Hypercalcemia

Calcium is an extremely vital element needed for our bodies to be healthy and operate at peak efficiency. However, it is possible to have too much of a good thing. Excess calcium can create a myriad of health problems, some of which can be life threatening. Fortunately, we have been designed with systems in place to keep calcium levels in check. However, if they are not operating properly, excessive amounts of calcium can build up. Let’s take a more in depth look at how this occurs and the effects it may have on our wellness.

What is Hypercalcemia?

Hypercalcemia is a condition associated with elevated levels of calcium in the blood. Calcium is one of the most important and abundant minerals found in the body, and it plays a key role in many bodily functions. Under normal conditions, our Creator endowed us with a complex network of checks and balances that serves to maintain the proper amount of calcium in the body, as either too much or too little can cause numerous health problems. Excessive amounts of calcium in the blood can be caused by a number of factors, but most cases are due to improper operation of the parathyroid glands. Other common causes of hypercalcemia are related to side effects from certain medications and medical conditions, and to the over use of calcium or vitamin D supplements.

Hypercalcemia occurs more commonly in women than in men, and while it can strike at any stage of life, the rate of incidence increases with age. The majority of hypercalcemia cases are found in women over the age of fifty. It is also much more common in many cancer patients than in the general population, for reasons we will discuss in more detail below.

Why is the Proper Amount of Calcium in the Body So Critical?

Probably the most well known purpose of calcium is its role in the development and maintenance of bones and connective tissues. It works with another important mineral in the body, phosphate, to enable bone growth and replacement of bone tissue that is lost. Beyond its functions in the musculo-skeletal system, calcium is also a key player in many other bodily functions. Without calcium, the body could not send or receive nerve impulses properly, and thus muscle contraction and movement would not be possible. Much of the metabolic activity within the body involves calcium. Tooth formation, enzyme activity, heart regulation, and blood clotting are also enabled by calcium.

How is the Level of Calcium in the Body Regulated?

Calcium enters the body largely through the foods we eat. For most people, dairy products are the main dietary source of calcium. Other foods that are relatively high in calcium include nuts, green leafy vegetables, broccoli, legumes, eggs, and whole grains. Calcium supplements are also a potential source for introducing calcium into the body. Only a small amount of pure calcium can be directly absorbed into the body from food, averaging about 10-30%. Most of the calcium in food is linked with other components, and must be broken down during the digestive process in order for it to become available.

The vast majority (up to 99%) of calcium that accumulates in the body is stored in the bones, and the rest is found mainly in the blood, with minimal amounts in other bodily fluids as well. There are several factors involved in maintaining calcium balance within the body. The major ones include:

1. The kidneys:  The first line of defense against calcium imbalance is the kidneys. When the body senses the presence of too much calcium, an increased amount is excreted in the urine. The kidneys are very flexible in the volume of calcium that they excrete, and can increase or decrease the amount by up to five-fold if necessary. When problems develop involving excess calcium in the kidneys, kidney stones often develop.
2. Hormones:  The parathyroid gland is actually a set of four tiny endocrine glands, each about the size of a pea, that are found behind the thyroid gland in your neck. One of the parathyroid gland’s numerous functions is to regulate the amount of calcium that is in the blood. It accomplishes this purpose in several ways:

1. 1. The main parathyroid hormone (PTH) acts to increase calcium when levels drop below normal. PTH can trigger the intestine to absorb more calcium from foods, it can cause more stored calcium to be drawn from the bones, and / or it can stimulate the kidneys to increase the amount of phosphate they excrete, which indirectly raises calcium levels in the blood.
   2. Another hormone called calcitonin is released when the body senses a need to reduce calcium in the blood. Calcitonin is produced by the thyroid gland, and its purpose is to lower the amount of calcium that is dumped into the bloodstream by the bones.

1. Vitamin D also plays a role in regulating calcium. It is an important factor in the process of bone formation involving calcium and phosphate, and it helps regulate the amount of calcium the body absorbs through dietary sources as well. A lack of vitamin D causes levels of calcium in the body to drop, but too much vitamin D can lead to hypercalcemia.

What Are the Signs and Symptoms of Hypercalcemia?

Often cases of hypercalcemia, especially if they are minor, can go undiagnosed because the patient will have minimal if any signs. If symptoms do occur, they may include:

1. Loss of appetite
2. Nausea
3. Vomiting
4. Abdominal pain
5. Constipation
6. Frequent urination
7. Increased thirst, sometimes to the extreme
8. Muscle weakness
9. Muscle and joint aches
10. Fatigue

More severe cases of hypercalcemia can also produce cognitive symptoms that result because too much calcium can adversely affect the operation of  the nervous system. These may include:

1. Confusion
2. Mood swings
3. Psychosis
4. Potentially, in extreme cases that are left untreated, coma and death.

What Possible Complications Can Occur Due to Hypercalcemia?

1. Kidney stones:  Also known as renal lithiasis, the formation of these crystals on the lining of the kidneys can lead to blockages in the urinary tract when the body attempts to pass them. Kidney stones can damage the kidneys, and they can also be extremely painful. They are composed of calcium and other minerals, so their likelihood increases if excess calcium is present.
2. Kidney failure: If the kidneys are over worked due to excessively high levels of calcium over an extended period of time, they may not be able to handle the load and will experience a shut down. Kidney failure can be temporary or permanent. Temporary failure may require dialysis (the use of a machine that mechanically duplicates kidney function) and / or other treatments until kidney function can return to normal. However, end-stage renal failure is a life-threatening condition that necessitates ongoing dialysis or a kidney transplant.
3. Intestinal blockage: Too much calcium can lead to severe constipation, and in extreme cases may lead to a blockage of the bowel. If not treated successfully, intestinal blockages can be life-threatening.
4. Arrhythmia:  Calcium plays a critical role in the communication between nerves and muscles, and is particularly important in heart function. Both both a lack of calcium and too much calcium can lead to irregular or abnormal beating of the heart muscle. This can result in life threatening cardiac problems in some cases.
5. Osteoporosis: When hypercalcemia is a result of excessive calcium in the blood, it is often a result of too much stored calcium being taken from bone and connective tissues. When this occurs, the bones in particular and the musculo-skeletal system in general can be weakened. This may lead to an increased susceptibility towards bone fractures or other issues such as abnormal curvature of the spine or reduced body height.

What Are the Main Causes of Hypercalcemia?

The majority of hypercalcemia cases are classified as primary hypercalcemia, and are caused by a condition known as hyperparathyroidism. This occurs when the parathyroid produces and excretes too much PTH. Up to 90% of all hyperparathyroidism is the result of tumors on the parathyroid, most of which are benign (non-cancerous). However, when malignant tumors are treated with radiation, hyperparathyroidism may occur as a side effect, sometimes years after the treatment.

Other major causes of hypercalcemia include:

1. Cancer:  Many types of cancer can contribute to the development of hypercalcemia. This is especially true for cancers of the lung, breast, head, neck, kidney, and blood. These malignancies tend to produce a protein that stimulates the bones to release calcium into the blood. When cancer spreads(metastasizes) hypercalcemia can also result.
2. Excessive calcium or vitamin D supplementation:  When a person supplements with too much vitamin D, the body may react by overproducing calcium. The same may be true if too many calcium supplements are used. In our “pop a pill” society, many people are in danger of hypercalcemia because of over use of antacids that contain significant amounts of calcium.
3. Immobility:  Individuals who are unable or unwilling to get enough physical activity, such as those severely ill or just plain “couch potatoes,” are also at increased risk for hypercalcemia. If bones are not used sufficiently, they often release higher than normal amounts of calcium into the blood stream. People who are very sick and suffer from vomiting or dehydration can also experience hypercalcemia.
4. Certain medications:  Some drugs have side effects that can contribute to hypercalcemia. Common offenders include diuretics and lithium.

How Can Hypercalcemia Be Treated?

In severe cases, patients may require hospitalization to avoid potential life threatening consequences. Treatments may include intravenous therapy with fluids alone, or sometimes including medications such as diuretics, artificial hormones (often calcitonin), or special corticosteroids that will offset the presence of too much vitamin D.

Surgery is also an option, with the most common being partial or total removal of the parathyroid gland, a procedure known as a parathyroidectomy. I would be very careful about what drugs you agree to be treated with, as they can have serious side effects, and about surgery as well. Removal of the parathyroid can lead to consequences such as diminished or total loss of vocal chord function, and the surgery is not always successful. A second or third opinion is always a good idea before proceeding with any treatment.

Prevention is always the best policy. If you take care of yourself on a regular basis by making wise lifestyle choices, most cases of hypercalcemia can be avoided. It is particularly important to drink plenty of pure, filtered water, and to stay away from the use of antacids or too much supplemental vitamin D. The best way to avoid the need for antacids it to eat a healthful diet and exercise regularly. As far as vitamin D goes, the best way to get enough is to spend at least 20 minutes a day in direct sunshine, the most natural source of vitamin D.