The Calcium Questions Everyone’s Googling - Answered

Transcript:

Britni: Hello and welcome to Dishing Up Nutrition, brought to you by Nutritional Weight & Wellness. Today we are going to be answering all your questions about one of our most important minerals, and that is calcium. We're going to be answering what are the best dietary sources?

How do you know if you're getting enough calcium or if you're deficient? How do you know if your calcium supplement is actually working and not a waste of money? Could your calcium supplement actually be causing harm? And how much calcium should we be aiming for each day? We are going to be answering all of these questions and more coming up.

First, let's introduce ourselves. I am Britni Vincent, a registered and Licensed Dietitian, and with me today is Kara Carper, who is a Licensed Nutritionist and Certified Nutrition Specialist, and has been co-hosting Dishing Up Nutrition for how many years? A long time, almost since the beginning.

Kara: I mean, I think it was, it's been about 15 years since I got licensed and started hosting Dishing Up Nutrition.

Britni: Yeah. That's amazing. I love it.

Kara: So yeah. Thanks Britni. It's very good to be here with you today. And you know, we're going to talk about this important topic of calcium because it does come up a lot. And with good reason. People, especially women, associate calcium with bone health. We will talk a lot more about that. And of course, women are concerned about their bone health as they should be. Osteoporosis is often referred to as the silent disease because many people don't even know they have it until they break a bone or fracture a bone.

And then once that occurs, the quality of life really can decrease significantly. Many women that are of older age don't fully recover from those fractures, unfortunately. So you know, this is a valid concern and it's important to know all the facts about calcium. And so we're going to answer those questions today.

Why do we need calcium?

Britni: Well, let's talk about why we need calcium and what it's used for in the bone. And you know, like you alluded to, Kara, most of us associate calcium with bone health. And yes, 99% of your bone’s calcium is stored in your bones and teeth. But the 1% that circulates in your blood is critical for muscle contraction, nerve function, heart health, and even blood clotting. Your body actually prioritizes that 1% so much that if you're not getting enough calcium from food, it'll actually start pulling it from your bones into your bloodstream.

Kara: Interesting. I actually did not know that until researching for the show today.

Britni: Yeah. It's crazy to think about. So calcium is just so important, and that is part of where the risk of osteoporosis comes from long term.

Signs of being calcium deficient

Kara: And so these terms, osteopenia, you know, that's just low bone density or an even more serious condition is called osteoporosis. How, besides those two diagnoses, how would we know if we're deficient? So there are some symptoms to look for. Here are some signs of being calcium deficient. First of all, muscle cramps or muscle weakness, especially in the legs, or could be leg cramps or spasms and muscle twitches;

Charlie Horses, and usually for those symptoms, you may hear us on other Dishing Up Nutrition podcasts recommending magnesium as a supplementation, but calcium can be just as important. Another sign of being calcium deficient is having brittle or soft nails. So just some body signs to kind of pay attention to.

Britni: Yeah, I think when we think about calcium, we do not necessarily think about our nails or on the same note, dry skin, hair loss can also be part of calcium deficiency, and there's a lot of other critical nutrients for hair and nails and skin, but calcium is just a piece of the puzzle because calcium will actually help with skin cell renewal if you have a lot of those body signs, symptoms.

Another surprising symptom of calcium deficiency might be numbness and tingling. Lack of calcium can actually affect our nerve function, causing that tingling in the hands, feet, maybe even the face.

Kara: Another sign of a calcium deficiency could be heart palpitations or abnormal heart rhythms. If you are experiencing anything like this, it's very important that you do get it checked out with your medical provider, but just kind of know that calcium imbalance could be part of that issue. Now another common sign is having trouble sleeping.

And so, you know, all the symptoms that Britni and I are listing, it doesn't mean you have a calcium deficiency. You know, it could be something else like magnesium. That's usually our go-to mineral when we're talking about issues sleeping. But calcium plays a big role as well in calming and getting a good night's sleep.

Britni: Yeah, that's really, really good to mention. This sign of calcium deficiency, I think will probably come as a surprise: PMS symptoms because calcium is actually connected to hormones like estrogen and can play a part in the severity of PMS symptoms like bloating, fatigue, moodiness, increased anxiety.

During the menstrual cycle when estrogen levels fluctuate, that can actually influence the amount of calcium in the blood. You know, I often work with women and girls on hormone balance, and if you're dealing with these life interrupting PMS symptoms, there are a lot of factors that come into play. Hormones are super complex, but calcium again, might be just one thing to consider.

Kara: And it is interesting as we go through these signs and symptoms to think about how calcium is connected to all these different bodily systems, way above and beyond just bone health, which we often associate calcium with, right?

Britni: Yeah.

Risk factors for becoming calcium deficient? (#1: long term use of antacids)

Kara: So you might be wondering, how, you know, how would someone become calcium deficient? What are the risk factors? One common risk factor is long-term use of antacids, particularly those known as PPIs, which stands for proton pump inhibitor. And, you know, PPIs, they're not meant to be used long term.

Britni: They are not.

Kara: You know, there's even a warning on the medication. However, a lot of people are just given these from their doctor or some are over the counter. And maybe don't realize they're not meant for long term use. One of the risk factors of being on these long term is that calcium absorption becomes blocked, and in fact, that correlation is so strong, the long term use of antacids and low bone density that, you know, that's considered a risk factor for developing things like osteopenia and osteoporosis.

So if, if this sounds like you, if you struggle with chronic acid reflux and you are relying on taking any form of antacid on a regular basis, it's really important, you know, you could, you could call our office: (651) 699-3438, set up an appointment to meet with a registered and licensed dietitian because there are ways to wean off of those.

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Britni: Yeah, absolutely.

Kara: And address that more naturally and really get to the root cause. What's causing this acid reflux, you know?

Britni: Yeah, we have a lot of experience with that. And I have seen clients that have been on them for 10 years, 15 years, and they have successfully been able to get off of them. And like you said, just find the root of what's going on. But yeah, I don't think people realize how harmful they can actually be; especially taking long term.

#2 risk factor for calcium depletion: overconsumption of caffeine & sugar

Another risk factor for calcium depletion is over consumption of caffeine. You know, one or two cups of coffee, no, no big deal. But if you're drinking several cups of coffee or other caffeinated beverages throughout the day, it could be leaching calcium from your bones. And I think the other caffeinated beverages is important because it's in so many things now. There's caffeinated sparkling water and iced tea. And the list goes on and on.

Kara: And the energy drinks as well.

Britni: Yes, absolutely.

Kara: Think of all the energy drinks that are ladened with not only caffeine, but often sugar or artificial sweeteners. And so there are other beverages as well that can put someone at risk for calcium deficiency, particularly like soda or energy drinks. Also alcoholic beverages.

Britni: Yeah.

Kara: You know, these are all beverages that deplete really all minerals, but calcium is a really important one that can get depleted.

Britni: So the soda and the energy drinks, not only do they have that caffeine, but that sugar.

Kara: Mm-hmm.

Britni: So really anything with sugar, eating a lot of sugar is also going to deplete minerals, including calcium.

Risk factor for osteoporosis: being of menopausal age

Kara: And unfortunately for women, a big risk factor of becoming osteoporotic is just being of menopausal age. And Britni, you had mentioned this, that estrogen plays a protective role in bone health. And so as we age and our hormone levels decline, that can negatively impact bone health. And so, you know, we can't prevent entering perimenopause and menopause. It's a natural part of aging. But there are certainly steps that we can take to prevent the risk factors associated with low bone density.

Dairy: a common food sensitivity

So all this being said, how do we make sure we're getting adequate calcium and also that we're not being depleted of calcium from the beverages and foods that we're eating and drinking?

Britni: That's a great question. I think it's probably the most frequently asked question around calcium, and we want to also talk about what are the best sources, because we all grew up being told to drink your milk and eat your dairy products with every meal to ensure that you're building strong bones. But here's a very interesting fact.

The United States has one of the highest rates of dairy consumption, yet according to the National Osteoporosis Foundation, about 54 million Americans have osteoporosis and low bone mass. So the United States is one of the countries with the highest rates of osteoporosis worldwide, and so obviously it's not just the dairy.

Kara: Right, right, right. There's more, much more to the picture.

Britni: Mm-hmm. I think that this could be from the compilation of a number of unhealthy lifestyle factors like being sedentary and the standard American diet. We were just talking about sugar and how that depletes minerals. And you know, the truth is we don't need to consume dairy for strong bones.

Kara: And a lot of people are intolerant or sensitive to dairy products, and so in some cases consuming dairy may be causing more harm than what it's doing good. Worldwide, about 65% of people are intolerant to lactose, which is the milk sugar part of dairy. So that really makes you question, why have we been pushed to consume dairy when over half the population is unable to tolerate it?

Britni: Yeah. That that is a big question, right?

Kara: Yeah.

Britni: So if you're not tolerating it well and you're consuming it, and that creates inflammation in the body, well that negatively affects even your bone health. So, if you don't tolerate dairy, it's all right. Like, I know I've had clients get a little scared that they're not getting enough calcium 'cause they, they don't tolerate dairy. And, you know, it is time for a break. But when we come back, we are going to talk about other sources of calcium.

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Signs of being sensitive or intolerant to dairy products

Kara: Welcome back. You're listening to Dishing Up Nutrition. I'm Kara Carper here with Britni Vincent, and we are answering your questions today about the mineral, calcium. And before break, Britni and I were talking about how 65% of the world's population are not able to tolerate dairy. And so maybe we should talk about what are some signs of being sensitive or intolerant to dairy products?

Britni: Yeah, I think that's a great idea. I do believe you can think of lactose intolerance as kind of a spectrum. I mean, there are some individuals that cannot have any at all, otherwise they are running to the bathroom. There are other people that might be able to tolerate smaller amounts, but, diarrhea, cramping, bloating.

Kara: Gas.

Britni: Gas. Those could all be signs. If you are very lactose intolerant, that's going to be a pretty immediate reaction. But I think there's some lesser connected signs of a dairy sensitivity or dairy intolerance too.

Kara: I mean, I don't tolerate dairy great. I, I'm one of those people that can have a little bit. But if I have too much cheese or even yogurt or cream, even heavy cream in my coffee, I tend to get that kind of nasal congestion, runny nose. Also, needing to clear my throat frequently. So for me, those are some telltale signs of my intolerance.

Britni: Skin, you know, acne, eczema, there can be other causes for those things as well. But dairy can contribute to a lot of that as well.

Kara: Yeah.

Britni: And I mentioned diarrhea earlier, but on the opposite side, dairy can also cause constipation in some people too.

Kara: Yeah. And so I mean, if you're wondering, oh goodness, I have irritable bowel syndrome. Like, I kind of go back and forth between loose stools and being constipated, we would encourage you to do a four week trial of just removing dairy products from your diet and just see if your digestion or whatever other symptoms you're having improve after a four week period.

Britni: I think that's a great suggestion. And after the four weeks, if it really dramatically improved your digestive symptoms, you're probably going to be pretty motivated to, to keep it up at that point.

Kara: Absolutely. Especially if you're someone that needs to know where every bathroom in town is. That's not a great way to live.

Dietary sources of calcium besides dairy

Britni: And you know, luckily there are other dietary sources of calcium besides dairy. You can actually get calcium from green vegetables like broccoli and leafy greens, fish like sardines and canned salmon with the bones, nuts and seeds, especially almonds and sesame seeds or tahini, which is ground up sesame seeds, and tahini you can find in hummus. You could make a salad dressing with tahini. You know the leafy greens, I think of kale.

Kara: Mm-hmm.

Britni: You could make a kale salad and if you actually just take it off the stems and massage it for a couple minutes, it becomes softer in texture. It's easier to chew, easier to digest, because I know some people just don't like how fibrous it is.

Kara: Right.

Britni: That texture of it.

Kara: That’s a great tip. I actually have not massaged my kale before.

Britni: I know it sounds so funny. Massage your salad before you eat it, and then maybe you top it with some almonds for a little extra calcium in there.

Kara: Also, you know, we do have the salmon salad supreme recipe on our website. I want to give a shout out to that because I've been making and eating that for over a decade. I love that recipe 'cause especially if I need a lunch or a meal just for myself, I use the whole can of wild caught canned salmon.

And it's just kind of like a tuna salad, but you know, you're getting more omega-threes, and you're more likely to get additional calcium from canned salmon. It's very delicious. It calls for frozen peas; gives it a little crunch.

Britni: Yeah.

Kara: And I just put it on a bed of greens.

Britni: Easy.

Kara: So it's very simple.

Britni: Yeah. People really, really love that recipe. And if you don't like salmon, you could use tuna in that recipe. You're just not, it's not going to be a great source of calcium. But it's equally as delicious. A lot of people think about bone broth, but surprisingly, bone broth is not a great source of calcium, even though its broth is made from bones.

You know, one cup of bone broth only contains about one to 4% of the daily recommended calcium intake. So while bone broth offers a ton of other great health benefits, just don't count on it to be a significant source of your calcium intake.

Avoid calcium calcium carbonate & where it is found

Kara: Another question that we received had to do with fortified foods, foods that are fortified with calcium, and you'll see that frequently at the grocery stores. You know, you might see on the label that something is a good source of calcium.

Now you have to know what it's being fortified with. And the form of calcium in fortified foods, it's calcium carbonate. Now that's a very cheap form that our bodies don't know how to utilize and absorb calcium carbonate. Some examples of these calcium fortified foods or beverages are orange juice, nut milks like almond milk;

I suppose soy milk, things like that. Breakfast cereals, breakfast bars, even those antacid tablets that we talked about at the beginning of this show for heartburn, that is calcium carbonate. Now the problem is, again, it's just a cheap, unabsorbable form, and so really it's just a marketing tactic to make you think that these products are going to improve bone health.

Most of those foods and beverages that I just mentioned, like orange juice, breakfast bars, cereal. Those are what we call ultra processed foods. They're not in their true original form. They are often high in sugar. And remember, those high sugar beverages and foods are actually pulling minerals like calcium and magnesium from our bones. We're excreting it through, mostly through urine. And we can become calcium deficient from those foods. So it's the opposite of what the marketing is indicating.

Britni: Yeah. They're doing more harm than good, you know, and the nut milks, you couldn't find nut milks now where it's just the nuts water and maybe some salt, which would be totally fine. And you're going to get like an almond milk, you're going to get a little bit of calcium in there, not to the amount of those fortified products, but those would be okay to consume if you can find them. And you definitely have to watch out for that calcium carbonate in supplements as well.

This is often used in generic brand supplements because like Kara said, it's the cheapest form. So if you're not absorbing it well it is definitely not worth your money and can actually do some harm, 'cause we do not want excess unabsorbable calcium floating around in our bloodstream instead of being absorbed into the bone.

How much & which forms of calcium are recommended?

Kara: Mm-hmm. Yeah. And this is where we kind of get into, you know, how much calcium. Calcium is something that we don't want to take too much of, especially in a supplementation form. And especially you don't want to be consuming any calcium carbonate. But in general, over supplementing with calcium can lead to plaque buildup, calcification of the arteries, even kidney stones.

Britni: So you're probably wondering what forms of calcium do we want to look at? So there are a few highly absorbable forms that I'm going to list off. One is called Di-Calcium Malate, or sometimes it's called DimaCal, and it's actually chelated or bound to a compound called malate, and that helps to carry it through the intestinal lining for better absorption.

Calcium citrate could be an option that is one of the more common ones that maybe you've heard of. That one is bound to citric acid to also help with absorption. And then the last one I'm going to mention is called microcrystalline calcium hydroxyapatite. It’s a mouthful. You may just see it as MCHA. And this is an organically bound complex of what's naturally part of the bone matrix; often derived from freeze dried calf bone.

Combine calcium with vitamin D & why

The other piece here that I want to mention is look to see if your calcium has a little bit of vitamin D3 in it as well, because vitamin D3 helps to pull calcium from the bloodstream into the bones. And most calcium supplements do have a little bit of vitamin D to help with absorption.

Vitamin D is a huge part of the puzzle with calcium because you know it's more complex than just simply taking your calcium supplement. If you are supplementing with calcium, but you have low levels of vitamin D, you're not able to actually utilize all that calcium that you're taking.

So we recommend 5,000 IUs a day. I like the one with vitamin K2 in it, because calcium, magnesium, vitamin D and vitamin K all actually works synergistically together. And if you've never had your vitamin D checked, that would be a great idea. Because some people actually need more than 5,000.  

Kara: Yeah. And the optimal blood levels, if you, it's a simple blood test that you can ask your provider for, and optimally we would be anywhere between 50 and 80. So it's important to not only get tested, but know your actual level. I remember the first time I got tested, I just received a lab result in the mail, and instead of giving me my actual vitamin D level, it just said like it was good.

Britni: Oh yeah.

Kara: Or it was, it was in the normal range. So of course I got on the phone, made about 10 phone calls before I was able to get the actual level, which was in the seventies, and I was pleased with that.

Britni: Yeah, that's good.

Kara: But some of those reference ranges for the labs might indicate that 30 is normal. And that actually is too low. We want, for optimal health, including optimal bone health, you know, cancer prevention, all, everything that we're looking for, for optimal health, we want our levels to be higher than that.

Recommended dosing with calcium

All right, so let's talk a little bit about dosing of calcium. The official RDA, which stands for recommended dietary allowance for the average person is 1,000 milligrams of calcium for men ages 18 to 70, and for women ages 18 to 50. Now it's important to note that includes what you're getting from food. So if you hear a thousand milligrams, it doesn't mean supplementing with 1,000 milligrams.

Britni: Yeah, I, I'm glad you mentioned that. You don't need to supplement all that amount, and you also don't need to count everything. You know, I've had some clients worried about their calcium intake, so they've wanted to add it all up on a daily basis.

I think that gets so stressful. If you are somebody that identifies, maybe you need a little extra calcium, you're supplementing with a good quality, you're eating a variety of foods that contain more calcium, you should be fine. I wouldn't stress about adding it all up on a daily basis.

Kara: And honestly I think it's more about what people are not eating. Because all those foods and beverages we discussed that can pull minerals and we excrete them through our urine. You know, if you're avoiding soda, alcohol, caffeine, high sugar, processed foods, and you're eating a variety of the calcium rich foods, that we talked about, you know, at the end of the day, you should be good.

Britni: Yeah, yeah. Very good point. You know, I think another very common question about supplementing is how to take it, what time of day with or without food, and then how much calcium can you take at once? So as far as time of day, you know, we generally recommend it at night because for some people it can be relaxing. We mentioned sleep. You know, you could take it earlier in the day, but you might get some extra benefit taking it at night. And if you're taking a high quality calcium supplement, you can take it with or without your food.

And then a very common question we get is how much can you take at once? So you can only absorb about 500 to 600 milligrams of one form of calcium. Well, we purposely in our calcium products contain more than one form so that you can take it all at once so you're not having to worry about splitting it up throughout the day. Just look at your calcium product and see how many different forms are in there. If there's multiple different forms, you could take it all at once at night, with or without food.  

So I mentioned the specific forms to be looking for to indicate a high quality calcium supplement. If you visit our product website, nutrikey.net, you're going to find different options.

Shop Nutrikey Supplements

We have one called Key Osteo Plus. Now that one is designed specifically for somebody that has osteopenia or osteoporosis. So it is kind of an all-in-one supplement for bone health. We also have Activated Calcium, so that would be a great option if you just want to add a little bit of calcium in. We have a chewable form of calcium for those that struggle with, with swallowing pills. I know that can be hard for some. And then we have a Cal-Mag, which is calcium and magnesium and those are our main calcium products that, that you can find. And if you do have a question, you can email it to info@nutrikey.net.

Kara: So we hope that you have gotten your calcium questions answered today, and really, if you do have additional individual questions, whether that's on bone health, on, you know, trying to get off of an acid blocker or if you're curious if you have a dairy sensitivity or intolerance, these are all things that meeting one-on-one with a licensed and registered dietitian could be very beneficial.

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And you know, our dietitians will make sure that you're getting the most out of your food and your supplement regimen so they can take the guesswork out of everything for you. And again, you can just, you can learn more about our company at weightandwellness.com.

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And thank you for listening. We hope you have a wonderful day.

Britni: Thank you.