My mother is about 65 years old. During a routine whole body check-up, calcium deficiency was found in her report. I want to know the amount of calcium recommended, their source, diet rich in calcium and absorption also.

The body of an adult normally contains about 1200 gm. of calcium. At least 99 per cent of this is present in the skeleton, where calcium salts (chiefly hydroxyapatite), held in a cellular matrix provide the hard structure of the bones and teeth. Obviously all of this calcium comes from the diet. Among common foods, the calcium containing protein of milk (caseinogen) is much the richest source, which is one reason why milk and cheese are especially valuable for growing children. Half a litre of cow’s milk contains about 0.6gm of calcium. Most other foods contribute much smaller amounts. However, peas, beans, other vegetables and particularly cereal grains are frequently the chief contributors because of the large amounts eaten. Drinking water can provide significant amounts of calcium.

In Britain the average intake from this source is about 75 mg calcium per day, but the variations are large, from none in water from peaty, acidic hill lochs in Scotland to 200 mg or even more in water obtained from wells sunk in chalk or limestone. 70 to 80 per cent absorption of the calcium in the food is normally excreted in the faces. Calcium absorption may be impaired either by lack of vitamin D, by any conditions causing small intestinal hurry, by the combination of calcium with excess fatty acids to form insoluble soaps in steatorrhoea or by certain substances in the diet which can form insoluble salts with calcium. These include foods rich in oxalic acid (eg. spinach) and phytic acid which is present in the outer layers of cereal grains. Hence ‘wholemeal’ bread contains more phytic acid than white. To overcome the influence of phytic acid, calcium carbonate has been added to flour in Britain. W.H.O. recommends a daily intake of 500 mg. for adult men and women, rising to 1200 mg. during pregnancy and lactation. For adolescent boys and girls the recommended intake is 600 to 700 mg. daily. In many parts of Africa and Asia children develop healthy bones and adults remain in calcium balance despite calcium intakes which may be no more than half the above recommendations. Abundant sunshine possibly produces this effect. However, a daily intake of 1000 mg. should be taken during pregnancy and lactation. Deficiency of calcium and vitamin D go hand in hand and are best considered together.

My mother is about 65 years old and usually remains inactive and functionally dependent on other family members. She is otherwise healthy and has no disease. We have consulted a physician for this problem. He advised to increase her level of physical activity with the help of exercises. I want your opinion about this problem.

Inactive elders are at greater risk of becoming functionally dependent then their more physically active counterparts. Higher levels of physical activity are associated with reduced risks of future disability, disease related morbidity and mortality. Even sedentary elders should be urged to increase their level of physical activity. By writing out an exercise prescription, a physician demonstrates the importance of the activity and may improve compliance. Components include strength training (isolated muscle group contractions), endurance training (walking, cycling, swimming), flexibility (static stretch of various muscle groups) and balance (tai chi, dance). Ideally, the patient should aim for a total of 30 minutes of activity daily, though any increase in exercise is likely to be beneficial.

The type of physical activity prescribed should be geared to the patient’s diagnoses and risk factors – eg. quadriceps strengthening for a man with osteoarthritis of the knee, tai chi for a woman with osteoporosis at risk for falls, and aerobic exercise for a man with cardiovascular risk factors.

I am a 50-years-old working woman. Since the last two to three years I am suffering with hypertension and diabetes. Recently I have consulted a physician for this problem. He told me that hypertensive patients with diabetes remains at a high risk of heart disease, kidney disease and some other side-effects on various organs of the body. What is your opinion about this problem?

There must be a special considerations in the treatment of diabetic hypertensive patients. Hyper­tensive patients with diabetes are at particularly high risk for cardiovascular events (heart diseases). More aggressive treatment of hypertension in these patients prevents progressive nephropathy (kidney disease), myocardial infarction (heart attack) and stroke. Treatment recommendations suggest a target of blood pressure less than 130 and 86 mm of Hg. However, most diabetics require combinations of three to five agents to achieve these goals, usually including a diuretic and a calcium channel blocker or beta-blocker. In addition to rigorous blood pressure control, management of diabetics should include aggressive treatment of other risk factors and early intervention for coronary arteries (arteries supplying blood to heart) disease and left ventricular dysfunction of heart.