In a developing country like India, there are always many concerns with regards to the dietary nutrition-related deficiencies. Calcium deficiency was not deemed to be as big a concern as was the deficiency of energy-rich foods, protein, and iron. Previous studies conducted by the Indian Council of Medical Research (ICMR) noted that a combination of factors allowed the Indian body type to maintain a healthy Calcium balance, even when the intake was as little as 300 mg/day for an adult. This was more than three times lower than the Calcium daily value of 1000 mg intake for a healthy adult, defined for developed countries such as the United States. The difference between the Indian and Western body type, as well as the diets, was considered as a reason for this huge difference. These differences were primarily about the innate ability of Indian body type to minimize the daily loss of Calcium. Indians also have a lower protein diet that helps in reducing the loss of Calcium. Relative abundance of Vitamin D also leads to better absorption of Calcium from the gut. A lower incidence of hip fractures on per capita basis was also used to confirm the above hypothesis.
Source: International Osteoporosis Foundation
Unfortunately, new research is dispelling the notion that Indian’s should assume that all is well, with regards to their Calcium intake. Here are some of the new findings that paint a not so rosy picture as presented earlier. [1, 2, 3]
- The ICMR committee of 2008 concluded that the previous recommendation for 400 mg of daily Calcium intake was insufficient, and led to widespread Calcium depletion, particularly in women after repeated pregnancy and lactation.
- Adaptation of body to chronic Calcium depletion has also resulted in a compromise in stature growth and restriction in skeletal function.
- Fractures in Femur neck occurred 10-15 years earlier in women from the low-income group as compared to that in high-income group.
- In a population sample comprising of different income groups, the average daily intake of 933, 606 and 320 mg Calcium from high to low-income group also correlated with the corresponding decrease in the bone mineral density.
- Study on 3 socio-economic groups found that the extent of Osteoporosis in Spine of women belonging to a high-income group that consumed with a daily intake of 1000 mg /day was 16%, compared to 65% in the low-income group with intake of 400 mg/day.
- A study reported a high prevalence of Osteopenia (52%) and Osteoporosis (29%) thought to be the result of inadequate nutrition in women belonging to the low-income group. 
Given several observations citing that the earlier recommendation of 400 mg/day for Calcium was insufficient, the ICMR committee in 2010 came up with the revised recommendation of 600 mg/day. Calcium intake for lactating and pregnant mothers was set at 1200 mg/day, making it same as the WHO recommendation. The ICMR committee also suggested that a minimum daily intake of 200 ml of milk would be necessary along with the remaining legume and cereal based diet.
In a country like India, the consumption of milk and dairy products is increasing among the high and medium income groups, but the consumption is still to catch up in the low-income group. The poverty line defines the total consumption of milk in a month to be just 1.61 liters; that translates to roughly about 50 ml per day. This is in stark contrast when compared against the ICMR 2010 guideline of 200 ml milk per day per person. The continuous rise in the milk prices has made it even more out of reach for the poor. The wholesale price of milk increased at a CAGR of 10.5% from April 2006 to March 2014. 
Therefore, given the noted Calcium deficiency, the increased daily intake guidelines and lack of access to dairy products, especially among the poorest is a cause for concern. Fortunately, few cost-effective and suitable alternatives exist which are within reach of almost everyone.
Raagi – 100 gram of Raagi contains nearly 370 mg of Calcium.  It has different names in various parts of India such as nachani, kezhwaragu or keppai, mandiaa, madua.
Rajgeera – Scientifically known as Amaranthus Cruentus, it also has many different names all over India such as Rajgeera, Chua, and Ramdana. A 100 gram serving of Rajgeera contains 159 mg i.e. 16% of the daily Calcium need.  It is available in both grain and powder form and commonly sold as Laddu’s.
White Beans – Soya beans, also known as lobia in Hindi, chora in Gujarati, they are an excellent source of Calcium. A 100 gram serving of White Beans contains as high as 175 mg of Calcium.
Turnips –A vegetable that is very rich in Calcium and other minerals. 100 g of Turnip contains nearly 190 mg of Calcium.
Spinach – A 100 gram serving of boiled Spinach can provide as much as 90 mg of Calcium. Spinach should be boiled for at least about a minute which helps in reducing its Oxalic Acid concentration. Otherwise, it comes in the way of effective absorption of Calcium.
Okra – A 100 gram serving of Okra, also known as Bhindi provides 82 mg of Calcium.
In addition to meeting the required intake of Calcium, other minerals such as Phosphorus and Vitamin K are also important for the bone health. Phosphorus is required in the same amount of Calcium. Indian diets are rich in Phosphorus, so there is little concern about its deficiency. Vitamin K is present in several green leafy vegetables.
The effective absorption of Calcium and Phosphorus, the two essential minerals in our bones is dependent on Vitamin D. Current guidelines suggest that an individual must get between 600 IU to 800 IU of Vitamin D. Exposure to Sunlight, of which we have plenty produces enough Vitamin D that our body needs. However, this only happens when any part of our skin is exposed to the Sun. Despite the fact that India is a Sunshine rich country, studies carried out in both North, and South show Vitamin D deficiency and is considered a possible reason for high prevalence of Osteoporosis, especially in the females. Females are more likely to stay indoors as well as have minimal exposure to Sun due to their clothing. Even a 5-minute adequate exposure to Sun can help meet the daily requirements but not when the body is fully covered in clothing. There are very few foods that contain Vitamin D. Therefore effort must be made to derive as much as Vitamin D as possible through the Sun exposure.
When one fails to get required Calcium and Vitamin D through diet, doctors typically recommend taking the Calcium and Vitamin D supplements. However, these supplements should not be taken without proper recommendation.
Does excess intake of Calcium cause any harm?
Research suggests that getting too much calcium through supplements can cause harm to the body, so it is important not to take more than the recommended amount.
- Excess supplementation causes a higher level of calcium in the blood. It leads to impairment of kidney function which then increases the absorption of iron, zinc, magnesium and phosphate. Moreover, it can also lead to Kidney stones formation.
- Supplementation with mega doses of 50,000 IU of calcium daily, when given to patients with advanced cancer, resulted in Hypercalcemia.
Can calcium supplements cause calcium deposits and bone spurs?
While taking excess Calcium is not advised, Calcium supplements do not cause bone spurs or other types of Calcium deposits in the body. Instead, bone spurs are created when there is inflammation, and bones grow to fuse together areas that are causing problems. Similarly, Calcium deposits are again formed as a result of body’s protective action against inflammation. If you have bone spurs or other calcifications in your body that are bothering you, or you just have pain in certain areas, an orthopedic doctor can help investigate the cause.
Even though a typical Calcium rich diet may be out of reach for the vast population of India, many naturally occurring sources of Calcium that are also affordable exist. There is a need to build greater awareness among the population about such alternatives, as well as about the healthy practices that can prevent deficiency of Vitamin D in our body. The female population in India is especially at a much larger risk of developing bone related disorders such as Osteoporosis and Osteopenia, but by taking certain preventive steps that are also very practical and feasible, it is possible to either completely prevent or delay the occurrence of such serious illnesses.
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- Shatrugna V, Kulkarni B, Kumar PA, et al. (2005) Bone status of Indian women from a low-income group and its relationship to the nutritional status. Osteoporos Int 16:1827.
Dr. Kaleem Mohammed graduated as a Bachelor of Physiotherapy in 2014 from Deccan College of Physiotherapy, affiliated to Dr. N.T.R. University of Health Sciences, Vijayawada, India. Dr. Kaleem is an expert at handling physiotherapy needs of patients suffering from orthopedic and spinal conditions and post-surgery rehabilitation. Dr. Kaleem is associated with HealthClues since its inception where he facilitates diagnosis and advanced consultation with senior doctors. He is also a medical researcher and prolific writer who loves sharing insightful commentaries and useful tips to educate the patient community about fitness, treatment options, and post-treatment recovery.
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