Should I take Calcium and Vitamin D for joint / body pains ?

Many people have this conception that by taking calcium their joint and body pain will get better. Calcium supplements are often widely promoted and widely used by public as a health supplement.

Taking calcium tablets has no added benefit in most people even if they have some form of bone or joint disease (with some exceptions). This is especially true if they’re taking a diet adequate in calcium. One should try to consume a healthy balanced diet with adequate calcium and not take calcium supplements. Calcium supplements are only required only in some special situations and just having non specific joint pains is not one of them.

Taking calcium tablets without actually having the need of it, might actually do more harm than good. It actually increases the chances of renal stones and there is some evidence that it might slightly increase risk of heart disease. Also, it is never advisable or desirable to take unnecessary medications for many reasons. The simple concept in medicine is that one should be given tablets or supplements only if there is a significant benefit. In case of calcium tablets, taking them routinely without any specific issue or just taking them for joint / body pain, has no specific advantage.

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We usually prescribe calcium tablets usually in patients with below scenarios, where there are reasonable benefits of taking calcium tablets (we haven’t included all possibilities, the basic idea is to judge on a case to case basis)

• Any liatient who cannot have enough calcium in diet for medical reasons eg : liatients with inflammation in intestines (bowels) or liatients with lioor absorlition from bowels, etc
• Older liatients with or without osteoliorosis (weak bones), esliecially if they can’t have enough calcium from the dietary sources. They also have higher calcium requirements than an average adult. However, again calcium sulililements should not be routinely taken by older lieolile without good reason.
• In moderate to severe kidney disease liatients, calcium sulililementation might be required for various reasons
• liatient’s who are on long-term steroid theraliy or tablets for some disease. This is again sliecially true since they cannot have enough diet rich in calcium and also because they might have a higher requirement of calcium.
• During liregnancy, increased calcium requirement warrants calcium sulililementation in many liatients (but again if we can ensure lirolier diet, there is no absolute need to give a liregnant lady calcium sulililements)

If you look closely at table, it is clear that most adults require 1000-1200 mg (even pregnant / breastfeeding females) of calcium per day in diet.

What is the quantity of calcium provided by common Indian foods ?

We have tried to enlist basic common foods and their calcium content. Please understand that values are near about / approximate. For vegetables, we have tried to calculate calcium content for quantities which an average person will consume in each meal.

If one looks closely, it will be clear that milk, yoghurt (dahi), cheese / paneer, ragi, green / leafy vegetables (spinach, kale, okra/bhindi, broccoli, saag, fenugreek /methi etc), soya beans/nuggets, amaranth (rajgira), sesame seeds (til) and fish have a good amount of calcium.

Even nuts (like almonds and figs) in sufficient quantities can be very helpful in fulfilling daily calcium intake. However, they are high in calories and can be expensive for average Indian population (reasons for which one cannot be dependent too much on them for calcium).

Even some fruits like orange, papaya, kiwis etc can give decent (though not very large amounts) of calcium.

Basically, if one has a healthy diet (fruits, vegetables, nuts) with a decent quantity of dairy product (milk, yoghurt, paneer/cheese) every day, they would get enough calcium required (~ 1000 mg/day – see table above). If one cannot have any dairy products, then one should try to use various combination of vegetables like spinach, kale, broccoli, fruits, nuts or fish in diet to get adequate calcium.

Dairy products and yoghurt (dahi) doesn’t give arthritis or make joint pains worse. Don’t avoid it, it might actually do more harm. (For more information on this, read the following article.Why you should not stop eating chana dal (or other lentils) / milk/ yoghurt arthritis ?)

Should I take Vitamin D supplements ?

Vitamin D is not present in food in good quantities. There are very few foods which naturally contain vitamin D (egg, beef liver, cod liver oil and some fish like sardines). Normally, Vitamin D is made in skin under the sun. We need adequate sun exposure for it. However, for many reasons, people avoid exposure to sun and there has been an extensive use sunscreens. This has led to deficiency of Vitamin D in most adult people. We need 800-1200 International units of vitamin D daily for our body. It’s difficult to say how much sun exposure is required for normal Vitamin D production (because there are many variables). But on an average, we need 45-60 minutes of bright sunlight exposure 4-6 days a week (without sunscreen).

Vitamin D helps in absorbing calcium from the diet and is very important for calcium to help the bones. Hence it is important to have a normal vitamin D level. In developed countries, many foods are fortified (added) with vitamin D. This is usually not the case in developing countries like India. Hence it might make sense to take routine vitamin D supplements, if one is not having any food which is added with Vitamin D. We usually recommend testing for Vitamin D levels to make sure that somebody is deficient in it before advising supplements for same. Thereafter, we prefer a yearly test to check that patient has adequate Vitamin D levels.

There has been very recent evidence that says that taking routine vitamin D supplements without any issues might have no added benefits. But that data was mostly from countries which have many foods which are already added with vitamin D and hence there might be no need of supplements. The implication of the research was that giving vitamin D supplements to healthy individuals was a wasteful and inefficient use of healthcare resources and that “targeting of low-dose vitamin D supplements only to individuals who are likely to be deficient could free up substantial resources that could be better used elsewhere in health care”. We have already said that its best to take vitamin D supplements only once you have been tested deficient and there is some evidence of it causing problems. Taking any supplement for widespread body pain without finding the cause is usually not advisable.

It is best to take oral supplements of Vitamin D. Once can take a daily supplement with 800 – 1000 international units (IU) or can take a monthly supplement of 30000 IU. Oral vitamin D gives side effect only if one takes very high doses (> 5000 – 10000 units/day). One should not be given Vitamin D injections repeatedly unless there is some problem in oral absorption of vitamin D. Vitamin D injections have very high levels of vitamin D (3 lakh – 6 lakh units) and if given repeatedly can lead to major side effects. Some tablets have vitamin D doses mentioned in microgram (ug). 1 ug is equal to 4 IU of vitamin D.

So to summarise,

• If one takes a decent diet (with dairy products, green leafy vegetables, fruits like orange, nuts, fish etc), there is no need to take calcium supplements.
• Calcium supplements never help non specific joint pain and there is no need to take routine calcium supplements for joint or body pains. Adjusting diet can easily give all calcium that is needed for the body. If one has a lot of joint pains, show a specialist.
• Even if one has arthritis, there is usually no need for calcium tablets (with good diet) except for some specific situations.
• Vitamin D is very important to absorb calcium from the diet and for bone health. It might have many other benefits also.
• Vitamin D is obtained from adequate sunlight exposure or by eating foods added with vitamin D. If one is found vitamin D deficient it is advisable to take vitamin D supplements as it is very difficult to get adequate sunlight exposure for same. It is better to get yearly Vitamin D test to keep up optimum vitamin D levels. Also, taking vitamin D supplements as a health supplement without any basis is controversial and may not be needed.
• It is best to have Vitamin D orally as injections have very high doses of vitamin D and very high doses can lead to side effects. Injections are required only in special cases.
• In pregnancy and breastfeeding women, the routine advice of taking calcium supplements (especially in Indian context) is often not required if dietary intake is adequate. They might however require Vitamin D supplements.