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Calcium Supplementation Modifies the Relative Amounts of Bile Acids in Bile and Affects Key Aspects of Human Colon Physiology^1,2,

Joanne R. Lupton³, Gideon Steinbach^*, Wen Chi Chang, Barbara C. O'Brien, Stella Wiese, Cynthia L. Stoltzfus, Gary A. Glober^*, Michael J. Wargovich^*, R. Sue McPherson^** and Rodger J. Winn

Faculty of Nutrition, Texas A&M University, College Station, TX 77843-2471 ^* Department of Gastrointestinal Medical Oncology and Digestive Diseases, Division of Medicine Department of Clinical Investigation, Community Oncology Program, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 ^** Cancer Nutritional Epidemiology Unit, The University of Texas School of Public Health, Houston, TX 77030

Use of calcium supplements has increased dramatically in recent years yet little is known about the effect of calcium supplementation on colon physiology. We supplemented 22 individuals with a history of resected adenocarcinoma of the colon, but currently free of cancer, with 2000 or 3000 mg calcium for 16 wk. The effects of supplementation on duodenal bile acids and important fecal characteristics including total fecal output, wet and dry weight, pH, bile acids (in solids and in fecal water), and concentrations and total excretion of calcium, magnesium, phosophates (organic and inorganic), unesterified fatty acids and total fat were determined. Calcium supplementation significantly decreased the proportion of water in the stool (P = 0.03), doubled fecal excretion of calcium (P = 0.006), and increased excretion of organic phosphate (P = 0.035) but not magnesium. Calcium supplementation significantly decreased the proportion of chenodeoxycholic acid in bile (P = 0.007) and decreased the ratio of lithocholate to deoxycholate in feces (P = 0.06). The concentration of primary bile acids in fecal water decreased after 16 wk Ca supplementation. Together with other reports of a "healthier" bile acid profile with respect to colon cancer when changes such as those observed in this study were achieved, these results suggest a protective effect of calcium supplementation against this disease.

KEY WORDS: • colon physiology • calcium supplementation • chenodeoxycholic acid • lithocholate • humans

¹ Supported by National Institutes of Health grants N01-CN-85108-02 and N01-CN-85108-03.

² The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked "advertisement" in accordance with 18 USC section 1734 solely to indicate this fact.

³ To whom correspondence and reprint requests should be addressed.

Manuscript received 11 August 1995. Revision accepted 7 February 1996.

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