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Dietary calcium intake : How much, from where, for whom?
Dr. M. Papagiorgeou, Geneva
Friday, May 13, 2022 · 2:42 p.m. · 28m 06s
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actions so it take out some day for me and there was they are with calcium
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and eh i don't use my background in they they take say so in the next twenty minutes or
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so i will i am summarise the evidence there on
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costume how much we need from where and therefore from
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so we all know the functions of cancer made about the the
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vast majority of the place fountain bonus say talks about that crystals
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and eh it gives the the skeleton it's with the in strength bone is also serves
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as the reservoir of got assume in order to a regulated the can somehow most bases
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no gas i mean they they can affect can compromise bones health by affecting
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bone mineral station meant by also a increasing ball remote the link thruway secondly batteries
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hyper or this
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so how much do we d. there so as you can see this table the physical requirements for
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these nutrients have been established the air they stumble
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great t. v. and specifically on a costume balance studies
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and don't the evidence some accelerated the bone loss so with menopause in there
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i've been state so we can see it differently commendation from different point to professional bodies
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and these for adults the reins between seven
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hundred and then the thousand they milligrams per day
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some professional bodies they said says the slightly more for
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a eh um eh menopausal women and the elderly people
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in switzerland the commendation for calcium intake is say one thousand milligrams say per
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day a for adults eh of both sexes so for me women and men
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and say a cuss mean takes should not exceed the the a two thousand five hundred milligrams per day
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a so how are we doing k. so you can see
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the snap taking this map of the situation throughout the world
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and custom it takes varies greatly so you can see
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the areas that they are marked taking matt read this colour
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and these areas in a is yeah in africa and didn't and south america
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and where overall it a the populations there they have
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in takes less than six under an uh milligrams per day
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in contrast in areas with a green nice and yellow
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colour a uh in my in most of the western
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countries and they have a participants have the population have
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the intake say it's greater than seven hundred milligrams per day
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a as you can see students probably in dark green colour so
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in quite good position but they have also you more studies about this
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so i am this is uh eh recent analysis said that
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summarise the data from three a studies from three database in switzerland
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and overall they found that they participant at least that is
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where meeting or they were closing meeting k. that recommendation for custom
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of course you can see that they over all the standard deviation so
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quite a great so they're still participant that they wear falling behind these recommendations
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if we go for um and if we focus some
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populations that there may be at risk for one fertility
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like a diary what about them do they really eh what about their custom intake
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so in the morning to present you some data from the jericho court and the latest analysis that we the the
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eh we included seven hundred something but the spend with the mean age of face seventy one year old and
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we found that overall the participant had high intake of
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calcium and slightly more than fifteen hundred milligrams per day
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and most of them were making the recommendation focus meant only four of
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them where are consumed less than seven hundred milligrams of calcium per day
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the greatest country because of of a and um of custom provision was the dairy products
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about one into participants eh where taking calcium supplements
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and accounting for eighty percent of the constant take
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a similar amount a of party spend where taking k. supplement taking the study
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i would say a investigated the costume in
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it where supplements with or without the vitamin d.
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and he met pace since seen by different space at it
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this way it's awfully interact with a a place invisible fragility
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so overall the mess that's here is that the difference does
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this so that the overall uh put it in a population level
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in switzerland participant half a a um an antarctic inadequate the calcium
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intake uh but by seeing grey variations save the different studies we
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we can there we can conclude that they're still of course many individuals that we don't need accommodations
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so we need to be individualised approach sort of um how we assess and what we recommend for patients
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so from where we can get calcium i in many
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countries dairy products account for most of got some provision
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eh so this is largely because calcium uh is
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is a aim at providing the concentrated form into
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their products and the by the by the by availability of got some from the source is quite good
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and the products overall are really available at relatively low cost
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in addition to that some you can see that the dairy products are also great sources from our there
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nutrients a um a row important for bomb
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shelf so they're high in costume minerals and vitamins
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most countries people meant to do for portions of fate dairy products per
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day that will cover most of the need for custom yeah at population level
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and they you can see that approximately two hundred fifty milligrams
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a of got some means a content in one classify or me
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and one part of your good the a small portion of sees the the size of a matchbox
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and greater portions a a greater size portions so all face of season caught the cheese
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a in they died recommendation for switzerland they it's recommended
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say the consumption of the portion of the products per day
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and also one portion of meat fees x. a top so the the protein rich group
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so this is a summary oh fey bob least the math analysis
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and um i produced by members of our group and as you can see
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and it says seven limit analysts have someone that the
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those that they consume dairy products that they have a lower
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a instance uh of uh of fracture few productions and or vertebral fractures
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and eh in some of this analysis the favoured associations
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are seen for fermented products uh so your goods and sees
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i would not go of far more in detail but i just want to show the say a graph
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which shows the method the makings that maybe the mediator this favourably effect
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and the overall this attribute it to carve some but also plot there and nutrients all
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have protein and we have other by so by active ingredients like paramedics and probably takes
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so are par for calcium i'm from dairy products we have that other animal source of calcium
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and these are a um a the to they are face
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it with softball and say like count sardines and sought asylum
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of course this can make important additions to consume take but from my experience
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and it's harder to introduce them on a daily basis
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and just to tell you that the i remember watching
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game masters of episode that we had to do it
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silence with a chance i'll moment even people that the
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and they have a formal engagement with cooking it was hard to find recipes to incorporate these fruits
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but definitely turn option so that other plant based sources of
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calcium and here i would like to make two points the
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first point is that apart from that of wisconsin puts it
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got have but conceded about a considerable amount of custom percent think
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are there am vegetable plant they sources of kyle somebody normally
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have a smaller cool is more quite difficult some pair serving
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the second point i want to make is that they buy availability of got some from the sources varies greatly
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and so for example in a influence likes peanut sweets
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has a fair amount of custom percent of it and
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the bible built of got some is quite low rethink
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the five percent which makes actually a full source of calcium
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and this goes in cal simply because i am in spain
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that's a there maybe and there are some compound silk so late
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which by jessica cement they don't allow it's observed the prevented absorption
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in contrast other plant based foods like ha and broccoli would say are low when these
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components a a a minute from the source there by availability of can sum is greater
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i i a plan pays the better it is that they're used as they alternatives say
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with our forty five in in got some they can also be important sources of calcium
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so i'm sure you are i am increasingly familiar with
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this product say in the supermarket but just for your information
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these products um are produced by sulking then then the heart
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of the legume of the grain and by pressing constraining the wheat
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so they and fortify the fashion of them is actually a little we can assume and does not make considerable
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contribution never the less um manufacturers that that thought about
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that point way they try to fortify this product sold him
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normally the fortified variation of this a of these
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better it is and has quantities of gals some similar
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to the quantities that we are included in the
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in the products in terms of how they're nutrients um
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yeah that's very important for self apart from same week the like protein for example
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apart from so i make that they has the same amount of protein compared to um
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milk from cow and v. out there and the other
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birds are quite lower five to ten net times lowering protein
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and in terms of other minuses by the means again it's a matter of face up there fortification
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if the board that is fortified with nutrients and normally to has considerable amounts if not it's quite low
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and so in terms of the by availability of this product several studies say have someone
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that the overall the by availability of focus
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some from same it is equivalent to cows milk
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never the less say even with all these products are increasing increasingly
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used we don't have enough data we don't have any data for
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they buy that ability of calcium from mather plant
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based beverages which would like to see in the future
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and also by availability is not to blame is not the
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nice you if the cows ms not even reaching the consumer
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so this is an interesting study would say actually measure how are how
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similar we get from ma'am and different therefore to fight so your drinks
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and what they found is that the if we use a product without
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staking we in most from most beverages we get about thirty percent of it
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and if we sake this increases to about sixty percent of the of the clear content in the label
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so this means that even uh after staking this falls behind their yeah declared content
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and so the best we can do is to do is say the product well
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and before we consume it to make sure we get the maximum of what we yeah
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and then how we can use this information uh with
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our pace in say so i think they would need tool
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educate our pace seems to identify this information in this product so
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this should be able to save a product is fortified in costume
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and we can make these by reading the has claims sent a the ingredient list
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this would also be able to spot the the quantity of got some per hundred grams
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and be able to compare these say compared to other products uh or
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and make simple calculations to calculate how much they
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would get from the quantity that big would actually consume
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and of course to one time and finally we have got some from
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him you know what to say which they can be a great um
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source of calcium as well bridging the gap between the
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the recommended level sent to the actual levels uh of calcium
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and as we can see this table of the custom
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content varies greatly for different pro that say so we
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have very mean of what is that they are very low income cement others in the first line that they are
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and are they providing considerable amounts of calcium with the the
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product that we provide more than three hundred milligrams say per later
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being get the most um indicated four bases that the for
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for for who may have some familiar with this make considerable contributions
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the overall the bible ability of pal summed observable either thousand from high calcium
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you know what this is comparable to me it can cause so many supplements
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and several studies on them you know what does have sown name or um increased ignorant
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pals you meant the overall reduce the the m. b. t. a. to bone reception markers
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we it's a with these say responses indicating that overall
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halfway up the absorption of fan a considerable amounts of calcium
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a even though everybody can consume uh yeah yeah and what there's so many i mean or what
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is in order to get the cows from this a way to achieve that some recommendation maybe up
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specifically appropriate for people that we aren't weight management so they
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can get tickets and that they need to without the extra calories
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and for those of course that they need to calculate what him and on the other hand we need to make sure it
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but that they i'm at and i'm an aspect that we need
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to pay attention to is this so the content of this product
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because sometimes this is quite high and the of
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course we don't want and excessive some people conception
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so we need to make sure that um eh on a regular
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basis we consume protects that they are overall are low in sodium
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and even now all these are not enough to get to the couch some
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that we need then treats the recommendation and i'm a calcium supplement is an option
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apple not go through the the the through this route but they just for you with
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their different forms of face customs implementation i'm sure most of you are familiar with that
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so have the more to get a multivitamin multi mineral supplements we have got
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some only supplements and we'll have to have some plus of vitamin d. supplements
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oh yeah i forgot that you hear a an important point to make here is that they um
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and um got some something like that with some supplements are over all
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the available over the counter so they are accessible to some people that
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they may not to be the fee c. and they or they may
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not have locus mean takes so for the space and if they take
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a additional caps mean bake the x. they may
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exceed that accommodation and may they they may be a
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closer to the higher intake so um and for quite some so we need to pay attention to these
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oh okay so some um some people around my calcium supplements they may
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have the main experience sadist intestinal side effects their possible solutions for that
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and we can switch to supplement containing the different they
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form of costume way we can take smaller amounts of calcium
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more often during the day or we can recommend taking this up and with a meal
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no for this this is infrequent the and infrequent side effects
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of uh to have some supplements that needs to be discussed with
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the basics and pay if you pay some studies have faced zones
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that they have some supplements uh it's basically one big contribute to
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hi consummate takes maybe associated with increased the risk of cardiovascular events
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of course this is a very debated to ease you and we can spend the whole day discussing going this and
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a but this is something to consider and do this
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to discuss the mm there is benefits with your pace it's
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so i was uh the last part of my presentation i want to refer to the it to two categories of
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of a base since that the you may senior clinics
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and we may hot at the maybe quiet um extra attention
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and um so they're increasing number of rare of for individuals
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that they eh be try to reduce the ring taking meat
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and for a number of reasons it can be pencil reason can be environmental
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reasons can be health reasons a but we see an increasing number of people a
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a choosing to follow a plant treats diet or the platte exclusive you
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plant based diets and pay in vic stream of these diets
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will have the victim died so it's actually exclude all animal products
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we can die it's our concern for bomb here with um and this
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is the reason met analysis would so that over all of the guns and
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have a eh i'm at lower bone mineral density compares those that it to meet
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the also investment analysis they also did an analysis of um and um i am effect
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began died is associated with a in yeah increase the factories can be found that actually
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and every can diet but not a vegetarian diet is associated with the increase fracture risk
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so what about the space in turn the call over they or
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their needs in calcium down sorry it's uh it's yes it is possible
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eh but say the if we need to be you need to be am do you need to
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pay attention to some specific uh um source's so
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just to summarise here whether this basin only got
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so what this bases can do i have begun to discuss impress
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me know what their as they can and consume soy based foods
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or other plant based beverage these and eric and then include in their diet they see
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it's not sit fruits and vegetables uh that they are good sources of fair of consume
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i would also like to pay your attention to some ma'am eh some
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of them will come to your office a to go clubbing and people say
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oh yes but there is no problem i consume the dairy
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alternatives um i think i'm i'm okay i'm covering my needs
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eh so maybe this is the case that but in many cases they
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they alternatives are very different from what we what we traditionally consider as barry
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so you can see that this is a recipe for a evidenced
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sees which is based on potatoes carrots and then the traditional east
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so the profile of this product that is very different from my uh the normal says
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i have also included here are the two different labels from two different per product say vacancies
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and you can see the the this the first one can see eh it
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has considerable amounts of calcium so you can make important contributions surgical some provision
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whereas the second one that they're not information about the cost to make the label
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according to my experience that would say that the there is no
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information is likely because there is not any cancer mean these products
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because they manufacturers would take advantage of it and i'm sure they would advertise it in the paper
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and i think you say that you are within current space since a in the features that hallway
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vague and tie it to make mindful choices what does this mean that for example instead of fame
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'kay choosing get are fortified the and fortified the free dessert and it
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choosing get the free desserts with i've got some is already a better solution
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even this does there too we are we are at some says some
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seeds or some dried foods that makes it a quite good source of calcium
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similarly a vegetable stir fries not about option is a good think but if we had some mad cow
00:21:03
some sit still full and and some moments we could get a considerable amount of concern from this meeting
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so finally eh i know that the most of you see places that they will come to your office they would be
00:21:18
reluctant to come some uh any dairy products because it would
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be would claim that do they have a a lactose intolerance
00:21:25
and that we get gastrointestinal if the symptoms after the consumption of dairy
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so just to summarise the evidence so far and um
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up to date a so the avoidance of all the product sing lactose intolerant base unit is no longer to comment it
00:21:41
so most base it's should be able to consume small portions of dairy
00:21:46
and that contain approximately up to twelve grams of flak
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does this would be equivalent to one cup of of me
00:21:53
and this will happen without offering custom tested on symptoms
00:21:57
and we can be eight dollars towards this level and the
00:22:01
say kinda cool by consuming increasingly consume a small quantity of
00:22:06
red dairy products over a period of two to three weeks
00:22:10
and i'm the actors uh in other option is it to consume me like with other faults
00:22:15
and this because by consuming came hold me rather than their male only
00:22:21
we have the delay the in casting damn think so
00:22:24
the quantity that ends elegant to deflect doesn't enters the
00:22:28
being tested at any time is slower so it's eh but the rebate estate
00:22:34
other available options are to choose um uh your groups
00:22:37
that we have a small quantity of uh of reactors
00:22:41
and take your goods that we i have eh active cultures a for microbes
00:22:46
which again will eh we lay there with them they just enough for doctors
00:22:51
and finally consumption of sees is uh is normally better
00:22:54
tolerated because eh the containing really smaller amounts of of laptops
00:23:00
other options are the electors say free pro that sergei beverage that we're
00:23:04
fortified with calcium and the of course the enzyme that activates the enzyme replacement
00:23:12
so time to summarise how much we need according to the ace we say that recommendations with me they
00:23:18
that a thousand milligrams per day for adult men and women of all ages
00:23:23
and the calcium intake should not exceed the two thousand five hundred milligrams per day
00:23:29
we can get it from various sources from ford with a
00:23:32
dairy foods the being the um the most consecrated the um
00:23:37
source of calcium and the effect we're not if bases are still
00:23:42
unable to aim to achieve the commented levels calcium supplements can be used
00:23:49
so for a whole month and for and how i so do you that
00:23:52
overall all pace it's all individuals needs to cover the meeting that consumer intake
00:23:58
and we need to give emphasis on those that they are they are at risk for one fertility nutritional deficiencies
00:24:05
in the teachers were willing to come right to consumer the dairy
00:24:08
products and we are they can consume dairy products without adverse effect
00:24:13
should be in parts to directly consider them alongside with other high custom fruits
00:24:18
for those that they don't want to consume or they cannot consume dairy there are
00:24:23
out there at this but i so you that a more careful planning case isn't it
00:24:27
and finally for individuals were unable to meet the the recommendations by
00:24:32
that only got some supplements is an option thank you very much
00:24:40
thank you very much for your uh uh like the watch for it's basically say q. because that's what we see every day maybe this
00:24:47
product is the question of our patients or all sting 'em specifically what
00:24:51
you were showing so are there any questions you it'll sneak of won't
00:24:58
i hope you
00:25:00
i i'm not sure that you distinguish between fragrance and vegetarian see
00:25:07
yes very good i i mean i didn't i just wanted to all for
00:25:12
the options that we are available for right before we send regions you agree
00:25:16
yes you should go to when dried mean d. like no major terrorist yes
00:25:21
exactly because it is it is actually they include the dairy products in their diet
00:25:26
so it's the v. can died that is um this weekend
00:25:29
is that they don't include their product thank you for your comment
00:25:35
fruit questions this edge
00:25:39
i'm sorry i missed puerto rican but but uh did you did you see your so what is the
00:25:45
we don't you couldn't amount but that's a topic you'd
00:25:49
be double got equivalent amount of you know water yes
00:25:54
so we'll see you to go very good neural to reach five hundred milligrams probably store
00:26:00
would use that to tour review we were going to offer you drove newark or wants to re shoe
00:26:07
between charles young from water and charles some from the re
00:26:11
i see that because most of you guys you know the thing that we do
00:26:14
use into peter do you do during treaters overeating or water probably in the reached go
00:26:20
what you're focusing with social because some opposite from four million what
00:26:24
it's not based on the equivalent to me can pick up some supplements
00:26:28
it's really don't yeah it's on the front very important for calcium absorption would putting smoking war
00:26:36
there are but they over all the evidence shows that they they are overall it that way
00:26:42
yeah that's a good question so what we see to hike into boston recently shouldn't
00:26:47
yeah we don't want it to the real cause of colours one
00:26:49
stove and doesn't want to recall or so can some supplements because of
00:26:53
what you read stories on on like it was stories how how
00:26:57
do like it was the restriction that she even though the recommendation focusing
00:27:03
yeah that's a very good question i think a great combination of different fruits
00:27:08
but overall i want to mention that they dairy products is not an exclusion for the space since because
00:27:13
more recent evidence it so that i actually dairy
00:27:16
products are not associated with the adverse cardiovascular effect
00:27:21
and the some of them and they may have even been a fee side effects for different cardiovascular risk factors
00:27:28
a little bit what i so go also what our a
00:27:31
sub analysis in jericho eh eh what we saw in this analysis
00:27:36
so yeah uh by consuming so it's not prohibit a pro he be tori to consume
00:27:42
a four basis that we're have hiker device varies to consume dairy products
00:27:47
and they can also choose other products uh
00:27:51
that behind customs recognition of very non varied sources
00:27:56
okay thank you chief burning questions otherwise we have of
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May 13, 2022 · 12:25 p.m.
Questions & Answers Session
May 13, 2022 · 12:40 p.m.
Short- or long-term denosumab therapy? Part 1
Dr. J. Everts-Graber, Bern
May 13, 2022 · 1:37 p.m.
401 views
Short- or long-term denosumab therapy? Part 2
Pr. Dr. S. Ferrari, Geneva
May 13, 2022 · 1:52 p.m.
Clinical debate: Short- or long-term denosumab therapy?
May 13, 2022 · 2:02 p.m.
113 views
