Calcium supplements and bone health

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Calcium

General Principles

  • Calcium guidelines are for total dietary calcium, not supplement requirements. The Institute of Medicine and the National Osteoporosis Foundation both recommend dietary sources as the preferred method of intake.

  • The Institute of Medicine has recently raised concern (particularly among older women) about the ingestion of too much calcium carbonate in pill form.

  • Calcium considerations are influenced greatly by several medical conditions - especially kidney disease - individual professional advice should be considered.

  • Current calcium supplements do not contain remotely adequate amounts of vitamin D for use as standalone vitamin D supplementation.

  • Calcium should not be taken with some medications.

  • Calcium carbonate requires acid for absorption and should be taken with food.

  • Calcium carbonate supplement contains 40% elemental calcium.

  • Calcium citrate does not require acid for absorption and contains 21% calcium.

  • Our bones are made of calcium phosphate and dairy products are an excellent source.

  • Convenience, cost and palatability are major considerations. (avoid bone meal products because of possible heavy metal contamination, "coral calcium" is calcium carbonate)

Vitamin D status appears to affect calcium absorption more than the amount of calcium taken:

Relationship Between Serum Parathyroid Hormone Levels, Vitamin D Sufficiency, and Calcium Intake
Laufey Steingrimsdottir; et. al. JAMA . 2005;294:2336-2341.
http://jama.ama-assn.org/cgi/content/abstract/294/18/2336

Large doses of calcium supplementation may interfere with phosphorus adsorption:

Phosphorus Nutrition and the Treatment of Osteoporosis
Robert P Heaney Mayo Clin Proc. 2004;79:91-97
http://www.mayoclinicproceedings.org/article/S0025-6196%2811%2963261-8/fulltext

Selected Food Sources of Calcium

Food

Calcium (mg)

% DV*

Yogurt, plain, low fat, 8 oz.

415

42%

Yogurt, fruit, low fat, 8 oz.

245-384

25%-38%

Sardines, canned in oil, with bones, 3 oz.

324

32%

Cheddar cheese, 1 ½ oz shredded

306

31%

Milk, non-fat, 8 fl oz.

302

30%

Milk, reduced fat (2% milk fat), no solids, 8 fl oz.

297

30%

Milk, whole (3.25% milk fat), 8 fl oz

291

29%

Milk, buttermilk, 8 fl oz.

285

29%

Milk, lactose reduced, 8 fl oz.**

285-302

29-30%

Mozzarella, part skim 1 ½ oz.

275

28%

Tofu, firm, made w/calcium sulfate, ½ cup***

204

20%

Orange juice, calcium fortified, 6 fl oz.

200-260

20-26%

Salmon, pink, canned, solids with bone, 3 oz.

181

18%

Pudding, chocolate, instant, made w/ 2% milk, ½ cup

153

15%

Cottage cheese, 1% milk fat, 1 cup unpacked

138

14%

Tofu, soft, made w/calcium sulfate, ½ cup***

138

14%

Spinach, cooked, ½ cup

120

12%

Instant breakfast drink, various flavors and brands, powder prepared with water, 8 fl oz.

105-250

10-25%

Frozen yogurt, vanilla, soft serve, ½ cup

103

10%

Ready to eat cereal, calcium fortified, 1 cup

100-1000

10%-100%

Turnip greens, boiled, ½ cup

99

10%

Kale, cooked, 1 cup

94

9%

Kale, raw, 1 cup

90

9%

Ice cream, vanilla, ½ cup

85

8.50%

Soy beverage, calcium fortified, 8 fl oz.

80-500

8-50%

Chinese cabbage, raw, 1 cup

74

7%

Tortilla, corn, ready to bake/fry, 1 medium

42

4%

Tortilla, flour, ready to bake/fry, one 6" diameter

37

4%

Sour cream, reduced fat, cultured, 2 Tbsp

32

3%

Bread, white, 1 oz

31

3%

Broccoli, raw, ½ cup

21

2%

Bread, whole wheat, 1 slice

20

2%

Cheese, cream, regular, 1 Tbsp

12

1%

*DV=Daily Value
** Calcium values are only for tofu processed with a calcium salt. Tofu processed with a non-calcium salt will not contain significant amounts of calcium.

For foods not listed in this table, please refer to the U.S. Department of Agriculture's Nutrient Database Web site: http://www.nal.usda.gov/fnic/cgi-bin/nut_search.pl.

There are a number of other good sites that address this. Here are a few links.
Dietary Guidelines for Americans 2005

Nutrition - HEALTHIERUS.GOV

Nutrition.gov

Food & Nutrition - MAYO CLINIC

Calcium extensive NIH fact sheet on calcium

 

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