Importantly, symptoms and clinical status should guide replacement rather than isolated levels, reserving IV calcium administration for acutely symptomatic patients. And, supplements made from calcium citrate only slow down bone loss. Liquid extraction is used by Tate & Lyle Co. (formerly Haarmann & Reimer Co., a subsidiary of Bayer Co.) in the Dayton (OH, USA) and Elkhart (IN, USA) plants. Both supplements come in tablet and liquid forms. Calcium carbonate, the form of calcium found in Caltrate, is the most concentrated form and is commonly found in food. Precipitation of dicalcium acid citrate results in one-third less consumption of lime and consequently of sulfuric acid for the subsequent regeneration of citric acid, in greater filterability and washability because of its crystalline structure, but 10–25% of the expected product yield is needed as seed. Ghasem D. Najafpour, in Biochemical Engineering and Biotechnology, 2007, Citric acid is an intermediate organic compound in the tricarboxylic acid (TCA) cycle, found naturally in citrus fruits, pineapples, pears and crystallised as calcium citrate. Toxicity is rare even if a dosage of 10,000 IU/day is given for up to 5 months. Citrate decreases urinary supersaturation and thus stone formation by binding with calcium and forming a soluble calcium-citrate complex. Figure 4. 3), whereas pH, magnesium, and ionized calcium remain relatively constant (141). Calcium citrate is often manufactured from citrus juices such as lime juice or added to food in the form of citric acid 1⭐⭐This is a verified and trusted source Goto Source . Citric acid is marketed as anhydrous crystalline chemical, as the crystalline monohydrate, and as the crystalline sodium salt. Changes in divalent ions and calcium equilibria at initiation of lactation and weaning in women. In conclusion, although there are good reasons to think about the choice of calcium supplements to treat osteoporotic individuals with HCH in the most efficient way, there is as yet no consensus, as there is only indirect evidence. These authors did not detect differences in serum calcium and PTH either, but they observed that supplementation with calcium citrate resulted in a significant decrease of four different bone resorption markers, which were all unaffected by supplementation with calcium carbonate [82]. Mycelia and suspended particles are separated by continuous belt filters under vacuum. Sour salt, used in cooking, is citric acid. Chemical synthesis of citric acid is possible but it is not cheaper than fungal fermentation. All sources of phosphorus intake should be curtailed. Amorphous tricalcium citrate tetrahydrate generally is obtained at ∼70 °C, while crystalline dicalcium acid citrate is obtained at 90 °C. Importantly, symptoms and clinical status should guide replacement rather than isolated levels, reserving IV calcium administration for acutely symptomatic patients. If we assume that many of them additionally display spontaneous or iatrogenic HCH, it is important to discuss the currently available calcium supplements and their potential impact for this subgroup of patients. For optimal treatment, adequate calcium intake of 1000 to 1500 mg/day should be maintained in all patients on any type of treatment. Among all calcium formulations, Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice (Fourth Edition). A person can take it with or without food. It can also be taken on an empty stomach, at any time. However, Koff et al. Process flowsheet of a typical citric acid fermentation from glucose-based media by A. niger. There are basically three different types of batch fermentation process used in industry. It is an organic carboxylic acid, can be extracted from the juice of citrus fruits by adding calcium oxide (lime) to form calcium citrate, which is an insoluble precipitate that can be collected by filtration; the citric acid can be recovered from its calcium salt by adding sulphuric acid. Simultaneous use of calcitriol and calcium-containing phosphate binders to manage renal secondary hyperparathyroidism increases the risk of hypercalcemia. If you have any questions about calcium citrate, please talk with your doctor, nurse, pharmacist, or other health care provider. Coe et al. Aasis Unnanuntana, ... Joseph M. Lane, in The Comprehensive Treatment of the Aging Spine, 2011. For bone health, I recommend that all women supplement with 500 to 700 mg of calcium citrate in two divided doses taken with meals, for a total daily calcium intake of 1,000-1,200 mg from all sources. By continuing you agree to the use of cookies. To maximize the absorption of calcium across the small bowels, no more than 500 to 600 mg of elemental calcium should be taken at any given time. [4] Calcium carbonate is harder to digest than calcium citrate,[4] and calcium carbonate carries a risk of "acid rebound" (the stomach overcompensates by producing more acid),[4] so individuals who are sensitive to antacids or who have difficulty producing adequate stomach acid may choose calcium citrate over calcium carbonate for supplementation. Patients with vitamin D insufficiency will have low levels of 25-hydroxy vitamin D and elevated serum PTH from secondary hyperparathyroidism. Dialysis is unpredictable because phosphate is a poorly diffusible ion. Ingredients Supplement Facts How to Use. With a high content of elemental calcium, the kind your body can absorb, calcium citrate is a beneficial supplement, food additive and preservative. (Figures taken with permission from Neville, M. C., Keller, R. P., Casey, C. E., and Allen, J. C. [1994]. It may be used to treat conditions caused by low calcium levels such as bone loss (osteoporosis), weak bones (osteomalacia/rickets), decreased activity of the parathyroid gland (hypoparathyroidism), and a certain muscle disease (latent tetany). The calcium citrate thus produced may be sold as-is, or it may be converted to citric acid using dilute sulfuric acid. Be ready to tell or show what was taken, how much, and when it happened. The extract is then heated and washed countercurrently with water, resulting in about 90% recovery yield and an aqueous citric acid concentrated solution, which is passed through a granular activated–carbon column before undergoing the aforementioned evaporation and crystallization steps. The downside is that it has less calcium per pill (20 percent). Calcium is a mineral that is found naturally in foods. Indeed, if HCH primarily affects the skeleton through calcium malabsorption and secondary hyperparathyroidism, the problems discussed above might easily be solved by supplementing with the right form of calcium. The equation that corrects for hypoalbuminemia is: corrected calcium=[0.8×(normal albumin−patient’s albumin)]+serum total calcium. The shaded areas equal calcium bound to proteins, presumably casein and α-lactalbumin. Ingredients. Citric acid is used in soft drinks and food additives. At the Hospital for Special Surgery, 45% of patients undergoing elective surgery and 66% of patients presenting with fractures have vitamin D insufficiency. Calcium citrate is a calcium salt that's easier to absorb but less potent than calcium carbonate. Differences. Similarities. Both supplements can provide calcium for the body’s use, though there are differences. It is also present in most plants and animals. Calcium salts such as calcium carbonate and calcium acetate also have been used as phosphate binders. Hypomagnesemia-induced reduction in parathyroid hormone secretion results in increased urinary loss and reduced absorption. No removal of oxalic acid is needed if the submerged-culture fermentation is used. Literature clearly shows that adequate calcium and vitamin D intake reduces the risk of fractures. If you think there has been an overdose, call your poison control center or get medical care right away. Liming temperature is critical. Because casein is not present in human milk until approximately day 3 of lactation (37,268) we can assume that much of the increase is due to the onset of casein secretion into milk. Calcium citrate malate's bioavailability stems from its water-solubility and its method of dissolution. Iatrogenic calcinosis cutis recently has been reported in a dog and cat with hypoparathyroidism given calcium gluconate subcutaneously.126,132, In patients with severe, chronic renal failure, low-phosphorus diets are helpful but often insufficient. (Because higher amounts have been linked to increased risks of prostate cancer, men generally should avoid supplemental calcium.) Either calcium citrate or calcium carbonate, both non-prescription supplements, can help fill the gap. They compared the administration of potassium citrate to lemonade in stone formers and found that lemonade failed to alkalinize the urine or increase urine citrate [30]. However, a small amount of citric acid is still produced from citrus fruits in Mexico and South America where they are available economically. It does not contain aluminum or calcium. All Products. While it isn’t the best source, it’s easier on the stomach, making it a good alternative if calcium carbonate doesn’t work for you. In the US the two most commonly applied forms of calcium are calcium carbonate and, Erin Nystrom PharmD, BCNSP, Whitney Bergquist PharmD, MBA, BCPS, in, In general, serum calcium levels should be assessed, as with all laboratory values, in the clinical context, as less than 1% of total body calcium is found in the serum, and calcium is bound to albumin in the blood. In this regard it is interesting to mention a third study involving 40 postmenopausal women by Kenny et al. This is the standard process used on an industrial scale (source), so it’s safe to say that virtually all, if not all calcium citrate comes from this process, which is completely vegan. Calcium citrate is also found in some dietary calcium supplements (e.g. In normophosphatemic patients with early renal insufficiency, one may monitor fasting FEPi to determine the efficacy of phosphate restriction. The precipitate is washed to remove the impurities adsorbed onto it (i.e., residual sugars and contaminants from the raw carbon source and soluble proteins from the autolysis of the fungus). In the US the two most commonly applied forms of calcium are calcium carbonate and calcium citrate. Given the molecular weight of citrate is 192 mg/mmol, this amounts to 633 mg/liter of citrate. Citracal). The two are equally well-absorbed by the body, although people with low stomach acid -- such as older adults -- tend to absorb calcium citrate better. Calcium citrate malate is a water-soluble calcium supplement. Calcium citrate can make it harder for your body to absorb certain medicines. There are, however, some clinical studies comparing the effects of calcium carbonate and calcium citrate on calcium homeostasis and bone turnover in postmenopausal women with unknown gastric status [78–83]. Calcium citrate may also be used for purposes not listed in this medication guide. (245). Until plant calcium was studied and introduced around 2005, slowing bone loss with rock derived citrate was considered the best we could hope for. While Heller et al. Thus patients with fat malabsorption and, notably, an intact colon are at risk of enteric hyperoxaluria, precipitation of oxalate salts, and renal stone formation (Smith et al., 1972). The residual citrate in the filtrate is precipitated as tricalcium citrate by further addition of lime to set the pH to 5.8. Phosphate binder effectiveness is monitored by measuring fasting serum phosphorus concentration. 3.1). This reduces calcium flux from osteocyte activity by reducing the secretion of parathyroid hormone (PTH) [T36]. Dogs with spontaneous chronic renal failure (mean serum creatinine concentration, 2.3 mg/dL) had significantly higher FEPi values than control dogs (23% versus 5%), respectively, and FEPi decreased in both groups after feeding of Prescription Diet K/D.65 In one dog with chronic renal failure, FEPi was below the mean value for the chronic renal failure group despite increased serum PTH concentration. Citric acid is precipitated as calcium citrate by the addition of lime to the filtrate. Calcium citrate is a common, inexpensive form of calcium. Hypomagnesemia-induced reduction in parathyroid hormone secretion results in increased urinary loss and reduced absorption. Ensure magnesium and vitamin D intake is adequate to optimize calcium stores. Patients with hypocitraturic nephrolithiasis given lemonade made with 120 mL of concentrated lemon juice with 2 liters of water have a significant increase in urinary citrate [27,28]. Joseph E. Pizzorno ND, ... Herb Joiner-Bey ND, in The Clinician's Handbook of Natural Medicine (Third Edition), 2016. Aluminum hydroxide and aluminum carbonate are commonly used phosphate binders. 16. Calcium citrate is used to prevent or treat low blood calcium levels in people who do not get enough calcium from their diets. However, many experts consider these recommendations to be too low and suggest that the minimum adult intake should be 1000 to 2000 IU/day. [3] However, alterations to the digestive tract may change how calcium is digested and absorbed. Its salts, the citrates, have many uses: for example, ferric ammonium citrate is used in making blue print paper. The reduction in calcium flux increases the amount of calcium deposited in bone resulting in an increase in bone mineral density. Aluminum-containing gels are better tolerated by many dogs and cats when given as tablets or capsules, but the desiccated form has a lower phosphate binding capacity than the liquid gel.128 Aluminum oxide gel prepared to maximize phosphate binding has been studied in dogs.128,129 Constipation is a common side effect of aluminum-containing phosphate binders. [2] The citric acid in the broth solution is neutralized by calcium hydroxide, precipitating insoluble calcium citrate. The crystals are recovered using another continuous belt filter and then recycled back to the liming step, while the filtrate has to be disposed. Citric acid is mainly produced by fermentation. FIG. This question is not easy to answer, since the absorption of calcium carbonate does not solely depend on gastric pH, but also on the way of administration [35]. They did not find any difference in urinary calcium oxalate, brushite or urate supersaturation with milk compared to calcium fortified orange juice. Lanthanum carbonate also contains no aluminum and no calcium, is not absorbed from the gastrointestinal tract, and acts as an efficient phosphorus binder.46 Its effects are similar to those of calcium carbonate but without risk of bone toxicity or hypercalcemia.41 Lanthanum is excreted primarily in bile and should not accumulate in patients with renal failure, but its long-term safety is unknown. The salt is then separated by filtration and the filter cake is treated with sulfuric acid. Calcium supplements are generally made with one of two sources of elemental calcium: either calcium carbonate or calcium citrate. did not observe differential effects of the two calcium supplements on serum calcium and PTH in their cohort of 24 postmenopausal women [81]. Thorsten Schinke, Michael Amling, in Translational Endocrinology of Bone, 2013. 2H2O were obtained by hydrothermal synthesis. Calcium makes up 24.1% of calcium citrate (anhydrous) and 21.1% of calcium citrate (tetrahydrate) by mass. Equipment and utility identification items: AE, anion exchanger; AF, antifoam agent; AL, alkaline reagent; BD, fluidized-bed drier; BF, vacuum belt filter; C, centrifuge; c, Condensate; CA, activated carbon adsorber; CE, cation exchanger; CR, vacuum crystallizer; cw, cooling water; CY, cyclone; D, holding tank; dcc, dicalcium citrate; DW, demineralized water; E, heat exchanger; EA, exhausted air; EV, evaporator; F, production-bubble fermenter; FI, sterile pressure filter; GR, grinder; HT, holding tube; LS, lime slurry; HA, hot air; HS, sulfuric acid; M, mixer; NA, nutrients and additives; PC, centrifugal pump; PE, plate–heat exchanger; S, low-pressure steam; SA, sterile compressed air; Se, dicalcium citrate seed; SF, seed-bubble fermenter; tcc, tricalcium citrate; WE, water evaporated. If we assume that many of them additionally display spontaneous or iatrogenic HCH, it is important to discuss the currently available calcium supplements and their potential impact for this subgroup of patients. The mother liquor is partly (∼20%) diluted with equipment-cleansing waters, decolorized, and fed back to liming; the remainder is in sequence decolorized and demineralized before being recycled to the crystallization unit. Calcium citrate is the calcium salt of citric acid. In this way, citric acid crystals do not need additional purification steps to meet specifications for U.S. Pharmacopeia or Food Chemical Codex material. Likewise, calcium carbonate is contraindicated in patients with achlorhydria, for whom supplementation with calcium citrate is recommended [75]. As a result, the calcium goes to work faster because calcium citrate has its own naturally acidic environment. 16C) show that the increase of calcium during initiation of lactation is entirely due to an increase of citrate- and protein-bound calcium during this period. It has been suggested that FEPi values less than 30% are indicative of adequate phosphate restriction.50 This method is limited by the wide range of normal values for FEPi.42,127 The response to phosphate binders may be relatively slow because the pool of accumulated phosphate is large and the persistent osteolytic effects of PTH provide a large endogenous phosphate load. Final refining of the filtrate is performed by decolorization on activated carbon and removal of residual calcium sulfate and iron and nickel salts on strong cation exchange and weak anion exchange (demineralization step). Lower dosages of calcium acetate (50 to 60 mg/kg/day) may be sufficient because it has a greater capacity to bind phosphate than does calcium carbonate.98 Magnesium-containing compounds are not useful as phosphate binders because they cause diarrhea, and limited ability to excrete magnesium in renal failure patients increases the risk of hypermagnesemia. Crystals are separated by centrifugation and dehydrated in a two-stage fluidized-bed dryer, the first one using hot air at 90 °C and the second one using air conditioned at 20 °C and relative humidity (RH) of 30–40% because of crystal hygroscopicity. Calcium supplements are typically sold in the form of calcium carbonate or calcium citrate. Calcium citrate binds to oxalate, reducing its intestinal absorption, and citrate in urine inhibits crystal formation, thus reducing the incidence of kidney stones. Phosphate binders work because the cation in the binder combines with dietary phosphate, producing insoluble, nonabsorbable phosphate compounds. * Calcium citrate also has been advocated as a phosphate binder but should not be given with aluminum-containing compounds because citrate enhances aluminum absorption.37,59,104,111,137 Nausea, constipation, and hypercalcemia are potential side effects of calcium-containing phosphate binders. Calcium citrate is a calcium supplement derived from citric acid—a substance commonly found in citrus fruits and other fruits and vegetables. Since calcium and citrate are released from the crystal in proportions of 1.5 calcium per di-citrate, one presumes the equilibrium citrate molarity will be 66% of calcium or 3.3 mmol. For optimal treatment, adequate calcium intake of 1000 to 1500 mg/day should be maintained in all patients on any type of treatment. Calcium citrate is used to prevent and to treat calcium deficiencies. Calcium is best absorbed when it's taken in smaller doses (typically less than 600 milligrams at one time). The colon is freely permeable to oxalate (see Fig. 16D) appears to be due to the loss of both protein- and citrate-bound calcium with no change in [Ca2+]. Calcium absorption: Calcium citrate is readily absorbed by the intestine in the absence of acid in the stomach whereas calcium carbonate is poorly absorbed in the absence ... Read More 0 Human digestive system - Human digestive system - Calcium: Calcium is required for the construction of bone; it forms part of the substance cementing together the walls of adjacent cells; and it is vital in the responsiveness to stimuli of muscle and nerve cells, which determines their excitability. It is used in the food and beverage industry for various purposes, as pharmaceuticals and for other industrial uses. Take four VegCaps daily with a meal or glass of water. Orange juice may have beneficial effects on preventing kidney stones. Marvin Grieff, David A. Bushinsky, in Nutritional Management of Renal Disease, 2013. To determine the basis for the changes in milk calcium, we calculated the equilibria among calcium-binding milk components using these data (38). They found that orange juice provided better urinary alkalinization and a higher urine citrate than lemonade [31]. Calcium is necessary for many normal functions of the body, especially bone formation and maintenance. Administration of glucose (and insulin if necessary) may temporarily decrease serum phosphorus concentration by promoting phosphorus entry into cells, although such therapy is rarely, if ever, necessary. Margaret C. Neville, in Knobil and Neill's Physiology of Reproduction (Third Edition), 2006. Stomach acid produced while eating helps your body absorb calcium carbonate. Calcium citrate is an organic compound made from the calcium salt of citric acid 1⭐⭐This is a verified and trusted source Goto Source . Thus calcium-containing phosphate binders should be given with meals to reduce the risk of hypercalcemia. Calcium carbonate should be taken with food. It is an important chemical used in medicines, flavouring extracts, food and candies, and the manufacture of ink and dyes. For men, I now suggest aiming for 500 mg from all sources. Increasing GFR by volume expansion increases the filtered load of phosphate, and natriuresis impairs proximal tubular phosphate reabsorption. A, B: Concentrations of milk components taken from studies of American women during initiation of lactation (12 subjects) and weaning (6 subjects) (141). Pure Encapsulations’ Calcium Citrate. Lemonade, a source of citrate, has been touted as being beneficial for kidney stones. Other drugs may interact with calcium citrate, including prescription and over-the-counter medicines, vitamins , and herbal products. Most formulas supply calcium in the form of calcium carbonate. found that lemonade was not as effective as potassium citrate in increasing urine citrate. Price: $$ Packing 300 mg of calcium into a single serving, … Thus the clinician should not be discouraged if the patient responds slowly to phosphate binder therapy. You may need to take more calcium citrate pills in order to achieve your desired dosage. Calcium is a mineral that is found naturally in foods. Moreover, there are no clinical studies so far, where the benefits of the different calcium forms on skeletal integrity have been directly compared in a cohort of individuals suffering from HCH and osteoporosis. Calcium carbonate, the form of calcium found in Caltrate, is the most concentrated form and is commonly found in food and drug stores. compared the effect of drinking orange juice to lemonade on stone risk. Calcium acetate binds more phosphate than either calcium citrate or calcium carbonate, and less calcium is absorbed from the intestine during its use.135 Calcium acetate binds phosphate better than aluminum carbonate at the neutral pH found in the small intestine, but aluminum carbonate is better at the lower gastric pH.135 In vivo, both were about equally effective. On the positive side, calcium citrate is less dependent on stomach acid for absorption. Penniston has shown that drinking lemonade will increase urine citrate and urine volume [29]. In people undergoing hemodialysis, osteomalacia and dialysis encephalopathy have been correlated with the aluminum content of dialysis water.110 In one study, encephalopathy occurred in dialysis patients receiving aluminum hydroxide despite a negligible aluminum content of dialysis water.4 Aluminum can be absorbed from the intestinal tract in normal people76 and uremic people,12,32 and aluminum-induced bone disease can occur in nondialyzed patients after oral administration of aluminum hydroxide.5 The toxicity of aluminum-containing phosphate binders in human patients with renal failure is now well established, and they have been replaced by calcium-containing phosphate binders.46 It still is unclear whether aluminum-containing phosphate binders represent a hazard to dogs with chronic renal failure. Initial reports suggested that sevelamer was similar in effectiveness to calcium acetate in binding phosphorus but with less risk of hypercalcemia.14 However, a recent study found calcium acetate superior to sevelamer in control of hyperphosphatemia and calcium-phosphorus product.120 Sevelamer decreased serum bicarbonate concentrations in this study, presumably as a result of the release and absorption of the hydrochloride moiety. Calcium carbonate decreases intestinal phosphate absorption in normal and uremic people. We find both calcium carbonate and, Osteoporosis and the Aging Spine: Diagnosis and Treatment, Aasis Unnanuntana, ... Joseph M. Lane, in, The Comprehensive Treatment of the Aging Spine. However, those with acid problems should avoid any extra acid, including calcium citrate. The total concentrations of calcium, phosphate, and citrate in human milk vary significantly with the stage of lactation (Fig. Odvina et al. Ingestion of a meal also decreased the absorption of calcium from the calcium acetate. In the diet, phosphorus restriction is accomplished primarily by protein restriction. Continuous fermentation has been studied at the laboratory scale.1,2, M. Papagianni, in Comprehensive Biotechnology (Second Edition), 2011. More isn't always better: Too much calcium has risks . Fifty thousand international units of vitamin D2 can be taken orally once a week or every other week for 6 to 8 weeks, followed by a maintenance dose of vitamin D3 of 1000 to 2000 IU/day. Therefore the most practical and effective way to treat hyperphosphatemia in patients with stable chronic renal failure is to decrease intestinal phosphate absorption by orally administered phosphate binders. Recommend Mg-rich diet: unprocessed whole foods (avoid milk and dairy), vegetables, whole grains, nuts, and seeds. The search for new phosphorus binders has continued because of the bone toxicity and encephalopathy associated with use of aluminum-containing compounds and the hypercalcemia and soft tissue (including cardiovascular) calcification associated with use of calcium-containing compounds.46 Sevelamer hydrochloride is a cross-linked polymeric resin that binds phosphorus and releases chloride. randomized hypercalciuric stone formers to drinking two six ounce glasses of calcium fortified orange juice per day or two eight ounce glasses of milk per day and determined urinary supersaturation in each group [32]. Many people are beginning to discover, and are intrigued by a new type of calcium supplement that is made entirely from plants. When dissolved, it releases calcium ions and a calcium citrate complex. Calcium citrate is well absorbed on an empty stomach and does not constipate. As a rule, low-protein diets are also low in phosphorus. It is commonly used as a food additive (E333), usually as a preservative, but sometimes for flavor. Calcium citrate: This contains 21% elemental calcium. Each salt contains varying amounts of elemental calcium. Calcium citrate is absorbed equally well when taken with or without food and is a form recommended for individuals with low stomach acid (more common in people over 50 or taking acid blockers), inflammatory bowel disease or absorption disorders. If you take other medications, take them at least 2 hours before or 4 to 6 hours after you take calcium citrate. The appropriate amount of vitamin D intake should be evaluated by monitoring 25-hydroxy vitamin D level and serum PTH. In many individuals, bioavailability of calcium citrate is found to be equal to that of the cheaper calcium carbonate. Phosphate binders are most effective when given with meals. As a result, it can be more suitable for people with: lower levels of stomach acid; … Calcium is necessary for many normal functions of the body, especially bone formation and maintenance. The washed crystals and 98% w/w sulfuric acid are simultaneously, but separately, fed to a mixer containing a 40% citric acid solution at pH 0.5–0.6, to free the citric acid with the formation of a precipitate of calcium sulfate dihydrate (gypsum). Copyright © 2020 Elsevier B.V. or its licensors or contributors. Coming from the data obtained with Cckbr-deficient mice, in whom osteoporosis is fully prevented by calcium gluconate but not by calcium carbonate supplementation, there is one important question that needs to be addressed: Should osteoporotic individuals with HCH receive calcium citrate or gluconate, instead of calcium carbonate? Although it is generally difficult to translate findings from mouse models into human pathology, one possibility should at least be considered. There are many potent microorganisms including fungi, yeast and bacteria that are able to produce citric acid by fermentation. Calcium partitioning in human and bovine milk. The resulting solution (250–280 kg m−3 of citric acid anhydrous) is concentrated using multiple-effect evaporators to about 700 kg m−3, before feeding a vacuum crystallizer operating at temperatures below (35 °C) or above (62 °C) the transition temperature (36.6 °C) between the monohydrate and anhydrous forms, depending on the form manufactured. But, despite the advances of plant calcium increasing bone density, it presently is still “little David” compared to “rock calcium Goliath”. This is then filtered off from the rest of the broth and washed to give clean calcium citrate. There are two very common and practical fermentation processes used: the liquid surface culture and the submerged fermentation process.