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Chapter 1: What is calcium and why is it important for our health?
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If you're a parent, you likely have a steady hum of questions following you around all day. Am I doing enough? Am I doing too much? Why does everyone on my feed have an opinion and why does it all seem so urgent? I'm setting out to find some answers.
I'm Dr. Shoshana Ungerleider and this month on my podcast, TED Health, I'm investigating the intersection of health and parenting, getting practical tips to hopefully ease your parenting anxieties and help your kids feel calmer too.
I'll share actual science, stats, and researched ideas from experts, discussing everything from what happens when you let your kids roam free, to how adolescent brains work, to how you can best model healthy lifestyles for your little ones.
Listen to this series only on TED Health. Mukava, miellyttävä, veden pitävä, lämmin, hengittävä. Minunkin täytyy hengittää. Sinä asetat vaatimukset. Meiltä löytyy käsine. Tegera. Suoja käsineet työhön kuin työhön.
Hello, welcome to What's Up Dogs. Zandi, have you had any milk today? I had some in a cup of tea. My son Rex starts every morning with his bottle of milk, and that's how he gets his calcium. I'm pleased you brought it up, Zandi, because calcium is, of course, what we are going to be discussing today. The fifth most common element in your body...
We're going to be finding out more about what it is beyond its place in the periodic table. We're going to be finding out how it works in our bodies and whether we're all getting enough. Before we get into the main topic, though, I haven't seen you for a week. What have you got for me? What I've got for you, Chris, is 25 kilos of oats. These were not ordered by me.
So my wife, Dolly, ordered oats. And when they arrived, it was a 25 kilo bag. Not lots of little bags, like a massive, the kind of bag you'd see on a farm or maybe at a stables or something like this, like enormous bags. And she's got form in this area. So when she was in her early 20s, she wanted to buy a nice shirt on eBay. And she saw one, she ordered it, and it was in her size.
But the size was actually a kid's size. So it arrived and it was for a baby, essentially. Or for like for a dolly or something. So she kept it, thinking, if I ever have a daughter... I'm going to call her Daphne and she will wear this shirt. Anyway, fast forward, I guess, sort of 15, 20 years and she has a daughter called Daphne and Daphne wears this little pink shirt.
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Chapter 2: How does calcium interact with vitamin D in our bodies?
We're doing flapjacks. We're doing a lot of porridge, especially when you feel this pressure to eat the oats constantly. A huge amount of golden syrup that you now have. That is the problem is that you then to use the oats, you start buying butter and golden syrup and all these other ingredients. And then you're eating huge quantities of flapjacks. And you get it wrong.
And then you buy 20 kilos of butter and then you have to buy more oats. So if anyone's got any thoughts about the greatest oat dish they've ever had or anything we could do with them that we haven't already thought of, I would love to hear it. What's the wellness point here, Chris? Maybe you should really switch to eating enormous quantities of oats. They're very good for you.
They have high fibre. They lower your cholesterol. Just start... Well, then you go on the socials and everyone says that oats are full of oxalic acid and they're terribly bad for you. These are organics and they're not full of pesticides, but that's the other thing people say. I don't know. I'm so confused. I mean, the wellness industry is endlessly confusing.
I think it's probably that you shouldn't... You were only adding to that confusion today. This is an opportunity to offer friends and neighbours some baked goods, to offer them some free oats, to send some to the food bank, to enjoy... I mean, an obvious solution seems to be a wellness point would be to make a load of flapjacks for the What's Up Docs team. You think I'm stupid? They're in my bag.
Oh, have you? Yes, of course. They're right there. Well, there's your problem solved. So I think the wellness point is, I suppose when life gives you lemons, you know, famously you've got to make lemonade... But when life gives you oats, you know, there's not... But there's more to make. We've got to be inventive. It's an opportunity to socialise. Everyone has enjoyed a good laugh at our expense.
For me, the wellness point is much... I want to drill into the flapjack stuff more and go, the idea of bringing baked goods, if you turn up to someone's house, it's so much nicer than a bottle of wine. People love it. Right, Chris, we're talking about calcium and calcium feels to me very deeply embedded in our lives.
That when we were kids, I remember getting milk at school, we had to put the straw through the little foil cap and being sort of told to drink your milk as a good thing. Milk and calcium, I think in our minds are very linked. And I think about it every time I go abroad to a country where milk is not the way you start the day. You don't have milk on cereal, milk and coffee.
It's not part of the ritual of life in a way that it is in the UK. Right. There are other sources of calcium. I think a lot of the link between milk and calcium is that calcium is white. We know that chalk has calcium in it. That's white.
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Chapter 3: What role does calcium play in bone health?
Bones have calcium in it. They're white. Milk is white. Teeth are white. And so it's all, it's just sort of... The whiteness of milk has nothing, I don't believe, I don't think it has anything to do with the calcium content of milk. Anyway, we're not talking about milk specifically today. We are going to talk about calcium.
And it is an element that has a huge number of different roles in the body. We want to find out how much we need, where we get it, because as you say, it isn't all from milk. And listener Alison has asked whether you always get enough calcium in your diet or should we be taking calcium supplements? Very good question. You can buy calcium supplements everywhere. Do we need them?
Should we drink our milk? And Chris, what's really interesting is I don't really know the answer to any of these questions. I'm suddenly even thinking about the history of my sort of cultural assumptions about calcium and milk and my diet and things. I think, oh, do I need any of this stuff?
Well, Sandy, you don't have to know the answers to these questions because we have an incredible guest today. Do you want to introduce them? Our guest today is Dr. Sergeant Zach Verghese, consultant in diabetes endocrinology and general internal medicine, and she is an honorary lecturer and a senior clinical teaching fellow at Imperial College in London. We are very excited to have her with us.
Let's welcome her in.
MUSIC
Sarjan, thank you for coming on the podcast.
It's a pleasure.
Can we start by you simply explaining what is calcium and what does it do in our body?
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Chapter 4: How can we maintain healthy levels of calcium in our diet?
So when you hyperventilate, you blow off all the acid and your blood becomes alkali. Right.
Okay. And then what you notice physically is you get pins and needles and tingling in your fingers. Yes. Okay. And that's because of the calcium. So what happens when you blow off all your carbon dioxide and your blood becomes alkalemic is you bind more of your calcium to proteins, albumin, and less is free.
And what that does is it lowers your threshold potential and increases your neuron excitability. So this level of calcium is super important. So it's very, very tightly regulated and very fiercely defended by our hormones.
So calcium, almost all of it in the body is structural, it's in our bones, but this remaining 1% has all these different effects on our nerves firing, on our muscles contracting, on the function of every single cell.
Yeah.
Is it right that we can think of our bones almost as a calcium reservoir? To keep this exact level of calcium in our blood and in our cells, we've got this big pool of it in our bones that we can draw on, is that right? Listeners, I think when we raise the subject of calcium, a lot of people go calcium, vitamin D. Those two things are kind of linked in our minds.
What is the link between calcium and vitamin D?
So vitamin D is called a vitamin, but it's actually a hormone. It's a steroid hormone. We get vitamin D mainly from the sun. So sunshine irradiates dehydrated cholesterol in the skin. And that goes to the liver to get activated. And it goes to the kidneys to get activated. And then you've got active vitamin D. And that vitamin D helps you to absorb calcium and phosphate through the gut.
So you can almost think of it as pushing calcium and phosphate through the gut into the blood and then helping that calcium mineralize the bone.
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Chapter 5: Do we need calcium supplements, and are they effective?
And calcium is found in dairy products, so things like milk and cheese, and also eggs, meat, fish, tofu. Lots of products have calcium in them. There's a really good calculator called the Edinburgh Calcium Calculator.
So if you're not sure, and I would definitely encourage everyone to do this, if you're not sure if you're getting enough calcium in your diet, you can put in your weekly diet into this calculation. It will tell you if you're getting enough calcium.
So are we getting enough calcium?
Probably not.
Really?
Probably not. And we're probably not getting enough vitamin D. So to make enough vitamin D, you need about 10 to 15 minutes in the sun between around April and September if you have Caucasian skin. And if you have non-Caucasian skin, it's about 30 to 40 minutes a day. But I think a lot of us don't get that time out in the sun. Unless you work outside, a lot of people are sat inside.
Most people I see in my clinic are vitamin D deficient.
And do you think the answer is more sun or is the answer not just a vitamin D supplement?
I think if you are able to get more sun, that's good. But most people can't achieve that because of their work or just because of life. And those people might well need a vitamin D supplement.
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Chapter 6: What are the best dietary sources of calcium?
I have a vitamin D spray on my shelf and I sometimes remember to take it and most I don't remember to take it. But when I remember, I take a few sprays because then I know it's in and it's done and I work a lot. So I very rarely see the sun. I know I'm vitamin D deficient without measuring it.
Right.
I think listeners are going to relate. Everyone's going to feel a sigh of relief when you've said that. It's a perfect answer. It's like, I've got it. I don't always use it. It's great. Sajan, is there ever a risk of having too much calcium?
Definitely, yeah. You don't want to take too much calcium or too much vitamin D. So normally the body takes what it needs and you excrete the rest. But if you overwhelm your body's ability to do that, what would happen is you get too much calcium and too much phosphate and you get calcium phosphate product, which causes hardening of the blood vessels. So that isn't a good thing.
So I've definitely seen it where people take too much vitamin D and that leads to a high calcium.
You talk about your clinic. So it has never occurred to me to go to the University of Edinburgh's website and use their calcium calculator. That seems like a hassle. I'd have to keep a food diary. But that is one route to your clinic. Yeah. Is to never think about your calcium intake. Am I oversimplifying it or is that right?
I think our bodies look after us in a really great way. The people I see in clinic tends to be people who are older, 70s, 80s, 90s even. So I think even if we don't think about our bodies, our bodies generally take care of ourselves. So we don't have to overthink it. But if it's something that you're worried about, then I definitely would have a look.
And one thing about bones is about 80% of our bone mass is genetically determined. So if you know, okay, my mum had osteoporosis, my mum fractured a hip, my sister's got this, my brother's got this, it might trigger you to look more closely into what you're able to do. So for that remaining 20% of bone health, it might influence some decisions you make and some things that you do.
Many of our listeners are in their 20s, 30s, 40s, they're pre or perimenopause. What are the things at this point that people can do to avoid essentially ending up in your clinic?
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Chapter 7: How does exercise influence bone health and calcium levels?
And that happens at different ages for different sites. So at your hip, it happens around age 20 and at your spine around age 25. So good nutrition, sunlight, not smoking, not drinking, all those things that will help your bone health and to help you... And impact? Impact. Exercise is really important. Okay. So you reach your peak bone mass, and then you level, you have a plateau.
For women, when you're about 40, you start to lose bone mass, and then that accelerates more rapidly during menopause. For men, that happens five to ten years later, and men achieve a higher peak bone mass than women. So you have a kind of bone age graph. So to achieve that peak bone mass,
at 25 is really good that's a good thing to do you can think of it as money in the bank for when you're older when later as we lose bone so you lose about one percent of bone per year afterwards
a lot of people think that their bones are like rocks.
Yeah.
And that's not true, is it? Bones are living tissue and they're not just fixed when you hit your mid-twenties. Tell us about how they keep being changed throughout our lives, what changes them and what we can do to support that process.
Yeah. Thank you for asking, Chris. So the bone modelling is when you're growing. So you have two groups of cells. You have your osteoblasts and your osteoclasts.
So osteoblasts build bone. The B is for build. And then osteoclasts are like iconoclasts. They break things down and the clasts break down the bone.
So the remodeling is when the bone has stress going through it or there's micro cracks or damage and then the bone gets fixed. That's your remodeling.
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Chapter 8: What should we know about calcium intake across different cultures?
Against gravity. So running, skipping, walking, they're all against gravity. Is impact important?
Yes. You can divide it into kind of mild intensity, moderate intensity and high intensity. So mild would be what you said, the walking. Moderate would be kind of skipping and jogging. And the high would be basketball. But then you've got to think, if you have frailty or you have a high risk of fractures... You have to offset that high intensity exercise with the impact of falling and fracturing.
So you have to be careful about exercise as well.
So our older listeners who maybe want to get into this, they don't immediately sign up to the local basketball team and do this. But, you know, some walking is a good way of building up to this.
Exactly. So you want to do progressive and repeated exercise. You want to build up and you want to build up very gently. And you might even do just sitting down exercises first.
You were doing three types of exercise? Yeah. Okay.
The second is muscle strengthening.
Okay.
Because we need our muscles to be strong for us to stay upright. Okay. And the third is balance. So things like dancing and yoga and Tai Chi and Pilates. So balance to keep us from falling. So those things are really important, especially as you get older.
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