Calcium is the most abundant mineral in the body. Every cell in your bones, heart, and brain needs a steady supply of calcium to work properly. Some people require more calcium and struggle to get enough from food. Are supplements the solution? Read on to learn about the benefits and risks of supplementing.
What is Calcium?
Calcium is the most abundant mineral in the human body and accounts for about 1-2% of your body weight. Each and every cell – in your bones, heart, muscles, and nervous system – need it to work. But only around 1% of your total body calcium is found in the blood; the remaining 99% is stored in your bones and teeth [1, 2].
- Canned or fresh fish with bones (sardines, sardelles, or even salmon)
- Beef tripe
- Tofu (calcium-set is best)
- Leafy greens (kale, broccoli, sprouts, bok choy, collard greens)
- Nuts (hazelnuts, walnuts, almonds)
- Kidney beans
A healthy and balanced diet should provide most people with all the calcium they need. But some people require more, while others are unable to get enough of this mineral from food. That’s when supplemental calcium may be a good solution.
That doesn’t mean you should rush off to grab any calcium-containing supplement from the pharmacy shelves and start taking it. As we’ll outline, the balanced intake of calcium along with other nutrients is key to getting the desired benefits while minimizing the risk of side effects.
Deciding to Supplement
If you decide to supplement, you might feel confused by the sheer number of different products to choose from. Let’s start with the basics.
Calcium is formulated into various salts in supplements. These all contain different amounts of pure or elemental calcium.
The best-researched and most common salt is calcium carbonate. It contains 40% elemental calcium, the highest of any form. On the downside, its absorption rate is relatively low: only around 22%. It is also the least water-soluble calcium salt, making it difficult to use in drinks .
People with low stomach acid will have trouble absorbing calcium carbonate, which needs an acidic environment to dissolve. If you take drugs for acid reflux, you are probably one of them (such as histamine-2 blockers and proton-pump inhibitors) [12, 13].
Other forms include calcium orotate, citrate, and hydroxyapatite salts, and coral- or oyster-derived products, to name a few. This post will go over the benefits and research behind calcium supplements inclusively, covering all formulations. If you’re looking for a breakdown of the pros and cons of each calcium salt, read through this post.
- Strengthens bones & reduces fractures
- Reduces the risk of falls in elderly
- May help prevent colon cancer
- Helps maintain normal blood pressure
- May improve fatty liver disease
- May prevent pregnancy complications
- Relieves PMS
- Fights inflammation
- Intake needs to be balanced with other nutrients
- Not beneficial for everyone
- Possibly unsafe along with high-calcium diets
- Increases the risk of kidney stones
- May increase the risk of prostate cancer
- May cause stomach upset
- Reduces iron absorption when taken with meals
- Some products may be contaminated with lead
Benefits of Calcium Supplements
1) Strengthen Bones and Reduce Fracture Risk
Calcium supplements reduce the risk of fractures when taken with vitamin D. This is the conclusion of the largest review of evidence to-date. The review was carried out by a group of experts, including the International Foundation for Osteoporosis. The reduction in fracture risk was modest but significant .
Supplements most effectively reduce fractures in groups at high risk of calcium and vitamin D deficiency. This includes the elderly (over 50 years), menopausal women, and those being treated for osteoporosis .
Some evidence suggests calcium can improve bone health in physically active people, including athletes, military personnel, and manual workers.
During intense exercise, blood pH levels drop as lactate levels rise. To compensate, the body releases calcium from bones, which increases bone loss if the demand for calcium isn’t met. Calcium supplements might be helpful during these periods of intense strain on the whole body and skeletal system [15, 16, 17].
In one trial with 243 army personnel, calcium and vitamin D improved bone density (BMD) and strength .
In yet another trial, 32 well-trained female athletes were given a meal with ~1,350 mg calcium 90 minutes before strenuous exercise. Calcium reduced the typical bone loss seen with prolonged high-intensity exercise .
In another study with 867 healthy men, calcium with vitamin D also improved BMD, especially in the neck, hips, and spine. However, a large review concluded that more evidence is needed before we can claim that supplementation is beneficial for all non-deficient, healthy, older men .
The Role of Vitamin D
Vitamin D helps absorb calcium in the gut, maintain calcium levels in the blood, and strengthen the mineral composition of the bones. If you get enough sun and dietary sources year-round, you probably don’t need to supplement with vitamin D [20, 20, 21].
In sum, calcium supplements strengthen the bones and reduce fractures in people at risk of deficiency; they might also protect the bones of vigorously-active healthy people.
2) Reduce the Risk of Falls in the Elderly
A review study of more than 16,000 elderly people found that a combination of calcium and vitamin D supplements reduces the risk of falls. Falls are a huge hazard for the elderly and often lead to serious or even fatal fractures .
There is no doubt that adequate vitamin D and calcium balance is important for bone and overall health in the elderly. Together, these nutrients help maintain normal posture and muscle-nerve communication .
But some findings about their combination in supplements are less conclusive, with a number of studies failing to find any benefit .
All in all, vitamin D-calcium supplements might improve posture and lower the risk of falls in the elderly. Their combination is safe and cheap, but more research is needed to determine how well it works.
3) May Help Prevent Colon Cancer
According to several review studies, calcium supplements may help prevent colon cancer or reduce the risk of it coming back. Most of the trials found that calcium supplements were more effective when taken with vitamin D at the same time [24, 25, 26, 27].
Most of the studies, however, didn’t take dietary and lifestyle factors into consideration. These can have a huge impact on colon cancer risk; they modify the gut flora and eventually affect the balance between health and disease .
Calcium supplements aid in colon cancer prevention by protecting cells in the colon lining from the damaging effects of free bile and fatty acids. Another way calcium might work is by activating a pathway called APC/beta-catenin, which becomes underactive early in colon cancer. Vitamin D, in turn, helps break down bile acids and enhances DNA repair [29, 30].
To sum it up, getting sufficient amounts of calcium from food or supplements and keeping your vitamin D levels in check might reduce your risk of colon cancer.
4) Maintain Normal Blood Pressure
Adequate calcium intake helps maintain normal blood pressure. It might prevent the onset of high blood pressure, according to a large review on over 3k healthy people. Calcium intake (via food or supplements) slightly reduced blood pressure, especially in those under 35 years of age. The benefits depended on the dose: ,1000 to 1,500 mg dropped blood pressure around 1 point, and over 1,500 mg almost 3 points (mmHg) :
5) May Improve Fatty Liver Disease
Vitamin D deficiency is common in people with liver disease. Low vitamin D status eventually reduces calcium absorption and can lead to bone diseases .
In two trials of 120 people with nonalcoholic fatty liver disease, calcium and vitamin D improved several markers of liver damage and heart health (ALT, AST, triglycerides, and LDL cholesterol). Vitamin D alone did not improve liver health [33, 34].
These findings highlight the tight synergy between calcium and vitamin D and their importance for liver, bone, and heart health.
6) Reduces the Risk of Pregnancy Complications
Preeclampsia is sudden high blood pressure during pregnancy, which usually starts around the 20th week. It affects about 5% of pregnant women and can lead to organ damage, pregnancy complications, and even death if left untreated. Adequate calcium intake is an important part of prevention .
According to a large review, calcium supplements (over 1g/day) cut the risk of preeclampsia in half .
Supplementation is particularly important if you don’t get enough calcium from food. The World Health Organization recommends 1.5-2 g/day for pregnant women with low dietary calcium intake. Consult your doctor before supplementing to rule out any risks or interactions .
7) Relieves PMS
Premenstrual syndrome (PMS) is extremely common and the exact causes are diverse. Low levels of vitamin D and calcium can trigger PMS or contribute to the symptoms, according to a large review of 28 trials .
According to several clinical trials with women suffering from PMS, calcium can relieve many of the symptoms of PMS. Supplementation helped with PMS-related anxiety, depression, fatigue, and water retention [39, 40, 41, 42].
8) May Reduce Inflammation
In clinical trials, calcium reduced several markers of inflammation, including IL-1, IL-6, IL-8, TNF-alpha, and C-reactive protein (CRP). Additionally, adequate levels of this mineral can boost the master antioxidant glutathione in cells [43, 44, 45, 46, 47].
However, supplementing is not always a good idea. The causes of inflammation are extremely diverse and calcium can do more harm than good in certain cases. For example, people with rheumatoid arthritis taking calcium supplements were more likely to die (from any cause or heart disease), based on the results of a recent Norweigan analysis .
9) Supports Weight Loss
However, a recent review of 41 studies concluded that calcium supplements don’t increase weight loss .
Limitations and Caveats
Some studies suggest calcium supplements carries health risks and doesn’t reduce fracture risk. Experts are still debating whether calcium supplements are helpful or if dietary intake is the only way to go. On top of that, many studies fail to take co-factors such as magnesium or vitamin K2 into account.
Future research has yet to clear the conflicting findings about calcium supplements.
Side Effects of Calcium Supplements
Risk of Kidney Stones
The most well-known side effect of calcium supplements is a modestly increased risk of kidney stones. Data from studies suggest around 17% increased risk. The chance of this happening may be reduced by using the calcium citrate form. Calcium citrate reduces the formation and growth of the most common kidney stones (oxalic acid) [14, 50].
Another relatively common side effect of calcium supplements is stomach upset. Symptoms may include constipation, cramping and bloating. Heartburn and nausea are also possible. Calcium carbonate is most likely to cause these problems, as it requires stomach acid for absorption. So again, choosing the citrate form may minimize this side effect [14, 51].
Decreased Nutrient Absorption
Calcium supplements can inhibit iron absorption when taken with meals. Women have higher iron requirements than men and should take calcium supplements at least 2 hours before or after meals [52, 53].
Safety of Calcium Supplements
Some studies have found that calcium supplements increase the risk of heart disease. However, several large reviews consider the evidence too weak to draw any reliable conclusions.
A 2012 review of 16 studies and over 350k people didn’t find a link between heart disease and calcium supplements .
Reviews by expert panels – including the National Osteoporosis Foundation, the American Society for Preventive Cardiology, and the International Foundation for Osteoporosis – back up this opinion [57, 14].
Concerns have been raised about high calcium intake in men and prostate cancer risk. However, it’s impossible to draw any conclusions yet.
According to a review study including more than 900k men aged 50-70 years, higher calcium intake (over 750 mg/day) increases the risk of prostate cancer .
A possible explanation is that high calcium intake ups your vitamin D requirements. Vitamin D protects cells from prostate and other cancer types. To stay on the safe side, make sure you get enough vitamin D if you take calcium supplements [61, 62].
The Dangers of Getting More than You Need
The safety and effectiveness of calcium supplements may depend on your dietary calcium intake. According to a trial with over 60k women, supplements increased the risk of death only in those who get over 1,400 mg/day from food .
Tolerable Upper Intake Levels (ULs) for Calcium
With calcium, more is not better. Below are the maximum daily levels of calcium you should not exceed, including both supplements and food sources. About 5% of women over the age of 50 years surpass these levels by almost 400 mg/day .
Going over the upper tolerable levels for a short while is unlikely to cause any issues, but doing so long term is unsafe .
|0–6 months||1,000 mg||1,000 mg|
|7–12 months||1,500 mg||1,500 mg|
|1–8 years||2,500 mg||2,500 mg|
|9–18 years||3,000 mg||3,000 mg||3,000 mg||3,000 mg|
|19–50 years||2,500 mg||2,500 mg||2,500 mg||2,500 mg|
|51+ years||2,000 mg||2,000 mg|
The Gender Effect
An observational study of more than 130k people revealed that men who supplement with over 1000 mg of calcium per day are at an increased risk of heart disease. The same dosage did not increase the risk in women .
Over-supplementing calcium may come at the expense of other nutrient deficiencies. When you increase your calcium intake, you need to ensure you are getting sufficient amounts of:
These are important nutrients help calcium work optimally in the body. If you lack any of them, you can set off a chain of imbalances in the body.
The importance of vitamin D status in people taking calcium supplements cannot be overstated.
We have already seen that vitamin D and calcium work in close synergy. Vitamin D maintains calcium blood levels, increases calcium absorption, and works together with calcium to enhance bone, muscle, and heart health. They were used in combination in most studies [65, 66].
Make sure to maintain your vitamin D levels through regular sun exposure and adequate dietary sources. Alternatively, consider supplementing.
Magnesium maintains calcium blood levels and is needed for the production and activation of vitamin D. The ratio of calcium to magnesium in your food or supplements is much more important than the dosage of each .
According to conventional advice, the optimal ratio is likely 2:1, which would mean you need twice as much calcium as magnesium. Shifting this balance slightly up (to 2.6:1) or down (to 1.7:1) might have detrimental health consequences [67+].
But it seems like most Americans are getting 3 times the amount of calcium to magnesium (3:1 ratio) – just from food! [67+].
Researchers speculate the relative abundance of calcium at the expense of magnesium in modern diets is driving many chronic health problems – from diabetes to heart and bone diseases.
Assure you’re getting enough magnesium relative to calcium from both supplements and foods.
Vitamin K2 helps calcium build bones while preventing the buildup of calcium in blood vessels and soft tissues (calcification). But the typical Western diet is low in this vitamin! Increasing vitamin K2 intake may reduce many health risks linked to calcium supplementation [68, 69].
Increase your vitamin K2 intake if you’re taking calcium supplements. Some good vitamin K2 food sources are dairy and fat from grass-fed animals, egg yolks, organ meats, and fermented foods [72, 73, 74].
Heavy Metal Contamination
Calcium supplements may be contaminated with heavy metals. Analyses discovered lead levels above the safe limits in some products. The “natural sources” of calcium (dolomite, coral calcium, oyster shell) contained the highest levels of lead: 4-12x that of refined supplements! [75, 76, 77]
Calcium supplements should not be taken with certain medications, including the following :
- Ceftriaxone: can result in life-threatening damage to the lungs and kidneys
- Dolutegravir, Elvitegravir (HIV): calcium can reduce the effectiveness of these
- Antacids (TUMS, Rolaids, Chooz): combining these may lead to an overdose of calcium
Talk to your doctor before supplementing if you take any prescription medication to rule out dangerous interactions.
Calcium supplements are likely safe if you don’t exceed the recommended levels and get sufficient amounts of other important nutrients. Otherwise, supplementing is unnecessary and may increase your risk of heart disease.
Most adults need at least 1,000 mg of calcium per day. Women over 50 years need a bit more, 1,200 mg a day. If you are a teenager who is pregnant or nursing, be sure to get at least 1,300 mg calcium per day .
The amount of supplemental calcium you need depends on your diet. If your dietary intake is low, you can supplement with up to 1,000 mg/day, unless directed differently by a doctor. Divided doses of no more than 500 mg work best . Aim to get 1,000 to 1,400 mg of calcium per day from both food and supplements.
The average daily calcium doses in clinical trials were as follows:
- Bone health: 1,000 to 1,200 mg
- Colon cancer: 1,200 to 2,000 mg
- Fatty liver disease: 500 mg
- Blood pressure: 1,000 to 1,500 mg
- Preeclampsia: 1,000 mg
- PMS: 1,000 to 1,200 mg
- Inflammation: 1,000 mg
This puts the typical calcium dosage in a range between 1,000 and 1,200 mg/day.
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Calcium supplements may strengthen the bones, reduce the risk of colon cancer, and improve fatty liver disease.
On the downside, they can cause stomach upset and kidney stones. Conflicting evidence linked their use to health risks. You can reduce or avoid most of the risks by making sure you get sufficient amounts of other nutrients: vitamin D, magnesium, and vitamin K.
Consult your doctor before supplementing to avoid any drug interactions with your medication. If you can’t get enough dietary calcium, are pregnant, or have low stomach acid, you may benefit from supplementing. Otherwise, you shouldn’t take calcium supplements. Going over the maximum tolerable intake can harm your health.