Calcium Supplements

Calcium supplements are an excellent alternative for people who fear their diet preferences are not giving them enough calcium. This is especially true for people who avoid dairy or who are lactose intolerant. The two main forms of calcium in supplements are carbonate and citrate. Calcium carbonate is more commonly available and is both inexpensive and convenient. The carbonate and citrate forms are similarly well absorbed, and both can be taken with or without food. One caveat, however, relates to people who don’t make much stomach acid, as is the case for those taking a proton-pump inhibitor or hydrogen blocker. In this scenario, taking the calcium supplement with a meal is best. Other calcium forms in supplements or fortified foods include gluconate, lactate, and phosphate. Calcium citrate malate is a well-absorbed form of calcium found in some fortified juices.

How well your body absorbs calcium from a supplement depends, in part, on how concentrated elemental calcium is in that supplement. Absorption is highest in doses equal to or less than 500 milligrams. So, for example, if you like to take 1,000 milligrams of calcium per day from supplement, it’s ideal to split the dose and take 500 milligrams at a time, two separate times during the day. Those who take a proton-pump inhibitor like Prilosec or Nexium to contral acid reflux and gastroesophageal reflux disease (GERD), or Tagamet or Zantac (which work a different way but have the same effect of inhibiting the production of acid in the stomach), need to be extra careful about getting enough calcium. Because stomach acid helps the body absorb calcium by dissolving the calcium pill, thus freeing the calcium so it can be absorbed by the small intestine, lowering stomach acid levels may stop its proper absorption. In 2006, the Journal of the American Medical Association published a study suggesting that long-term (more than a year) use of proton-pump inhibitors in high doses increased the risk of hip fracture by 245 percent. The subjects in the study were all over the age of fifty, and the researchers said the effects were particularly in people already at risk of osteoporosis.

However, if you take your calcium pill with a meal, as your meal is being ground up in the stomach so, too, is the calcium pill – without the need for stomach acid. This is why doctors tell their patients to take their calcium pill with their meals.

Some people who take calcium supplements experience gas, bloating, constipation, or a combination of these symptoms. These symptoms can often be resolved by spreading out the calcium dose throughout the day, taking the supplement with meals, or changing the brand of supplement used. The older you get, the harder it becomes to produce adequate stomach acid, as you did when you were younger (and able to down just about anything without gastrointestinal problems). For this reason, taking a calcium supplement with a meal is best.

Supplements that combine calcium and vitamin D are an even better option, as the vitamin, once it gets activated in the liver and kidneys, increases calcium absorption and provide other health benefits. Vitamin D is essential to the uptake of calcium from your diet, helping the calcium to become more easily absorbed in the bloodstream and bones.

Because of its ability to neutralize stomach acid, calcium carbonate is found in several over-the-counter antacid products, such as Turns and Rolaids. Thus these drugs serve two purposes – calming stomach acid and providing bioavailable calcium. The fact that you’re chewing the calcium makes it easily absorbed.

People at Risk for Calcium Deficiency and Why

Postmenopausal women: Low estrogen stores dampen proper calcium metabolism and regulation.

Vegetarians: Avoiding diary and consuming mostly vegetables, some of which have compounds known to inhibit calcium absorption, including phytates and oxalate, act as a double whammy.

People whose diets include lots of protein and sale: High intake of sodium and protein increases calcium excretion.

Lactose-intolerant people: Those who have trouble digesting dairy products, and thus avoid them, are frequently found to be calcium deficient and have lower bone density.

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