Calcium and calcium supplements are some of the most popular products sold in the health and wellness industry. Let’s look at how to make sure you have the right ratio of calcium – to get your calcium from food, calcium supplements, or a combination of both.
Calcium is critical to the proper functioning of our bodies. However, the right balance between calcium intake and calcium excretion brings the best outcomes. Excessive intake of calcium at once may cause health problems like constipation, poor absorption, and even kidney stones.
Calcium and calcium supplements: Achieving the right balance
Calcium is important for bone health. See how much you need and how to get it.
Calcium is important for bone health throughout your life. Although diet is the best way to get calcium, calcium supplements may be an option if your diet falls short.
Before you consider calcium supplements, be sure you understand how much calcium you need, the pros and cons of calcium supplements, and which type of supplement to choose.
The benefits of calcium
Your body needs calcium to build and maintain strong bones. Your heart, muscles, and nerves also need calcium to function properly.
Some studies suggest that calcium, along with vitamin D, may have benefits beyond bone health: perhaps protecting against cancer, diabetes and high blood pressure. But evidence about such health benefits is not definitive.
The risks of too little calcium
If you don’t get enough calcium, you could face health problems related to weak bones:
- Children may not reach their full potential adult height.
- Adults may have low bone mass, which is a risk factor for osteoporosis.
Many Americans don’t get enough calcium in their diets. Children and adolescents are at risk, but so are adults age 50 and older.
How much calcium you need depends on your age and sex.
|19-50 years||1,000 mg|
|51-70 years||1,000 mg|
|71 and older||1,200 mg|
|19-50 years||1,000 mg|
|51 and older||1,200 mg|
The recommended upper limit for calcium is 2,500 mg a day for adults 19 to 50. For those 51 and older, the limit is 2,000 mg a day.
Calcium and diet
Your body doesn’t produce calcium, so you must get it through other sources. Calcium can be found in a variety of foods, including:
- Dairy products, such as cheese, milk, and yogurt
- Dark green leafy vegetables, such as broccoli and kale
- Fish with edible soft bones, such as sardines and canned salmon
- Calcium-fortified foods and beverages, such as soy products, cereal and fruit juices, and milk substitutes
To absorb calcium, your body also needs vitamin D. A few foods naturally contain small amounts of vitamin D, such as canned salmon with bones and egg yolks. You can also get vitamin D from fortified foods and sun exposure. The RDA for vitamin D is 600 international units (15 micrograms) a day for most adults.
Who should consider calcium supplements?
Even if you eat a healthy, balanced diet, you may find it difficult to get enough calcium if you:
- Follow a vegan diet
- Have lactose intolerance and limit dairy products
- Consume large amounts of protein or sodium, which can cause your body to excrete more calcium
- Are receiving long-term treatment with corticosteroids
- Have certain bowel or digestive diseases that decrease your ability to absorb calcium, such as inflammatory bowel disease or celiac disease
In these situations, calcium supplements may help you meet your calcium requirements. Talk with your doctor or dietitian about whether calcium supplements are right for you.
Do calcium supplements have risks?
Calcium supplements aren’t for everyone. For instance, if you have a health condition that causes excess calcium in your bloodstream (hypercalcemia), you should avoid calcium supplements.
It’s not definitive, but there may be a link between high-dose calcium supplements and heart disease. The evidence is mixed and more research is needed before doctors know the effect calcium supplements may have on heart attack risk.
A similar controversy surrounds calcium and prostate cancer. Some studies have shown that high calcium intake from dairy products and supplements may increase risk, whereas another more recent study showed no increased risk of prostate cancer associated with total calcium, dietary calcium, or supplemental calcium intakes.
Until more is known about these possible risks, it’s important to be careful to avoid excessive amounts of calcium. As with any health issue, it’s important to talk to your doctor to determine what’s right for you.
Types of calcium supplements
Several different kinds of calcium compounds are used in calcium supplements. Each compound contains varying amounts of calcium — referred to as elemental calcium. Common calcium supplements may be labeled as:
- Calcium carbonate (40% elemental calcium)
- Calcium citrate (21% elemental calcium)
- Calcium gluconate (9% elemental calcium)
- Calcium lactate (13% elemental calcium)
The two main forms of calcium supplements are carbonate and citrate. Calcium carbonate is the cheapest and therefore often a good first choice. Other forms of calcium in supplements include gluconate and lactate.
In addition, some calcium supplements are combined with vitamins and other minerals. For instance, some calcium supplements may also contain vitamin D or magnesium. Check the ingredient list to see which form of calcium your calcium supplement is and what other nutrients it may contain. This information is important if you have any health or dietary concerns.
Choosing calcium supplements
When looking at calcium supplements, consider these factors:
Amount of calcium
Elemental calcium is important because it’s the actual amount of calcium in the supplement. It’s what your body absorbs for bone growth and other health benefits. The Supplement Facts label on calcium supplements is helpful in determining how much calcium is in one serving. As an example, calcium carbonate is 40% elemental calcium, so 1,250 milligrams (mg) of calcium carbonate contains 500 mg of elemental calcium. Be sure to note the serving size (number of tablets) when determining how much calcium is in one serving.
Calcium supplements cause few, if any, side effects. But side effects can sometimes occur, including gas, constipation, and bloating. In general, calcium carbonate is the most constipating. You may need to try a few different brands or types of calcium supplements to find one that you tolerate the best.
Things you need to know about calcium supplements for bone health
1. Why is Calcium important?
Calcium plays a critical role in proper function throughout the body, including blood cells, muscle, and nerves. Over 98% of the Calcium in our body is in bone tissues, where it provides strength. For proper function, the body keeps blood Calcium levels within a narrow range. We lose a small amount of Calcium each day through skin, hair, nails, urine, and feces. When dietary calcium intake is not adequate to replace this, Calcium is taken from the bone. People with inadequate Calcium intake lose bone at a faster rate and have a greater chance of developing weak, fragile bones (Osteoporosis).
2. How much Calcium do I need?
Experts generally agree that a total of 1000-1200 mg of elemental Calcium per day is enough for adults. This includes the Calcium in your diet plus any Calcium from supplements.
3. Does everyone need to take Calcium supplements?
No. If you get enough calcium from the foods you eat, then you don’t need to take a supplement. Calcium supplements are only necessary if dietary intake is too low. In the USA, the average dietary Calcium intake is around 600 mg per day. Changes in diet or the addition of supplements are the two options to make up for any shortfall.
4. How much Calcium is in my diet?
Most people obtain about 250 mg per day from food, plus an additional 200-300 mg per serving of dairy products (glass of milk, cup of yogurt, or an ounce of cheese). Check food labels- when they refer to % daily value (%DV), that is based on a daily intake of 1000 mg. (20% DV=200 mg, 30%DV=300 mg, etc.)
5. Is there one Calcium supplement that is best?
Choose a Calcium tablet labeled USP (United States Pharmacopeia). This indicates it passed tests for dissolving completely within the intestinal tract. There are only minor differences in absorption between Calcium Citrate and Carbonate. Patients that have difficulty swallowing pills may consider one of the chewable Calcium options.
6. Are the more expensive Calcium supplements better and are liquids preferable?
No. Generic Calcium supplements are fine. High-priced “brand name” Calcium tablets offer no advantages, in spite of their marketing claims. Liquid preparations are not necessary. Calcium from tablets is absorbed very well- as well as Calcium from dairy products, and better than many food sources such as spinach.
7. How much Calcium is in a Calcium supplement?
The amount of Calcium per tablet is listed under ingredients and generally ranges between 200 and 600 mg per tablet. Note that the label states the amount of Calcium per serving, and the serving size sometimes maybe two or more tablets. Does a 600 mg Calcium seem bigger and harder to swallow compared to medications of similar dose? That is because the total tablet size is indeed much larger. For Calcium Carbonate, 40% is Calcium and the other 60% is Carbonate. A 1500 mg tablet contains 600 mg Calcium and 900 mg Carbonate.
8. Should I take all Calcium supplements at once, or spread out the doses?
Spread them out. For example, take one Calcium pill twice a day, rather than two Calcium tablets at once. The intestinal tract absorbs Calcium more efficiently when it is spread throughout the day. Taking Calcium supplements with food also improves absorption.
Benefits of Calcium
Getting enough calcium can help your body in different ways, most notably by keeping your bones healthy and strong. In fact, 99% of the calcium in the body is stored in bones and teeth.3
Your body is constantly breaking down and remodeling bone, and you need calcium to help rebuild your bone. Calcium also helps your body maximize the size and strength of your bone, also known as peak bone mass.
Although your genes primarily determine your peak bone mass, calcium can be an influencing factor. Most people don’t reach peak bone mass until the ages of 25 to 30.4 From age 25 to 50, bone density tends to stay stable, and it usually begins to break down after age 50.5
A diet that includes adequate calcium consumption from childhood to adulthood can help the peak bone mass reach its greatest potential, which can delay bone loss when the bone starts to break down with age.
Calcium also plays an important role in other bodily functions. It’s needed for the chemical processes that cells use to carry out a variety of actions in the body, such as releasing essential enzymes for digestion6 and enabling muscles to contract, including the heart muscle.7
What Happens If You Don’t Get Enough
Not getting enough calcium can be harmful to your health. Since calcium is required for so many vital functions, your body will take it from your bones if you don’t get enough in your diet.8 This can weaken your bones and make them more susceptible to fractures.
A severe calcium deficiency can lead to a condition known as hypocalcemia, which is when there is deficient calcium in the blood.
Hypocalcemia may lead to symptoms such as:
- Muscle cramps
- Tingling in the fingers
- Poor appetite
- Abnormal heart rhythms
The Role of Vitamin D
Vitamin D is important for calcium absorption. However, according to the Dietary Guidelines for Americans, up to 90% of adults are not receiving an adequate amount of vitamin D from their diet.1
Vitamin D and calcium supplementation may help you get enough of these nutrients if you’re deficient in them.
How Much Calcium You Need Per Day
The Recommended Dietary Allowance (RDA) is the national system of nutrition recommendations. In 2020, The U.S. Department of Agriculture (USDA) and the U.S. Department of Health and Human Services (HHS) jointly released updated Dietary Guidelines for Americans, which set the following RDAs for calcium:1
- Age 2 to 3 years: 700 milligrams (mg)
- Age 4 to 8 years: 1,000 mg
- Age 9 to 18 years: 1,300 mg
- Age 19 to 50 years: 1,000 mg
- Over Age 51 years: 1,200 mg
- Under Age 19: 1,300 mg
- Age 19 and Over: 1,000 mg
- Under Age 19: 1,300 mg
- Age 19 and Over: 1,000 mg
- Age 9 to 18 years: 1,300 mg
- Age 19 to 70 years: 1,000 mg
- Over Age 71 years: 1,200 mg
The Best Way to Get Calcium
The best way to get calcium is from natural sources in your diet. Dietary sources are absorbed into the body more efficiently than calcium supplements9 and different types of calcium-rich foods also contain other important nutrients that your body needs, like protein, iron, vitamin A, vitamin D, and vitamin C.