http://naturalmedicines.therapeuticresearch.com. Tolerable Upper Intake Level (UL): Maximum daily intake unlikely to cause adverse health effects. The U.S. Preventive Services Task Force (USPSTF) concluded with moderate certainty that daily doses of less than 1,000 mg calcium and less than 400 IU (10 mcg) vitamin D do not prevent fractures in postmenopausal women and that the evidence on larger doses of this combination is inadequate to assess the benefits in this population [40]. Additional research is needed before conclusions can be drawn about the use of calcium supplements to improve bone health and prevent fractures in older adults. In the United States, approximately 72% of calcium intakes come from dairy products and foods with added dairy ingredients [1]. Some studies have shown that high calcium intake from dairy products and supplements may increase risk, whereas another more recent study showed no increased risk of prostate cancer associated with total calcium, dietary calcium or supplemental calcium intakes. Supplementation with both calcium and vitamin D or consumption of dairy products fortified with both nutrients increased total BMD as well as BMD at the lumbar spine, arms, and femoral neck. [, Hofmeyr GJ, Manyame S, Medley N, Williams MJ. This association was strongest in women, adults aged 2044 years, those who did not have diabetes, and, especially, women aged 2044 years. Dietary supplements The study also found no associations between consumption of dairy foods (milk, yogurt, and cheese) at age 13 and BMI at age 21. A substantial body of evidence has addressed the role of calcium in preventing colorectal cancer or its precursor, adenomas. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. These levels remain constant in men, but they start to drop in women as a result of increases in bone remodeling due to decreased estrogen production at the start of menopause [1]. Mayo Clinic does not endorse companies or products. For rickets and osteomalacia, the requirements for calcium and vitamin D appear to be interrelated in that the lower the serum vitamin D level (measured as 25-hydroxyvitamin D [25(OH)D]), the more calcium is needed to prevent these diseases [21]. 1,500 mcg Approximately what percentage of body weight consists of minerals? For additional information on calcium and weight management, see the health professional fact sheet on weight loss. [, Boursiquot BC, Larson JC, Shalash OA, Vitolins MZ, Soliman EZ, Perez MV. Weaver CM, Heaney RP. Age-related bone loss can also occur in men and lead to osteoporosis, but fracture risk tends to increase in older men about 5 to 10 years later than in older women [1]. Calcium carbonate and reduction of levothyroxine efficacy. The recommended daily amount of vitamin D is 400 international units (IU) for children up to age 12 months, 600 IU for people ages 1 to 70 years, and 800 IU for people over 70 years. The effect of calcium or calcium and vitamin d supplementation on bone mineral density in healthy males: a systematic review and meta-analysis. Dairy products, such as cheese, milk and yogurt, Dark green leafy vegetables, such as broccoli and kale, Fish with edible soft bones, such as sardines and canned salmon, Calcium-fortified foods and beverages, such as soy products, cereal and fruit juices, and milk substitutes, Have lactose intolerance and limit dairy products, Consume large amounts of protein or sodium, which can cause your body to excrete more calcium, Are receiving long-term treatment with corticosteroids, Have certain bowel or digestive diseases that decrease your ability to absorb calcium, such as inflammatory bowel disease or celiac disease, Calcium carbonate (40% elemental calcium). Calcium carbonate is cheapest and therefore often a good first choice. Dietary supplements verification program. The DRIs for calcium Age group Recommended Dietary Allowance (RDA) per day Tolerable Upper Intake Level (UL) per day; Infants 0-6 months: 200 mg : 1000 mg: Infants 7-12 months: 260 mg : 1500 mg: Children 1-3 years: 700 mg: 2500 mg: Children 4-8 years: 1000 mg: 2500 mg: Children 9-18 years: 1300 mg: 3000 mg: Adults 19-50 years: 1000 mg: 2500 mg . Just 2 ounces of cheese or 1 cup of milk, yogurt or calcium-fortified beverage contains 300 milligrams of calcium, about 30 percent of your daily requirement. October 6, 2022 Adult women who are planning pregnancy or could become pregnant should be advised to get 400 to 1,000 mcgof folic acid a day. J Am Heart Assoc 2016;5. Results were similar in 698 of the women who were followed for 6 years, even though mean daily intakes of calcium dropped by an average of 40 mg during this period. Elemental calcium is listed in the Supplement Facts panel, so consumers do not need to calculate the amount of calcium supplied by various forms of calcium in supplements. [, Yao X, Hu J, Kong X, Zhu Z. [, Kahwati LC, Weber RP, Pan H, Gourlay M, LeBlanc E, Coker-Schwimmer M, et al. For example, the American College of Obstetrics and Gynecology states that daily supplementation with 1,5002,000 mg calcium might reduce the severity of preeclampsia in pregnant women who have calcium intakes of less than 600 mg/day [76]. https://www.usp.org/verification-services/dietary-supplements-verification-program. Amounts of calcium in supplements vary widely; multivitamin/mineral supplements commonly contain about 200 to 300 mg, and common amounts in calcium or calcium plus vitamin D supplements are 500 or 600 mg [14]. [. The Canadian Hypertensive Disorders of Pregnancy Working Group [83], the International Society for the Study of Hypertension in Pregnancy [84], and the Society of Obstetric Medicine of Australia and New Zealand [85] have similar recommendations. Even if you eat a healthy, balanced diet, you may find it difficult to get enough calcium if you: In these situations, calcium supplements may help you meet your calcium requirements. Br J Nutr 2016;116:286-93. Dietary calcium is generally safe, but more isn't necessarily better, and excessive calcium doesn't provide extra bone protection. Natural Medicines. Your body doesn't produce calcium, so you must get it through other sources. Similarly, in a follow-up study an average of 55 months after administration of 1,200 mg/day calcium, 1,000 IU (25 mcg)/day vitamin D3, or both for 3 to 5 years in 1,121 participants, supplements had no effect on risk of recurrent adenomas [55]. SOMANZ guidelines for the management of hypertensive disorders of pregnancy 2014. [, Bristow SM, Bolland MJ, MacLennan GS, Avenell A, Grey A, Gamble GD, et al. The evidence is mixed and more research is needed before doctors know the effect calcium supplements may have on heart attack risk. A diet containing more calcium than the typical U.S. diet because of added low-fat or non-fat dairy products lowered systolic blood pressure by an average of 5.5 mmHg and diastolic blood pressure by 3.0 mmHg [66]. https://www.bones.nih.gov/health-info/bone/osteoporosis/conditions-behaviors/celiac. However, findings were negative in another systematic review and meta-analysis that included 14 RCTs of calcium supplementation and 13 trials comparing calcium and vitamin D supplements with hormone therapy, placebo, or no treatment in participants older than 50 years [38]. Several large observational studies have shown an association between lower calcium intakes and higher risk of hypertension, stroke, and atherosclerosis. Several recent systematic reviews and meta-analyses have found that supplementation with calcium alone or a combination of calcium and vitamin D increases BMD in older adults. Experts recommend a daily intake of 600 IU (International Units) of vitamin D up to age 70. [, Song X, Li Z, Ji X, Zhang D. Calcium intake and the risk of ovarian cancer: a meta-analysis. However, they contribute to calcium intakes, even though they contain small amounts of calcium, because people consume them frequently [1]. Am J Clin Nutr 2021;114:231-7. [, Chlebowski RT, Johnson KC, Kooperberg C, Pettinger M, Wactawski-Wende J, Rohan T, et al. Earlier systematic reviews and meta-analyses found a positive relationship between calcium and vitamin D supplementation and increased BMD in older males [35] and between higher calcium intakes from dietary sources or supplements in adults over 50 and higher BMD [25]. Declining levels of estrogen in women during menopause and for approximately 5 years afterward lead to rates of bone resorption that are higher than rates of bone formation, resulting in a rapid decrease in bone mass [7]. London and New York: Informa Healthcare; 2010:101-6. Dietary Guidelines Advisory Committee. You may need to try a few different brands or types of calcium supplements to find one that you tolerate the best. Accessed Oct. 18, 2020. A 4-year study of 1,500 mg calcium and 2,000 IU (50 mcg) vitamin D or placebo daily for 4 years in 2,303 healthy women aged 55 years and older showed that supplementation did not reduce the risk of all types of cancer [41]. The U.S. Department of Agricultures (USDAs) FoodData Central lists the nutrient content of many foods and provides a comprehensive list of foods containing calcium arranged by nutrient content and by food name. Calcium supplement intake and risk of cardiovascular disease in women. This amount rises quickly after birth, reaching about 1,200 g in women and 1,400 g in men by adulthood [1]. For example, calcium carbonate is 40% calcium by weight, whereas calcium citrate is 21% calcium [1]. Calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation. Which of the following categories include the majority of the elements? Br J Nutr 2013;110:1384-93. Effects of sevelamer hydrochloride and calcium acetate on the oral bioavailability of ciprofloxacin. Nutritional status and food intake of children with cow's milk allergy. Effects were greatest in adults younger than 35 years and with doses higher than 1,500 mg/day calcium. Calcium can be found in a variety of foods, including: To absorb calcium, your body also needs vitamin D. A few foods naturally contain small amounts of vitamin D, such as canned salmon with bones and egg yolks. Recommended amounts are even higher for athletes, vegetarians, and vegans. Archives of Internal Medicine 2007;167:893-902. information submitted for this request. [, Song L. Calcium and bone metabolism indices. Adequate Intake (AI): Intake at this level is assumed to ensure nutritional adequacy; established when evidence is insufficient to develop an RDA. In addition, when 132,823 adults (mean age 63 years) were followed for an average of 17.5 years, the risk of CVD mortality was 22% higher in men with calcium supplement intakes of 1,000 mg/day or more than in those not taking calcium supplements [47]. More evidence, including from well-designed clinical trials, is needed to determine whether higher intakes of calcium can reduce the risk of metabolic syndrome. The recommended daily intake is 400-420 mg for adult men and 310-320 mg for adult women. Cancer Prev Res (Phila) 2019;12:295-304. FDA has approved a health claim for the use of supplements containing calcium and vitamin D to reduce the risk of osteoporosis [29]. An RCT in 1,355 women in Argentina, South Africa, and Zimbabwe also found that 500 mg/day calcium supplementation starting before conception made no difference in the risk of preeclampsia [80,81]. In an analysis of data from 2,776 men who participated in the French SU.VI.MAX (Supplementation en Vitamines et Minraux Antioxydants) prospective study and were followed for an average of 7.7 years, prostate cancer risk was higher with higher calcium intakes [57]. [, Lowe SA, Bowyer L, Lust K, McMahon LP, Morton M, North RA, et al. Nutr Cancer 2011;63:827-41. Inadequate calcium and vitamin D intake and osteoporosis risk in older Americans living in poverty with food insecurities. Calcium supplements are available in a variety of forms, including tablets, capsules, chews, liquids and powders. An analysis of 20012010 NHANES data on 9,148 adults found that women in the highest quintile (at least 1,172 mg/day) of calcium intake, based on 24-hour recall, had a 27% lower risk of metabolic syndrome than those in the lowest quintile (less than 547 mg/day) [93]. Clinical trials have also not shown that supplemental calcium alone or combined with vitamin D has an impact on risk of mortality from all cancers. Ask ODS Use the library or the Internet to research common uses for sodium Colorectal Cancer. For example, an analysis of 19992010 NHANES data from 14,408 adults (mean age 54 years) with obesity found that calcium intakes were 10% lower in adults with obesity and hypertension than in those without hypertension [62]. Osteoporosis increases the risk of fractures, especially of the hip, vertebrae, and forearms [1,7]. However, whether these BMD increases were clinically significant is not clear. In general, calcium carbonate is the most constipating. Usual Adult Dose for Osteoporosis. For instance, if you have a health condition that causes excess calcium in your bloodstream (hypercalcemia), you should avoid calcium supplements. The recommended upper limit for calcium is 2,500 mg a day for adults 19 to 50. For children aged 219, mean daily intakes of calcium from foods and beverages range from 965 to 1,015 mg [18]. Nutr Rev 2002;60:360-7. Mayo Clinic offers appointments in Arizona, Florida and Minnesota and at Mayo Clinic Health System locations. Dual x-ray absorptiometry testing of bone mineral density can be used to assess cumulative calcium status over the lifetime because the skeleton stores almost all calcium in the body [3]. Check food and supplement labels to monitor how much total calcium you're getting a day and whether you're achieving the RDA but not exceeding the recommended upper limit. Estimated Average Requirement (EAR): Average daily level of intake estimated to meet the requirements of 50% of healthy individuals; usually used to assess the nutrient intakes of groups of people and to plan nutritionally adequate diets for them; can also be used to assess the nutrient intakes of individuals. [, Cano A, Chedraui P, Goulis DG, Lopes P, Mishra G, Mueck A, et al. Total calcium levels can be measured in serum or plasma; serum levels are typically 8.8 to 10.4 mg/dL (2. Eur J Clin Nutr 2018;72:541-7. about your interest in, questions about, or use of dietary supplements and what may be best for your overall health. Serum 25-hydroxyvitamin D requirements to prevent nutritional rickets in Nigerian children on a low-calcium dieta multivariable renanalysis. Calcium intake and colorectal cancer risk: dose-response meta-analysis of prospective observational studies. More than 99% of calcium in the body is in the form of calcium hydroxyapatite, an inorganic matrix of calcium and phosphate that is stored in the bones and teeth [1,4,5]. [, Tantamango-Bartley Y, Knutsen SF, Jaceldo-Siegl K, Fan J, Mashchak A, Fraser GE. In: Ross AC, Caballero B, Cousins RJ, Tucker KL, Ziegler TR, eds. Recommended daily calcium intakes (IOM, NAM) Age. include protected health information. Br J Nutr 2015;114:1013-25. Calcium intake and mortality from all causes, cancer, and cardiovascular disease: the Cancer Prevention Study II Nutrition Cohort. [, Singh N, Singh PN, Hershman JM. The median dietary intake in the U.S. for women age 50 or older is 589-649 mg per day and 728-777 per day for men. [, Bonovas S, Fiorino G, Lytras T, Malesci A, Danese S. Calcium supplementation for the prevention of colorectal adenomas: A systematic review and meta-analysis of randomized controlled trials. Additional well-designed randomized trials are needed to determine whether dietary or supplemental calcium intakes increase, decrease, or have no effect on risk of cancer in general or of specific types of cancer, or on cancer mortality. [, Wallace TC, McBurney M, Fulgoni VL, 3rd. [, Boaventura RM, Mendonca RB, Fonseca FA, Mallozi M, Souza FS, Sarni ROS. [, Asemi Z, Saneei P, Sabihi SS, Feizi A, Esmaillzadeh A. Am J Clin Nutr 2016;103:886-94. J Natl Cancer Inst 2008;100:1581-91. For example, a meta-analysis of 8 RCTs in 30,970 adults older than 50 years found that 500 to 1,200 mg/day calcium and 400 to 800 IU/day (10 to 20 mcg/day) vitamin D supplementation for 1 to 7 years reduced the risk of total fractures by 15% and hip fractures by 30% [37]. This section focuses on six health conditions and diseases in which calcium might play a role: bone health in older adults, cancer, cardiovascular disease (CVD), preeclampsia, weight management, and metabolic syndrome. Can Fam Physician 2012;58:158-62. Some scientists have questioned these findings because of the lack of statistical power (the studies were designed to detect differences in bone health measures, not cancer incidence), details from the investigators on the study sample and randomization procedures [45,46]. Am J Clin Nutr 2016;104:1263-73. They are based on observational evidence from the WHI showing a link between higher intakes of supplemental calcium (1,000 mg/day for 7 years) and a greater risk of kidney stones [96,97]. Dairy calcium intake, serum vitamin D, and successful weight loss. Am J Clin Nutr 2015;101:87-117. Magnesium is necessary for calcium absorption. Food Chem Toxicol 2017;109:585-648. Vitamin D, calcium, or combined supplementation for the primary prevention of fractures in community-dwelling adults: evidence report and systematic review for the US Preventive Services Task Force. [, Schabas R. Artifact in the control group undermines the conclusions of a vitamin D and cancer study. JAMA 2018;319:1592-9. [, Jones BJ, Twomey PJ. Independent associations of dairy and calcium intakes with colorectal cancers in the Adventist Health Study-2 cohort. The FDA-approved label for this medication instructs patients taking calcium carbonate supplements to avoid taking levothyroxine within 4 hours of taking the supplement [106]. Those who avoid dairy products because of allergies or for other reasons can obtain calcium from non-dairy sources, such as some vegetables (e.g., kale, broccoli, and Chinese cabbage [bok choi]), canned fish with bones, or fortified foods (e.g., fruit juices, breakfast cereals, and tofu) [1]. It is recommended that 1000-1300mg of calcium be consumed per day, with a greater emphasis placed on female tennis athletes due to their varying estrogen levels that can affect calcium absorption. Br J Nutr 2015;114:924-35. In addition to spinach, foods with high levels of oxalic acid include collard greens, sweet potatoes, rhubarb, and beans [1]. . Calcium is available in many dietary supplements, including multivitamin/mineral products and supplements containing calcium only or calcium plus vitamin D [14].
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