Calcium deficiency

Types Of Calcium deficiency

1. Acute hypocalcemia

It refers to the severe drop of calcium in the blood rapidly. It may lead to serious complications which may also require hospitalization.

2. Chronic hypocalcemia

In this, the level of calcium drops gradually. Chronic hypocalcemia is well tolerated. However, treatment is required to prevent long-term complications.

Symptoms Of Calcium deficiency

The most important functions of calcium include:

• Regulating normal heart rhythms

• Maintaining structure of bones and teeth

• Clotting of blood clotting

• Contraction of muscles

• Normal functioning of nerves 
  
  

Acute hypocalcemia can result in severe symptoms that may require hospitalization. These symptoms involve the heart, kidney, neuromuscular systems:

• Burning sensation usually in the arms, legs, and feet

• Fainting

• Muscle spasms

• Muscle cramps (especially in the legs and back)

• Difficulty in swallowing

• Fatigue

• Involuntary muscle movements

• Wheezing

• Numbness 

• Seizures

• Laryngospasm (involuntary muscular contraction of the vocal folds)

• Change in voice

• Neuromuscular irritability

• Impairment of memory

• Kidney injury
  
  

Individuals who develop calcium deficiency gradually or have mild deficiency usually remain asymptomatic. Chronic hypoglycemia usually affects skin and hair over a period of time. The symptoms of which include:

• Rough hair

• Brittle nails

• Dry skin

• Itching

• Cataracts (clouding of eye lens)

• Poor quality of teeth

Causes Of Calcium deficiency

The following causes and risk factors can contribute to calcium deficiency:

1. Low calcium diet

Individuals who are on a low calcium diet are more likely to develop calcium deficiency. This includes people with lactose intolerance and food allergies. 

Restrictive diets like those consumed by vegans that involve elimination of rich sources of calcium from food also increases the risk of calcium deficiency. Studies have also shown that vegans have a low mineral density due to lower blood calcium levels.

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2. Vitamin D deficiency

It is one of the most significant risk factors of calcium deficiency as Vitamin D plays a very important role in the absorption of calcium.

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3. Pregnancy

Pregnant women are also at higher risk of developing hypocalcemia due increased nutritional requirements, and persistent vomiting.

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4. Menopause

Menopause increases the risk of calcium deficiency. Women lose upto 1% of their bone mineral density every year after menopause. It is because of the decrease in the level of calcium due to hormonal changes.

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5. Certain medical conditions

Certain medical conditions increase the risk of calcium deficiency through several mechanisms. Some of them include:

• Hypoparathyroidism

• Pseudohypoparathyroidism

• Altered magnesium levels

• High levels of potassium

• Liver diseases

• Chronic kidney diseases

• Sclerotic metastases

• Sepsis

• Pancreatitis

• Fanconi syndrome
  
  

6. Massive blood transfusion

The massive blood transfusion makes the individual more prone to develop deficiency of calcium. This is due to the use of chelation products as a preservative which binds with calcium and makes it inactive.

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7. Certain medications

The prolonged use of certain medications is also associated with a decrease in calcium level. The common examples include:

• Intravenous bisphosphonates

• Denosumab

• Cisplatin

• Cinacalcet 

• Foscarnet

• Rifampin 

• Chloroquine
  
  

8. Radioactive iodine (RAI) therapy

People who have undergone RAI therapy may develop calcium deficiency due to the destruction of the parathyroid gland. Studies have shown a decrease in serum calcium levels after 6 months of RAI. 

Diagnosis Of Calcium deficiency

Thorough medical history and physical examination is done before initiating any laboratory test. 

1. Blood tests

The basic investigations through a blood test include:

• Total blood calcium

• Phosphorus

• Magnesium

• Electrolytes

• Creatinine 

• Alkaline phosphatase 

• PTH

• Complete blood count (CBC)

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2. Imaging tests

• Renal ultrasonography: This involves the use of sound waves to look for the images of kidneys. It is performed to look for the abnormalities in the kidney which may be a cause of increased excretion of calcium. 

• Electrocardiography (ECG): The deficiency of calcium affects the normal functioning of the heart. An ECG  is  obtained to look for the changes in heart. 

• Bone X-rays: X-rays will be conducted to check for any deformities in the bones.

3. DNA sequencing 

It is done to look for genetic causes of calcium deficiency.

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Prevention Of Calcium deficiency

1. Ensure adequate intake of calcium

The best way to prevent calcium deficiency is to fulfill the recommended diet. The dietary recommendations amount as per the age are:

• 0-6 months: 200 mg

• 7-12 months: 260 mg

• 1-3 years: 700 mg

• 4-8 years: 1000 mg

• 9-13 years: 1300 mg

• 19-70 years: 1000 mg

• >70 years: 1200 mg
  
  

This can be achieved by consuming food rich in calcium which include:

• Milk, yogurt, and cheese ( richest source of calcium)

• Soybeans

• Spinach

• Green turnip

• Kale

• Apple with skin

• Broccoli

• Fortified breakfast cereals

• Tofu made from calcium salts

• Canned sardines and salmon

• Nuts

• Almond butter

• Eggs
  
  

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2. Avoid restrictive diets

Fad diets generally lead to nutrient deprivation. Avoiding restrictive diets may help prevent the deficiency.

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3. Treat underlying medical conditions 

People with underlying health conditions such as liver disease and chronic kidney disease are more likely to develop calcium deficiency. Therefore treating the underlying condition may help in maintaining the optimum level of calcium. 

Specialist To Visit 

The diagnosis and management of calcium deficiency requires a team of doctors. The speciality of doctors that helps in correcting calcium deficiency along with managing symptoms and complications include:

• General physician

• Endocrinologist

• Nutritionist

• Ophthalmologist

• Dermatologist

• Orthopediacian

• Dentist

A general physician helps in diagnosing calcium deficiency through general examination and blood tests. 

An endocrinologist helps in managing the condition of the parathyroid gland which can be involved in many calcium deficiency cases. 

A nutritionist can guide and help improve calcium intake through diet.

An ophthalmologist helps in managing the eye related disorder such as cataracts that may manifest as a result of this deficiency. 

A dermatologist helps in treating the symptoms related to skin, hair, and nails that generally occurs in case of chronic calcium deficiency. 

An orthopedician and dentist can take care of the complications of bones and teeth, respectively.

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Treatment Of Calcium deficiency

The treatment of the calcium deficiency depends upon the duration and severity of symptoms. The underlying disorder is treated alongwith correcting the level of calcium. The treatment options include:

1. Calcium supplementation

Oral calcium supplements are available in chewable tablets, capsules, liquids, and powders. The goal is to administer 1500 to 2000 mg elemental calcium per day divided into 2 to 3 doses. 

The common example of calcium supplements include:

• Calcium carbonate

• Calcium citrate

• Calcium gluconate 

• Calcium lactate

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Patients with a severe drop in calcium require a continuous intravenous drip of calcium. This is done to prevent cardiac complications such as arrhythmia.

2. Vitamin D supplementation

The supplements of Vitamin D are always given with calcium supplements. It helps in increasing the absorption of calcium. 

A dose of 50,000 units weekly for 8 to 12 weeks is given in patients with significant Vitamin D deficiency. It is followed by lower doses of 1000 to 5000 units daily.

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Home Care For Calcium deficiency

Apart from dairy products, other rich sources of calcium that is available from your kitchen include:

1. India gooseberry (amla): It is a very rich source of calcium. The daily consumption of amla also boosts immunity. It can be taken raw. It can also be boiled in water and consumed.

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2. Sesame (til): There are various hidden benefits of sesame including the abundance of calcium. An estimated 88 milligrams of calcium is present in one tablespoon of sesame seeds. It can be used as dressings in cereals, soups, and salads after crushing in the form of a powder.

The roasted sesame powder can also be consumed with a cup of warm milk.

2. Cumin (jeera): A small amount of cumin seeds contains a huge amount of calcium. The consumption of cumin water at least twice/day is proven to be beneficial in calcium deficiency. The cumin water can be prepared by boiling a teaspoon of cumin seeds with a glass of water.

3. Ashwagandha: It is a very ancient ayurvedic herb that is known for its antioxidant and anti-inflammatory properties. It also contains calcium and thus helps in managing calcium deficiency. It is available in the market in the form of tablets and capsules.

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4. Guggul: It is a very well known herb for improving bone density as it is a rich source of calcium. It also fastens the recovery period of bone fracture. The consumption of guggul is also associated with an improvement in joint pain.

Mix the the extract of ¼  teaspoon of guggul extracts or powder in lukewarm water and sip it.

5. Ragi: It is a well known cereal used in Indian kitchens. It contains a huge amount of calcium. It is consumed as whole grain or flour. 

Complications Of Calcium deficiency

Individuals with severe hypocalcemia (calcium level less than 7 mg/dl) or having an acute drop in calcium may develop:

• Seizures

• Arrhythmia

• Cardiovascular collapse

• Hypotension

• Congestive heart failure

• Angina

• Coma (in rare cases)
  
  

The chronic long term calcium deficiency may lead to:

• Osteoporosis

• Rickets

• Bone fracture

• Weakened tooth enamel

Living With Calcium deficiency 

Calcium deficiency mostly resolves within a few months with conscious eating and dietary supplements. The following measures might help in faster recovery:

1. Consume calcium rich chapatis

Make a dough by combining 2 parts wheat, 1 part soybean, and 1 part chana (chickpeas). Use this to make delicious, calcium-rich rotis for lunch and dinner. Chapatis made from ragi flour are also beneficial in elevating the level of calcium.

2. Spend time in the sun 

The early morning exposure of sunlight helps in the synthesis of Vitamin D in the body. This aids the absorption of calcium into the body.

3. Do not self medicate

It is advised to consult health care professionals before starting supplements. The doctor prescribes the right dose as per your need. Calcium interacts with other medications which a doctor may help you to find and fix. Some common drugs to which calcium can interact include levothyroxine and lithium.

4. Be aware of toxicity

Consuming a large amount of calcium supplements over a short period of time can cause toxicity. It is advised to consume supplements as per the recommended dose. The total calcium intake, from combined dietary and supplemental sources, should not exceed 2,500 mg per day.

The signs and symptoms of toxicity include:

• Constipation

• Nausea

• Vomiting

• Increased urination

• Confusion

• Irregular heart rhythm

• Kidney damage
  
  

5. Dealing with calcium deficiency if lactose intolerant

Individuals with lactose intolerance have a high probability to develop calcium deficiency. This is because of the avoidance of dairy products which are the richest source of calcium.The following measures might help in maintaining the optimum level of calcium:

• Limit dairy products instead of avoiding

• Include lactose-free or reduced-lactose dairy products, which contain the same amounts of calcium 

• Add non dairy sources of calcium in the diet. This includes some vegetables (e.g., kale, broccoli, and Chinese cabbage), canned fish with bones, or fortified foods (e.g., fruit juices, breakfast cereals, and tofu) 

• Eat the dairy products in conjunction with other foods to avoid symptoms of lactose intolerance