Calcium carbonate can decrease drug absorption if taken at the same time.35
Nutrient – Nutrient Interactions
Iron: high doses of Calcium can reduce iron absorption.36
Zinc: high doses of Calcium can reduce zinc absorption.37
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Meschino Health Comprehensive Guide to Minerals
Pregnancy and Lactation
During pregnancy and lactation, the only supplements that are considered safe include standard prenatal
vitamin and mineral supplements. All other supplements or dose alterations may pose a threat to the
developing fetus and there is generally insuf icient evidence at this time to determine an absolute level of
safety for most dietary supplements other than a prenatal supplement. Any supplementation practices
beyond a prenatal supplement should involve the cooperation of the at ending physician (e.g., magnesium
and the treatment of preeclampsia.)
References: Pregnancy and Lactation
1. Encyclopedia of Nutritional Supplements. Murray M. Prima Publishing 1998.
2. Reavley NM. The New Encyclopedia of Vitamins, Minerals, Supplements, and Herbs. Evans and
Company Inc. 1998.
3. The Healing Power of Herbs (2nd edition). Murray M. Prima Publishing 1995.
4. Boon H and Smith M. Health Care Professional Training Program in Complementary Medicine.
Institute of Applied Complementary Medicine Inc. 1997.
1. Standard Textbooks of Nutritional Science:
- Shils M, Shike M, Olson J, Ross C. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Lippincott Williams & Wilkins; 1993.
- Escott-Stump S, Mahan LK, editors. Food, Nutrition and Diet Therapy. 10th ed. Philadelphia, PA: W.B. Saunders Company; 2000.
- Bowman B and Russell RM, editors. Present Knowledge in Nutrition, 8th ed. Washington, DC:.ILSI Press; 2001.
- Kreutler PA, Czajka-Narins DM, editors. Nutrition in Perspective. 2nd ed. Upper Saddle River, NJ: Prentice Hall Inc.; 1987.
2. McKeown-Eyssen GE, Bright-See E. Dietary factors in colon cancer: international relationships. Nutr Cancer 1984; 6:160-70.
3. Levenson, D, Backman, R. A review of Calcium preparations. Nutr Reviews 1994;52:221-32.
4. National Institutes of Health Consensus Conference. NIH consensus development panel on optimal calcium intake. JAMA.
1994;272:1942-8.
5. Osteoporosis Society of Canada. Clinical practice guidelines for the diagnosis and management of osteoporosis. Can Med Assoc J
1996;155:1113-33.
6. Nelson ME, Fiatarone MA, Morganti CM, Trice I, Greenberg RA, Evans WJ. Effects of high intensity strength training on multiple risk
factors for osteoporatic fractures: a randomized controlled trial. JAMA 1994;272:1909-14.
7. Murray TM. Prevention and management of osteoporosis: consensus statements from the Scientific Advisory Board of the
Osteoporosis Society of Canada. 4. Calcium nutrition and osteoporosis. Can Med Assoc J 1996;155(7):935-9.
8. McCarron DA, Morris CD. Blood pressure response to oral calcium in persons with mild to moderate hypertension: a randomized
double-blind placebo-controlled crossover trial. Ann Intern Med 1985; 103:825-33.
9. Meese RB, et al. The inconsistent effects of Calcium supplements upon blood pressure in primary hypertension. Am J Med Sci Comment [c1]: Could not find other authors.
1987;294:219-24.
10. Belizan JM, Villar J, Pineda O, et al. Reduction of blood pressure with Calcium supplementation in young adults. JAMA
Comment [c2]: Could not find other authors.
1983;249:1161-5.
11. Belizan JM, et al. Calcium supplementation to prevent hypertensive disorders of pregnancy. N Engl J Med 1991;325:1399-405.
Comment [c3]: Could not find other authors.
12. Knight KB, Keith RE. Calcium supplementation on normotensive and hypertensive pregnant women. Am J Clin Nutr 1992;55:891-5.
13. Heaney RP. Protein intake and bone health: the influence of belief systems on the conduct of nutritional science. Am J Clin Nutr
2000;73(1):5-6.
14. Hotz J, et al. Behaviour of gastric secretion in acute EDTA-hypocalcemia in Man. Verh Dtsch Ges Inn Med 1971;77:501-4.
Comment [c4]: Could not find other authors.
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Meschino Health Comprehensive Guide to Minerals
15. Lambs L, Brion M, Berthon G. Metal ion-tetracycline interactions in biological fluids. Part 3 formation of mixed-metal ternary complexes of tetracycline, oxytetracycline, doxycycline and minocycline with Calcium and Magnesium, and their involvement in the
bioavailability of these antibiotics in blood plasma. Agents Actions 1984;14(5-6):743-50.
16. Kelnar CJ, et al. Hypomagnesaemic hypocalcaemia with hypokalaemia caused by treatment with high dose gentamicin. Arch Dis
Comment [c5]: Could not find other authors.
Child 1978;53(10):817-20.
17. Amphotericin B depletes Sodium, Calcium, Potassium, Magnesium. Physicians’ Desk Reference. 53rd ed. Montvale, NJ: Medical
Economics Company Inc.; 1999. p. 1038.
18. Shafer RB, Nuttall FQ. Calcium and Folic Acid absorption in Patients Taking Anticonvulsant Drugs. J Clin Endocrinol Metab
1975;41(06):1125-9.
19. Foxx MC, et al. The effect of anticonvulsants phenobarbital and diphenythydantoin on intestinal absorption of Calcium. Acta Physiol
Comment [c6]: Could not find other authors.
Lat Am 1978;29(4-5):223-8.
20. Winnacker JL, Yeager H, Saunders JA. Rickets in children receiving anticonvulsant drugs. Biochemical and hormonal markers. Am J
Dis Child 1997; 31(3):286-90
21. Kato Y, et al. Hypocalcemic action of the several types of salicylic acid analogues. Shika Kiso Igakkai Zasshi 1989;31(1):89-94.
Comment [c7]: Could not find other authors.
22. Watkins DW, Khalafi R, Cassidy MM, Vahouny GV. Alterations in Calcium, Magnesium, Iron, and Zinc metabolism by dietary
cholestyramine. Dig Dis Sci 1985;30(5):477-82.
23. Frayha RA, et al. Acute colchicine poisoning presenting as symptomatic hypocalcaemia. Br J Rheumatol 1984;23(4):292-5.
Comment [c8]: Could not find other authors.
24. Reid IR, Ibbertson HK. Evidence for decreased tubular reabsorption of calcium in glucocorticoid-treated asthmatics. Horm Res
1987;27(4):200-4.
25. Adachi JD, Ioannidis G. Calcium and Vitamin D therapy in corticosteroid-induced bone loss: what is the evidence? Calcif Tissue Int
1999;65(4):332-6.
26. Ghishan FK, Walker F, Meneely R, et al. Intestinal Calcium transport: effect of cimetidine. J Nutr 1981; 111(12):2157-61.
Comment [c9]: Could not find other authors.
27. Edwards H, Zinberg J, King TC. Effect of cimetidine on serum calcium levels in an elderly patient. Arch Surg 1981;116(8):1088-9.
28. Brodie MJ, et al. Effect of osoniazid on Vitamin D metabolism and hepatic monooxygenase activity. Clin Pharmacol Ther
Comment [c10]: Could not find other authors.
1981;30(3):363-7.
29. Beermann B. Thiazides and loop-diuretics therapeutic aspects. Acta Med Scand Suppl 1986;707:75-8.
30. Weberg R, Berstad A, Aaseth J, Falch JA. Mineral-metabolic side effects of low-dose antacids. Scand J Gastroenterol.
1985;20(6):741-6.
31. Hanze S, et al. Studies of the effect of the diuretics furosemide, ethacrynic acid and triamterene on renal magnesium and calcium
Comment [c11]: Could not find other authors.
excretion. Klin Wochenschr 1967;45(6):313-4.
32. Kupfer S, Kosovsky JD. Effects of cardiac glycosides on renal tubular transport of calcium, magnesium, inorganic phosphate and
glucose in the dog. J Clin Investig 1965;44:1143.
33. Marchbanks CR. Drug-drug interactions with fluoroquinolones. Pharmacotherapy 1993;13(2 Pt 2):23S-28S.
34. Sahai J, Healy DP, Stotka J, et al. The influence of chronic administration of calcium carbonate on the bioavailability of oral Comment [c12]: Could not find other authors.
ciprofloxacin. Br J Clin Pharmacol. 1993;35(3):302-4.
35. Singh N, Singh PN, Hershman JM. Effect of calcium carbonate on the absorption of levothyroxine. JAMA 2000;283(21):282-5.
36. Hallberg L, Rossander-Hulthen L, Brune M, Gleerup A. Inhibition of haem-iron absorption in man by calcium. Br J Nutr
1993;69(2):533-40.
37. Wood RJ, Zheng JJ. High dietary calcium intakes reduce zinc absorption and balance in humans. Am J Clin Nutr 1997;65(6):1803-9.
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Meschino Health Comprehensive Guide to Minerals
Chromium
General Features
Chromium is an essential trace element required for maintenance of normal glucose metabolism. The function of
chromium is directly related to the function of insulin, as chromium enhances (potentiates) the activity of insulin. Some
human studies demonstrate that chromium supplementation results in improvement of glucose intolerance. Thus, it
may have important applications for diabetics, hypoglycemic patients, and in Syndrome X (the metabolic syndrome).
Insulin-chromium interactions are not restricted to glucose metabolism. Animal and human studies indicate that
chromium stimulates amino acid transport into the cells with a corresponding increase in protein synthesis.
Only the trivalent state of chromium is biologically active (nutritional chromium). By contrast the hexavalent form of
chromium used as metal alloys by industry (industrial chromium) can be extremely toxic.
The chromium concentration of most body tissue decreases steadily as we age. As well, increasing impairment of
glucose tolerance throughout normal pregnancy has been amply documented, and the changes in chromium
concentration in the plasma may reflect decreased glucose tolerance or may actually reflect deficiency.
Concentration of chromium in the hair is ten times higher than in blood, and hair concentration has been suggested as
a means of assessing chromium status.
Absorption and Metabolism
The exact mechanism of chromium absorption is not known, but it is not simple diffusion. Chromium is transported in
the plasma in combination with transferrin. Unlike other metals, once chromium is absorbed, it is almost entirely
excreted in the urine. Thus, daily intake is important to optimize chromium’s functions in the body. Generally
speaking, absorption of inorganic chromium found in food and water appears to be only about one percent.
Organically-bound chromium (e.g., GTF-chromium, chromium-chelates found in many supplements) permits a
bioavailability of 10-25 percent.
The total amount of chromium found in the body averages less than 6 mgs. The hair, spleen, kidney and testes
contain the highest concentrations.1,2
Recommended Daily Allowance (Chromium)
There is no of icial RDA for chromium, but the following recommendations have been suggested:
Age Group
Dosage
(mcg)
0 – 6 mths
10 - 40
6 – 12 mths
20 - 60
1 – 3 yrs
20 - 80
4 – 6 yrs
30 - 120
7 years and older
50 – 2003
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Meschino Health Comprehensive Guide to Minerals
Supplementation Studies and Clinical Applications