Pharmax Cal : Mag-Berry Liquid + 15.2 fl oz (450 ml)

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Pharmax Cal : Mag-Berry Liquid + -15.2 fl oz (450 ml)

Comprehensive bone support formula with100% citrate minerals

Calcium and magnesium along with therapeutic dosages of vitamins A, D and K to help in the development and maintenance of bones and teeth (1)
Calcium intake, when combined with sufficient vitamin D, a healthy diet, and regular exercise, may reduce the risk of developing osteoporosis (2)
Magnesium and vitamin K help in the development and maintenance of bones and teeth (3)

Natural blueberry-flavored

Great taste for excellent patient compliance

High bioavailability potential

Calcium and magnesium are delivered in citrate form providing superior bioavailability (4),(5)

References:
1 NHPD Monograph on Multi-Vitamin and Mineral. October 2007.
2 Heller HJ, Greer LG, Haynes SD, Poindexter JR, Pak CY. Pharmacokinetic and pharmacodynamic comparison of two calcium supplements in postmenopausal women. J Clin Pharmacol. 2000 Nov;40(11):1237-44. Abstract
3 Walker AF, Marakis G, Christie S, Byng M. Mg citrate found more bioavailable than other Mg preparations in a randomised, double-blind study. Magnes Res. 2003 Sep;16(3):183-91. Abstract;Conclusion
4 NHPD Monograph on Multi-Vitamin and Mineral. October 2007.

Additional product info:
Calcium and the vitamin D hormonal system are both essential for the development and maintenance of skeletal health. Calcium plays a vital role in neuromuscular function, many enzyme-mediated processes, blood clotting and in providing rigidity to the skeleton by virtue of its phosphate salts. Over 99% of the body’s calcium is stored in the bone, where, apart from providing mechanical strength, it serves as a mineral reservoir that can be drawn upon to maintain normal plasma calcium. Vitamin D is required to maintain normal blood levels of calcium and phosphate, which are in turn needed for the normal mineralization of bone, muscle contraction, nerve conduction and the general cellular functioning of all body cells. Vitamin D, derived from both endogenous (skin) and exogenous (diet) sources, is converted into 25OHD in the liver and then into 1,25(OH)2D in the kidneys. The latter metabolite controls calcium absorption. However, plasma 25OHD closely reflects vitamin D nutritional status, and because it is the substrate for the renal enzyme that produces 1,25(OH)2D, it could have mainly an indirect and also a direct effect on calcium absorption. A vitamin D shortage would reduce the intestinal absorption of calcium, which could worsen if the diet is deficient of this element. Osteoporosis and its clinical consequence, fragility fractures, are now recognized as major public health problems. Bone mass declines and the risk of fractures increases as people age, especially postmenopausal women. An adequate intake of calcium and vitamin D, including supplementation, has been advocated as a universal primary intervention in the prevention and treatment of high-risk patients. Evidence shows that there is still a high proportion of people with inappropriately low calcium and vitamin D intake and serum levels. For selective groups of people, such as the elderly (frequently older than 70 years), those with low solar exposure and in generally poor or inadequate nutritional condition, guaranteeing a daily intake of at least 1 g of calcium and 700–800 IU of vitamin D with supplements would have beneficial effects on bone health. In those individuals with a high risk of osteoporotic fracture, calcium and vitamin D supplements are necessary but frequently insufficient (5). The Women’s Health Initiative (WHI) clinical trial randomly assigned 36,282 postmenopausal women to receive 1000 mg of elemental calcium as calcium carbonate with 400 IU of vitamin D3 daily or placebo for an average follow-up period of 7.0 years. Significantly higher hip bone density but a non-significant reduction (12 percent) in the rate of hip fracture among those assigned to calcium with vitamin D were observed (6). A recent review discusses vitamin D status and supplementation when treating patients with osteoporosis in relation to risks and prevention of falls and fractures. The authors conclude that poor vitamin D status and low calcium intake are important determinates for osteoporosis and fracture risk. Based on evidence from literature, adequate supplementation with at least 700 IU of vitamin D, preferably cholecalciferol, is required for improving physical function and prevention of falls and fractures. Additional calcium supplementation may be considered when dietary calcium intake is below 700 mg/day, with a supplementation dose that leads to a maximum total daily calcium intake of 1000 to 1200 mg (7).

Calcium Citrate is a bio-available source of calcium which is the source material of calcium in Cal:Mag Berry Liquid +. A randomized crossover study compared the single-dose bioavailability and effects on parathyroid function of two commercially formulated calcium supplements containing 500 mg of elemental calcium. Twenty-five postmenopausal women underwent three phases of study wherein they each took a single dose of calcium citrate with a standard breakfast (as Citracal 250 mg + D), calcium carbonate (as Os-Cal 500 mg + D), or placebo at 8 a.m. Compared with calcium carbonate, calcium citrate provided a 46% greater peak-basal variation and 94% higher change in area under the curve for serum calcium and a 41% greater increment in urinary calcium. Moreover, the decrement in serum parathyroid hormone concentration from baseline was greater after calcium citrate. In conclusion, calcium citrate is more bioavailable than calcium carbonate when given with a meal (8).

Magnesium (Mg) is the second most abundant intracellular cation in vertebrates. Mg ion is a critical cofactor in more than 300 enzymatic reactions involving energy metabolism, and protein and nucleic acid synthesis. Accordingly, Mg is essential for various normal tissue and organ functions. The primary source of Mg in humans is from the diets. The dietary Mg ion is absorbed in the intestine through both active and passive transport systems. Excessive Mg is rapidly excreted into the urine. During Mg deprivation, the kidney avidly conserves Mg and excretes virtually no Mg in the urine. Approximately half of the total Mg in the body of a normal adult human is present intracellularly in soft tissues, and the other half is found in bone, either as exchangeable, surface-bound, divalent cations, which may serve as a reservoir for maintaining normal extracellular Mg level, or as an integral component of the hydroxyapatite lattice in bone matrix, which may be released during bone resorption. Thus, in addition to the intestine and kidney, the bone is involved in Mg homeostasis. Past studies with Mg depletion in both humans and animals indicate that Mg may have key regulatory roles in bone and mineral metabolism. A study examined the effects of daily oral magnesium (Mg) supplementation on bone turnover in 12 young (27–36 yr old) healthy men. The study group received orally, for 30 days, 15 mmol Mg (Magnosolv powder, Asta Medica, containing 670 mg magnesium carbonate precipitate (equivalent to 169 mg Mg) and 342 mg magnesium oxide (equivalent to 196 mg)) daily in the early afternoon with 2-h fasting before and after Mg intake. Mg supplementation reduced levels of both serum bone formation and resorption biochemical markers after 1–5 days, consistent with the premise that Mg supplementation may have a suppressive effect on bone turnover rate. The study concludes that oral Mg supplementation may suppress bone turnover in young adults. Because increased bone turnover has been implicated as a significant etiological factor for bone loss, these findings raise the interesting possibility that oral Mg supplementation may have beneficial effects in reducing bone loss associated with high bone turnover, such as age-related osteoporosis (9). In another study, twenty postmenopausal women have been divided into two groups. Ten patients were given magnesium citrate (1,830 mg/day) orally for 30 days. Ten postmenopausal women of matching age, menopause duration, and BMI were recruited as the control group and followed without any medication. Thirty consecutive days of oral magnesium supplementation caused significantly decrease in serum iPTH levels in the Mg-supplemented group. Serum osteocalcin levels were significantly increased and urinary deoxypyridinoline levels were decreased in the Mg-supplemented group. This study has demonstrated that oral magnesium supplementation in postmenopausal osteoporotic women suppresses bone turnover (10).
Magnesium Citrate is a bio-available source of magnesium which is the source material of magnesium in Cal:Mag Berry Liquid +. The relative bioavailability of three preparations of Mg (amino-acid chelate, citrate and oxide) were compared at a daily dose of 300 mg of elemental Mg in 46 healthy individuals. The study was a randomized, double-blind, placebo-controlled, parallel intervention, of 60 days duration. Results showed that supplementation of the organic forms of Mg (citrate and amino-acid chelate) showed greater absorption at 60 days than MgO, as assessed by the 24-h urinary Mg excretion. Mg citrate led to the greatest mean serum Mg concentration compared with other treatments following both acute and chronic supplementation. Furthermore, although mean erythrocyte Mg concentration showed no differences among groups, chronic Mg citrate supplementation resulted in the greatest mean salivary Mg concentration compared with all other treatments. Daily supplementation with Mg citrate shows superior bioavailability after 60 days of treatment when compared with the other treatments studied (11).

Vitamin D receptor has been found on many immune cells, such as macrophages, dendritic cells, T and B cells, mainly after activation. It has been shown that vitamin D inhibits pro-inflammatory processes by suppressing the over-activity of CD4+ Th1, Th2 and Th17 cells and the production of their related cytokines such as interleukin-2, interferon-gamma and tumor necrosis factor-alpha. When immunomodulatory mechanisms of vitamin D are discussed, many studies point to their ability to enhance
the anti-inflammatory loop, namely, their ability to modulate T regulatory cell function (12). An uncontrolled vitamin D supplementation trial among 50 apparently healthy subjects including supplementation of 140,000 IU at baseline and after 4 weeks (visit 1) was conducted. A final follow-up visit was performed 8 weeks after the baseline examination (visit 2). Vitamin D supplementation was associated with significantly increased % Regulatory T Cells (%Tregs) in apparently healthy individuals. This finding supports the hypothesis that vitamin D-induced stimulation of Tregs is a possible pathophysiologic mechanism by which vitamin D may prevent autoimmune diseases (13).

Vitamin D has complex effects on pulmonary cell biology and immunity with impact on inflammation, host defense, wound healing, repair, and other processes. While the knowledge on direct mechanistic links between Vitamin D and lung diseases is limited, a number of epidemiological and experimental are available that highlight the relevance of this connection (14). A placebo-controlled, double-blinded study involving 164 young Finnish men provides some evidence for a preventive effect of daily supplementation with 400 IU of vitamin D for 6 months against respiratory tract infection (15).

References:
5 Díaz-López B, Cannata-Andía JB. Supplementation of vitamin D and calcium: advantages and risks. Nephrol Dial Transplant. 2006 Sep;21(9):2375-7. Page 2375, Introduction, 1st, 3rd and 4th paragraphs; Page 2376, last 2 paragraphs
6 Jackson RD, LaCroix AZ, Gass M, Wallace RB, Robbins J, Lewis CE, Bassford T, Beresford SA, Black HR, Blanchette P, Bonds DE, Brunner RL, Brzyski RG, Caan B, Cauley JA, Chlebowski RT, Cummings SR, Granek I, Hays J, Heiss G, Hendrix SL, Howard BV, Hsia J, Hubbell FA, Johnson KC, Judd H, Kotchen JM, Kuller LH, Langer RD, Lasser NL, Limacher MC, Ludlam S, Manson JE, Margolis KL, McGowan J, Ockene JK, O'Sullivan MJ, Phillips L, Prentice RL, Sarto GE, Stefanick ML, Van Horn L, Wactawski-Wende J, Whitlock E, Anderson GL, Assaf AR, Barad D; Women's Health Initiative Investigators. Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med. 2006 Feb 16;354(7):669-83. Page 669, Abstract; Page 680, Discussion, last paragraph; Page 680, Conclusion
7 van den Bergh JP, Bours SP, van Geel TA, Geusens PP. Optimal use of vitamin D when treating osteoporosis. Curr Osteoporos Rep. 2011 Mar;9(1):36-42. Page 36, Abstract; Page 40, Conclusion
8 Heller HJ, Greer LG, Haynes SD, Poindexter JR, Pak CY. Pharmacokinetic and pharmacodynamic comparison of two calcium supplements in postmenopausal women. J Clin Pharmacol. 2000 Nov;40(11):1237-44. Abstract
9 Dimai HP, Porta S, Wirnsberger G, Lindschinger M, Pamperl I, Dobnig H, Wilders-Truschnig M, Lau KH. Daily oral magnesium supplementation suppresses bone turnover in young adult males. J Clin Endocrinol Metab. 1998 Aug;83(8):2742-8. Abstract; Page 2742, Introduction; Page 2743, 1st paragraph on the right side; Page 2748, Conclusion
10 Aydin H, Deyneli O, Yavuz D, Gözü H, Mutlu N, Kaygusuz I, Akalin S. Short-term oral magnesium supplementation suppresses bone turnover in postmenopausal osteoporotic women. Biol Trace Elem Res. 2010 Feb;133(2):136-43. Abstract
11 Walker AF, Marakis G, Christie S, Byng M. Mg citrate found more bioavailable than other Mg preparations in a randomised, double-blind study. Magnes Res. 2003 Sep;16(3):183-91. Abstract;Conclusion
12 Toubi E, Shoenfeld Y. The role of vitamin D in regulating immune responses. Isr Med Assoc J. 2010 Mar;12(3):174-5. Page 174, 2nd & 5th paragraphs
13 Prietl B, Pilz S, Wolf M, Tomaschitz A, Obermayer-Pietsch B, Graninger W, Pieber TR. Vitamin D supplementation and regulatory T cells in apparently healthy subjects: vitamin D treatment for autoimmune diseases? Isr Med Assoc J. 2010 Mar;12(3):136-9. Page 136, Abstract; Page 138, Discussion, 1st paragraph
14 Herr C, Greulich T, Koczulla RA, Meyer S, Zakharkina T, Branscheidt M, Eschmann R, Bals R. The role of vitamin D in pulmonary disease: COPD, asthma, infection, and cancer. Respir Res. 2011 Mar 18;12:31. Page 4, 2nd paragraph
15 Laaksi I, Ruohola JP, Mattila V, Auvinen A, Ylikomi T, Pihlajamäki H. Vitamin D supplementation for the prevention of acute respiratory tract infection: a randomized, double-blinded trial among young Finnish men. J Infect Dis. 2010 Sep 1;202(5):809-14. Page 810, Subjects and Methods, 1st paragraph; Page 811, Discussion, 1st paragraph; Page 813, Conclusion

Other ingredients: Purified water, xylitol, citric acid, natural blueberry flavor, xanthan gum, potassium sorbate, ascorbic acid, stevia leaf extract