Blanch Rubio J., Diaz Curiel M., Diez Perez A. Calcium citrate and vitamin D in the treatment of osteoporosis // Clin Drug Investig. 2011; 31 (5): 285–98 doi.
17. Tang BM, Eslick GD, Nowson C., Smith C., Bensoussan A. Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis // Lancet. 2007, Aug 25; 370(9588):657–666.
18. Sakhaee K., Bhuket T., Adams-Huet B., Rao DS Meta-analysis of calcium bioavailability: a comparison of calcium citrate with calcium carbonate // Am J Ther. 1999; 6 (6): 313–321.
19. Jehle S., Hulter HN, Krapf R. Effect of potassium citrate on bone density, microarchitecture, and fracture risk in healthy older adults without osteoporosis: a randomized controlled trial // J ClinEndocrinolMetab. 2013; 98(1):207–217.
20. Krall EA, Wehler C., Garcia RI, Harris SS, Dawson-Hughes B. Calcium and vitamin D supplements reduce tooth loss in the elderly // Am J Med. 2001; 111(6):452–456.
21. Limanova O. A., Torshin I. Yu., Sardaryan I. S., Kalacheva A. G., Hababpashev A., Karpuchin D., Kudrin A., Yudina N. V., Egorova E. Yu., Grishina T R., Gromov A.N., Fedotova L.E., Rudakov K.V., Gromova O.A. Micronutrient provision and women’s health: establishing relationships based on intellectual analysis of clinical and epidemiological data // Issues of gynecology, obstetrics and perinatology. 2014, vol. 13, no. 2, p. 5–15.

O. A. Gromova*, 1, Doctor of Medical Sciences, Professor I. Yu. Torshin**, Candidate of Chemical Sciences A. V. Pronin* E. Yu. Egorova*, Candidate of Medical Sciences A. Yu. Volkov***

* State Budgetary Educational Institution of Higher Professional Education IvSMA Ministry of Health of the Russian Federation, Ivanovo ** RSC International Institute of Trace Elements UNESCO, Moscow *** State Budgetary Educational Institution of Higher Professional Education Russian National Research Medical University named after. N. I. Pirogova Ministry of Health of the Russian Federation, Moscow

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Calcium gluconate

A cheap calcium supplement that is not as effective as the above remedies. Nevertheless, calcium gluconate is as safe as possible and is well absorbed by the body. This drug has a wide range of applications: it is prescribed for inflammation and allergies, it is approved for children, and is used to prevent osteoporosis.

Calcium gluconate

CJSC "Moscow Pharmaceutical Factory", Russia

The calcium supplement replenishes the deficiency of calcium ions necessary for the transmission of nerve impulses, contraction of skeletal and smooth muscles, myocardial activity, bone tissue formation, and blood clotting.
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Calcium content in foods

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Causes and consequences of calcium imbalance

The following factors may be the reason for the deficiency of this element:

• incorrect nutrition (diet, fasting, monotony);
• bad habits (smoking, alcohol, caffeine in large quantities, physical inactivity);
• disruption of the gastrointestinal tract;
• some diseases of the kidneys, liver, thyroid gland;
• excess of microelements such as iron, phosphorus, magnesium, potassium, sodium;
• adolescence, postmenopause;
• pregnancy and lactation period;
• increased physical activity.

A lack of calcium leads to obvious disorders and disruptions in the body, among which are:

• muscle weakness, causeless fatigue, irritability;
• spasms, muscle pain;
• diseases of bone tissue;
• rickets;
• bleeding;
• fragility of tooth enamel, bleeding gums;
• fragility, hair loss, etc.

Foods High in Calcium

You can compensate for the lack of calcium in the body through a properly balanced diet. To strengthen bones, teeth, hair and nails, include the following foods in your diet:

• almond;
• cheese;
• yogurt;
• milk
• tofu;
• greenery;
• soy;
• sardines;
• broccoli;
• bananas;
• salmon;
• pumpkin seeds;
• beans;
• lentils;
• figs;
• tuna;
• olive oil.

But remember that the body absorbs calcium only in combination with vitamin D and ascorbic acid, so do not forget about foods such as butter, egg yolk, fatty fish, and vegetables.

The presence of magnesium and phosphorus is also important for the absorption of calcium, and this is wholemeal bread, bran, nuts and the same fish. If this balance is not maintained, calcium from foods will simply be deposited in the form of stones in the kidneys or joints.

By the way, diuretics flush calcium from the body, so reduce the amount of drinks containing caffeine and alcohol.

Which calcium is better absorbed in the body?

Almost every person in his life has encountered the concept of calcium deficiency.
And he understands that the condition of bones, teeth, and hair often deteriorates for this reason. It has actually become the norm when a doctor recommends taking a course of calcium supplements to pregnant and lactating women, patients with fractures, older people, and teenagers.

Why has this phenomenon become widespread? And what forms of this element exist, how effective are they? Which calcium is better absorbed? It is important to answer these questions so as not to get confused in the variety of options offered and to be confident in your choice and in its real benefits.