(Ca, Ca2+, lat. Calcis)
Kalcijum je najzastupljeniji mikroelement u ljudskom organizmu. Prosečni odrastao muškarac ga sadrži oko 1,5 kilogram, a žena oko 1 kilogram. Oko 99% kalcijuma iz organizma se nalazi u kostima i zubima. Ostala količina se nalazi u krvi, limfi i ostalim telesnim tečnostima, ćelijskim membranama, kao i u ćeliji.
Biološka uloga
Učestvuje u strukturi kostiju i zuba. Najmanje 99% od ukupne količine kalcijuma se nalazi u kostima i zubima. Kalcijum se u kostima pretvara u hidroksiapatit – Ca10(PO4)6(OH)2 ali kosti sadrže i znatne količine nekristalnog kalcijum-fosfata, karbonata, citrata, fluorida, magnezijuma, tragove stroncijuma kao i manje količine drugih soli. Minerali čine oko 50% ukupne mase kostiju, a ostala masa se sastoji od organskog matriksa u kome ima proteina, glikoproteina i proteoglikana na koje se vezuju kalcijumove soli. Kost se neprestano troši i obnavlja, pa količina minerala u kostima predstavlja ravnotežu između izbacivanja i mobilizacije minerala. Svaki dan se u kostima može razmeniti i do 700 mg kalcijuma. Neposredni izvor kalcijuma za kosti jeste kalcijum iz telesnih tečnosti i ćelija. Iako je ova količina mala (<10 g) u odnosu na količinu u kostima ipak je kritički važna za regulaciju izneneđujuće velikog broja ćelijskih aktivnosti.
Metabolička regulacija. Ovo je jedna od glavnih uloga kalcijuma. Protein kinaze, koje modulišu aktivnost ključnih enzima kao odgovor na vezivanje hormona na površinu ćelija, su aktivirane kalcijumom – bilo direktno, bilo bilo vezivanjem za visoko afinitetni protein koji vezuje kalcijum – kalmodulin.
Regulacija ćelijskih aktivnosti. Tu spadaju funkcije živaca i mišića, hormonska delovanja, koagulacija krvi, pokretljivost ćelija i mnoge druge. Kontrakciju mišića reguliše tako što reguliše kontraktilnost aktina i miozina. Obzirom da učestvuje u tako velikom broju ćelijskih regulacija naziva se »drugim glasnikom« (eng. Secondary messenger).
Posreduje u reakcijama ćelija na razne stimuluse. Način ovog delovanja je analogan regulacionim delovanjem cikličnih nukleotida. Delovanje kalcijuma je posredovano jednim intracelularnim proteinskim receptorom, kalmodulinom koji veže jone kalcijuma kada im koncentracija u reakciji na stimulus poraste. Kalmodulin je do sada nađen u svakoj proučenoj ćeliji koja sadrži jedro. Kada se Ca2+ veže za kalmodulin on modulira aktivnost velikog broja enzima, a među njih spadaju i oni koji učestvuju u metabolizmu cikličnih nukleotida, fosforilaciji proteina, sekrecijskoj funkciji, mišićnoj kontrakciji, sastavljanju mikrotubula, metabolizmu glikogena i fluksu kalcijuma. Nađeno je da su snažni inhibitori delovanja kalmodulina fenotijazinski lekovi, koji relaksiraju glatke mišiće i nekoliko peptida koje nalazimo kod otrovnih insekata.
Ulazi u sastav brojnih metaloenzima. Npr. α-amilaza i fosfolipaza sadrže kalcijum kao esencijalni deo katalitičkog mesta. Osteokalcin je protein iz kostiju koji je značajan za normalnu kristalizaciju minerala kostiju. Kalbindin D je esencijalan za intestinalnu resorpciju kalcijuma, prevođenje kalcijuma u ćelije i resorpciju kalcijuma iz glomerularnih filtrata u bubreg. Neki od proteina krvi moraju vezivati kalcijum za svoju aktivnost. Mnogi antikoagulanti helatne strukture vezuju kalcijum (kao što je EDTA i citrat).
U okviru kalcijum-vezujućih proteina kalcijum utiče i na:
Sekreciju hormona i neurotransmitera. Protein aneksin mora vezati kalcijum da bi se mogao vezati za fosfolipidnu membranu. Tom prilikom inicira fuziju inracelularnih sekretornih vezikula sa površinom ćelijske membrane i egzocitozu.
Ćelijsku adheziju. Kaderini su kalcijum-zavisni proteini koji regulišu ćelijsku adheziju i normalnu kontaktnu inhibiciju ćelijske replikacije. Defekt u funkciji kaderina je povezan sa razvojem maligniteta.
Citoskeletni proteini.
Važnost Ca2+ u ovim aktivnostima odražava se i u preciznosti kojom se reguliše koncentracija Ca2+ u plazmi. Normalna plazma sadrži 9-11 mg kalcijuma u 100 mL. Dnevne varijacije su retko veće od ±3%. Ove uske granice odražavaju se složenim regulacijskim delovanjem vitamina D, paratiroidnog hormona, kalcitonina i drugih hormona.
Metabolizam
Prosečan odrastao organizam resorbuje od 25 do 50% kalcijuma koji se unese hranom. Kalcijum se resorbuje iz duodenuma i proksimalnog jejunuma pomoću jednog proteina koji vezuje kalcijum, a sintetiše se u odgovoru na delovanje 1,25-dihidroksiholekalciferola (1,25-dihidroksivitamin – D3). Resorpciju inhibiraju jedinjenja koja sa kalcijumom grade nerastvorne soli kalcijuma (oksalati, fitati, fosfati) i nerazgrađenim mastima koje sa kalcijumom grade kalcijumove sapune. Veliki deo kalcijuma primljenog iz hrane se ne resorbuje, već se izlučuje fecesom.
Nivo kalcijuma u krvi je regulisan hormonom kalcitoninom, paratiroidnim hormonom i vitaminom D. Ovi hormoni deluju zajedno i regulišu nivo kalcijuma u organizmu. Oni kontrolišu resorpciju kalcijuma iz creva, njegovu ekskreciju u bubregu, kao i brzinu ugradnje u kostima. U nedostatku vitamina D resorpcija opada na 10% od količine koja se unese hranom. Kada je unos kalcijuma nedovoljan dolazi do njegovog uklanjanja iz depoa u kostima i koristi se za održanje nivoa kalcijuma u krvi. Drugi hormoni koji se utiču na nivo kalcijuma su estrogen, glukokortikoidi, tiroidni hormon, insulin i hormoni rasta.
Neka jedinjenja kao što su fitati koji su poznati i kao vlaknaste materije, ali i oksalati koji su prisutni u lisnatom povrću smanjuju resorpciju.
Resorpcija i zadržavanje kalcijuma o organizmu se smanjuje sa godinama, pre svega zbog nižeg nivoa estrogena i testosterona u organizmu, dok organizam žena u postmenopauzi može da resorbuje svega 7% kalcijuma unetog hranom.
Resorpcija kalcijuma se povećava u toku trudnoće, a ukoliko u ishrani nema dovoljno ovog elementa dolazi do imobilizacije kalcijuma iz kostiju.
Kada je jednom resorbovan, kalcijum se može izlučiti iz organizma na nekoliko načina. Bubrezi izlučuju kalcijum kada je njegova koncentracija u krvi veća od 7 mg/100 mL. Velika količina kalcijuma se luči u lumen creva i uglavnom se gubi fecesom; dok se manje količine gube znojenjem. Za svaku osobu važi da su količine izlučene urinom relativno konstantne, dok količina fekalnog kalcijuma jako varira u zavisnosti od načina ishrane. Hrana bogata proteinima znatno povećava ekskreciju kalcijuma.
Pušenje, unos visoko rafinisanog šećera, kofeina, alkohola i previše soli koja sprečava resorpciju čime se povećava rizik od deficijencije.
Prirodni izvori
Dobri izvori kalcijuma su mleko i ostali mlečni proizvodi, kelj, tofu, aronija, konzervirana riba sa kostima, kikiriki, orah, semenke suncokreta, brokoli, karfijol, soja, pasulj. Dobri izvori mogu biti i obogaćena hrana kao što su sokovi, hleb ili cerealije. Često je i kalcijum koji potiče iz vode značajan izvor.
Kalcijum se iz mleka mnogo bolje usvaja nego iz biljnih namirnica. Izuzetak su biljna hrana sa tamno zelenim listovima, kao što su brokoli, kelj, repa i slačica. U jednoj studiji je pokazano da se iz kelja usvoji više kalcijuma nego iz mleka.
Neke biljke, kao što je spanać sadrže velike količine kalcijuma, ali je njegova usvojivost niska zbog visokog sadržaja oksalne kiseline koja vezuje kalcijum ćineći ga teže usvojivim. Nerastvorne vlaknaste materije takođe doprinose slabom usvajanju kalcijuma, dok rastvorne vlaknaste materije (kao što su pektini koji se nalaze u voću) ne utiču na usvojivost kalcijuma.
Sadržaj kalcijuma u prehrambenim proizvodima
| Namirnica | % |
| Mleko – punomasno | 23 |
| Mlečni proizvodi | 22 |
| Cerealije (izuzev beli hleb) | 16 |
| Sir | 13 |
| Hleb – beli | 9 |
| Meso | 5 |
| Jaja | 2 |
| Riba | 2 |
| Voće – koštunjavo | 1 |
Kod velikog broja osoba unos kalcijuma hranom je nedovoljan, posebno kod žena. Osim toga manje od 10% starijih osoba unosi dovoljnu količinu kalcijuma što dovodi do pojave osteoporoze. Ćene u trudnoći, dojilje, devojke u periodu adolescencije, žene u periodu postmenopauze su takođe rizične grupe. Tada se preporučuje dodatni unos kalcijuma putem kalcijumom obogaćene hrane ili preparatima koji sadrže kalcijum.
Preparati kalcijuma mogu sadržati kalcijum u različitim oblicima: kalcijum-karbonat, kalcijum-aspartat, kalcijum-citrat, kalcijum-glukonat i kalcijum laktat. Kisela forma kalcijuma: kalcijum-citrat se usvaja bolje od kalcijum-karbonata što može biti značajno za starije osobe koje imaju nizak nivo kiseline u želucu. Kalciju-laktat i kalcijum-aspartat se takođe dobro usvajaju. Kalcijum-karbonat može uzrokovati i sporedne negativne efekte kao što su: mučnina, gasove i konstipaciju (zatvor). Preporučuje se unos preparata kalcijuma sa hranom, jer se tada kalcijum bolje usvaja. Prilikom unosa preparata kalcijuma, preporučuje se ujedno unos i preparata magnezijuma. Ovo sprečava pojavu konstipacije.
NAPOMENA: Preparate kalcijuma ne bi smele da koriste osobe sa oboljenjem bubrega, srčanom aritmijom, osobe koje su imale kamen u bubregu i koje boluju od konstipacije ili dehidratacije.
Poremećaji
Nedostatak
Umereni nedostatak kalcijuma u organizmu može dovesti do nervne osetljivosti, grčeva mišića, krtih noktiju, ubrzanog kucanja srca i nesanice. Veći nedostatak kalcijuma izaziva neuobičajene otkucaje srca, grčeve i bolove u mišićima, ukočenost, žmarci u rukama i nogama. Deca mogu oboleti od rahitisa – bolesti koju karakteriše intenzivno znojenje glave, usporeni pokreti, deformitet kostiju, i usporenost rasta. Nedostatak kalcijuma kod odraslih može izazvati i osteomalaciju koju karakteriše bol u kostima, slabost mišića i usporeno zarastanje rana.
Rizična grupa kod koje se može javiti nedostatak kalcijuma su starije osobe, zatim osobe koje u ishrani ne koriste hranu bogatu kalcijumom, sportisti koju su na visoko proteinskoj ili vlaknastoj dijeti i alkoholičari.
Simptomi nedostatka kalcijuma su tetanija i srodni mišićni i neurološki poremećaji. Ovi se simptomi najčešće pojavljuju u slučaju nedostatka vitamina D, hipoparatiroidizma ili zatajivanja bubrega, ali i suviše mala količina kalcijuma u hrani može biti uzrok. Kad se koncentracije u plazmi snize ispod normale mobiliše se kalcijum iz kostiju pa Ca2+ u cirkulaciji poraste, ali je stvaranje nove kosti usporeno ili sprečeno. Negativna neto ravnoteža Ca2+ dovodi do rahitisa kod dece ili osteomalacije kod odraslih.
Još jedan faktor utiče na gubitak kalcijuma iz kostiju, a to je odnos kalcijuma prema fosforu u hrani (Ca : P). Kod životinja odnos Ca : P = 2 : 1 dovodi do maksimalne resorpcije kalcijuma i minimalnih gubitaka minerala iz kostiju, dok veliki udeo fosfata povećava gubitke kalcijuma fecesom. Ne zna se koji je najidealniji odnos Ca : P kod ljudi ali sadašnja tendencija u potrošnji hrane je da se poveća konzumacija fosfora, što je posledica fosfatnih aditiva u hrani. Osim toga, ishrana bogata fosforom dovodi do bržeg uklanjanja kalcijuma iz organizma. Fosfor se nalazi u hrani bogatoj mesom, sirom, fabrifikovanoj hrani i gaziranim napicima. Stoga su osobe koje konzumiraju veće količine ovakve hrane podložnije pojavi nedostatka kalcijuma u organizmu. Takođe i osobe koje su na dijeti za gubitak suvišnih kilograma su rizična grupa, jer ne unose kaloričnu hranu, koja je često dobar izvor kalcijuma.
Osteoporoza je oboljenje kod kog kosti postaju porozne i u težim slučajevima može doći do njihovog loma usled veće telesne mase osoba obolelih od osteoporoze. Simptomi osteoporoze mogu izostati sve dok se kost ne polomi, a u drugim slučajevima javlja se bol u leđima. Osteoporoza se najčešće javlja kod žena koje unose hranu siromašnu kalcijumom. Oko 35% žena oboljeva od osteoporoze nakon menopauze. Kod muškaraca se ova bolest ređe javlja. Pravilnom ishranom smanjuje se mogućnost oboljevanja od osteoporoze. Dovoljan unos kalcijuma je od presudne važnosti u ranijoj fazi adolescencije jer se tada gomila najviše kalcijuma u kostima. Nedostatak kalcijuma je samo jedan od faktora koji doprinose pojavi osteoporoze. Velika je verovatnoća da genetski uticaj veliki. Adekvatan unos vitamina D, magnezijuma i bora je neophodan za gradnju zdravih kostiju. Pokazano je da se najveći gubitak kalcijuma javlja noću, najverovatnije zbog povećanog sadržaja hormona kortizol-a.
Tumor debelog creva može biti povezan sa nedostatkom kalcijuma u organizmu. Naime, kalcijum svoju zaštitnu ulogu ispoljava i vezivanjem za supstance kao što su žučne kiseline i masti i time smanjuju mogućnost pojave kancera u crevima. Takođe, kalcijum može da normalizuje rast ćelija u zidovima intestinuma.
Pored toga nedostatak kalcijuma može dovesti i do niskog krvnog pritiska, grčeva u mišićima i paradentoze.
Toksičnost
Izgleda da kod zdravih ljudi ne može doći do hiperkalcijemije uzrokovane prehranom, jer se višak kalcijuma jednostavno ne resorbuje. Suviše veliki udeo kalcijuma može međutim pridoneti povećanju koncentracije Ca2+ u serumu kad se radi o hiperparatiroidizmu, stvaranju kamena u bubregu, trovanju vitaminom D, sarkoidozi i kanceru. Osim toga visoke koncentracije kalcijuma su povezane sa razgradnjom vitamina K, slabom usvojivošću gvožđa i cinka i pogađa aktivnost neurona u mozgu koji kontrolišu raspoloženje i emocije.
Preporučene dnevne količine
Potrebe za kalcijumom variraju od životnog doba i najveće su periodu rasta i razvoja, ali i kasnije u životu. Najnovije studije iz 1997. godine su pokazale da se u toku peroda trudoće i laktacije potreba za kalcijumom NE POVEĆAVA!
Muškarci: 700-1300 miligrama
Žene: 700-1300 miligrama
Trudnoća i laktacija: 1000-1300 miligrama
Kao gornja granica se uzima 2500 miligrama kalcijuma dnevno.
Upotreba u medicini
Unos kalcijuma u kasnijim godinama može da uspori proređivanje kostiju koje je povezano sa osteoporozom. Tretman žena u postmenopauzi koji uključuje unos kalcijuma u kombinaciji sa estrogenom se je pokazao kao efikasniji od tretmana koji uključuje unos samo estrogena.
Dovoljan unos kalcijuma kod dece dovodi do stvaranja jačih kostiju.
Kalcijum ima i zaštitnu ulogu kod sporednih efekata u tretmanu kortikosteroidnim lekovima. Ovi lekovi se najčešće koriste u lečenju artritisa, astme i ostalih hroničnih bolesti. Tada dolazi do smanjenja koštane mase, čime se povećava mogućnost pojave osteoporoze. Kalcijum se u ovom slučaju najbolje kombinuje sa vitaminom D.
Preparati kalcijuma mogu smanjiti visok krvni pritisak kod osoba srednje hipertenzivnih osoba.
Kalcijum se koristi i za sprečavanje grčeva nogu kod žena u trudnoći, najverovatnije smanjujući nervnu iritabilnost. Takođe se koristi za smanji pojavu menstrualnih bolova i simptoma koji su povezani sa premenstrualnim sindromom.
Kalcijum se može koristiti i kod lečenja infarkta miokarda, obzirom da povećava pokretljivost srčanog mišića. Pri tretmanu infarkta se unose soli kalcijuma u kombinaciji sa visokim nivoom kalijuma i magnezijuma.
Kalcijum se može koristiti i za tretiranje alergije, depresije, napada panike, artritisa, hipoglikemije, bolova u mišićima i zglobovima, slabog varenja i čira. U kombinaciji sa magnezijumom može da ima neurorelaksirajući efekat i koristi se za lečenje nesanice.
Kalcijum sa fosforom doprinosi jačanju kostiju i zuba. Visok unos fosfora dovodi do povećanog gubitka kalcijuma. Kalcijum se mora unositi zajedno sa fosforom u odnosu 1 : 1.
Kalcijum može interagovati i sa cinkom, manganom, bakrom i gvožđem. Visok unos bilo kog od ovih mikroelemenata smanjuje resorpciju drugih. Ovo se posebno odnosi na gvožđe i namirnice bogate ovim nutrijentima ne bi smele da se uzimaju u isto vreme.
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