Choosing the Best Calcium Supplement for Your Needs

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Transcript

Leah: Hello and welcome back to “Ask a Nutritionist”, our weekly mini episode of Dishing Up Nutrition. I'm Leah Kleinschrodt, Registered and Licensed Dietitian with Nutritional Weight & Wellness. And today we're talking about how to choose a calcium supplement. Now, calcium is a mineral that is important for bones, but many aren't sure if and when they need to start supplementing and which one to choose with the many options that are out there.

If you've ever been told by your provider that you should start taking a calcium supplement, and then you've stood in the supplement aisle confused by all the different forms of calcium and dosages that are out there, this episode is for you. And it comes at the perfect time because our Nutrikey bone support supplements are going to be 15% off for the month of July.

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When would a person need to supplement with calcium?

So it's the perfect time to learn more about them and possibly try them on for size. So let's start out by asking why would anyone want to supplement with calcium in the first place? Calcium is the most abundant mineral in the body. 99% of it is stored in our bones and our teeth, while the remaining 1% circulates in the blood and it helps with a lot of different things like muscle contractions, nerve signaling, blood clotting, and also heart function.

When calcium is too low, the body will pull calcium from the bones to keep blood levels of calcium stable. Now, over time that can be a problem because when we leach too much calcium out of the bones over a long period of time, like years or decades, that leaching from the bones can contribute to problems like osteopenia or osteoporosis.

Food sources of calcium

Now, the good news is many people can meet their calcium needs through diet alone. Dairy products are what most of us probably think about to get calcium, and rightly so. But there are other great non-dairy sources that include canned salmon and sardines with the bones in them, cooked dark leafy greens, so think about collard greens, mustard greens, bok choy, kale, arugula, and then also for some people if they enjoy tofu; a good calcium set tofu can work for calcium intake. Some nuts and seeds have calcium in lower amounts like almonds, sesame seeds, and even chia seeds.

More on who may benefit from calcium supplementation

Now, all that being said, there are still some people that may fall short in their dietary calcium, especially because our needs do go up with age. So calcium supplementation is something to consider. If you're not sure where you fall on the spectrum of calcium intake, grab an app that does give you a report of your vitamin and mineral intake.

And track your food and beverages for a few days. Get a sense of what your average calcium intake is over the course of say three to seven days, and then decide from there if or how much you need to supplement with in terms of calcium.

Calcium supplement options & which ones to choose

So, what are options when it comes to calcium supplements? Let's start with the more common forms that you'll see on the store shelves. I'd say calcium carbonate is the one you're probably going to see the most often. It's the most widely available form. To be blunt, this is one we do not recommend. You'll find calcium carbonate in many of your basic kind of big box store calcium supplements.

And if you've ever picked up orange juice or different nut milks, or if you've looked at your antacids that you buy over the counter, you'll probably see calcium carbonate as the form of calcium that's being used in these things. They use it because it's an inexpensive form of calcium.

And so again, this is why it's probably the one that gets plopped in different products and different supplements the most. The downside is that it does have a low absorbability compared to other forms of calcium. It requires actually a pretty robust amount of stomach acid for absorption.

So it does need to be taken with foods. And calcium carbonate isn't a great option for people who are taking acid-reducing medicines like omeprazole and other PPIs. This one can also cause digestive side effects. So some clients will report constipation, some clients will report actually more looser stools, some people will say more gas and bloating. So again, this is just one form that we typically do not recommend supplementing with.

Calcium citrate is another form that you'll see, probably the second most common option that you'll find out in the store or in different products. It is a more absorbable option. It doesn't require as much stomach acid to absorb it, so it can be taken without food and is probably a better option for somebody who is on an acid blocking medication.

It also doesn't typically have the same kind of GI side effects that you'll see potentially with the carbonate form. So, calcium citrate is found in many of our go-to Nutrikey products that do contain calcium. So, this includes our Nutrikey Activated Calcium supplement. So, it does contain that calcium citrate. It also contains a few other forms of calcium. One is dicalcium malate. You'll also see calcium bisglycinate in there, and also a little guy called MCHC or microcrystalline hydroxyapatite.

It's a little bit of a mouthful, so you'll hear me say MCHC more often. These forms have very high absorption without the digestive side effects common with the calcium carbonate supplements. So for those who are wanting a straightforward calcium supplement, no bells, no whistles, our Nutrikey Activated Calcium is our go-to recommendation.

Now, going back to that MCHC, it is also found in our Nutrikey Activated Cal-Mag supplement as well as our Nutrikey Activated Calcium Chewable supplement. And what is unique about this MCHC is that it does contain calcium, but it is calcium in a bone-like matrix, which means it has that calcium piece and it also naturally includes phosphorus and some other trace minerals that are important for bone health.

So in other words, you can kind of think of this as a whole bone calcium supplement. This might be a preferred option for those who are interested in that bone matrix approach rather than just an isolated calcium.

The ultimate bone health supplement: Key Osteo Plus

So then we also have our ultimate bone health supplement called Key Osteo Plus, which contains that dicalcium malate, the same form that's in the Activated Calcium supplement, and it also has that MCHC or that calcium hydroxyapatite. Now this is what we refer to as the Cadillac of bone supplements because the key osteo plus is the most comprehensive bone formula you will find.

So it contains those highly absorbable forms of calcium, the malate-based calcium, the bone matrix calcium sorts, and the hydroxyapatite. But then it also contains a lot of the key supporting nutrients that go along with bone health and just health in general. So it has your vitamin D3, it has vitamin K2, it has magnesium, it has strontium, it has zinc, copper, manganese, boron, and other nutrients as well.

We recommend this supplement for those who are really targeting bone support. For most of my clients who have osteopenia or osteoporosis, this is the recommendation I'm giving them. Some clients even try to get ahead of the game if they know they have a family history of osteopenia or osteoporosis or they've had a DEXA scan or a bone scan that has shown that they're kind of tipping on the edge of osteopenia; this would be a great supplement to jump on and try to stay ahead of the game and get that prevention piece in place.

Which calcium supplement might be right for you?

So to answer the question like which one is right for me. If the goal is to have a high-quality calcium supplement, but again, no bells, no whistles, keeping it simple, I would recommend that Nutrikey Activated Calcium supplement. It's simple and it's a highly absorbable formula. If the goal is more of that comprehensive bone density support to prevent or combat significant bone loss, the Key Osteo Plus really stands out because it combines multiple forms of those highly absorbable forms of calcium.

Plus a lot of those supporting minerals and vitamins, vitamin D3, K2, magnesium, which we'll touch on a little bit more in just a bit. So sometimes I'll describe the Key Osteo Plus as your multivitamin, but tailored for more of that structural bone support also. The Nutrikey Activated Calcium chewable, that's another great option that gives you that MCHC plus a few other forms of that calcium, but it can be a great option just for those who either prefer a chewable or maybe you have trouble swallowing capsules.

We do also have our Nutrikey Activated Cal-Mag supplements, which combines calcium and magnesium, a few other minerals in there as well. Some people prefer to try to get a bang for your buck in terms of combining calcium and magnesium. And so some people prefer to take these over separate tablets or capsules.

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More on how might you know if you need a calcium supplement

Now I want to backtrack for just a moment, asking the question, like, how do you know if you truly need a calcium supplement? Are there signs of calcium deficiency or poor calcium intake to look for? It's not a great simple answer. The tricky part is that calcium deficiency usually develops very slowly.

Like I mentioned earlier, this is years and sometimes decades in the making. And there's not super obvious symptoms at first unless you're really in a dire strait. Because the body works really, really hard to keep blood calcium level stable, that low intake can go unnoticed for many years because it has a great reserve to draw from. It can draw from those bones. It can draw from the teeth if it needs to.

And many people only find out about the status of their bones after they do a routine DEXA scan, which is only done at least here in the U.S., after a certain age for many women. It's either in your late 50s, early 60s, early to mid-60s, somewhere in that range. But there are some possible signs and symptoms to look for. So this would include muscle cramps and muscle spasms because calcium is important for muscle contractions.

This can include tingling or numbness in the fingers, brittle nails, dry skin, fatigue, generally just kind of feeling weak and some malaise. And then if you are constantly running into tooth problems: weakness, cavities, and there hasn't been any other explanation, we may look at calcium intake.

In more severe cases, like I mentioned, low calcium can contribute to abnormal heart rhythms, significant muscle spasms, and even seizures. But again, by that time, you're pretty far down the rabbit hole of having some low calcium or calcium dysfunction in the body before things like that happen.

And then for long-term inadequate calcium intake, we're concerned about osteopenia, osteoporosis, increased risk of fractures. All of this would be diagnosed through a bone scan with your doctor. And it's important to remember that symptoms alone can't diagnose a calcium deficiency. So what we're really trying to look at the totality of the evidence. If possible, we want to see has there been any bone density testing done, any laboratory testing done?

Do you have any of those symptoms I mentioned earlier? And then we do want to do that dietary analysis. Maybe we are keeping food records for at least a few days or a week or two to see what your intake is like. All of these would be taken into consideration to evaluate calcium status and also bone health.

Who is at risk for low calcium status?

Now, who's at risk for low calcium status? Bone loss naturally accelerates with age, especially after menopause and the loss of some of that hormone input. So women who are over 50 and men who are over 70 often benefit from paying close attention to calcium intake.

And this may be a group where we do want to look at some high-quality supplements if the food intake is not matching the need or the demand. Women can be more at risk again, just because, especially going through menopause, we have those declining estrogen levels, we see a rapid degradation or more bone loss during those years.

So we can't always necessarily control that aspect of our biology, but making sure we have adequate calcium intake is especially important and it is something that is within our control. The general recommended diet daily calcium guidelines for adults who are 19 to 50 years old, we're looking at about a thousand milligrams of calcium per day.

Women who are 50 and older, we're looking at about 1200 milligrams per day. And men who are 70 or older also looking at about 1200 milligrams per day. And I do want to emphasize that those numbers include both food and supplements. So this isn't necessarily a one size fits all number. If you are eating a diet rich in real whole foods that doesn't promote a lot of calcium loss, unlike the standard American diet, you may truly not need that full RDA to maintain optimal bone health and muscle health and things like that. We do recommend getting as much calcium as possible from food first and then using those supplements to fill in the gaps.

Are there vitamins & minerals that should not be taken with calcium?

Now let's cover the question: are there vitamins and minerals that should not be taken together with calcium? So this is a question that I field fairly often. Calcium is one that will compete with other minerals for absorption. So timing does matter. And it may not always be perfect, but we try to optimize for timing the best we can.

A big one that I look out for is iron and calcium. These two compete for absorption. So if you're taking an iron supplement for any reason, ideally we want to separate that from calcium by at least two hours, maybe a little more ideally, four hours. So for example, you may take your iron supplement in the morning with breakfast, and then you do calcium with your lunch or your dinner. Large doses of calcium may also reduce zinc absorption.

Don't worry about this so much if someone is taking a supplement where maybe you're getting five or eight or ten milligrams of zinc. But if you're taking a high dose zinc supplement, so one of our supplements that we carry through Nutrikey is over 50 milligrams of zinc, it may be a good idea to separate the calcium and the zinc that you're taking at that point.

Now, calcium and magnesium can be taken together in moderate amounts, and many bone support supplements do include both calcium and magnesium because they play together well in the sandbox. But this is a case where form does matter.

So for example, again, the forms that are in our Nutrikey Cal-Mag are highly absorbable forms of both calcium and magnesium compared to other supplements that you may see out there where the calcium form is that calcium carbonate that we've talked about, and the magnesium form is a magnesium oxide, which is another example of a magnesium supplement that's not really well absorbed.

So ideally, we want to be taking high-quality, well-absorbed forms of both calcium and magnesium. And there still may be a little interaction, or you may not get like the full-blown dose from both of them. But oftentimes the benefits of just being able to be consistent with taking a supplement, you get the convenience of both in one supplement, these far outweighs any potential small amount of competition that you may get from the two.

What should be taken with calcium?

So those are some things that we want to watch for that may compete with calcium. The flip side of that question is what should be taken with calcium? First of all, vitamin D, and I think most people kind of are clued in at this point that calcium and vitamin D go well together. Vitamin D is essential for calcium absorption in the gut. So without adequate vitamin D, your body just cannot effectively absorb and utilize that calcium. So this is why many calcium supplements, not just ours but others, include at least a small amount of vitamin D.

I will say most people, at least here in the upper Midwest, need more vitamin D than what is typically in regular calcium supplements. But this is why we want to test vitamin D also. If you're taking a calcium supplement, you may need to have a higher dose of an additional vitamin D to go with it.

I mentioned vitamin K2 before, so K2 is important to help take the calcium from the bloodstream and put it into the important tissues in the body, our bones and our teeth, and we want to keep it from getting deposited in some of our soft tissues. Emerging research suggests it plays a supportive role both in bone health alongside calcium and vitamin D.

More on bone health: it’s much more than just calcium

And then adequate protein intake is another overlooked component of bone health. We're always talking about the importance of protein intake here on our “Ask a Nutritionist” episodes and our Dishing Up Nutrition episodes. And bone health is one of those key reasons why we want to have that high protein intake.

So when you think about keeping bones healthy and strong, it's easy to reduce it down to simply a calcium supplement, but strong bones require much more than just the calcium alone. We have many, many great episodes talking about bone health, osteopenia, osteoporosis, fracture risk, and all the things on our website and through some of our old episodes. We've got over a thousand episodes now to go back and listen to and grab some more great information. So I would highly recommend if you're interested in those topics, go back and do a little search in our history.

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At Nutritional Weight & Wellness, we do prioritize a real food diet first. We want it to be rich in those bone-supporting proteins. We will need those great healthy fats. And then we need all the vitamins and minerals we can get from our real food carbs like vegetables, from some other fats like nuts and seeds, some of our whole grains, if you can tolerate those.

And then if you do find that maybe you're falling a few hundred milligrams short in terms of your calcium intake, you're just looking for a little bit of that safety net, if you do decide to supplement with calcium or other bone supporting supplements, look for some of those forms of calcium that we chatted about earlier.

I do highly recommend our NutriKey brand. We've had lots of great reviews and great feedback, and we've seen improvements on DEXA scans and things like that from our clients over the years. So we know and trust our brand and would highly recommend the supplements that we carry.

So I want to thank you all so much for joining me today. If you found this episode helpful, the best way you can support our podcast is to share it with a friend or a family member who's also just standing there trying to make sense of the supplement aisle. And remember that supplements work best when they are supplemental and combined with a nutrient-dense diet and healthy lifestyle habits.

If you need some help with making a bone support diet and a supplement plan that works for your individual needs, come and work with me or one of the other dietitians at Nutritional Weight & Wellness.

Schedule Nutrition Counseling

We work with people day in and day out to create a plan based on your individual goals, your lifestyle, and we tailor it so that you can be successful. To find out more about our counseling, visit us at weightandwellness.com or give us a call at 651-699-3438. Thanks again for listening, and I'll talk to you next time.