RPh: 칼슘제는 하루에 한 번 드시면 되고요.
Pt: 칼슘이요? 저 쓸개에 돌이 있는데 왜 의사 선생님이 그걸 넣으셨지?
RPh : ...??
Pt: 병원에 좀 갔다 올게요.
칼슘이 몸의 모든 돌의 생성에 관여하는 것으로 생각하시는 분들이 많습니다. 요로결석 환자의 대부분이 수산칼슘 결석이란 데에서 나온 오해인 것 같지만, 요로결석의 경우에도 특별한 경우가 아닌 이상 칼슘 섭취를 금지하지 않습니다.
칼슘이 담석의 일부를 구성하긴 하지만, 칼슘의 섭취는 bile acid와 결합하여 장관순환이 일어나지 않게 하는 요소가 더 큰 것으로 보입니다.
During the 25 years of follow-up, 54 clinically diagnosed gallstone cases occurred. The incidence rate was 3.1/1000 person-years. Median age at diagnosis was 63 years. The baseline intake of eggs, cholesterol, and calcium was significantly lower for those with future clinically diagnosed gall- stones (Tables 1 and 2). According to the univariate analysis, the intake of eggs, cheese, animal protein, and calcium was significantly and inversely associated with gallstone incidence in the highest tertile (Tables 3 and 4).
Calcium in the presence of phosphate is capable of binding secondary bile acids in the lumen of the small intestine (46). Subsequently, the bile acids are excreted with the feces, attached to the insoluble calcium-phosphate complexes. As a result of the binding process, the duodenal bile acid composition is altered, preferentially removing chenodeoxycholic acid and deoxycholic acid (46). Cholesterol gall- stones are positively associated with secondary bile acids, mainly deoxycholic acid, in bile (47). Depletion of biliary deoxycholic acid lowers the elevated cholesterol saturation of bile (36), which may result in a lowered risk of gallstones.
< 참고문헌 >
Moerman, C. J., Smeets, F. W. M., & Kromhout, D. (1994). Dietary risk factors for clinically diagnosed gallstones in middle-aged men A 25-year follow-up study (The Zutphen study). Annals of Epidemiology, 4(3), 248–254. doi:10.1016/1047-2797(94)90104-x