Calcium
uit voeding of supplementen voor sterke botten?*
Uit een kleine studie onder 183 oudere vrouwen blijkt dat calcium uit de voeding zonodig aangevuld met supplementen de hoogste botdichtheid geeft. De 183 vrouwen konden in 3 groepen worden verdeeld: de dieetgroep die voor min. 70% hun calcium uit voeding binnen kregen, de supplementgroep die voor min. 70% hun calcium uit
supplementen kreeg en de derde groep waren de vrouwen die zowel uit dieet als supplementen hun calcium kregen in een gemiddelde verhouding van 50-50%.
De dieetgroep kreeg gemiddeld 830 mg calcium per dag binnen, de supplementengroep 1.030 mg en de dieet-supplementengroep 1.620 mg. Botdichtheid werd gemeten en de hoogste botdichtheid vond men in de dieet-supplementengroep meteen gevolgd door de dieetgroep, de supplementengroep had de laagste botdichtheid. Nog opgemerkt werd dat calciumsupplementen nogal wat verschillen qua opname in het lichaam. Vooral calciumcarbonaat wordt slecht opgenomen en alleen bij voldoende maagzuur,
calciumcitraat daarentegen wordt makkelijker opgenomen in het lichaam. Calcium in de voeding wordt veruit het makkelijkste opgenomen.
For Protecting Bone Health, Dietary Calcium Better Than Supplements
Women who get most of their daily calcium from food have healthier bones than women whose calcium comes mainly from supplemental
tablets, say researchers at Washington University School of Medicine in St. Louis.
Surprisingly, this is true even though the supplement takers have higher average calcium intake.
Adequate calcium is important to prevent osteoporosis, which affects an estimated 8 million American women and 2 million American men. Another 34 million Americans have low bone
mass, placing them at increased risk for osteoporosis. Calcium consumption can help maintain bone density by preventing the body from stealing the calcium it needs from the
bones.
The researchers' conclusions about calcium intake, published in the American Journal of Clinical
Nutrition, came from a study of 183 postmenopausal women. The researchers asked the women to meticulously detail their diet and their calcium supplement intake for a week. "We assumed that this sample represented each woman's typical
diet," says senior author Reina Armamento-Villareal, M.D., assistant professor of medicine in the Division of Bone and Mineral Diseases and a bone specialist at Barnes-Jewish
Hospital. "In addition to analyzing the volunteers' daily calcium intake, we tested bone mineral density and urinary concentrations of estrogen
metabolites."
The researchers found that the women could be divided into three groups: one
group, called the "supplement group," got at least 70 percent of their daily calcium from tablets or
pills; another, the "diet group," got at least 70 percent of their calcium from dairy products and other
foods; and a third, the "diet plus supplement group," consisted of those whose calcium-source percentages fell somewhere in between these ranges.
The "diet group" took in the least calcium, an average of 830 milligrams per
day. Yet this group had higher bone density in their spines and hipbones than women in the "supplement
group," who consumed about 1,030 milligrams per day. Women in the "diet plus supplement
group" tended to have the highest bone mineral density as well as the highest calcium intake at 1,620 milligrams per
day.
The hormone estrogen is known to maintain bone mineral density. But the standard form of estrogen is broken down or metabolized in the liver to other forms - some active and some
inactive. Urinalysis showed that women in the "diet group" and the
"diet plus supplement group" had a higher ratio of active to inactive estrogen metabolites than women in the "supplement
group."
"This suggests that dietary calcium is associated with a shift in estrogen metabolism that favors production of active forms of
estrogen," says Armamento-Villareal. "Although we're not yet certain what underlies this effect, it could be that nutrients other than calcium cause this shift. It's also known that dairy
products, which are a major source of calcium, can contain active estrogenic
compounds, and these can influence bone density and the amount of estrogenic metabolites in the urine."
Calcium supplements differ in how well their calcium can be absorbed, and this also could play a role in the study's
findings, according to its authors. For example, calcium carbonate tablets need to be taken with a meal so that stomach acid can facilitate
absorption, but calcium citrate tablets don't have this limitation. If the study participants taking calcium carbonate weren't conscientious about the timing of their
supplements, they might not have received the highest benefit from them.
"Only about 35 percent of the calcium in most supplements ends up being absorbed by the body," Armamento-Villareal
says. "Calcium from the diet is generally better absorbed, and this could be another reason that women who got a high percentage of calcium in their food had higher bone
densities."
Although dairy foods are excellent sources of calcium, Armamento-Villareal suggests that individuals with dairy sensitivities could consume other calcium-rich food sources such as calcium-fortified orange
juice. Dark green leafy vegetables also contain calcium, but it is not as readily absorbed as calcium from dairy
sources.
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Napoli N, Thompson J, Civitelli R, Armamento-Villareal RC. Effects of dietary calcium compared with calcium supplements on estrogen metabolism and bone mineral
density. American Journal of Clinical Nutrition 2007;85:1428-1433.
Funding from the National Institutes of Health and the General Clinical Research Center at Washington University supported this research.
Washington University School of Medicine's full-time and volunteer faculty physicians also are the medical staff of Barnes-Jewish and
St. Louis Children's hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the
nation, currently ranked fourth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and
St. Louis Children's hospitals, the School of Medicine is linked to BJC
HealthCare. (Juli 2007)
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