Calcium

Patients on the Marshall Protocol (MP) must not consume vitamin D. Unfortunately, a number of foods high in calcium, including milk, are often supplemented with vitamin D or folic acid.

For patients concerned about not consuming the Recommended Daily Allowance for calcium, there are these options.¹ If item is in italics, MP patients should check the label for vitamin D.

Other good options include:

• beans, including baked, limas, chickpeas, kidney
• cottage cheese
• cream (usually sold as whipping cream)
• half and half (good substitute for milk when cooking)
• oranges (the whole fruit, not the juice)
• sesame seeds
• sour cream
• leafy greens, including collards, kale, mustard greens, turnip greens, and bok choy (Chinese cabbage)

Note that certain green vegetables are less-effective sources of calcium. While their calcium content is high, their fiber and oxalic acid content interferes with the absorption of calcium.

Based on the best current evidence, it is unwise to consume (through food or supplements) the recommended maximum of calcium. Calcium supplements have been linked to an increased risk for cardiovascular events, vascular calcification, and kidney stones in the Women's Health Initiative Calcium/Vitamin D Supplementation Study. More recently, a large prospective study from Sweden published in the British Medical Journal² indicates that even when it comes to bone health, more is not better for calcium intake.

The Institute of Medicine (IOM) released dietary guidelines for calcium early in 2011, and the recommended dietary allowance (RDA) for calcium from a combination of diet plus supplements was set at 1000 mg a day for adult women until age 50 years and 1200 mg a day for women older than 50 years of age. The IOM also set a tolerable upper intake level of about 2000 mg a day for women in these age groups because of some concern about kidney stones and other health risks when calcium intake is very high.

A number of brands list calcium without vitamin D, but it is possible that some have unlabelled vitamin D. The primary ways to ensure the supplement is D-free is by using brands other MP members have used without a rise in their 25-D and to also monitor your own 25-D after beginning the supplement. One brand a number of patients use is Solgar Chelated calcium available from various online sources such as Amazon.com and health food stores. Other patients find they tolerate Trader Joe's Calcium/magnesium/zinc better. They do have one without vitamin D.

Note that calcium supplements may interact with various other non-MP medications including fluorquinolones, beta blockers, calcium channel blockers, digoxin and furosemide.

Do not consume more than 500 mg of calcium at any one time (i.e., take in divided doses). When eating a meal with food containing significant amounts of calcium (e.g., cheese or yogurt), decrease the amount of calcium supplement you take so you do not go over 500 mg at that meal.

Calcium can interfere with the body's ability to absorb tetracycline medications such as minocycline and demeclocyline and, therefore, diminish their effectiveness. Any calcium containing supplements or antacids should be taken at least two hours before or after taking these drugs.

Taking minocycline with dairy products may alter its absorption. Take this into consideration only if you need to eliminate any variable that might be affecting immunopathology. In that case, take your minocycline dose one hour before or two hours after consuming dairy products or other foods high in calcium. Otherwise, it is okay to take minocycline with food.

Several patients and physicians have reported that when patients with low levels of calcium begin to consume the recommended daily intake, they have an increase in symptoms. In the absence of more evidence, it would be difficult to characterize the exact nature of this reaction for certain, however, a 2001 study in mice showed that when mice with low levels of calcium were given supplemental calcium, they had a stronger immune response.³

In cases where patients experience a strong immune response after taking calcium, the dosage can be lowered to the level the patient tolerates and it can be increased later, as tolerated. It may also be worthwhile trying a different calcium source, in case the reaction is a sensitivity to the particular food or supplement.

If one becomes constipated, it may be helpful to take magnesium to counter balance the constipating effect of the calcium. The less well-absorbed types will be more effective for relieving constipation (e.g., Milk of Magnesia or magnesium oxide, like Twin Labs Magnesium Caps). But if the level of intake is high enough, other types may also work to counter constipation too, if the other forms are not tolerated (e.g., Solgar chelated magnesium).