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.
Tips for upping your calcium intake
To boost your daily intake, try to include calcium-rich foods in multiple meals or snacks.
Tips for adding more calcium from dairy to your diet
- Use milk instead of water when making oatmeal or other hot breakfast cereals.
- Substitute milk for some of the liquid in soups such as tomato, squash, pumpkin, curries, etc.
- Milk can be added to many sauces or used as the base in sauces such as Alfredo and Béchamel sauce.
- Make whole-wheat pancakes and waffles using milk or yogurt.
- Get creative with plain yogurt. Use it to make a dressing or a dip, or try it on potatoes in place of sour cream.
- Add milk or yogurt to a fruit smoothie. You can even freeze blended smoothies for popsicles.
- Enjoy cheese for dessert or as a snack. Try cheddar, mozzarella, Gouda, jack, Parmesan, or a type of cheese you’ve never had before.
Tips for getting more calcium from non-dairy sources
Greens can easily be added to soups, casseroles, or stir-fries. Opt for kale, collard greens, turnip greens, dandelion greens, mustard greens, beet greens, broccoli, and cabbage. Spice up these and other dishes with garlic, basil, thyme, oregano, and rosemary to add more nutrients.
Eat dark green leafy salads with your meals. Try romaine hearts, arugula, butter lettuce, mesclun, watercress, or red leaf lettuce (avoid iceberg lettuce as it has very little nutrient value).
Add extra servings of veggies to your meals, i.e. asparagus, fresh green peas, broccoli, cabbage, okra, bok choy.
Top salads or make a sandwich with canned fish with bones, such as sardines and pink salmon.
Use beans/legumes as part of your meals. They are wonderful in stews, chili, soup, or as the protein part of a meal. Try tofu, tempeh, black-eyed peas, black beans, and other dried beans. You can also snack on edamame.
Start your day with oats. Steel cut oats or rolled oats make a filling breakfast. For an added punch include cinnamon
Snack on nuts and seeds such as almonds and sesame seeds. You can also add these to your morning oatmeal.
Order or prepare sandwiches on whole grain wheat bread.
Beyond calcium: Other nutrients for healthy bones
When it comes to healthy bones and preventing osteoporosis, calcium alone is not enough. There are a number of other vital nutrients that help your body absorb and make use of the calcium you consume.
Why it’s important: Magnesium helps your body absorb and retain calcium to help build and strengthen bones and prevent osteoporosis. Since your body is not good at storing magnesium, it is vital to make sure you get enough of it in your diet.
How much do you need? For adult men, 400-420 mg daily. For adult women, 310-320 mg daily (more during pregnancy).
How to include more in your diet: Magnesium is found in nuts (especially almonds and cashews), seeds (pumpkin, sesame, flax, sunflower), whole grains, seafood, legumes, tofu, and many vegetables, including spinach, Swiss chard, summer squash, turnip and mustard greens, broccoli, sea vegetables, cucumbers, and celery. Reduce sugar and alcohol, which increase the excretion of magnesium.
Why it’s important: Vitamin D helps the body absorb calcium and regulates calcium in the blood.
How much do you need? Up to age 70, 600 IU (international units) per day. Over 70, 800 IU per day.
How to include more in your diet: Your body synthesizes vitamin D when exposed to the sun. Spend at least 15 minutes outside in the sun each day and include good food sources of vitamin D in your diet, such as fortified milk, eggs, cheese, fortified cereal, butter, cream, fish, shrimp, and oysters.
Why it’s important: Phosphorous works with calcium to build bones. But again, it’s important to get the balance right: too much phosphorous will cause your body to absorb less calcium and can even be toxic.
How much do you need? For adults, 700 mg a day.
How to include more in your diet: Good sources include dairy, fish (cod, salmon, tuna), pork, poultry, lentils, nuts, and whole grains.
Why it’s important: Vitamin K helps the body regulate calcium and form strong bones.
How much do you need? Adult men, 120 micrograms daily. Adult women, 90 micrograms daily.
How to include more in your diet: You should be able to meet the daily recommendation for vitamin K by simply eating one or more servings per day of broccoli, Brussels sprouts, dark green lettuce, collard greens, or kale.
Vitamin C and vitamin B12
New research suggests that vitamin C and vitamin B12 may also play important roles in bone health and the prevention of osteoporosis.
Consuming foods rich in vitamin C may help to prevent bone loss. Good sources include citrus fruit, such as oranges and grapefruit, strawberries, kiwi, mango, Brussels sprouts, and green bell peppers.
Studies have also found a link between vitamin B12 levels and bone density and osteoporosis. Good sources of B12 include seafood such as salmon, haddock, and canned tuna, as well as milk, yogurt, eggs, and cottage cheese.
Other tips for building strong bones and preventing osteoporosis
In addition to adding calcium-rich foods to your diet, you can also minimize the amount of calcium you lose by reducing your intake of foods and other substances that deplete your body’s calcium stores.
Lower your salt intake. Eating too much salt can contribute to calcium loss and bone breakdown. Reduce packaged and convenience foods, fast foods, and processed meats which are often high in sodium. Instead of salt, try using herbs and spices to enhance the taste of food.
Limit the caffeine you consume. Drinking more than 2 cups of coffee a day can lead to calcium loss. The amount lost can have a significant impact on older people with already low calcium levels. You can buffer the effects to an extent by drinking coffee with milk.
Watch your alcohol consumption. Drinking alcohol inhibits calcium absorption and disrupts your body’s calcium balance in a number of ways. Try to keep your alcohol consumption to no more than 7 drinks per week.
Beware of soft drinks. In order to balance the phosphates in soft drinks, your body draws calcium from your bones, which is then excreted. Opt for water or calcium-fortified orange juice instead.
Exercise is crucial to lifelong bone health
When it comes to building and maintaining strong bones, exercise is essential, especially weight-bearing activities such as walking, dancing, jogging, weightlifting, stair climbing, racquet sports, and hiking. Find something that you enjoy doing and make it a regular activity.
Calcium supplements: What you need to know
While food is the best source of calcium, making up any shortfall in your diet with supplements is another option. But it’s important not to take too much.
Calcium citrate is a highly absorbable calcium compound.
Calcium ascorbate and calcium carbonate are not as easily absorbed as calcium citrate.
Be smart about calcium supplements
Don’t take more than 500 mg at a time. Your body can only absorb a limited amount of calcium at one time, so it is best to consume calcium in small doses throughout the day.
Don’t take more than the recommended amount for your age group. Take into account the amount of calcium you get from food. And remember: more isn’t better; it may damage the heart and have other negative health effects.
Take your calcium supplement with food. All supplemental forms of calcium are best absorbed when taken with food. If it’s not possible to take your supplement with food, choose calcium citrate.
Purity is important. It’s best to choose calcium supplements with labels that state “purified” or, if you’re in the U.S., have the USP (United States Pharmacopeia) symbol. Avoid supplements made from unrefined oyster shell, bone meal, or dolomite that don’t have the USP symbol because they may contain high levels of lead or other toxic metals.
Be aware of side effects. Some people do not tolerate calcium supplements as well as others and experience side effects such as acid rebound, gas, and constipation. For acid rebound, switch from calcium carbonate to calcium citrate. For gas or constipation, try increasing your intake of fluids and high-fiber foods.
Check for possible drug interactions. Calcium, magnesium, and vitamin K supplements can interfere with other medications and vitamins you’re taking, including heart medicine, certain diuretics, antacids, blood thinners, and some cancer drugs. Talk with your doctor or pharmacist about possible interactions. Any medications that you take on an empty stomach should NOT be taken with calcium.
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 the mineral 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 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.
What prescriptions you take
Calcium supplements can interact with many different prescription medications, including blood pressure medications, synthetic thyroid hormones, bisphosphonates, antibiotics and calcium channel blockers. Depending on your medications, you may need to take the supplement with your meals or between meals. Ask your doctor or pharmacist about possible interactions and which type of calcium supplement would work for you.
Quality and cost
Manufacturers are responsible for ensuring that supplements are safe and claims are truthful. Some companies have their products independently tested by U.S. Pharmacopeial Convention (USP), ConsumerLab.com (CL) or NSF International. Supplements that bear the USP, CL or NSF abbreviation meet voluntary industry standards for quality, purity, potency, and tablet disintegration or dissolution. Different types of calcium supplements have different costs. Comparison shop if cost is a factor for you.
Calcium supplements are available in a variety of forms, including tablets, capsules, chews, liquids and powders. If you have trouble swallowing pills, you may want a chewable or liquid calcium supplement.