Dietary calcium reduces blood pressure, parathyroid hormone, and platelet cytosolic calcium responses in spontaneously hypertensive rats

Proposed role of calcium and dairy food components in weight management and metabolic health

Dietary calcium and dairy foods have demonstrated an antiobesity effect in animal studies, observational and population studies, and randomized clinical trials. Moreover, there is a strong theoretical framework to explain the effects of dietary calcium on energy metabolism. The supporting mechanisms include dietary calcium-correcting suboptimal calcium intakes, thereby preventing the endocrine response (parathyroid hormone [PTH] and calcitriol), which favors adipocyte energy storage and inhibits adipocyte loss via apoptosis. Dietary calcium appears to further promote energy loss via formation of calcium soaps in the gastrointestinal tract and thereby modestly reduces net energy absorption. Dietary calcium appears to be responsible for approximately 50% of the antiobesity bioactivity of dairy foods. The additional dairy bioactivity has not been fully identified, but is primarily localized in whey protein. The major components are the angiotensin-converting enzyme (ACE) inhibitor activity of whey proteins and the high concentration of leucine in whey. This high leucine content appears to be primarily responsible for the repartitioning of dietary energy from adipose tissue to skeletal muscle during weight loss, resulting in greater preservation of skeletal muscle and accelerated loss of adipose tissue during negative energy balance. Finally, high-calcium diets suppress obesity-induced oxidative and inflammatory stress independently from its role in modulating adiposity; these effects are similarly augmented by other dairy food components. However, the number of randomized clinical trials conducted is still modest, and a small number have not confirmed significant effects in weight management. Thus, the protective effects of dairy foods against obesity and its comorbidities are promising, but warrant further large-scale studies.

Calcitriol and energy metabolism

Calcitriol, a calcitrophic hormone that can be suppressed by high dietary calcium, favors fatty acid synthesis and inhibits lipolysis via non-genomic modulation of Ca(2+) influx. Calcitriol also suppresses UCP2 expression via the nVDR and thereby increases energy efficiency. Calcitriol exerts a dose-dependent impact on adipocyte apoptosis and regulates adipose tissue fat depot location and expansion by promoting glucocorticoid production and release. Recent data also demonstrate a pivotal role of calcitriol in the modulation of cytokines, with potential roles in energy metabolism in adipocytes, macrophages, and skeletal muscle.

Dietary calcium and dairy products modulate oxidative and inflammatory stress in mice and humans

We have recently shown 1alpha,25-dihydroxycholecalciferol increased oxidative stress and inflammatory stress in vitro, whereas suppression of 1alpha,25-dihydroxycholecalciferol with dietary calcium (Ca) decreased oxidative and inflammatory stress in vivo. However, dairy products contains additional factors, such as angiotensin-converting enzyme inhibitors, which may further suppress oxidative and inflammatory stress. Accordingly, this study was designed to study the effects of the short-term (3 wk) basal suboptimal Ca (0.4%), high-Ca (1.2% from CaCO(3)), and high-dairy (1.2% Ca from milk) obesigenic diets on oxidative and inflammatory stress in adipocyte fatty acid-binding protein-agouti transgenic mice. Adipose tissue reactive oxygen species (ROS) production and NADPH oxidase mRNA and plasma malondialdehyde (MDA) were reduced by the high-Ca diet (P < 0.001) compared with the basal diet and ROS and MDA were further decreased by the high-dairy diet (P < 0.001). The high-Ca and -dairy diets also resulted in suppression of adipose tissue tumor necrosis factor alpha and interleukin (IL)-6 mRNA (P = 0.001) compared with the basal diet, whereas an inverse pattern was noted for adiponectin and IL-15 mRNA (P = 0.002). Consequently, we conducted a follow-up evaluation of adiponectin and C-reactive protein (CRP) in archival samples from 2 previous clinical trials conducted in obese men and women. Twenty-four weeks of feeding a high-dairy eucaloric diet and hypocaloric diet resulted in an 11 (P < 0.03) and 29% (P < 0.01) decrease in CRP, respectively (post-test vs. pre-test), whereas there was no significant change in the low-dairy groups. Adiponectin decreased by 8% in subjects fed the eucaloric high-dairy diet (P = 0.003) and 18% in those fed the hypocaloric high-dairy diet (P < 0.05). These data demonstrate that dietary Ca suppresses adipose tissue oxidative and inflammatory stress.

The effect of nutrient profiles of the Dietary Approaches to Stop Hypertension (DASH) diets on blood pressure and bone metabolism and composition in normotensive and hypertensive rats

Hypertension has been associated with abnormalities of Ca and bone metabolism. Consequently, dietary strategies aimed at reducing blood pressure may also benefit bone health; however, this issue has received little attention. Therefore, the objective of the present study was to investigate the effect of two antihypertensive-type diets on blood pressure and bone metabolism and composition in normotensive (Wistar-Kyoto NHsd, WKY) and hypertensive (spontaneously hypertensive NHsd, SHR) rats. Thirty WKY and thirty SHR male rats, 14 weeks old, were separately randomized by weight into three groups of ten rats each. One group from each strain was given a control diet while the other two groups were fed two anti-hypertensive (high fruit and vegetable (F/V) and high fruit and vegetable and low-fat dairy produce (combination)) diets for 8 weeks. SHR rats were significantly (P<0.01) heavier than WKY rats. Blood pressure and femoral length, width, dry weight, ash, Ca, Mg, P and bone mineral mass were significantly (P<0.0001) greater in SHR than WKY rats, but were unaffected by diet, irrespective of strain. While markers of bone formation (serum osteocalcin) and bone resorption (urinary pyridinoline and deoxypyridinoline) were similar in both strains, these markers were significantly (P<0.05) lower (28-31, 16-23, 31-33 % respectively) in the SHR rats fed the combination diet relative to those fed the control and F/V diets. Bone turnover in WKY rats was unaffected by diet. In conclusion, these findings suggest that the combination diet may benefit bone metabolism in hypertensive animals. However, as blood pressure was unaffected by this diet, the mechanism by which it reduced bone turnover requires further investigation.

Effect of calcium supplementation on blood pressure in patients with secondary hyperparathyroidism

The aim was to study the effect of calcium supplementation 477 mg twice daily on BP in patients with secondary hyperparathyroidism during an intervention study (6 weeks) and after 954 mg during a short study (3 h). The intervention study was a placebo-controlled, double-blind, cross-over, while the short study gave a placebo and calcium in random order on separate days. The participants were obtained from an epidemiological survey in Tromsø 1994-1995 that included more than 27.000 subjects. The re-examination was performed in 2000/2001 at the University Hospital of North Norway, Norway. There were 18 subjects with secondary hyperparathyroidism and 28 control subjects in the intervention study while there were 14 cases and 8 control subjects in the short study. The results showed that in the subjects with secondary hyperparathyroidism after calcium supplementation in the intervention study there was an increase in serum calcium from 2.28 +/- 0.09 to 2.36 +/- 0.06 mmol/l (mean +/- SD) and a decrease in serum PTH from 8.6+/-1.6 to 6.5+/-2.4 pmol/l. However, there was no significant difference in either systolic or diastolic BP between calcium supplementation and placebo (138.3 +/- 21.0 vs 135.9 +/- 17.0 mm Hg and 80.9 +/- 11.1 vs 78.9+/-9.5 mm Hg, respectively). Similar results were seen in the control group. In the short study, serum calcium increased and serum PTH decreased after oral calcium, but the BP did not differ as compared to when placebo was given. To conclude, in the present setting we did not find any effect on BP by calcium supplementation in subjects with moderate secondary hyperparathyroidism.

Regulation of blood pressure with calcium-dependent dopamine synthesizing system in the brain and its related phenomena

The effects of calcium on blood pressure regulation remain controversial. Although the mechanism by which calcium increases blood pressure when it is given intravenously and acutely has been elucidated, that by which calcium reduces blood pressure when it is supplemented chronically and slightly through daily diet is unclear. From a number of animal experiments concerning the effects of calcium on blood pressure, we believe that calcium ions have two separate roles in the regulation of blood pressure through both central and peripheral systems: (1) calcium ions reduce blood pressure through a central, calcium/calmodulin-dependent dopamine-synthesizing system and (2) calcium ions increase blood pressure through an intracellular, calcium-dependent mechanism in the peripheral vasculature. These concepts were applied to elucidate the mechanisms underlying hypertension in spontaneously hypertensive rats (SHR) and changes in blood pressure in other experimental animals, and the following conclusions were reached. The decrease of the serum calcium level in spontaneously hypertensive rats (SHR) causes a decrease in calcium/calmodulin-dependent dopamine synthesis in the brain. The subsequent low level of brain dopamine induces hypertension. The increase in susceptibility to epileptic convulsions and the occurrence of hypertension in epileptic mice (El mice) may be linked through a lowering of calcium-dependent dopamine synthesis in the brain, and epilepsy and hypertension may be associated. Exercise leads to increases in calcium-dependent dopamine synthesis in the brain, and the increased dopamine levels induce physiological changes, including a decrease in blood pressure. Cadmium which is not distinguished from calcium by calmodulin, activates calmodulin-dependent functions in the brain, and increased dopamine levels may decrease blood pressure. In this report, our studies are considered in light of reports from many other laboratories.