A significant number of studies have been conducted to analyze calcium deficiency and its causes across different populations. A survey was conducted in 2018 on an average group of individuals that revealed that a considerable portion of the population does not meet the daily calcium intake requirements, leading to a calcium deficiency. This study involved around 38,000 participants from diverse backgrounds, highlighting the widespread nature of calcium insufficiency.
Dietary calcium deficiency is common worldwide, and studies show that about half of the global population does not get enough calcium from their diet. Calcium is crucial for healthy bones and many other body functions. Not getting enough calcium can lead to health issues such as pregnancy complications, cancers, and heart disease.
Calcium intake recommendations vary according to the severity of the deficiency and are customized based on other dietary factors, health-related behaviors, or the risk of calcium-related health outcomes. However, the standard methods to assess the calcium status of an individual or population are still lacking, which has challenged efforts to estimate the prevalence of calcium deficiency and the global burden of related adverse health consequences.
What is Calcium?
Calcium (Ca+2) is a divalent cation that plays a critical role in numerous body functions such as skeletal mineralization, signal transduction, nerve conduction, muscle contraction, and blood coagulation. It is the most abundant mineral in the body and the majority of it is stored in the bones and teeth and helps in supporting the structure and hardness. The rest of the calcium is found in the blood, muscles, and intercellular fluids, where it plays critical roles in various bodily functions.
Also, Ca+2 metabolism is linked to magnesium (Mg+2) and phosphate metabolism. Ca+2 homeostasis is dependent on intestinal absorption, bone turnover, and renal reabsorption. Disorders of Ca+2 metabolism are easily recognized because Ca+2 is included in routine chemistry panels. Measurement of ionized Ca+2 is the preferred way to ascertain the diagnosis of hypocalcemia and hypercalcemia.
Mechanism of Action of Calcium
Calcium (Ca²) is a vital mineral that plays numerous roles in the body such as neurotransmission (a process of communication between neurons in the brain). Ca²⁺ is the active or ionized form of calcium in the body, which participates in various cellular processes. This Ca²⁺ is crucial for neurotransmitter production, this process involves the conversion of electrical signals into chemical signals at the synapse.
In the presynaptic neuron, an action potential arriving at the axon terminal triggers the opening of voltage-gated calcium channels. The influx of Ca²⁺ ions into the neuron is considered a pivotal step in the neurotransmission process. The elevated intracellular calcium concentration facilitates the fusion of synaptic vesicles, which contain neurotransmitters along with the presynaptic membrane. This fusion involves a complex set of proteins such as synaptotagmin, which acts as a calcium sensor. When synaptotagmin binds to Ca²⁺, it undergoes a structural change that facilitates vesicle fusion, leading to the release of neurotransmitters into the synaptic cleft.
After the release, these neurotransmitters traverse the synaptic cleft, bind to receptors on the postsynaptic neuron, and propagate the signal. This process is dependent on calcium which indicates the essential role of Ca²⁺ in neurotransmission. Proper neurotransmitter release and function are crucial for regulating mood and cognitive functions. Dysregulation of calcium homeostasis can lead to impaired neurotransmission and can cause various other neurological and psychiatric conditions, including depression and anxiety.
Natural Sources of Calcium
Calcium is crucial for many important functions. Consuming natural sources of calcium is important because they provide additional nutrients that enhance calcium absorption and overall health.
Adequate calcium intake is essential for preventing osteoporosis and other bone-related diseases, making it crucial to include calcium-rich foods in the diet. Many food items can naturally increase blood calcium levels, even if individuals have lactose intolerance or eat a vegan diet. It is important to include the following calcium sources to meet the daily calcium requirements.
Here are some of the natural sources of calcium:
- Dairy Products- Dairy products are a very good source of calcium. Such as milk, cheese, and yogurt. They also provide vitamin D, which also helps in calcium absorption.
- Leafy Green Vegetables- These vegetables offer a variety of vitamins and nutrients that help in maintaining overall health. For example: spinach, kale, and broccoli.
- Nuts and Seeds- Almonds and chia seeds are high in calcium. They are also packed with healthy fats, protein, and fiber.
- Fish- Sardines and salmon with bones contain significant amounts of calcium. These fish are also good sources of omega-3 fatty acids, promoting heart health.
- Legumes- Beans and lentils are excellent sources of calcium. They also provide protein, fiber, and other essential nutrients.
- Fortified Foods- Certain plant-based milks, juices, and cereals are fortified with calcium. These options are beneficial for those who are lactose intolerant or follow a vegan diet.
- Fruits- Oranges and figs contain moderate amounts of calcium. These fruits are also rich in vitamins, antioxidants, and fiber.
- Tofu- Tofu made with calcium sulfate is a great source of calcium. It is also a versatile protein source for vegetarians and vegans.
What is Calcium Deficiency
Calcium deficiency is a global public health problem. Calcium is important for maintaining bone health, muscle function, and nerve transmission. Apart from these, low calcium intake can have many other detrimental effects on different body systems, including the risk of osteoporosis. However, many people do not get enough calcium through diet alone and sometimes have difficulty absorbing it, leading to various health problems.
Calcium deficiency often develops over time due to inadequate dietary intake or absorption issues. Populations in low and middle-income countries (LMICs) are at the greatest risk of low calcium intake, although many individuals in high-income countries (HICs) also do not meet recommendations.
Generally, bones absorb calcium from the bloodstream. But when calcium is insufficient it results in bone damage. Healthy people typically have blood levels of calcium between 8.8 and 10.4 milligrams/deciliter.²
Calcium Deficiency and Depression?
An analysis was done on a group of individuals and it was concluded that calcium deficiency may have a significant impact on mental health and potentially contribute to the development of depression.
Studies indicate that calcium ions help in the production of neurotransmitters, such as serotonin and dopamine, which play crucial roles in mood regulation and any disruption in their signaling can lead to mood disorders, including depression. A calcium deficiency may impair the release and function of these neurotransmitters leading to various mood imbalances.
In addition to this, calcium deficiency also affects the hypothalamic-pituitary-adrenal (HPA) axis, which is important for stress response and mood regulation. Dysregulation of the HPA axis has been associated with the symptoms of depression and anxiety. Decreased levels of calcium lead to increased stress hormone (cortisol) production, which can exacerbate symptoms of depression and anxiety.
What Causes Calcium Deficiency
Calcium is one of the most important and common minerals in the body. It was found that most of the calcium is stored in the bones, but blood also requires calcium for various functions. When there is not enough calcium in the diet, the body takes calcium from the bones to use in the blood. This can result in weakened bones and increase the risk of fracture. This condition can be referred to as hypocalcemia when the blood does not have enough levels of calcium.
Addressing various causes through dietary adjustments, supplementation, and medical management can help in preventing and treating calcium deficiency. It is important for maintaining overall health and well-being.
Recommended Intake of Calcium Daily
The recommended daily intake (RDI) of calcium varies by age, gender, and life stage but generally increases with age:
- Infants (0-6 months): 200 mg
- Infants (7-12 months): 260 mg
- Children (1-3 years): 700 mg
- Children (4-8 years): 1,000 mg
- Children (9-18 years): 1,300 mg
- Adults (19-50 years): 1,000 mg
- Men (51-70 years): 1,000 mg
- Women (51-70 years): 1,200 mg
- Adults (71+ years): 1,200 mg
- Pregnant and Breastfeeding Women (14-18 years): 1,300 mg
- Pregnant and Breastfeeding Women (19-50 years): 1,000 mg
Some of the causes of calcium deficiency are mentioned below:
- Inadequate Dietary Intake- Consuming insufficient amounts of calcium-rich foods like dairy products, leafy greens, and fortified foods can lead to deficiency, especially in populations with limited access to these foods or dietary restrictions.
- Vitamin D Deficiency- Vitamin D is vital for calcium absorption in the intestines. Lack of adequate sun exposure, poor diet, or certain medical conditions can lead to vitamin D deficiency, which in turn causes calcium deficiency.
- Gastrointestinal Disorders- Conditions such as Crohn’s disease, celiac disease, and other malabsorption syndromes can impair the body’s ability to absorb calcium from the diet, leading to deficiency.
- Hormonal Imbalances- Disorders of the parathyroid glands, which regulate calcium levels in the blood, can result in imbalanced calcium levels. Hypoparathyroidism, for example, leads to low calcium levels due to insufficient production of parathyroid hormone.
- Renal Disorders- Chronic kidney disease can disrupt calcium metabolism and phosphate balance, reducing calcium levels in the blood. Kidneys play a crucial role in converting vitamin D to its active form, necessary for calcium absorption.
- Medications- Long-term use of certain medications, such as corticosteroids and some anticonvulsants, can interfere with calcium absorption or increase calcium excretion, leading to deficiency.
- Aging- As people age, their ability to absorb calcium decreases, and their dietary intake often diminishes, increasing the risk of deficiency, especially in postmenopausal women due to lower estrogen levels.
- Lactose Intolerance- Individuals with lactose intolerance often avoid dairy products, which are rich in calcium, thus putting them at higher risk for calcium deficiency if they do not find alternative sources.
Alcohol and Calcium Deficiency
Excessive alcohol consumption can have many adverse effects on human health. Alcohol consumption disrupts the calcium metabolism cycle. Studies show that alcohol interferes with the absorption of calcium in the intestines.
Recently a study was published in the Journal of Nutrition that chronic alcohol intake impairs the body’s ability to absorb and utilize calcium, which results in lower serum calcium levels. Due to this bone health also gets affected, such as decreased bone density and an increased risk of osteoporosis.
In another study in the Journal of Bone and Mineral Research, it was published that individuals with chronic alcohol use disorder were found to have significantly lower bone mineral density compared to non-drinkers, underscoring the long-term risks associated with alcohol consumption on skeletal health.
Studies show that vitamin D is essential for calcium absorption in the gut, but alcohol consumption can impair the liver’s ability to convert vitamin D into its active form. It leads to lower levels of activated vitamin D and thereby reduces the calcium absorption efficiency.
How to Test for Calcium Deficiency?
It is important to test for calcium deficiency because an undetected deficiency in the long term can cause serious health issues such as osteoporosis and increased fracture risk. Testing for calcium deficiency is essential for proper diagnosis and treatment.
The calcium blood tests are checked to ensure the body has appropriate levels of calcium in the blood to be healthy. Sometimes certain conditions affect the amount of calcium in the blood, in these cases routine calcium blood tests can make sure that the treatment is working.
Healthcare providers use various methods to assess calcium levels in the body and help in identifying deficiencies early for the appropriate treatment.
Various testing strategies for calcium deficiency are mentioned below:
- Blood Test (Serum Calcium Test)- A blood test is the most common method to measure the calcium levels in the body. This test measures the calcium attached to certain proteins in the blood and “free” or unattached calcium.
- Ionized Calcium Test- This test is considered to provide more accurate calcium status in blood because it also measures the level of free and biologically active calcium in the blood.
- 24-Hour Urine Test- A 24-hour urine test measures the amount of calcium excreted in the urine over 24 hours this helps in the evaluation of calcium absorption and excretion.
- Bone Density Scan (DEXA Scan)- This is a type of imaging test, which measures bone mineral density and helps in detecting the early signs of bone loss, which can be a result of calcium deficiency.
- Parathyroid Hormone (PTH) Test- Parathyroid hormone regulates the calcium levels in the blood by affecting bone resorption, kidney reabsorption, and intestinal absorption. Therefore, elevated PTH levels result in calcium deficiency.
- Vitamin D Test- Studies show that vitamin D plays an essential role in calcium absorption, therefore measuring vitamin D levels can help in diagnosing the underlying causes of calcium deficiency.
- Magnesium Levels Test- Magnesium is crucial for calcium metabolism, and low magnesium levels can affect calcium status. Testing magnesium levels can help in analyzing the calcium status in the body.
Symptoms of Calcium Deficiency
- Muscle cramps and spasms
- Numbness or tingling in fingers and toes
- Weak and brittle nails
- Dental issues, such as tooth decay
- Osteoporosis or brittle bones
- Fatigue and weakness
Psychiatric Symptoms of Calcium Deficiency
- Anxiety and irritability
- Depression
- Cognitive impairment or memory issues
- Insomnia or sleep disturbances
- Mood swings
- Confusion or disorientation
Psychiatric Illness exacerbated by Calcium Deficiency
- Generalized Anxiety Disorder (GAD)
- Major Depressive Disorder (MDD)
- Bipolar Disorder
- Schizophrenia
- Panic Disorder
- Obsessive-Compulsive Disorder (OCD)
Medical Illness exacerbated by Calcium Deficiency
- Osteoporosis
- Hypoparathyroidism
- Rickets in children
- Cardiovascular disease
- Hypertension
- Osteomalacia in adults
Consequences of Calcium Deficiency
Calcium is an essential mineral that is necessary for many important bodily functions, including bone health, muscle function, and nerve signaling. A calcium deficiency can lead to several significant health consequences, affecting both physical and mental well-being.
If calcium deficiency remains untreated for the long term, it can cause dental changes, cataracts, alterations in the brain, and osteoporosis, which causes the bones to become brittle.
It was observed that calcium deficiency may cause no early symptoms. It is usually mild, but without treatment, it can become life-threatening. Though calcium deficiency can be managed through dietary adjustments, supplementation, and medical intervention, this can help in maintaining overall health and preventing adverse health outcomes.
Some of the consequences of calcium deficiency are mentioned below:
- Osteoporosis- Calcium deficiency is a major cause of osteoporosis, it is a condition in which bones get weakened and are more prone to fractures. It happens due to insufficient calcium leading to decreased bone density and making bones more susceptible to breaks.
- Rickets in Children- In the development phase of the children, it is important to get adequate levels of calcium in the body. Inadequate calcium intake during childhood can result in rickets, in which bones become soft and deformed.
- Muscle Cramps and Spasms- Study shows that calcium plays a crucial role in muscle contraction. When calcium content is low in the body, it can lead to muscle cramps, spasms, and in severe cases, tetany, which is characterized by involuntary muscle contractions.
- Dental Problems- Tooth enamel mainly consists of calcium. Low calcium levels can affect dental health, including tooth enamel. This increases the risk of cavities and periodontal disease. Calcium is found to be vital for the maintenance of strong teeth and jawbones.
- Neurological Symptoms- Calcium plays a crucial role in nerve functioning by promoting neurotransmitter production. Therefore, calcium deficiency can lead to neurological symptoms such as numbness and tingling in fingers, toes, and around the mouth.
- Cardiovascular Issues- Calcium is involved in cardiac muscle contraction and blood clotting. Therefore, calcium deficiency can cause multiple heart problems, such as irregular heartbeats and hypertension.
- Mood Disorders- Calcium is vital for neurotransmitter regulation. Its deficiency can disrupt mood stability as it increases the production of neurotransmitters, which helps in regulating the mood.
- Poor Blood Clotting- It is observed that calcium plays a role in the blood clotting process. Its deficiency can impair clotting ability, leading to excessive bleeding and bruising.
Calcium Deficiency Treatment
The best approach to treat calcium deficiency is to add more calcium to the diet. Sometimes, due to certain conditions, this is not possible, in such cases a doctor may recommend supplements, either as oral tablets or injections. Oral calcium supplements are the most common treatment for calcium deficiency.
It was observed that most people who receive treatment experience an improvement in symptoms within a few weeks. Consulting with a healthcare provider ensures the appropriate treatment plan is according to the severity of the deficiency.
Some of the calcium deficiency treatment options are mentioned below:
- Dietary Changes- It is important to have a proper diet that provides all important nutrients. Try to increase calcium-rich foods such as dairy products (milk, cheese, yogurt), leafy green vegetables (kale, broccoli), and fortified foods (orange juice, cereals) to reach optimum levels of calcium in the body.
- Calcium Supplements- Sometimes diet alone is not sufficient to fulfill the calcium levels in the body, in such cases supplements can help, for example: calcium carbonate, calcium citrate, and calcium phosphate are effective in increasing calcium intake.
- Vitamin D Supplementation- Studies show that vitamin D enhances calcium absorption in the gut. Getting adequate vitamin D levels through sunlight exposure, diet, or supplements is vital for effective calcium absorption.
- Weight-Bearing Exercise- Engaging in weight-bearing exercises like walking, running, and resistance training helps stimulate bone formation and maintain bone density.
- Limit Caffeine and Alcohol- Reducing the consumption of caffeine and alcohol can help improve calcium levels in the body, as they interfere with calcium absorption and increase calcium excretion.
- Monitor and Manage Underlying Conditions- It is important to address and treat underlying health conditions that may affect calcium absorption, such as hypoparathyroidism or chronic kidney disease. Regular check-ups can help in managing the symptoms.
Supplements for Calcium Deficiency
An analysis was done, where it was found that appropriate calcium intake can have many health benefits, such as reduction of hypertensive disorders of pregnancy, lower blood pressure, particularly among young people, prevention of osteoporosis and colorectal adenomas, lower cholesterol values, and lower blood pressure in the progeny of mothers taking sufficient calcium during pregnancy.
Calcium supplements can help individuals who do not get enough minerals from their diets alone, which can lead to calcium deficiency. This can result in weakened bones, increased risk of fractures, and conditions such as osteoporosis. In this condition, supplements are recommended by healthcare providers. Supplements can be helpful but it is important to choose the right type based on the individual needs and health conditions.
Some key types of calcium supplements and their benefits are mentioned below:
- Calcium Carbonate- Calcium carbonate is the most commonly used calcium supplement due to its high elemental calcium content, which is around 40% elemental calcium. It is best absorbed when taken with food because it requires stomach acid for absorption.
- Calcium Citrate- Calcium citrate has 21% elemental calcium and is often used more as it gets more easily absorbed than calcium carbonate and can be taken with or without food, which makes it more suitable for individuals with lower stomach acid or digestive issues.
- Calcium Gluconate- Calcium gluconate contains a lower percentage of elemental calcium, which is around 9% elemental calcium. It is often used in intravenous formulations for more immediate calcium needs. So, that it can provide immediate relief.
- Calcium Lactate- Similar to calcium gluconate, this form has a lower elemental calcium content, which is around 13% elemental calcium but is well absorbed and used in various dietary supplements and food fortifications.
- Calcium Phosphate- Calcium phosphate is mostly recommended to those individuals who have additional phosphate needs. It is a combination that is used along with other calcium supplements and provides a balanced option.
Toxicity from Calcium Supplementation
Calcium supplementation is one of the best ways and most recommended to treat calcium deficiency. Some recent studies have concluded that excessive intake of calcium can cause toxicity in the body and increase the risk of cardiovascular diseases. Toxicity can be referred to as hypercalcemia when the body’s calcium level is higher than the normal level.
When the level of calcium crosses the Upper Limit (UL), which is 2,500 mg daily from food and supplements, it can be considered as toxicity. However, people over the age of 50 should not take more than 2,000 mg daily (including supplements), as it can increase the risk of other health problems like kidney stones, heart problems, and many others.
Some of the key impacts of calcium toxicity are mentioned below:
- Kidney Stones- Kidney stones can be referred to as clusters of crystals that form from minerals in the urinary tract. When there is excessive calcium in the body, it can cause kidney stones by increasing calcium oxalate concentration in the urine, it causes severe pain and can lead to potential kidney damage.
- Cardiovascular problems- Cardiovascular problems are a group of conditions that affect the blood vessels and the proper functioning of the heart. High calcium in the blood can lead to vascular calcification, a condition where calcium phosphate salts get deposited into veins and arteries. This can increase the risk of heart disease and stroke.
- Gastrointestinal Disturbances- Gastrointestinal disturbances are related to health problems in the digestive tract. This can happen due to overconsumption of calcium supplements and symptoms can include constipation, nausea, vomiting, and abdominal pain. These symptoms disrupt the normal gastrointestinal function.
- Impaired Absorption of Other Minerals- Studies show that excessive calcium interferes with the absorption of other essential minerals such as iron, zinc, and magnesium, which can lead to their deficiency and associated health problems.
- Skeletal Issues- Excessive calcium levels in the body can also cause skeletal issues. It can lead to conditions such as osteomalacia, a condition where bones become soft and weak due to an imbalance in bone mineralization.
- Neurological Symptoms- Calcium has a great impact on the nervous system and in hypercalcemia conditions it affects the neurological functions, resulting in confusion, lethargy, and muscle weakness, and in severe cases, it can also lead to coma or death.
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