Editing Calcium carbonate (section)

===Health and diet===
[[File:500 mg calcium supplements with vitamin D.jpg|thumb|500-milligram calcium supplements made from calcium carbonate]]
Calcium carbonate is widely used medicinally as an inexpensive dietary calcium supplement or  [[antacid|gastric antacid]]<ref name = medline>{{cite web|website = Medline Plus|publisher = [[National Institutes of Health]]|title = Calcium Carbonate |date=1 October 2005|access-date = 30 December 2007|url = https://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a601032.html |archive-url = https://web.archive.org/web/20071017031324/http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a601032.html <!-- Bot retrieved archive --> |archive-date = 17 October 2007}}</ref> (such as [[Tums]] and [[Eno (drug)|Eno]]). It may be used as a [[phosphate binder]] for the treatment of [[hyperphosphatemia]] (primarily in patients with [[chronic kidney failure]]). It is used in the pharmaceutical industry as an inert [[Excipient|filler]] for [[Tablet (pharmacy)|tablets]] and other [[pharmaceuticals]].<ref>{{cite book|last1=Lieberman |first1=Herbert A. |last2=Lachman |first2=Leon |last3=Schwartz |first3=Joseph B. |title = Pharmaceutical Dosage Forms: Tablets|url=https://archive.org/details/pharmaceuticaldo03lach |url-access=limited |year = 1990|isbn = 978-0-8247-8044-9|page=[https://archive.org/details/pharmaceuticaldo03lach/page/n171 153]|publisher = Dekker|location = New York}}</ref>

Calcium carbonate is used in the production of calcium oxide as well as toothpaste and has seen a resurgence as a food preservative and color retainer, when used in or with products such as organic apples.<ref>{{cite web |url=http://chemistry.about.com/od/foodcookingchemistry/a/cadditives.htm |title=Food Additives – Names Starting with C |website=Chemistry.about.com |date=10 April 2012 |access-date=2012-05-24 |archive-url=https://web.archive.org/web/20061016112555/http://chemistry.about.com/od/foodcookingchemistry/a/cadditives.htm |archive-date=16 October 2006}}</ref>

Calcium carbonate is used therapeutically as phosphate binder in patients on maintenance [[haemodialysis]]. It is the most common form of phosphate binder prescribed, particularly in non-dialysis chronic kidney disease. Calcium carbonate is the most commonly used phosphate binder, but clinicians are increasingly prescribing the more expensive, non-calcium-based phosphate binders, particularly [[sevelamer]].

Excess calcium from supplements, fortified food, and high-calcium diets can cause [[milk-alkali syndrome]], which has serious toxicity and can be fatal. In 1915, [[Bertram Welton Sippy|Bertram Sippy]] introduced the "Sippy regimen" of hourly ingestion of milk and cream, and the gradual addition of eggs and cooked cereal, for 10 days, combined with alkaline powders, which provided symptomatic relief for peptic ulcer disease. Over the next several decades, the Sippy regimen resulted in [[kidney failure]], [[alkalosis]], and [[hypercalcaemia]], mostly in men with peptic ulcer disease. These adverse effects were reversed when the regimen stopped, but it was fatal in some patients with protracted vomiting. Milk-alkali syndrome declined in men after effective treatments for [[peptic ulcer]] disease arose. Since the 1990s it has been most frequently reported in women taking calcium supplements above the recommended range of 1.2 to 1.5&nbsp;grams daily, for prevention and treatment of osteoporosis,<ref name="pmid17483976">{{cite journal |vauthors=Caruso JB, Patel RM, Julka K, Parish DC |title=Health-behavior induced disease: return of the milk-alkali syndrome |journal=J Gen Intern Med |volume=22 |issue=7 |pages=1053–5 |date=July 2007 |pmid=17483976 |doi=10.1007/s11606-007-0226-0 |pmc=2219730}}</ref><ref name="pmid16702792">{{cite journal |vauthors=Beall DP, Henslee HB, Webb HR, Scofield RH |title=Milk-alkali syndrome: a historical review and description of the modern version of the syndrome |journal=Am. J. Med. Sci. |volume=331 |issue=5 |pages=233–42 |date=May 2006 |pmid=16702792 |doi= 10.1097/00000441-200605000-00001|s2cid=45802184}}</ref> and is exacerbated by [[dehydration]]. Calcium has been added to over-the-counter products, which contributes to inadvertent excessive intake. Excessive calcium intake can lead to hypercalcemia, complications of which include vomiting, abdominal pain and altered mental status.<ref>{{cite journal|title=Clinical problem-solving, back to basics|last1=Gabriely|first1=Ilan|journal=New England Journal of Medicine|year=2008|volume=358|pmid=18450607|doi=10.1056/NEJMcps0706188|issue=18|last2=Leu|first2=James P.|last3=Barzel|first3=Uriel S.|pages=1952–6}}</ref>

As a [[food additive]] it is designated [[E numbers|E170]],<ref>{{cite web|website=Food-Info.net|title=E-numbers: E170 Calcium carbonate|url=http://www.food-info.net/uk/e/e170.htm|access-date=19 April 2008|archive-date=14 October 2022|archive-url=https://web.archive.org/web/20221014050719/http://www.food-info.net/uk/e/e170.htm|url-status=live}} 080419 food-info.net</ref> and it has an [[International Numbering System for Food Additives|INS]] number of 170. Used as an [[acidity regulator]], [[anticaking agent]], [[Stabilizer (food)|stabilizer]] or [[Food coloring|color]] it is approved for usage in the EU,<ref>{{cite web |publisher=UK Food Standards Agency |url=http://www.food.gov.uk/safereating/chemsafe/additivesbranch/enumberlist |title=Current EU approved additives and their E Numbers |access-date=27 October 2011 |archive-date=7 October 2010 |archive-url=https://web.archive.org/web/20101007124435/http://www.food.gov.uk/safereating/chemsafe/additivesbranch/enumberlist |url-status=live}}</ref> US<ref>{{cite web|url=https://www.fda.gov/Food/FoodIngredientsPackaging/FoodAdditives/FoodAdditiveListings/ucm091048.htm|publisher=US [[Food and Drug Administration]] |title=Listing of Food Additives Status Part I |access-date=27 October 2011 |archive-url=https://web.archive.org/web/20130314104055/https://www.fda.gov/Food/FoodIngredientsPackaging/FoodAdditives/FoodAdditiveListings/ucm091048.htm |archive-date=14 March 2013}}</ref> and [[Australia]] and [[New Zealand]].<ref>{{cite web |url=http://www.comlaw.gov.au/Details/F2011C00827 |title=Standard 1.2.4 – Labelling of ingredients |date=8 September 2011 |access-date=27 October 2011 |publisher=Australia New Zealand Food Standards Code |archive-date=2 September 2013 |archive-url=https://web.archive.org/web/20130902084805/http://www.comlaw.gov.au/Details/F2011C00827 |url-status=live}}</ref> It is "added by law to all UK milled bread flour except wholemeal".<ref name="lhbread">{{cite news |last1=Holdstock |first1=Lee |title=Why go organic? |url=https://www.sustainweb.org/realbread/why_go_organic/ |access-date=3 April 2021 |agency=Soil Association Certification Limited |publisher=Real Bread Campaign |archive-date=14 October 2022 |archive-url=https://web.archive.org/web/20221014050716/https://www.sustainweb.org/realbread/why_go_organic/ |url-status=live}}</ref><ref name="defra13">{{cite news |title=Bread and Flour Regulations 1998 A summary of responses to the consultation and Government Reply |url=https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/226553/bread-flour-sum-resp-130805.pdf |publisher=Department for Environment, Food and Rural Affairs |date=August 2013 |access-date=9 April 2021 |archive-date=19 September 2021 |archive-url=https://web.archive.org/web/20210919172916/https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/226553/bread-flour-sum-resp-130805.pdf |url-status=live}}</ref> It is used in some [[soy milk]] and [[almond milk]] products as a source of dietary calcium; at least one study suggests that calcium carbonate might be as [[bioavailable]] as the calcium in [[cow's milk]].<ref>{{Cite journal| pmid = 16177199| year = 2005| last1 = Zhao| first1 = Y.| title = Calcium bioavailability of calcium carbonate fortified soymilk is equivalent to cow's milk in young women| journal = The Journal of Nutrition| volume = 135| issue = 10| pages = 2379–2382| last2 = Martin| first2 = B. R.| last3 = Weaver| first3 = C. M.| doi = 10.1093/jn/135.10.2379| doi-access = free}}</ref> Calcium carbonate is also used as a [[firming agent]] in many canned and bottled vegetable products.

Several calcium supplement formulations have been documented to contain the chemical element [[lead]],<ref name="Kauffman-2007">{{Cite journal|date=2007-07-01|title=Lead in pharmaceutical products and dietary supplements|url=https://www.sciencedirect.com/science/article/abs/pii/S0273230007000360|journal=Regulatory Toxicology and Pharmacology|language=en|volume=48|issue=2|pages=128–134|doi=10.1016/j.yrtph.2007.03.001|issn=0273-2300|last1=Kauffman|first1=John F.|last2=Westenberger|first2=Benjamin J.|last3=Robertson|first3=J. David|last4=Guthrie|first4=James|last5=Jacobs|first5=Abigail|last6=Cummins|first6=Susan K.|pmid=17467129|access-date=11 July 2021|archive-date=11 July 2021|archive-url=https://web.archive.org/web/20210711074707/https://www.sciencedirect.com/science/article/abs/pii/S0273230007000360|url-status=live}}</ref> posing a [[public health]] concern.<ref name="ross20">{{cite journal |doi=10.1001/jama.284.11.1425|title=Lead Content of Calcium Supplements|year=2000|last1=Ross|first1=Edward A.|last2=Szabo|first2=N. J.|last3=Tebbett|first3=I. R.|journal=JAMA|volume=284|issue=11|pages=1425–1429|pmid=10989406}}</ref> Lead is commonly found in natural sources of calcium.<ref name="Kauffman-2007" />