Welcome back and today we are going to explore why “Let them eat chalk!” is not in your patient’s best interests…
I’ve received lots of comments from yesterday’s email concerning not only Vitamin D but also on using calcium carbonate aka chalk as a source of calcium, which was new for a lot of you.
In order to absorb calcium as well as Vitamin D, you need a very acidic (low ph) stomach and for many patients this is a real issue, especially the elderly.
Well, think about it, do you make more or less of your endogenous molecules as you get older?
You make less of everything, so the older people get the less stomach acid secretion they have.
Another cause of lower stomach acid is our persistent states of fight or flight. We are in constant sympathetic overdrive and digestion is not top of the list of things for the body to do when it’s preparing to kill or run away.
So if we want to maximise our chances of absorbing the calcium what’s the best form to use?
Well, we definitely want to maximise our intake of leafy green veggies, nuts, sardines (due to the bones) and dairy if tolerated.
Although dairy is a high source of calcium, there is an argument however about the net contribution to calcium it provides given that it is quite acid forming in the blood.
The argument runs as follows: If dairy creates acidity in the blood then the body will leech alkaline minerals from the bone in order to neutralise it, thus resulting in a net calcium loss.
This is controversial with no definite research conclusions either way. If tolerated however, I encourage the use of non-pasteurised butter, and cheeses like Comte, Caerphilly and Roquefort, which are all widely available now in supermarkets.
On the supplement front it’s very well researched that calcium citrate is far superior to calcium carbonate in healthy subjects but especially so in the elderly for the reasons mentioned above.
In fact 500 mg of calcium citrate gives you more absorption than 2,000 mg of calcium carbonate
If that’s the case then, why then does the NHS persist in using calcium carbonate?
Simply because it’s very cheap and the average GP doesn’t know any better.
However, its use creates another issue – compliance. When questioned, patients often reveal they routinely don’t take it as they hate the “chalky” taste!
But wait… if stomach acid is low, why then are so many patients on anti-acid medications? H2 (histamine) blockers like Ranitidine? Or the proton pump inhibitors (PPI’s) like Omeprazole and Lansoprazole?
Well, ironically, one of the most common symptoms of low stomach acid is heartburn.
So the patient goes to the GP and get medicated (and rarely ever comes off) with the knock-on effect that the digestion of protein, minerals, vitamin B12 and fats is reduced (acid triggers the release of bile in the small intestine), which then leads to other symptoms and then to more medications and… well, you get the idea.
By the way, guess what is the main acid reducing ingredient in over the counter remedies for heartburn such as Rennies or Gaviscon?
Yep, you’ve got it, calcium carbonate…
You couldn’t make this stuff up.
Action to take today: Order some calcium citrate (it’s actually pretty cheap). Ask patients on calichew if they take it at the prescribed dose daily (often not as explained above). Explain they can take a lower dose of another form of calcium which will actually give them more calcium and start prescribing your pre-stocked calcium citrate.
Don’t waste those valuable adjustments…