Everything You Need to Know About Calcium

dairy calcium

They say you can never have too much of a good thing. That said, there has been concern in the media about calcium supplements and an increased risk for heart disease.

What is Calcium?

Calcium is an essential nutrient for the body.  Many people think of it for maintaining healthy teeth and bones, but it is a workhorse that drives the body on a cellular level. Calcium channels work to keep our cell’s functioning. It fires off our neurons. It contracts our muscles. Simply put, we could not live without it.

Consequences of Calcium Imbalance

Impaired calcium metabolism can lead to osteopenia and osteoporosis, conditions where the bones are weakened and at risk for fractures. Some people may be at risk for gallstones or kidney stones. Having too much or too little calcium in the body, especially over a long length of time, can have other clinical consequences as well.

 Hypocalcemia (Low Calcium)Hypercalcemia (High Calcium)
Cardiovascular symptoms– Chest pain/pressure
– Low blood pressure
– Irregular heartbeat
 
Gastrointestinal symptoms Loss of appetite– Abdominal pain
– Constipation
– Loss of appetite
– Nausea and vomiting
Nervous system symptoms– Confusion
– Loss of consciousness
– Numbness around the mouth
– Seizure
– Tingling in the fingers and toes
– Confusion
– Lethargy and fatigue
Musculoskeletal symptoms– Muscle cramps
– Tetany (intense muscle contractions)
– Muscle weakness
– Muscle and joint aches
Respiratory symptoms– Choking
– Shortness of breath
– Wheezing
 
Other– Generalized weakness
– Increased bruising
– Excessive thirst
– Frequent urination

How Much Calcium Do You Need?

You will need different amounts based on your age. This table simplifies the recommendations suggested by the RDA.

1000 mg Calcium per Day1200mg Calcium per Day
– Men 18-70 years
– Women 18- 50 years
– Men 70+ years
– Women: 50+ years

The combined intake from the dietary sources and vitamin supplements should not exceed 1500mg per day. Keep in mind you also need adequate amounts of vitamin D for your bone health.

Dietary vs. Supplemental Calcium

Calcium can be ingested as part of the diet or it can also be taken as a supplement. The dietary form is preferred but if you need to, consider a supplement.

There are two major points to be made about supplements.

  1. Supplements comes in different varieties, some cheaper than others. Calcium carbonate products must be taken with food to be properly absorbed.  Calcium citrate products can be taken with or without food.  Read the product labeling to make sure you are getting your body’s and your money’s worth.
  2. The body can only absorb so much at a time and that threshold is set at 500mg to 600mg per dose.  Be leery of supplements that offer once-daily supplementation to meet the day’s needs.

The Association with Heart Disease

Heart attacks occur when blood cannot get to an area of the heart. This can happen when a clot blocks flow through an artery but it can also happen if the artery fills up with plaque. Plaque forms from fatty streaks and cholesterol but can thicken and harden with calcium. 

The Women’s Health Initiative (WHI) assessed more than 36,000 women. In one subgroup analysis, there was an increased risk for heart disease in women who took calcium supplements (with or without Vitamin D).

The hypothesis is that a sudden rise in blood calcium can increase the risk for plaque formation. When you eat it in your diet, you introduce small amounts into the body. When you take a supplement, you expose yourself to higher amounts at one time. The calcium levels in your blood spike. You may not be able to absorb or process that amount as easily (remember the 500mg to 600mg maximum), and the extra calcium may stick to plaque in the arteries.

Should You Take Supplements?

Whether or not you should take a supplement depends on your personal situation. We want to decrease our risk for both heart disease and osteoporosis. Where are your risks higher?

 Low RiskMedium RiskHigh Risk
Heart Disease Risk Factors  
– Family history of heart attack
– High blood pressure
– High cholesterol
– Obesity (BMI > 30)
– Smoking
 0 elements1-2 elementsKnown heart disease
-or-
Known diabetes
-or-
3+ elements
Osteoporosis Risk Factors
– Family history of osteoporosis
– Medication with bony side effects
– Menopause
– Epilepsy medications (e.g., phenytoin)
– Oral steroids (e.g., prednisone)
 0 elements 1 elementKnown osteopenia or osteoporosis
-or-
2+ elements
  • If you have high risk for heart disease, a supplement is likely a bad idea.
  • If you have low risk for heart disease and you do not get enough calcium in your diet, a supplement might be a good idea.
  • Everything else is a grey area, and different primary care providers will have different opinions on what they think is best.  I recommend you talk to your provider to see what they recommend for you.

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