The Calcium Challenge

James Brodsky, M.D. on 09/26/2016

I regularly get questions from patients about calcium. Do I need more? How much do I take? Can I take it just once a day? Should it have magnesium? Will it fix my osteoporosis? Lots of questions… Well, I start by reminding patients that calcium isn’t just for bones. It’s required for muscle contraction, blood vessel contraction/expansion, secretion of hormones and enzymes, and sending messages through the nervous system. About 99% of your total body calcium is stored in bones and the remaining 1% is found throughout the body in muscle, cellular fluids and blood. It’s about 2% of your total body weight. If you don’t have a calcium-rich diet, your body will continue to extract calcium stored in your bones to meet your active daily needs. Besides providing structure, the bones are a bank for minerals. One reason osteoporosis occurs is that minerals are being withdrawn from this bank, and paid out to fill the cellular needs of the rest of your body. When calcium (and other minerals) are removed from bones, they become more porous. If you don’t replace them, your body can’t replenish the reserves in that bank leaving tiny gaps (osteo- for bones, -porosis meaning full of holes). Consuming insufficient calcium, poor calcium absorption, and increased calcium usage (through more physical activity, or less rest) all contribute to lower total calcium and minerals stored in your bones. So, what do you do? If you’re not already eating a calcium-rich diet (which includes yogurt, broccoli, dark green leafy vegetables, soy foods, orange juice, etc.) then that’s a place to start. Even with a calcium-rich diet, I tell patients they might not be absorbing enough calcium. Then I recommend a calcium supplement to make up the difference. Very important point here… not all calcium supplements are created equal! The absorption of calcium is affected by many factors. First is the form of calcium. Calcium carbonate (e.g. antacids or oyster shell) is poorly absorbed. Calcium citrate (e.g. Citracal®) is better, but calcium hydroxyapatite, known as MCHC (microcrystalline hydroxyapatite concentrate) is best. It contains calcium and phosphorus in the identical ratio formed in your own body (2:1 ratio) plus other trace minerals. I recommend you take this type of calcium because it saves your body the step of trying to separate and convert elemental calcium into usable calcium for your bones. So what other minerals get stored in your bones besides calcium? They include: magnesium, phosphorus, strontium, zinc, boron, manganese, copper and silica. There are also some important vitamins that go into rebuilding bone which include vitamins C, D and K. Cartilage is also involved in bone building, and can be supported with supplemental chondroitin. So, why is there no one-a-day calcium? Well the main reason is that when the bottle says 1000mg calcium, they’re not talking about the calcium weight by itself. Your body is estimated to need 1000 to 2000mg a day of elemental calcium. What the bottle is not telling you is the weight of the part of the molecule that the calcium is attached to: carbonate, malate, hydroxyapatite or citrate. Sometimes the calcium portion of that molecule is as little as 30% of the total weight. To get 1000mg of elemental calcium, you may need 1.3 to 3.3 times the 1000mg dosage on the label. Multiply that by the low absorption rates I mentioned above and you see why it takes some effort to get enough calcium. Note that taking calcium with meals significantly improves absorption versus on an empty stomach. So, do I have a specific calcium brand that I recommend? Reading all those labels can be so tiresome. I recommend a good overall calcium supplement called Bone Guardian by Pathway. For those people with allergies or food sensitivities, I also recommend Bone Guardian because it does not contain any wheat, rye, oats, barley, gluten, sugar, wax, soy, egg, yeast, preservatives, phosphates, casein, or any other milk derivatives. It also comes in capsules form for people with absorption problems or impaired digestion. Top 11 minerals and vitamins for bone building and what they do:

Calcium provides bones strength and rigidity. The MCHC form already contains the necessary ratio of calcium to phosphorus (2:1) for optimized use in bone building.
Magnesium contributes to the strength and firmness of bone. It will stimulate thyroid production of calcitonin, the bone-preserving hormone needed to convert vitamin D into its active form. It also supports the heart and cardiovascular system.
Vitamin D3 has been shown to substantially reverse the process of bone loss in post-menopausal women, and it helps intestinal absorption of calcium as well as improving bone density.
Vitamin K adds chemicals called carboxyl groups to osteocalcin and other proteins that maintain, remodel, and rebuild bone tissue.
Vitamin C is essential for the formation of bone, collagen, and connective tissue.
Boron has been found to greatly reduce loss of calcium and magnesium in urine.
Strontium aids the cells that rebuild bone to create a stronger “architecture” of calcium and mineral crystals.
Zinc is useful in tissue repair and enhances vitamin D activity. Low zinc means lower osteoblast (bone forming cells) activity and less collagen formation.
Manganese is used in the synthesis of mucopolysaccharides used for bone matrix formation, and has an important role in cartilage and bone collagen creation.
Copper aids in the strength and formation of collagen and connective tissue important to bones.
Silica concentration is high in strong tissues like tendons, collagen, and bone.

What else can you do about low calcium? The high amount of phosphoric acid from drinking too much soda and other carbonated beverages has been linked to bone loss. High sodium consumption from processed foods can increase the amount of calcium excretion in the urine by 20%, and too much sugar contributes to calcium, magnesium, chromium, copper and zinc loss the same way. Smoking depletes the body of vitamin C. Alcohol decreases mineral absorption and contributes to the overall loss of calcium, magnesium, vitamin C, zinc and copper. If people aren’t going to stop the bad habits, it is critical to replace the lost minerals. Exercise is one of the keys to maintaining good bone density! It doesn’t have to be a hard workout, but when your body has to do work, lift weight, and resist gravity, it sends the signals that your body needs a stronger support structure, and the process of building bones begins. If you’re a couch potato, sit in a chair all day at work, or lift nothing heavier than a cocktail glass, you’re sending the signals to your body that you don’t need strong bones to hold you up. Take some evening walks with a pet or a friend. Climb the stairs a few extra times for no reason, or instead of a short elevator trip. Use some leg or wrist weights when you do some low-impact aerobics. As they say, if you don’t use it, you will lose it. Photo from here, with thanks.

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