Calcium deficiency

The most important functions of calcium include:

• Regulating normal heart rhythms
• Maintaining the structure of bones and teeth
• Clotting of blood
• Contraction of muscles
• Normal functioning of nerves

Acute hypocalcemia can result in severe symptoms that may require hospitalization. These symptoms involve the heart, kidney, and 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 a mild deficiency usually remain asymptomatic. Chronic hypocalcemia may affect skin and hair over time, with symptoms including:

• Rough hair
• Brittle nails
• Dry skin
• Itching
• Cataracts (clouding of the eye lens)
• Poor quality of teeth

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

1. Low calcium diet
   Individuals on a low calcium diet are more likely to develop calcium deficiency. This includes people with lactose intolerance and food allergies. Restrictive diets, such as those followed by vegans that eliminate rich sources of calcium, also increase the risk. Studies have shown that vegans have a lower mineral density due to decreased blood calcium levels.
2. Vitamin D deficiency
   Vitamin D deficiency is a significant risk factor for calcium deficiency, as it plays a crucial role in calcium absorption. Symptoms may include tiredness, weakness, or joint pain.
3. Pregnancy
   Pregnant women are at higher risk of developing hypocalcemia due to increased nutritional requirements and persistent vomiting.
4. Menopause
   Menopause increases the risk of calcium deficiency. Women may lose up to 1% of their bone mineral density each year after menopause due to hormonal changes affecting calcium levels.
5. Certain medical conditions
   Several medical conditions can increase the risk of calcium deficiency, including:
   • Hypoparathyroidism
   • Pseudohypoparathyroidism
   • Altered magnesium levels
   • High levels of potassium
   • Liver diseases
   • Chronic kidney diseases
   • Sclerotic metastases
   • Sepsis
   • Pancreatitis
   • Fanconi syndrome
6. Massive blood transfusion
   Massive blood transfusions can increase the risk of calcium deficiency due to the use of chelation products as preservatives, which bind with calcium and render it inactive.
7. Certain medications
   Prolonged use of certain medications is associated with decreased calcium levels. Common examples include:
   • Intravenous bisphosphonates
   • Denosumab
   • Cisplatin
   • Cinacalcet
   • Foscarnet
   • Rifampin
   • Chloroquine
8. Radioactive iodine (RAI) therapy
   Individuals 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.

Thorough medical history and physical examination are conducted before initiating any laboratory tests.

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)

Here’s more on what you must know about the CBC test and its various parameters.

2. Imaging Tests

• Renal ultrasonography: This involves the use of sound waves to create images of the kidneys. It is performed to identify abnormalities in the kidneys that may cause increased excretion of calcium.
• Electrocardiography (ECG): Calcium deficiency affects the normal functioning of the heart. An ECG is obtained to detect changes in heart activity.
• Bone X-rays: X-rays are conducted to check for any deformities in the bones.

3. DNA Sequencing

This test is performed to identify genetic causes of calcium deficiency.

Looking for a trusted lab to get your tests done? Get tested with Tata 1mg labs for accurate and timely results.

1. Ensure adequate intake of calcium
   The best way to prevent calcium deficiency is to fulfill the recommended dietary intake. The dietary recommendations based on 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 foods rich in calcium, which include:
   • Milk, yogurt, and cheese (richest sources 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
   Along with calcium, vitamin D is also essential for calcium absorption in the body. Here are ways to obtain vitamin D through sun exposure, diet, and supplements.
2. Avoid restrictive diets
   Fad diets often lead to nutrient deprivation. Avoiding restrictive diets may help prevent deficiency. Consult our expert on how to achieve complete nutrition through healthy eating habits.
3. Treat underlying medical conditions
   Individuals with underlying health conditions such as liver disease and chronic kidney disease are at a higher risk of developing calcium deficiency. Therefore, treating these conditions may help maintain optimal calcium levels.

The treatment of calcium deficiency depends on the duration and severity of symptoms. The underlying disorder is treated along with correcting the calcium levels. The treatment options include:

• Calcium supplementation: Oral calcium supplements are available in chewable tablets, capsules, liquids, and powders. The goal is to administer 1500 to 2000 mg of elemental calcium per day, divided into 2 to 3 doses.
• The common examples of calcium supplements include:
• Calcium carbonate
• Calcium citrate
• Calcium gluconate
• Calcium lactate
• Patients with a severe drop in calcium require a continuous intravenous drip of calcium to prevent cardiac complications such as arrhythmia.
• Vitamin D supplementation: Vitamin D supplements are always given with calcium supplements as they help increase calcium absorption. A dose of 50,000 units weekly for 8 to 12 weeks is administered to patients with significant Vitamin D deficiency, followed by lower doses of 1000 to 5000 units daily.

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

• India gooseberry (amla): A very rich source of calcium, daily consumption of amla also boosts immunity. It can be taken raw or boiled in water and consumed.
• Sesame (til): Sesame seeds offer various hidden benefits, including an abundance of calcium. One tablespoon contains approximately 88 milligrams of calcium. It can be used as a dressing in cereals, soups, and salads after being crushed into a powder. Roasted sesame powder can also be consumed with a cup of warm milk.
• Cumin (jeera): A small amount of cumin seeds contains a significant amount of calcium. Consuming cumin water at least twice a day is beneficial for calcium deficiency. To prepare cumin water, boil a teaspoon of cumin seeds in a glass of water.
• Ashwagandha: This ancient Ayurvedic herb is known for its antioxidant and anti-inflammatory properties. It also contains calcium, helping to manage calcium deficiency. Ashwagandha is available in the market in the form of tablets and capsules.
• Guggul: A well-known herb for improving bone density, guggul is a rich source of calcium and can expedite recovery from bone fractures. It is also associated with improvements in joint pain. Mix ¼ teaspoon of guggul extract or powder in lukewarm water and sip it.
• Ragi: A popular cereal in Indian kitchens, ragi contains a substantial amount of calcium and can be consumed as whole grain or flour.

Individuals with severe hypocalcemia (calcium level less than 7 mg/dl) or experiencing 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 fractures
• Weakened tooth enamel

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 calcium levels.
2. Spend time in the sun: Early morning exposure to sunlight helps in the synthesis of Vitamin D in the body, aiding the absorption of calcium.
3. Do not self-medicate: It is advised to consult healthcare professionals before starting supplements. The doctor prescribes the right dose as per your needs. Calcium interacts with other medications, which a doctor can help you identify and manage. Some common drugs that can interact with calcium include levothyroxine and lithium.
4. Be aware of toxicity: Consuming a large amount of calcium supplements over a short period can lead to 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 of developing calcium deficiency due to the avoidance of dairy products, which are the richest source of calcium. The following measures might help in maintaining optimum calcium levels:
   • Limit dairy products instead of avoiding them.
   • Include lactose-free or reduced-lactose dairy products, which contain the same amounts of calcium.
   • Add non-dairy sources of calcium to the diet, including some vegetables (e.g., kale, broccoli, and Chinese cabbage), canned fish with bones, or fortified foods (e.g., fruit juices, breakfast cereals, and tofu).
   • Consume dairy products in conjunction with other foods to avoid symptoms of lactose intolerance.