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					NASA TECHNICAL TRANSLATION                                      NASA TTF



                    COMMENTS ON EXCESS CALCIUM IN THE BODY
                             Dr. J.-P. Rombauts




           Translation of Unpublished Report Dated January 1972,
                               Ghent, Belgium




                                     (ACCESSION NUMBER)




                                (NASA CH OR TMX OR AD NUMBER)     (CATEGORY)




              NATIONAL AERONAUTICS AND SPACE ADMINISTRATION
              WASHINGTON, D. C. 20546         FEBRUARY 1972
                                                             NASA TT F-14,155
                    COMMENTS ON EXCESS CALCIUM IN THE BODY
                             Dr. J.-P. Rombauts

          ABSTRACT: The possible ill effects of excess calcium in
          the body are discussed in connection with clinical observations,
          together with the importance of proper diet.

Considerations and Suggestions on the Basis of Observation
     The observation of similar phenomena which are repeated in situations         /I*
which appear to be identical leads us to create hypotheses, which study and
experimentation will either confirm or disprove.
     Thus, in the human body, in conjunction with what is called calcium
balance, I feel that I can suggest the proposition that in addition to the
multiple functions which determine it, including the hormonal factors such as
parathormcne and its antagonist, calcitonin, which I would like to include as
the gears in the system for its regulation, still too little known, let us add
the equally harmful role played by vitamin D in excess; it would be necessary to
consider the importance of ionic or electrolytic balance, in the sense of an
equation in which calcium would be a component together with phosphorus, potas-
sium, sodium, chlorine and others, perhaps.
     This is in toto the subject of this paper, which is neither a note nor an
exhaustive study.
     Thus, let us take the case of hypocalcemia, not that which is idiopathic
to certain frequently hormonal problems, caused directly by dysfunction or in-
directly, of tumoral origin, but rather that which is produced by diarrhetic
collapse, as we know it so often nowadays under the term, so-called "estival"
epidemics, with their frequent manifestations of tetany, often especially
serious among children and old people, and which were attributed to a brief
dehydration, but which also could have as their cause subsequent calcium
imbalance.

*Numbers in the margin indicate pagination in the foreign text.
     I have keen able to observe in those cases that the abundant absorption
of liquid rich in minerals, such as fruit juice and vegetable broth, was not
only well-tolerated but also gave much better results and a shorter con-
valescence than rehydration by means of dairy products, as was usually done.
     It seems in this case that in addition to rehydration, it was riot really   /2
the calcium per se which was the cause but father an ionic equilibrium in which
the calcium was a component to the same degree as phosphorus, potassium, sodium,
chlorine, magnesium and others, perhaps; at least, rehydration was favored and
was more rapid through hydric resorption which was facilitated more by the
presence of these electrolytic substances than by dairy products.
     This still does not seem very convincing I
     Let us continue. At birth, the infant possesses a significant mineral
reserve; which it would be interesting to measure qualitatively and quantita-
tively and which cannot last him for all his life, so that it is necessary to
have an input both varied and regular in the course of development, as well as
replacement to make up losses.
     It is curious to find in the human body such a vast and diversified range
of minerals, which seem to play a role even though it is poorly defined as yet
as far as our knowledge is concerned, but which appear to be indispensable,
otherwise they would be expelled as foreign bodies according to proven bio-
logical laws.
     Thus, iron, which has been known for thousands of years as far as its
physiological function is concerned, is nearly the only one which has
naturally deserved a relatively deep study as far as its assimilation, transfer,
deposition and toxicity are concerned, and with respect to the natural and
pharmaceutical sources that we have available, and even as to the selectivity
of its absorption by certain segments of the digestive tract
     And the others — what do we know about them?
     Not to mention, for example, that phosphorus, sulfur and chlorine, whose
atoms are found in all combinations in our organic chemistry at all levels of
biochemistry, what do we know about their functions, their transfer; their
deposits, their assimilation, their toxicity, their normal sources?
     Isn't that interesting?
     Hence, the current hypothesis! We must take assimilation into account.
First of all, the organism must be able to have access not only to the pos-        /3
sibility of gaining this entire range of minerals in a convenient form, but
also having capacities for absorption, not to mention assimilation.
     Normally, these arrangements are furnished in nature by the diet; it is
necessary that the latter be highly varied and take the form of the most
adequate form for assimilation, in order to respond to needs and all conditions,
in the most complex forms in biochemistry whence comes the danger in the
institution of exclusive regimens, which I refuse for this reason.
     It is therefore a fact that observation has led me to want to believe that
many pathological conditions, different in appearance, may likely be a con-
sequence of defects in assimilation.
     It seems to me that it is worth the trouble to make a real effort by which
I must appeal to science, so that by its study, capacities and methods of
experimentation and laboratories, it will be able to increase our knowledge on
this subject on the basis of these few modest observations.
     Thus, it has been more than forty years now that we have noticed that
numerous children are affected with rickets and suffer from convulsions, and
that few families were formerly able to combat these problems if they did not
know how to treat the spectacular symptoms of rickets and those so pathetic
convulsions of tetany in their children, and to save them they had to give them
calcium and Vitamin D.
     As far as calcium is concerned, our children were given abundant quantities
of milk which they had to drink.
     For those who did not know about it in those days, as well as those who
did not manage to read it in the plentiful medical.literature of this era in
order to become convinced, it was full of unexploited teachings, based on
observations, such as those which we received from our masters of the day, and
to whom I render homage here again.
     It was then too (oh great heresy!) that we began to ration milk in the       /£
feeding of infants and to recognize the danger of overdosing with Vitamin D;
we saw rickets as well as convulsions becoming more and more rare!
     WHY??
     In large measure, we have substituted in the diet, instead of an excess
of milk (so rich in calcium), foods which are rich in mineral substances,
presented in the form which we feel would be the most susceptible to be well-
assimilated, namely raw foods, fruit juice and vegetable broth. And with what
good balance! Thus far, we have been satisfied with the results that have been
obtained empirically, mostly quite brilliant, except for some exceptions which
prove the rule that we have neglected a little too much so far.
     In principle, with organisms that are young and healthy and with a good
method of assimilation, our prescriptions (applied with a certain authority,
crowned with maternal love) have given these results in our children.
     When we encounter these problems of nutrition in the adult, we are shocked
by prejudice, gustatory caprices and others, the influence of modern life as
far as nutrition is concerned, and especially in regard to individual capa-
cities for assimilation.
     We will say that if the latter are as large as normal in nature among
individuals who are very healthy and have good constitutions and are still
relatively young, the problems will not show up, and if they do they will show
up much later.
     But for these to be diminished due to congenital debility or acquire the
consequence of repeated digestive troubles, essentially at variance levels or
sectors which are privileged and selective as far as assimilation of the
digestive tract is concerned, and also at the level of the digestive glands,
which must elaborate assimilation, they can then show various symptoms which
appear to have particular natures, depending on the age of the individual, his
deficiencies or localizations in poor absorption.
     This has led me to consider in dietetics that the study of the primary
function of the organ of absorption can be expressed in one word: "The            /5
Intestine," which seems to me to be much neglected due to the fact that it is
generally considered as an organ of excretion, while this is only a subsidiary
function; we must also consider it as an organ of assimilation.
    Here I .would like (between parentheses) to add a bizarre and complex
observation. It is in the course of these troubles in assimilation that I have
seen appearing almost constantly (especially at the level of the thoracic cage,
in patients suffering from neuritis and neuralgia) the points of Valleix,
definitely positive and nearly exclusively in adults, and that for some time
I have observed them more and more often among young people beginning at
fifteen, approximately.
    This observation does not appear to have been made earlier, not only be-
cause of a lack of sufficient information, but mainly due to the actual lack of
constancy among the clientele, so carefully selected and refined by the group
of polyclinics and specialists which have sent them to our doors more and more
frequently during the last twenty years.
    The classical treatment with various B vitamins in massive oral doses pro-
duces only a hypothetical result and one which is only brief; with an improve-
ment in the state of the intestine, the results will be more durable and
especially clear, especially if assimilation is not disturbed any longer. It
is astonishing, however, to see that under these situations the B vitamins
appear to be well-absorbed instead of being eliminated massively by the kidneys.
    What then is happening, exactly?
    Is it the fact that assimilation (in the true sense of the word), as I
feel, plays a still poorly known role?
    Since when have these phenomena started to make themselves more frequently
evident among young people?
    This leads to the following question:
         Is the colibacillus responsible for the assimilation of Vitamin B         /6
missing?
    Perhaps by abuse or antibiotics administered in the course of ailments
during their infancy, such as those which we have been able to interpret as
particularly grave states of the genre, extending up to pernicious anemia, at
the time when we treated what we called colibacilloses by means of anti-
colibacillar vaccines, which undoubtedly cause the-elimination first of all and
more specifically of the indispensible colibacillus in out intestines, which appear
to have disappeared almost completely since the use of auto-anatoxin was
started!
    We must admit that we have disturbed this organ shamelessly: the intestine,
which is exposed to laxatives and purgatives, whose formidable arsenal is at
the disposal of its clientele, which every day consumes large quantities with-
out protest, and too often with our complicity under circumstances which are
not always justified!
    How to understand that we readily allow in our hospitals, our clinics and
our maternity hospitals digestive problems so often provoked by a diet which
is produced in a very elaborate form by the culinary art, but is in no way
adapted to the function of this organ, and finally the ease with which we accept
the malfunction of these operations by prolonged and often repeated abuse, with
effects which are often very harmful in this regard: some antibiotics are not
always justified under all circumstances and too often uniquely preventative
hypothetically, as if immunity no longer existed, and so we ease our consciences
by adding B vitamins and lactic enzymes, which seems to me today to be too
widespread a practice, and for what?
    It seems to me logical and absolutely indispensible to try to demonstrate
the method of presentation of foods in such a way as to adapt them for in-
dividual capacity of intestinal function and not to deal with this in an
inconsiderate fashion. It is not only from the standpoint of carbonic hydrates,
lipids and proteins in which our general alimentation is generally much too
rich, but also from the standpoint of mineral substances in which it has become
so poor, often by illogical artifices.
    For example, the vegetables, which are such an important and principal         /7
source of mineral substances of all kinds, by means of their-usual culinary
preparation which is irrational for individuals in whom saponification of fats
is more or less altered by congenital deficiency or acquired by the digestive
glands, not only do not furnish the mineral elements at the proper moment
for assimilation but can become a cause of changes in function due to irritation
which they can produce, and provoke the incorrect expulsion or false consti-
pation called "spastic," as paradoxical as this might appear and, equally
paradoxical, by this type of torture of Tantalus, an organism even though it
theoretically is sufficiently furnished with phosphorus in its diet, becomes
incapable of assimilating it, may find itself in a state of prolonged depriva-
tion, and its hypophosophoremia may lead to hypercalcemia, which the organism
will have to compensate, or even to a chronic hypercalciuria, with all of the
renal consequences, or even to reestablish equilibrium by a liberation of fixed
phosphorus, thanks to osteoclasts in an osteolysis, thus affecting the function
of the osteoblasts, which through the intermediary of calcitonin are supposed
to be able to fix excess calcium, which cannot take place indefinitely in
hyperphosphoremia.
    Where then will the excess calcium be fixed?
    In the circulatory system?   Perhaps!   Otherwise, with consequences which
we can only suppose I
    How often we still see, in our homes for the elderly, asylums, which try
in particular to furnish nutrition so rich in calories and so poor in material
substances so that they unbalance the mineral equilibrium which has become
more fragile with age and is less capable of being reversed?
    And in our daily practice with people who come to talk to us, we learn that
their alimentation is so full of calories that they are still told to drink more
milk, calcium and Vitamin D, on the occasion of a bone fracture or multiple
dental caries, without having taken the trouble at least to determine the
approximate calcium balance.
    How long will we still see among the pre-menopausal and the pre-retreated      /8
the harmful and so stealthily produced hypercalcemia which is both chronic and
iatrogenic, produced by the prolonged adminstration of hypotensive substances
with their diarrhetics for treatment of all these pretended hypertensions of
our era, which have had only one indication, if a certain tensiometer be
applied nearly mechanically under all circumstances in order to measure only
the nervous tension of our modern life (in which the mean's, of defense in our
society are fatally broken down by age and these deficiencies).
    In effect, let us not forget the danger of iatrogenic hypohaliemia which
is too frequent among certain of those who cause hypercalcemia by hyperkaliuria,
nor the role of K+ in the neuromuscular excitability.
    Without being exhaustive, let us end this chapter, however, and recall that
a massive hyperc&loric regime exhausts the B cells of the pancreas and that a
hypokaiiemic state, especially through depletion of K+,: runs a risk of creating
a state of hypoinsulinemia which is quite understandable, and can also cause
reduction of the ability of fixation of calcium on proteins, which is a new
cause of free hypercalcemia,
    How to interpret the currently admitted finding that at the beginning of my
career the circulatory problems which were so plentiful among our diabetics have
generally become less frequent among them, that they are better treated and
better balanced in their diets, as compared to the rest of the population of
the same age?
    It is evident that in a healthy man who takes care of all his means of
assimilation the troubles will only show up quite late and will easily be
reversible by adequate correction of the diet.
    It will not be the same for an individual who is less equipped with capa-
cities from this standpoint. The pathological symptoms will be more or less
precocious and be more difficult to reverse in the same fashion.
    Hence, I observed in young people after prolonged gastrointestinal problems,
the appearance of painful arthritic lesions which were highly macroscopic in
their appearance and even if they had been poorly treated previously by steroids,
still disappeared without leaving a trace following adequate treatment of the     /9
digestive tract, maintained by appropriate diet, or judged to be so by common
sense.
    The manifestations in older people, although they are more definite and
more insidious, are no less frequent, and they are generally located specifi-
cally at the level of the painful joints by the aggression of daily professional
activity.
                                                                             8
    While the osteopathic locations are observed so often, obviously those at
the level of the circulatory apparatus, although they show, up rarely in
clinical examinations, do not appear to be any more probable and they are still
reversible (but later) by the same counteraction, which I was able to demon-
strate clinically.
    This is true in the case of phosphorus, for example, as a possible cause
of deficiency. What about the others, such as sulfur, iron, chlorine,
magnesium, fluorine and other possible ones?
    Thus, as far as assimilation of IRON is covered, for example:
         I am mentioning briefly here one case of many which illustrate the
subject of this paper. A young girl who had just turned twenty, and was taking
a physical examination to get a job, was found to be hyppchromically anemic,
without any apparent blood loss. For more than two years, all pf the current
specialties based on iron given orally had been tried in succession without
success.
    The subject became amenorrheic and depressed, and came to see me in regard
to her chronic digestive problems, and on this occasion told me about her
hematological situation.
    I was able to start a strict therapy parenterally by giving drop by drop
intravenous to cure this deficiency rapidly. Since there was no emergency, I
preferred to deal first of all with the causal factor; in my opinion, her
digestive problems with chronic diarrhea could be attributed to her various       /1Q
martial [sic] absorptions.
    I had the satisfaction of observing that in the absence of any administra-
tion of medicinal iron, including oral, she absolutely could not withstand the
treatment of intestinal problems with a diet rich in mineral substances; I was
correct as to her reduced capacity for assimilation, as was evident in about
a month, when her deficiency of hematological iron was discovered by the
revelation of Labo concerning the return to normal of her hemoglobin level;
buth without having had the opportunity to determine the level of her iron
reserves, which I proposed to determine, it was however, her opinion, feeling
  herself undoubtedly healed, that she concluded that the examination had
become useless. Not having had the chance to see her again, I hope that she
continued to follow the dietetic advice I gave her.
    Finally, in a last category of obviously serious cases, the results will
be in any case very mediocre and very labile, and it is here that it is
necessary to be able to determine, at least initially, by means of tests and
laboratory research, the essential deficiencies, in order to be able to remedy
them by parenteral medicinal substitution judiciously applied to the physiology
of the specific metabolism of these incriminated minerals.
    It will be necessary to be able to make determination initially in a normal
human being or one who has been judged so, in order to be able to have standards
to which the pathological cases can be compared and treatment adequately
established.
    Here I feel that this would be possible after detailed examinations and
biological tests to which astronaut candidates as well as deep-sea divers who
would be going down to great depths and for a long time would be subjected,
and it also seems to me that it would be personally useful to them, in order
to understand better their physiological behavior during their exploits, to be
able to foresee dangers, counteract biological problems which might show up and
perhaps be able to prevent them if they have an understanding of these things.
    Thus, we already know that after a more or less prolonged stay in space,
astronauts regularly show a loss of calcium, while an equal stay spent at high
altitude has only a minimal effect and one which is negligible in their calcium
balance.
    In this regard, I must point out that in the results obtained on this sub-     /ll
ject, which I have already examined, those which apply to the averages of
groups, such as those (mentioned in parentheses) at the beginning, the
individual differences from one subject to another seemed to me to be very
considerable.
    In addition, if the results of [using] calcitonin to fix calcium in the
subjects used in the experiments appear to be encouraging, it seems to me it
would be interesting to determine the location of its action in the context of

                                                                           10
the cycle of calcium equilibrium but non-regulated experimentally by a prolonged
stay in weightlessness, and to compare this state with the effects produced
after a long dive to a great depth among divers.
    After this last voyage, that of Apollo XV, didn-'t we learn that Irwin re-
covered very rapidly from a sense of great fatigue in a couple of days, and
it took Scott and Worden two weeks to recover their normal condition?
    If an individual mineralogical balance had been made prior to and after the
flight, it seems to me that it would have been interesting to look for some
interpretation of this difference in recovery time, especially if it had been
followed before return to the former normal physiological state.
    In regard to the sensation of great fatigue, which in our practice has
shown up as being very significant, and which I have though for a long time
could be interpreted as exhaustion, especially when it was concomitant with
chronic gastrointestinal problems» I was undoubtedly correct, since generally
the patients approve of it as a more adequate expression of this subjective
sensation which shows up with such great constancy and in such precocious
fashion, more so than the troubles with assimilation which I have been able to
observe.
    I am comparing voluntarily this lassitude in the adult to that which we       /12
call "laziness" in our students and pupils, which is so harmful to their studies,
but also to this apathetic and complaining attitude which has been familiar to
us for fifty years among infants, comparative to the playfulness and gaiety of
our children now.
    This sensation of great prolonged fatigue with its accompaniment of depres-
sive states at all levels often leads to a vicious cycle which has its own
consequences, i.e., hormonal and psychic problems.
    Do we not see among our students and pupils those who are often poorly
nourished (from my standpoint) by consecutive lack of appetite? They do not
eat at all, or only a little bit in the morning (what is the pretext?) because
they lack time, not sustaining themselves, out of capriciousness, or are forced
to drink a full glass of more or less sweetened milk in the course of the


 11
morning in order to reduce their appetite for the noon meal, often ending the
day of studies in the evening with a more or less copious meal, all too
frequently less carefully chosen, not allowing themselves less productive work
at the beginning of the night if it is not too late, and the next day the same
cycle begins.
    This is why I feel that it is high time to put in order all of these
anomalies, the solution to which is so important for our society, especially
in view of the fact that I invite to this research Work and experimentation
those who have the capacity and the means and in whom I have stirred up some
interest in this subject in order to begin as soon as possible to get rid of the
contradictions in our advice which disturb our patients too often, too much,
and that we establish once and for all some good basic principles in dietetics,
allowing ourselves individual application to the well-being of our patients in
our society and as a whole.
    I wish to avoid any polemic or controversy, which I may have stirred up,
because I have no scientific or experimental competence to allow me to inter-
vene in it, with only my limited good sense as baggage and the fruit of my
observation which I deliver here.                                                  /13
Resume                              .
    On the basis of the observation of calcium equilibrium, considering the
hypothesis of an equation in which calcium is only one component, the problem
arises of absorption and assimilation of mineral materials in amines, as well
as the essential function of this organ, to wit, the intestine, as well as the
importance of the method of presentation of these materials.
   The following suggestions are made:
       Research in a healthy and normal individual to determine thermineral
levels which are to serve as standards for deficiencies in pathology.
       The scientific study in a laboratory of the most precise possible
fashion of the means to be applied to correction of these deficiencies, the
judicious definition of the basic principles of a rational diet for all of



                                                                              12
current society, and in pathological cases its careful therapeutic application
in individual cases depending on well-defined situations.

                                  REFERENCES
1. De Visscher, M., "Thyrocalcitonin," Rev. Louvain Medical, Vol. 87, pp. 327- /14
      -335, 1968.
2. Fiasse, R. et al., "latrogenic Pathology in Gastroenterology," Rev. Louvain
      Medical, Vol. 90, pp. 289-302, 1971.
3. Nagant de Deuxhaisnes, C., "Hypercalcemia — Cause and Treatment,'1 Rev.
      Louvain Medical, Vol. 88, pp. 273-304, 1969.
4. Norman, Major D. and colleagues, "Development and Evaluation of a Simplified
      Formula Food for Aerospace Feeding Systems,"'U.S.A.F. School of Aero-
      space Medicine, Vol. 38, Texas, January 1968.
5. Quoidbach, A., "The Hypokaliemias," Rev. Louvain Medical, Vol. 87, pp. 731-
      -747, 1968.
6. Theodore, Capt. N. arid colleagues, "Metabolic Effects of Prolonged Bed
      Rest: Their Modification by Simulated Altitude," U.S.A.F. School for
      Aerospace Medicine, Vol. 10, Texas, January 1967.
7. Van Ypersele de Strihou, C., "Mechanism of the Action of Diuretics," Rev.
      Louvain Medical, Vol. 86, pp. 174-184, 1967.

Translated for the National Aeronautics and Space Administration under contract
No. NASw-2037 by Techtran Corporation, P. 0. Box 729, Glen Burnie, Maryland
21061, translator: William J. Grimes, M.I.L.




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