Calcium Supplements

Are Calcium Supplements
worth taking?
an honest look at a controversy

We all know we need calcium supplements to make and keep strong bones, right? Is the milk mustache the best way to get my calcium? Can I get enough calcium for bone health if I am a vegetarian? Maybe you thought you knew the answers to these questions, but the facts are not that simple.

Here’s what we know about calcium and bones. Calcium is the major mineral that makes up bone structure. Actually, there is a collagen connective tissue framework, sort of like a 3-dimensional web, onto which calcium is deposited to make the hardened mineral structure that makes bones strong (and breakable instead of bendable). And we know that loss of calcium from bones is a major factor in making bones weak and prone to fracture: we call this loss of calcium and decreased bone density “osteoporosis.” (or osteopenia if the bones are thinned but not severely so).

But there’s a lot about calcium we don’t know. We don’t really know if calcium supplementation (either from milk or other calcium-rich foods) does anything to prevent fractures or to prevent calcium loss from weakening bone. Calcium supplementation has been studied enough to say it is slightly better than “nothing” at reducing how fast osteoporosis is happening, but that’s only after at least 2 years of treatment, and that’s as much as we know about it.

So maybe it’s not all about taking calcium supplements; maybe a whole food approach is better and we should be studying milk instead. OK, been there and done that too. Milk intake is higher in the US than almost anywhere in the world, yet we have higher rates of osteoporotic fractures in this country. For example, Americans drink 3 times as much milk as the Japanese, but have a 2.5 times higher rate of hip fractures in the population. Maybe the milk mustache is not as cool as you thought.

So should we ignore calcium sources in the diet? I think not, as clearly some calcium in the human system is important not only for bone health but also for essential body functions like normal blood pressure and transmission of nerve signals. After years of study and experience with patients, I am not a big fan of cow milk for humans. Probably OK for cows, but maybe that’s all. So consider non-dairy sources of calcium in your diet. These include legumes (such as black beans, navy beans, etc.), broccoli, kale, squashes, and more.

If you are going to increase your calcium intake from foods or supplements, it is very important to make sure your vitamin D level is normal, as this improves the absorption of calcium into the body. Another way to enhance calcium absorption is the addition of inulin (a fiber prebiotic, often derived from chicory root) to foods, often found in commercial yogurts.

Various forms of supplements with calcium are found on the market. Data suggest that calcium citrate and calcium gluconate are better utilized by the body than calcium carbonate (more commonly used and cheaper). The other major concern with calcium carbonate supplements has been the occasional contamination with lead and aluminum. And for men, there have been some concerns about increased risk for prostate cancer when calcium supplements are taken, so I do not generally recommend them for men. 

Read the latest on the link between taking calcium supplements and heart attack risk. My final opinion on the matter? To preventosteoporosis or attempt to stop its progression, it makes sense to optimize calcium intake even though data are weak. Find a guide to calcium content in food, and estimate your daily intake; if below 800 mg per day, take enough calcium citrate or calcium gluconate to make up the difference, but always combine a dietary calcium supplement with Vitamin D.

Let me emphasize that last point again. Especially for women after menopause, always take a calcium supplement with vitamin D, and recent data are suggesting that taking supplements of calcium may not be safe. There seems to be a link between taking calcium supplements and added risk of heart attack. That’s one more reason to get your calcium from foods, not pills.

If uncertain how to do this, consult a registered dietitian, who will know much more about the subject than 99% of doctors.

For your health and wellness,




Robert Pendergrast, M.D. 

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