Q: I am a 60 years old woman taking Macalvit (calcium) tablets daily after having breakfast. I have been told that calcium is necessary after menopause. Is it advisable and should I continue or not?

A:This can help protect you from osteoporosis later in life. Mature women need calcium to prevent break down of bone. While calcium is good for a woman's body, too much of anything can cause problems. The body has a natural mechanism for protecting against calcium overdose, but it can be over-ridden if more than 4 grams of calcium are consumed per day. To do this, a woman would need to be taking 3-4 times the usual dose in supplement tablets a day. The two most serious effects of calcium overdose are renal damage and the deposit of calcium in other areas of the body besides the bones. Women who are already at risk for developing kidney stones should take caution about taking supplements. They can contribute to stone formation. Any woman taking supplements may get constipation and acid stomach. Keeping total intake to 1500 mg/day virtually eliminates this problem. Calcium supplements can be involved in drug interactions with medications. You should always touch base with her doctor before starting calcium supplements. He can make sure there are no drug interactions or medical reasons to avoid them. Do not stop the supplement without consulting your doctor. Not to worry, there are many other ways you to get your recommended daily allowance of calcium, beyond milk products.

1. Non-dairy foods: broccoli (36 mg/0.5 cup cooked), mustard greens.
2. Artificially calcium-fortified: juices and cereals. Calcium-fortified orange juice contains 320 mg/cup, while calcium-fortified cereals-wheat flakes contain 200 mg/cup.
3. Supplements: calcium carbonate, calcium citrate, calcium gluconate, calcium glubionate, calcium lactate, tricalcium phosphate.
4. Other forms: Soy milk (200-500 mg/cup).
5. Milk (whole, 2%, 1%, and skim) contains 315 mg/cup and fruit-flavoured yoghurt contains 259 mg per ¾ cup.

Putting the supplement the mouth and swallowing is not enough! What you eat or drink around supplement ingestion can help or hinder its absorption into the body. Thirty minutes before or after the supplement is taken is the time frame for avoiding the bad and coupling with the good. Dividing the daily supplementation is two or three doses. Avoiding bedtime doses will avoid nighttime heartburn. It doesn’t matter which form of calcium is used. They are all absorbed the same in the same circumstances. Types of foods/situations that increase absorption of calcium supplements:

• Proteins
• Lactose (milk sugar, occurs naturally in milk)
• Vitamin D
• Acidic foods

The main foods that can cause decreases absorption are those that contain oxalate:

• Cocoa
• Spinach
• Kale
• Unpolished rice
• Wheat bran (only in large amounts)

Alkaline foods also interfere with absorption. Less significant factors include fat, phosphate, caffeine, and magnesium.