I’ve come to believe, through my experience treating hundreds of patients, that many of us benefit from supplementation even if we’re eating a nutrient-dense, whole-foods diet. Some nutrients are challenging to get through food alone due to challenges like declining soil quality, a growing toxic burden, an increase in digestive issues and chronic diseases that interfere with nutrient absorption, and several other factors that are now common in the modern world. The latest statistics suggest that most Americans don’t get enough of several essential vitamins and minerals, and low nutrient intake is associated with a higher risk of chronic disease and a shorter lifespan.
That said, there are some nutrients that we need to be careful with when supplementing. More is not always better, and the specific form of the nutrient in the supplement can make a big difference in how it impacts us. This doesn’t mean that we should never take these nutrients as supplements, but it does mean that we have to be smart about how we supplement with them.
Calcium supplements are a prime example of this.
Do Calcium Supplements Work?
Calcium has become extremely popular as a supplement, especially among aging women, in the hope that it will prevent fractures and protect against osteoporosis.
We’ve all seen the products on the market aimed at the “worried well,” such as Viactiv and Caltrate, suggesting that supplementing with calcium can help maintain bone health and prevent osteoporosis. Osteoporosis is a serious concern in women’s health, and it affects at least 10 percent of American women. (1) Yet the evidence that calcium supplementation strengthens the bones and teeth was never strong to begin with, and it has grown weaker with new research published in the past few years.
Are you taking a common supplement that may increase the risk of heart disease, stroke, and death? Read this article to find out. #bonehealth #heartdisease #nutritionalsupplements
A 2012 analysis found that consuming a high amount of calcium beyond recommended dietary guidelines, typically from supplementation, provided no benefit for hip or lumbar vertebral bone mineral density in older adults. (2) A 2007 study published in The American Journal of Clinical Nutrition found that calcium supplements don’t reduce fracture rates in postmenopausal women and may even increase the rate of hip fractures. (3)
Are Calcium Supplements Safe?
Beyond being ineffective for bone health, standard calcium supplements are associated with some pretty serious health risks.
Heart Disease Risk
Studies on the relationship between calcium and cardiovascular disease (CVD) suggest that dietary intake of calcium protects against heart disease, but supplemental calcium may increase the risk. A 2012 study of 24,000 men and women aged 35 to 64 years published in the British Medical Journal (BMJ) found that those who used calcium supplements had a 139 percent greater risk of heart attack during the 11-year study period, while intake of food calcium did not increase the risk. (4) A meta-analysis of studies involving more than 12,000 people also published in the BMJ found that calcium supplementation increases the risk of:
- Heart attack by 31 percent
- Stroke by 20 percent
- Death from all causes by 9 percent (5)
An analysis involving 12,000 men published in JAMA Internal Medicine found that intakes of over 1,000 mg of supplemental calcium per day—from multivitamins or individual supplements—were associated with a 20 percent increase in the risk of death from CVD. (6) Researchers suspect that the increase of calcium in the blood that occurs after supplementation may facilitate the calcification of arteries, whereas calcium obtained from food is absorbed at slower rates and in smaller quantities than from supplements. (7) It is also suspected that extra calcium intake above one’s requirements is not absorbed by the bones, but is excreted in the urine, increasing the risk of calcium kidney stones. The excess calcium could also be circulated in the blood, where it might attach to atherosclerotic plaques in arteries or heart valves. (8)
Cancer, Kidney Stones, and Other Health Risks
The Office of Dietary Supplements at the National Institutes of Health has compiled a comprehensive review of the health risks associated with excess calcium, particularly from supplementation. (9)
For example, daily supplementation of calcium at 1,000 mg is associated with increased prostate cancer risk and an increase in kidney stones. (10)
Additionally, a recent Swedish study reported a 40 percent higher risk of death among women with high calcium intakes (1,400 mg and above), and a 157 percent higher risk of death if those women were taking a 500-mg calcium supplement daily. Those rates were compared to women with moderate daily calcium intakes between 600 and 1,000 mg. (11) A Consumer Lab analysis found that many of the calcium supplements they analyzed failed quality testing for reasons including lead contamination and mislabeled contents. (12)
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Other Forms of Calcium Supplementation
Even if you’re not popping a calcium pill every morning, that doesn’t mean you’re not consuming supplemental calcium. Many commonly consumed foods in the United States are fortified with supplemental forms of calcium, including:
- Orange juice
- Breakfast cereals
- Non-dairy milk
- Instant oatmeal
- Graham crackers
- Other staples of the Standard American Diet
While these foods are typically eliminated on a whole-foods or Paleo diet, it’s important to pay attention to whether some of your fridge staples, such as commercial almond, coconut, or other varieties of non-dairy milk, are fortified with calcium. You may be consuming more supplemental calcium than you realize.
In addition, many multivitamins contain high doses of cheap or inferior forms of calcium that are not well absorbed. This can lead to an accumulation of calcium in the soft tissues (where we don’t want it), which in turn contributes to the adverse effects discussed in this article.
Not all multivitamins are created equal. When I formulated Adapt Naturals Bio-Avail Multi, I included a minimal dose (50 mg) of calcium, which is only 4 percent of the total daily requirement. I also used di-calcium malate, a highly bioavailable form of calcium that is much better absorbed than calcium carbonate and other forms of calcium.
Bio-Avail Multi also contains meaningful doses of vitamins A, D, and K2, as well as magnesium. Each of these nutrients plays critical roles in calcium metabolism and bone health and may be even more important for improving bone health than increasing calcium intake—at least for some people.
Vitamin E is another important nutrient for bone health—but here, I’m referring to delta- and gamma-tocotrienols, a newly discovered form of vitamin E, rather than alpha-tocopherol, the more common form that is in most supplements. Tocotrienols have several positive effects on bone health: they decrease bone resorption, increase bone turnover rate, and improve osteoblast number, bone formation, mineral deposition, and bone microarchitecture. Adapt Naturals Bio-Avail E+ contains 300 mg of delta- and gamma-tocotrienols (with no tocopherols), sourced from the annatto plant. Taken together with Bio-Avail Multi, you can have confidence that you’re getting the nutrients you need for optimal bone health.
The Safest Ways to Get Enough Calcium
If you’re concerned about keeping your bones healthy, you’re better off getting your calcium from food sources like:
- Dairy products
- Canned, bone-in fish (e.g., sardines, salmon, etc.)
- Dark, leafy greens
- Seeds (especially poppy and sesame)
The Recommended Dietary Allowance (RDA) for calcium for adult men and women is 1,000 mg—or approximately three servings of dairy products or bone-in fish per day. Pregnant and lactating women, and adults 70 and older, need 1,200 mg per day.
It’s critical to understand that healthy bone formation also depends on other nutrients like vitamins A, D, and K2, and minerals like magnesium and silica, each of which plays a role in regulating calcium metabolism. Some research suggests that consuming optimal levels of these nutrients may reduce the amount of calcium you need each day, due to their synergistic effects. Regular weight-bearing exercise can also make a big difference for maintaining healthy bones. (13)