Calcium: A Deep Dive Into Why It’s Crucial for Bone Health And More

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Calcium is the cornerstone of strong bones. From childhood through old age, calcium is the mineral that helps construct and maintain your bones. As we grow older, our bodies still rely on calcium to keep bones dense and sturdy. Ensuring you consume enough calcium, whether through diet or supplements, is a simple yet powerful step in protecting and supporting your skeletal system. If you have osteopenia or osteoporosis, see our full article: Stronger Bones: The Essentials for Managing Osteoporosis. Read on to learn the best sources of calcium and how to make sure you’re getting enough to keep your bones strong.

What is Calcium?

Calcium is a mineral that’s essential for our bodies to function properly. It’s the most abundant mineral found in the human body. Most of the calcium in our bodies is stored in the bones and teeth, where it provides structure and strength. Calcium is also crucial for many other tasks in the body. It helps our blood to clot when we get a cut, it allows our muscles to contract so we can move, and it’s important for sending messages through the nerves.

Our bodies don’t make calcium, so we need to get it from the foods we eat or supplements if we don’t get enough from our diet. Dairy products like milk, cheese, and yogurt are high in calcium. Leafy green vegetables, nuts, and certain fish are also good sources. If someone doesn’t get enough calcium, their bones can get weak, a condition called osteoporosis. This makes it easier for bones to break. So, getting enough calcium is key to keeping bones healthy and strong, especially as we age.

Why Calcium Matters: Osteoporosis

Osteoporosis is a condition where bones become weak and brittle, making them more likely to break. It often develops gradually over time, and people may not realize they have it until a bone breaks. Osteoporosis is more common in women than in men and tends to occur in older adults. Risk factors for osteoporosis include low calcium intake, vitamin D deficiency, smoking, excessive alcohol consumption, and a family history of the condition.

Osteoporosis is usually not the list of teenagers or pregnant women’s priorites. Yet, these are the most critical periods if you want to keep your bones strong in your elder years. You need about 1000 mg of calcium per day to meet your calcium need during pregnancy.

Whatever calcium needs you don’t meet through food and supplements will be taken out of your bones. If you’re thin, less physically active, or have a fine bone structure, you don’t have as much extra bone to lose and you’re more at risk for osteoporosis.

Other Functions Of Calcium

Calcium, an essential mineral, offers numerous health benefits:

• Muscle Function: Calcium plays a vital role in muscle contraction. It helps in the transmission of nerve signals that instruct muscles to contract, an essential function for everyday movements, including walking and running.
• Cardiovascular Health: Calcium is important for heart health. It’s involved in maintaining the normal rhythm of the heart and helps in the regulation of blood pressure [PMC8748265]. An adequate intake of calcium can contribute to overall cardiovascular health.
• Blood Clotting: Calcium is a key component in the process of blood clotting. It’s part of a series of steps necessary to stop bleeding when injuries occur, thus playing a critical role in wound healing.
• Nerve Signaling: Calcium is essential for the proper functioning of the nervous system. It facilitates the transmission of messages between the brain and different parts of the body, ensuring that body systems work efficiently and cohesively.
• Hormonal Secretion: Calcium aids in the release of hormones and enzymes that affect almost every function in the human body. This includes hormones vital for digestion, energy metabolism, and others.
• Dental Health: Calcium is important for maintaining strong teeth and protecting against tooth decay. Adequate calcium intake contributes to the structural integrity of teeth and supports overall oral health.
• Weight Management: Some studies suggest that calcium may play a role in regulating body weight and could help with weight management, though this area requires more research for conclusive evidence.
• Preventing Certain Cancers: There is ongoing research into whether adequate calcium intake might reduce the risk of certain types of cancer, such as colorectal cancer, though the results are not yet definitive.
• Regulating pH Levels: Calcium helps to maintain a stable acid-alkaline balance in the blood, which is essential for normal bodily functioning.
• Prevention of Kidney Stones: Calcium may play a role in preventing certain types of kidney stones. While excessive amounts of calcium (especially from supplements) can contribute to the risk of kidney stones, dietary calcium can actually help prevent their formation by binding to oxalates in the intestines, reducing oxalate absorption.
• PMS Symptom Reduction: Some research suggests that calcium intake might help reduce the symptoms of premenstrual syndrome (PMS). Calcium appears to influence hormone levels that are related to mood and physical symptoms experienced during the menstrual cycle.
• Dental Plaque Prevention: Calcium can be beneficial in oral health beyond just strengthening teeth. It may also play a role in reducing the formation of dental plaque, thus lowering the risk of gum disease and tooth decay.
• Blood Pressure Regulation: Adequate calcium intake has been linked to lower blood pressure levels or reduced risk of hypertension. This is especially notable in the context of a balanced diet rich in fruits, vegetables, and low-fat dairy products.
• Support for Child Development: In children and adolescents, calcium is essential not only for bone growth but also for proper development of the body. Adequate calcium intake supports the development of a strong skeletal structure and healthy teeth.
• Enhanced Athletic Performance: For athletes or those with a very active lifestyle, calcium is important for maintaining muscle and nerve function during intense physical activity. It helps in muscle recovery and reduces the risk of stress fractures.
• Metabolic Benefits: There is some evidence suggesting that calcium may play a role in metabolic processes, including fat metabolism and storage, which could have implications for energy use and weight management.

How Much Calcium Do We Need?

Our calcium needs vary slightly over the course of our lives, and there are some periods that are considered critical for calcium intake. During pregnancy, the RDA for calcium is the same as for adolescents (9-18 years) as calcium is critical for the developing fetus’s bone growth and development. However, the exact amount of calcium needed during pregnancy can vary based on individual circumstances, such as age, weight, and health status, and should be determined in consultation with a healthcare provider.

Calcium Intake During Childhood and Adolescence

Research has shown that the amount of calcium consumed during childhood and adolescence plays a crucial role in the development of healthy bones and the prevention of osteoporosis later in life. During childhood and adolescence, our bones are still growing, and our bodies need more calcium to support this growth. The recommended daily intake of calcium for children and adolescents is 1300mg, which can be obtained from a variety of sources, including milk, cheese, yogurt, and leafy greens.

Calcium Intake During Adulthood

Calcium intake is also essential during adulthood to maintain bone health and reduce the risk of osteoporosis. The recommended daily intake of calcium for adults aged 19-50 is 1000mg, while for adults aged 51 and older, it increases to 1200mg.

Calcium Helps Prevent Osteoporosis

Calcium builds strong bones and prevents bone loss, making it an important mineral for preventing osteoporosis. Our bodies store calcium in our bones, which provides them with strength and structure. Without adequate calcium intake, the body will start to take calcium from our bones, which can lead to bone loss and increase the risk of osteoporosis.

Nutrients that work with calcium to keep bones strong: K2 and Vitamin D

In addition to calcium, there are several other nutrients that are important for strong bones, including vitamin D, magnesium, and vitamin K2. Vitamin D helps the body absorb calcium, and magnesium plays a role in bone formation. Vitamin K2, on the other hand, helps regulate calcium in the body, directing it towards the bones and away from soft tissues where it can be harmful.

Vitamin K2 works together with calcium and vitamin D to promote healthy bones and reduces the risk of fractures. Getting enough of these important nutrients through a balanced diet can help promote healthy bones and reduce the risk of osteoporosis and other bone-related conditions.

What Foods Have the Most Calcium?

There are many food sources of calcium, including dairy products, fish, leafy greens, and calcium-fortified products such as cereals and juices. Non-dairy sources of calcium include tofu, almonds, and fortified plant-based milk. A good rule of thumb is that you need 3 full servings of dairy or a dairy substitute. If these foods don’t work for you, it’s a good idea to consider a supplement.

Calcium Absorption: Oxalates and Phytic Acid

Some food sources are high in calcium but are poorly absorbed due to the presence of compounds that interfere with calcium absorption. These include spinach and Swiss chard, which contain oxalates that can bind to calcium and reduce its absorption, as well as rhubarb, which also contains oxalates. Whole grains, such as brown rice and oats, are a good source of calcium but also contain phytic acid, which can bind to calcium and reduce its absorption. Similarly, legumes such as beans, lentils, and peas are a good source of calcium but also contain phytic acid and other compounds that can interfere with calcium absorption. Nuts and seeds, while a good source of calcium, also contain phytic acid, which can reduce calcium absorption.

What Else Affects Calcium Absorption?

Calcium absorption from foods and supplements can be influenced by a variety of factors. Here are some of the main factors that can affect calcium absorption:

• Vitamin D: Vitamin D plays a key role in calcium absorption. It helps to regulate the amount of calcium that is absorbed from the intestine and is necessary for the proper utilization of calcium in the body.
• Calcium source: Different sources of calcium have different absorption. For example, calcium from dairy products is generally well-absorbed, while calcium from plant-based sources, such as spinach or kale, is less well-absorbed due to the presence of oxalates and other compounds that can interfere with absorption.
• Other nutrients: Several other nutrients can impact calcium absorption, including magnesium, phosphorus, and vitamin K. These nutrients work together to support bone health and ensure proper calcium utilization.
• Age: As people age, their ability to absorb calcium may decrease. Older adults may need to consume more calcium to maintain healthy bones.
• Medications: Certain medications, such as corticosteroids, proton pump inhibitors, and anticonvulsants, can interfere with calcium absorption.
• IBD, Celiac and Other Health conditions: Some health conditions, such as inflammatory bowel disease, celiac disease, and certain types of cancer, can impair calcium absorption.
• Timing of consumption: Calcium supplements and certain calcium-rich foods are better absorbed when taken with meals. Taking calcium supplements between meals may decrease absorption.
• Dosage: The amount of calcium consumed at one time can also affect absorption. Larger doses of calcium may be less well-absorbed than smaller doses.

Who Should Avoid Calcium Supplements?

While calcium supplements can be beneficial for some people, there are certain individuals who may need to avoid them. For example:

• People with a history of kidney stones: Calcium supplements can increase the risk of kidney stone formation in some individuals, particularly those with a history of kidney stones.
• People with hypercalcemia: People with high levels of calcium in their blood, either due to a medical condition or excessive calcium intake, should avoid calcium supplements.
• People taking diuretics or steroids: Some medications, such as certain types of diuretics and corticosteroids, can affect calcium levels in the body and may interact with calcium supplements.
• People with kidney disease: Kidney disease can cause osteoporosis, and yet it may impair the ability to excrete excess calcium from the body. If you have been told you have renal insufficiency or kidney disease, seek out a consultation with a kidney specialist dietitian to talk about how to optimize your intake.

It’s important to speak with a healthcare provider before taking calcium supplements if you fall into any of the above categories or have any underlying medical conditions. In general, it’s often best to try to obtain calcium through a balanced diet that includes calcium-rich foods such as dairy products, leafy greens, and fortified foods.

Who Is Most Likely To Need Calcium Supplements?

Calcium supplements are not a replacement for a healthy lifestyle, which includes regular exercise and a balanced diet that includes calcium-rich foods. Food is a better source of calcium than supplements because it provides a balance of nutrients that the body needs, rather than only the single calcium nutrient.

There are several groups of individuals who may be more likely to need calcium supplements to meet their daily calcium needs, including:

• People taking medications for GERD: Certain medications used to treat gastroesophageal reflux disease (GERD), such as proton pump inhibitors (PPIs), can interfere with calcium absorption and increase the risk of osteoporosis. Calcium supplements may be recommended for individuals taking these medications to ensure they meet their daily calcium needs.
• People with a history of fractures: Individuals who have previously fractured a bone may be at increased risk for future fractures. Calcium supplements can help improve bone density and reduce the risk of fractures in those with a history of fractures.
• People with a thin bone structure: Individuals with a naturally thin bone structure may be at increased risk for osteoporosis and fractures. Calcium supplements can help improve bone density and reduce the risk of fractures in those with a thin bone structure.
• People with a history of steroid use: Long-term use of steroids can interfere with calcium absorption and increase the risk of osteoporosis. Calcium supplements can help prevent bone loss in individuals who have a history of steroid use.
• Women over 50: As women age, they are at increased risk for osteoporosis, a condition characterized by weakened bones that can lead to fractures. Calcium supplements can help prevent bone loss and reduce the risk of fractures in postmenopausal women.
• People with lactose intolerance: Lactose intolerance can make it challenging to obtain adequate calcium from dairy products, which are one of the best dietary sources of calcium. Calcium supplements can help ensure that individuals with lactose intolerance meet their daily calcium needs.
• People with certain digestive conditions: Certain medical conditions, such as celiac disease or inflammatory bowel disease, can interfere with calcium absorption and increase the risk of osteoporosis. Calcium supplements may be recommended to ensure that individuals with these conditions meet their daily calcium needs.
• People with low exercise levels: Regular exercise is essential for maintaining healthy bones, and individuals who have a sedentary lifestyle may be at increased risk for osteoporosis. Calcium supplements can help support bone health in those with low exercise levels.
• Smokers: Smoking has been linked to an increased risk of osteoporosis and fractures, and smokers may need more calcium to maintain healthy bones. Calcium supplements may be recommended for individuals who smoke to ensure they meet their daily calcium needs.
• People with a vegan or vegetarian diet: Individuals following a vegan or vegetarian diet may have a harder time getting enough calcium from their diet alone, as many calcium-rich foods are animal products. Calcium supplements can help ensure that individuals on plant-based diets meet their daily calcium needs.

How Should Calcium Supplements Be Taken?

In general, it’s best to take calcium supplements with food, as this can help improve calcium absorption and reduce the risk of side effects, such as constipation or stomach upset. Taking calcium supplements with a meal that contains fat can also help enhance calcium absorption. People with low stomach acid levels should take calcium supplements with meals, as absorption is reduced when taken on an empty stomach.

It’s important to be aware that calcium can interfere with the absorption of certain medications, such as antibiotics and thyroid hormones. Therefore, it’s important to space out the timing of calcium supplements and medication intake to prevent potential interference. Generally, it’s recommended to wait at least two hours before or after taking medication before taking a calcium supplement.

Your body can absorb only about 500-600 mg of calcium at a time. So, if you need more than that, it’s good to take some in the morning and some later in the day. This way, your body gets the most from the supplements.

Circadian Rhythm: Calcium Supplements Are Better At Night

Our bodies naturally break down and rebuild bone in a process called bone resorption, and this happens in a daily cycle. Interestingly, when researchers gave women a calcium supplement (1000 mg) in the evening, the nighttime increase in bone breakdown was reduced. However, when they took the same supplement in the morning, it didn’t have the same effect. The takeaway is that the timing of calcium intake may be important for bone health. [PMID: 8077353]

Are Calcium Supplements Safe?

Calcium is typically safe when used in recommended amounts, usually between 1000-1200 mg daily. Minor side effects such as gas or belching can occur. Children should consume sufficient calcium to meet daily needs but should not consume extra calcium.

While calcium is essential for maintaining strong bones and teeth, taking too much calcium can be harmful. The Tolerable Upper Intake Level (UL) for calcium, which is the highest level of daily intake that is likely to be safe for most people, is 2500mg for adults. Excessive calcium intake, especially from supplements, can lead to a condition called hypercalcemia, which is characterized by high levels of calcium in the blood. Symptoms of hypercalcemia can include nausea, vomiting, constipation, abdominal pain, excessive thirst, frequent urination, and bone pain.

Long-term hypercalcemia can lead to the buildup of calcium in soft tissues, such as the kidneys and blood vessels, which can increase the risk of kidney stones, kidney damage, and cardiovascular disease. It’s important to avoid exceeding the UL for calcium without medical supervision. The UL for calcium is a conservative guideline, and many individuals may be able to tolerate higher levels of calcium intake without experiencing adverse effects. However, it’s still important to be aware of the UL and to speak with your healthcare provider before taking calcium supplements or significantly increasing your calcium intake.

Medication Interactions with Calcium Supplements

Calcium supplements can interfere with many medications by binding to the medication in the stomach. This is why you always want to take medications and other supplements separately from calcium supplements. Here are some specific medications to be aware of:

• Bisphosphonates: These medications, used to strengthen bones, should not be taken with calcium supplements. Calcium can hinder their absorption. It’s best to take them at different times of the day.
• Antibiotics: Certain antibiotics, particularly tetracyclines and fluoroquinolones, can bind to calcium. This reduces their effectiveness. To avoid this, space out the timing of calcium supplements and these antibiotics by several hours.
• Blood pressure medications: Calcium supplements can affect how your body processes beta-blockers and calcium channel blockers. They might reduce the efficacy of these medications. It’s important to monitor blood pressure and discuss timing with a healthcare provider.
• Thyroid medicine: Levothyroxine can bind to calcium supplements. It is recommended to take thyroid medication several hours before or after calcium supplements.

Supplements that Interact with Calcium

• Iron When taken with food, calcium supplements may reduce the absorption of iron. However, individuals with sufficient iron stored in their bodies are not affected by long-term calcium consumption. Those at risk of iron deficiency should take calcium supplements at bedtime instead of with meals.
• Magnesium High doses of calcium supplements (2600 mg daily) can hinder the absorption of magnesium from the diet. Those who are at a high risk of magnesium deficiency should take calcium supplements at bedtime instead of with meals.
• Zinc Calcium supplements may impede the absorption of zinc from the diet. However, people with sufficient zinc stored in their bodies are not affected by long-term calcium consumption.
• Vitamin D Taking vitamin D and calcium together increases the absorption of calcium, which may raise the risk of high calcium levels in some people.

The Best Forms of Calcium: Carbonate or Citrate

There are several types of calcium supplements available in the market, and each type has different rates of absorption. The main types of calcium supplements are:

Calcium Carbonate

Calcium carbonate is an inexpensive form of calcium supplement that is well absorbed by anyone who has good levels of stomach acid, are not on acid-blocking medications, and are not at risk for kidney stones. Also, for individuals who need to take large doses of calcium, calcium carbonate may be a more practical and cost-effective option.

Calcium citrate:

Calcium citrate may be a better choice for some people over calcium carbonate. The following are some situations where calcium citrate may be preferred:

• Bariatric Surgery. Calcium citrate is a better option for individuals who have had bariatric surgery because it is more easily absorbed and does not require stomach acid for absorption. Additionally, calcium citrate supplements are available in smaller doses, which can be easier for individuals with limited stomach capacity to tolerate.
• Low Stomach Acid. Older people tend to have lower stomach acid: Calcium carbonate requires stomach acid for optimal absorption, so people with low stomach acid may have difficulty absorbing calcium from this form. In contrast, calcium citrate is better absorbed by people with low stomach acid.
• Medications for GERD: Medications used to treat acid reflux and heartburn can reduce stomach acid levels, which can also reduce calcium absorption from calcium carbonate. Calcium citrate is a better option for people taking these medications.
• Kidney Stone Risks. Calcium citrate may be a better choice for people with a history of kidney stones, as it may reduce the risk of developing calcium oxalate stones. Calcium citrate increases urinary citrate excretion, which can help to prevent the formation of kidney stones.
• People who prefer to take supplements without food: Calcium citrate can be taken with or without food, whereas calcium carbonate is best taken with food to enhance absorption. If someone prefers to take their supplements without food, calcium citrate would be a better choice.

Other Forms Of Calcium

Calcium citrate is derived from citric acid and has a lower elemental calcium content, typically around 21%. Calcium citrate is better absorbed than calcium carbonate and can be taken on an empty stomach. It has an absorption rate of around 20-25%.

Hydroxyapatite calcium has high bioavailability owing to its similarity to bone calcium. Calcium malate is known for its better digestive tolerance. These can both offer relatively high percent absorption compared to more common forms of calcium supplements.

Calcium gluconate and calcium lactate are also sold in supplement form. They are less desirable because of cost and the number of pills needed compared to carbonate and gluconate forms of calcium. Calcium gluconate contains only 9% elemental calcium, so larger doses are needed to get the same amount of calcium as other forms. Calcium lactate contains 13% elemental calcium.

This is the most common form of calcium supplement. It is often derived from limestone or marble, and it contains 40% elemental calcium. Calcium carbonate is best absorbed when taken with food, as stomach acid helps to break it down. It has a relatively high absorption rate of about 40%.

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Combined Calcium Supplement with Magnesium and Zinc

Along with concerns about calcium, many people are deficient in magnesium and zinc due to dietary choices, soil depletion, and processed foods. Only whole foods, such as leafy greens, nuts, seeds, and legumes are rich in these minerals. For these reasons, it can be challenging for people to meet their daily requirements for magnesium and zinc.

Not only that, but Zinc and magnesium deficiencies are often not diagnosed because their symptoms can be nonspecific and easily overlooked, and routine blood tests may not accurately reflect the body’s true mineral status.

Magnesium Deficiency is present in about 50% of the population and may be a major driver of Cardiovascular disease. [PMC5786912]. “Zinc deficiency is frequent in the elderly and leads to changes similar to those that occur in oxidative inflammatory aging (oxi-inflamm-aging) and immunosenescence.” [PMC4321209]

Food First!

Although this article discusses supplements in detail, don’t forget that we are absolutely committed to the “Food First” approach to nutrition. When it comes to your health, the totality of your eating habits far surpasses the impact of individual nutrients or any single supplement you consume. Even though this article doesn’t delve into the broader picture of your overall diet, it’s crucial to keep this element at the forefront of our minds. Your food needs to provide all the vitamins, minerals, fiber, and phytochemicals to nourish your body systems down to the cellular level.

Food choices, rather than supplements, are the most critical factors for a healthy gut microbiome. These trillions of tiny inhabitants in your gut affect your brain waves; they orchestrate your immune system. They possess the power to create molecules that can switch genes on or off and are even capable of synthesizing neurotransmitters. Opting for organic foods and steering clear of plastic packaging (including those labeled BPA-free) is a smart move to limit toxin exposure. The sum of all these parts leads to a powerful conclusion: the ultimate key to your health lies in the quality and balance of the food you consume. Supplements are secondary.