Calcium and Vitamin D: Skeletal and Extraskeletal Health

Papers of particular interest, published recently, have been highlighted as:

• Of importance

•• Of major importance

1••. Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266–281. [PubMed] [Google Scholar]N Engl J Med. 2007;357:1980–1981. [Comment in. author reply 1981−1982. [PubMed] [Google Scholar]N Engl J Med. 2007;357:1981. author reply 1981−1982. [Google Scholar]N Engl J Med. 2007;357:1981. author reply 1981−1982. [Google Scholar]N Engl J Med. 2007;357:1981. author reply 1981−1982.]
[Of major importanceThis very comprehensive review of vitamin D deficiency includes 126 references.] [Google Scholar]

2. Tangpricha V, Spina C, Yao M, et al. Vitamin D deficiency enhances the growth of MC-26 colon cancer xenografts in Balb/c mice. J Nutr. 2005;135:2350–2354. [PubMed] [Google Scholar]

3•. Zhou C, Assem M, Tay JC, et al. Steroid and xenobiotic receptor and vitamin D receptor crosstalk mediates CYP24 expression and drug-induced osteomalacia. J Clin Invest. 2006;116:1703–1712. [PMC free article] [PubMed] [Google Scholar]J Clin Invest. 2006;116:2564. Comment in.
[Of importanceThis manuscript was one of the first to describe the mechanism for drug-induced osteomalacia by anticonvulsants.] [PMC free article] [PubMed] [Google Scholar]

4. Walters JR, Balesaria S, Chavele KM, et al. Calcium channel TRPV6 expression in human duodenum: different relationships to the vitamin D system and aging in men and women. J Bone Miner Res. 2006;21:1770–1777. [PubMed] [Google Scholar]

5. Pattanaungkul S, Riggs BL, Yergey AL, et al. Relationship of intestinal calcium absorption to 1,25-dihydroxyvitamin D [1,25(OH)2D] levels in young versus elderly women: evidence for age-related intestinal resistance to 1,25(OH)2D action. J Clin Endocrinol Metab. 2000;85:4023–4027. [PubMed] [Google Scholar]

6. Walters JR, Balesaria S, Khair U, et al. The effects of vitamin D metabolites on expression of genes for calcium transporters in human duodenum. J Steroid Biochem Mol Biol. 2007;103:509–512. [PubMed] [Google Scholar]

7. Amling M, Priemel M, Holzmann T, et al. Rescue of the skeletal phenotype of vitamin D receptor-ablated mice in the setting of normal mineral ion homeostasis: formal histomorphometric and biomechanical analyses. Endocrinology. 1999;140:4982–4987. [PubMed] [Google Scholar]

8. Hollis BW, Wagner CL. Normal serum vitamin D levels. N Engl J Med. 2005;352:515–516. author reply 515−516. [PubMed] [Google Scholar]

9. Chapuy MC, Preziosi P, Maamer M, et al. Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int. 1997;7:439–443. [PubMed] [Google Scholar]

10. Heaney RP, Dowell MS, Hale CA, Bendich A. Calcium absorption varies within the reference range for serum 25-hydroxyvitamin D. J Am Coll Nutr. 2003;22:142–146. [PubMed] [Google Scholar]

11. Chapuy MC, Arlot ME, Duboeuf F, et al. Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med. 1992;327:1637–1642. [PubMed] [Google Scholar]

12. Chapuy MC, Pamphile R, Paris E, et al. Combined calcium and vitamin D3 supplementation in elderly women: confirmation of reversal of secondary hyperparathyroidism and hip fracture risk: the Decalyos II study. Osteoporos Int. 2002;13:257–264. [PubMed] [Google Scholar]

13. Trivedi DP, Doll R, Khaw KT. Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomised double blind controlled trial. BMJ. 2003;326:469. [PMC free article] [PubMed] [Google Scholar]

14. Dawson-Hughes B, Harris SS, Krall EA, Dallal GE. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med. 1997;337:670–676. [PubMed] [Google Scholar]ACP J Club. 1998;128:47. Comment in. [Google Scholar]N Engl J Med. 1997;337:701–702. [PubMed] [Google Scholar]

15. Larsen ER, Mosekilde L, Foldspang A. Vitamin D and calcium supplementation prevents osteoporotic fractures in elderly community dwelling residents: a pragmatic population-based 3-year intervention study. J Bone Miner Res. 2004;19:370–378. [PubMed] [Google Scholar]

16. Thomas MK, Lloyd-Jones DM, Thadhani RI, et al. Hypovitaminosis D in medical inpatients. N Engl J Med. 1998;338:777–783. [PubMed] [Google Scholar]N Engl J Med. 1998;339:344–345. Comment in. author reply 345−346. [PubMed] [Google Scholar]N Engl J Med. 1998;339:345–346. [PubMed] [Google Scholar]N Engl J Med. 1998;338:828–829. [PubMed] [Google Scholar]

17. van der Wielen RP, Löwik MR, van den Berg H, et al. Serum vitamin D concentrations among elderly people in Europe. Lancet. 1995;346:207–210. [PubMed] [Google Scholar]

18. Holick MF, Siris ES, Binkley N, et al. Prevalence of Vitamin D inadequacy among postmenopausal North American women receiving osteoporosis therapy. J Clin Endocrinol Metab. 2005;90:3215–3224. [PubMed] [Google Scholar]

19. Tangpricha V, Pearce EN, Chen TC, Holick MF. Vitamin D insufficiency among free-living healthy young adults. Am J Med. 2002;112:659–662. [PMC free article] [PubMed] [Google Scholar]

20. Jackson RD, LaCroix AZ, Gass M, et al.Women’s Health Initiative Investigators Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med. 2006;354:669–683. [PubMed] [Google Scholar]N Engl J Med. 2006;354:1102. Erratum in. [Google Scholar]ACP J Club. 2006;145:4–5. Comment in. [PubMed] [Google Scholar]Evid Based Nurs. 2006;9:114. [PubMed] [Google Scholar]N Engl J Med. 2006;354:750–752. [PubMed] [Google Scholar]N Engl J Med. 2006;354:2285–2287. author reply 2285−2287. [PubMed] [Google Scholar]N Engl J Med. 2006;354:2285–2287. author reply 2285−2287. [PubMed] [Google Scholar]N Engl J Med. 2006;354:2285–2287. author reply 2285−2287. [PubMed] [Google Scholar]

21. Porthouse J, Cockayne S, King C, et al. Randomised controlled trial of calcium and supplementation with cholecalciferol (vitamin D3) for prevention of fractures in primary care. BMJ. 2005;330:1003. [PMC free article] [PubMed] [Google Scholar]ACP J Club. 2005;143:72–74. Comment in. [PubMed] [Google Scholar]Age Ageing. 2005;34:542–544. [PubMed] [Google Scholar]BMJ. 2005;331:108–109. author reply 109. [Google Scholar]BMJ. 2005;331:108. author reply 109. [Google Scholar]BMJ. 2005;331:108. author reply 109. [Google Scholar]

22. Grant AM, Avenell A, Campbell MK, et al. Oral vitamin D3 and calcium for secondary prevention of low-trauma fractures in elderly people (Randomised Evaluation of Calcium Or vitamin D, RECORD): a randomised placebo-controlled trial. Lancet. 2005;365:1621–1628. [PubMed] [Google Scholar]ACP J Club. 2005;143:72–74. Comment in. [PubMed] [Google Scholar]J Fam Pract. 2005;54:658. [PubMed] [Google Scholar]Lancet. 2005;366:543. author reply 543−544. [Google Scholar]Lancet. 2005;366:543. author reply 543−544. [Google Scholar]Lancet. 2005;366:544. [Google Scholar]Lancet. 2005;365:1599–1600. [PubMed] [Google Scholar]

23. Lips P, Graafmans WC, Ooms ME, et al. Vitamin D supplementation and fracture incidence in elderly persons. A randomized, placebo-controlled clinical trial. Ann Intern Med. 1996;124:400–406. [PubMed] [Google Scholar]ACP J Club. 1996;125:16. Comment in. [Google Scholar]

24. Meyer HE, Smedshaug GB, Kvaavik E, et al. Can vitamin D supplementation reduce the risk of fracture in the elderly? A randomized controlled trial. J Bone Miner Res. 2002;17:709–715. [PubMed] [Google Scholar]

25•. Boonen S, Lips P, Bouillon R, et al. Need for additional calcium to reduce the risk of hip fracture with vitamin D supplementation: evidence from a comparative metaanalysis of randomized controlled trials. J Clin Endocrinol Metab. 2007;92:1415–1423.
[Of importanceThis meta-analysis demonstrates that vitamin D and calcium together are most effective in preventing hip fractures.] [PubMed] [Google Scholar]

26. Bischoff-Ferrari HA, Dawson-Hughes B. Where do we stand on vitamin D? Bone. 2007;41(1 Suppl 1):S13–19. [PubMed] [Google Scholar]

27. Holick MF. High prevalence of vitamin D inadequacy and implications for health. Mayo Clin Proc. 2006;81:353–373. [PubMed] [Google Scholar]Mayo Clin Proc. 2006;81:297–299. Comment in. [PubMed] [Google Scholar]

28. Bischoff-Ferrari HA, Dietrich T, Orav EJ, et al. Higher 25-hydroxyvitamin D concentrations are associated with better lower-extremity function in both active and inactive persons aged > or = 60 y. Am J Clin Nutr. 2004;80:752–758. [PubMed] [Google Scholar]

29. Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC, et al. Effect of vitamin D on falls: a meta-analysis. JAMA. 2004;291:1999–2006. [PubMed] [Google Scholar]

30. Cantorna MT, Zhu Y, Froicu M, Wittke A. Vitamin D status, 1,25-dihydroxyvitamin D3, and the immune system. Am J Clin Nutr. 2004;80(6 Suppl):1717S–1720S. [PubMed] [Google Scholar]

31. Vaisberg MW, Kaneno R, Franco MF, Mendes NF. Influence of cholecalciferol (vitamin D3) on the course of experimental systemic lupus erythematosus in F1 (NZBxW) mice. J Clin Lab Anal. 2000;14:91–96. [PMC free article] [PubMed] [Google Scholar]

32. Merlino LA, Curtis J, Mikuls TR, et al.Iowa Women’s Health Study Vitamin D intake is inversely associated with rheumatoid arthritis: results from the Iowa Women’s Health Study. Arthritis Rheum. 2004;50:72–77. [PubMed] [Google Scholar]Arthritis Rheum. 2006;54:3719–3720. Comment in. [PubMed] [Google Scholar]

33•. Costenbader KH, Feskanich D, Benito-Garcia E, et al. Vitamin D intake and risks of systemic lupus erythematosus and rheumatoid arthritis in women. Ann Rheum Dis. 2007 [Epub ahead of print].
[Of importanceA prospective cohort study of the Nurses’ Health Study and Nurses’ Health Study II cohorts. After 22 years of follow-up, of 186,389 women, investigators found 190 new cases of confirmed SLE and 722 new cases of RA. No association was found between vitamin D intake (based on food frequency questionnaire) and incidence of SLE or RA.] [PMC free article] [PubMed] [Google Scholar]

34. Munger KL, Levin LI, Hollis BW, et al. Serum 25-hydroxyvitamin D levels and risk of multiple sclerosis. JAMA. 2006;296:2832–2838. [PubMed] [Google Scholar]

35. Liu PT, Stenger S, Li H, et al. Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science. 2006;311:1770–1773. [PubMed] [Google Scholar]

36•. Mathieu C, Gysemans C, Giulietti A, Bouillon R. Vitamin D and diabetes. Diabetologia. 2005;48:1247–1257.
[Of importanceThis is a very well-written review for the evidence of vitamin D in the prevention of type 1 and type 2 diabetes.] [PubMed] [Google Scholar]

37. Scragg R, Sowers M, Bell C. Serum 25-hydroxyvitamin D, ethnicity, and blood pressure in the Third National Health and Nutrition Examination Survey. Am J Hypertens. 2007;20:713–719. [PubMed] [Google Scholar]

38. Ford ES, Ajani UA, McGuire LC, Liu S. Concentrations of serum vitamin D and the metabolic syndrome among U.S. adults. Diabetes Care. 2005;28:1228–1230. [PubMed] [Google Scholar]

39. Judd SE, Nanes MS, Ziegler TR, et al. Optimal vitamin D status attenuates the age-associated increase in systolic blood pressure in white Americans: results from the third National Health and Nutrition Examination Survey. Am J Clin Nutr. 2008;87:136–141. [PubMed] [Google Scholar]

40. Pfeifer M, Begerow B, Minne HW, et al. Effects of a short-term vitamin D(3) and calcium supplementation on blood pressure and parathyroid hormone levels in elderly women. J Clin Endocrinol Metab. 2001;86:1633–1637. [PubMed] [Google Scholar]

41. Hsia J, Heiss G, Ren H, et al.Women’s Health Initiative Investigators Calcium/vitamin D supplementation and cardiovascular events. Circulation. 2007;115:846–854. [PubMed] [Google Scholar]Circulation. 2007;115:e466. Erratum in. [Google Scholar]Circulation. 2007;115:827–828. Comment in. [PubMed] [Google Scholar]Circulation. 2007;116:e85. author reply e87. [PubMed] [Google Scholar]Circulation. 2007;116:e86. author reply e87. [PubMed] [Google Scholar]

42••. Autier P, Gandini S. Vitamin D supplementation and total mortality: a meta-analysis of randomized controlled trials. Arch Intern Med. 2007;167:1730–1737.
[Of major importanceThis very intriguing manuscript reviewed all randomized placebo-controlled trials with vitamin D in which death was collected as an end point. The results show a survival advantage when taking usual over-the-counter doses of vitamin D (∼500 IU daily).] [PubMed] [Google Scholar]

43•. Lappe JM, Travers-Gustafson D, Davies KM, et al. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr. 2007;85:1586–1591. [PubMed] [Google Scholar]Am J Clin Nutr. 2007;86:1804–1805. [Comment in. author reply 1805−1806. [PubMed] [Google Scholar]Am J Clin Nutr. 2007;86:1549. author reply 1549−1550.]
[Of importanceA double-blind, randomized controlled trial of Nebraska women with primary outcome of fractures and principal secondary outcome of cancer incidence. Subjects (n = 1179) were randomly assigned to calcium (1400−1500 mg) plus vitamin D (1100 IU), calcium alone, or placebo, with a 4-year follow-up. Treatment with vitamin D and levels of 25(OH)D were significantly associated with decreased cancer incidence, with a RR of 0.232 for cancers diagnosed 1 year after study initiation in the vitamin D and calcium group. ] [PubMed] [Google Scholar]

44. Huybers S, Naber TH, Bindels RJ, Hoenderop JG. Predniso-lone-induced Ca2+ malabsorption is caused by diminished expression of the epithelial Ca2+ channel TRPV6. Am J Physiol Gastrointest Liver Physiol. 2007;292:G92–G97. [PubMed] [Google Scholar]

45. Recker RR. Calcium absorption and achlorhydria. N Engl J Med. 1985;313:70–73. [PubMed] [Google Scholar]

46. Sakhaee K, Bhuket T, Adams-Huet B, Rao DS. Meta-analysis of calcium bioavailability: a comparison of calcium citrate with calcium carbonate. Am J Ther. 1999;6:313–321. [PubMed] [Google Scholar]Am J Ther. 2001;8:73–74. Comment in. [PubMed] [Google Scholar]Am J Ther. 2001;8:74–77. [PubMed] [Google Scholar]

47. Heaney RP, Dowell MS, Bierman J, et al. Absorbability and cost effectiveness in calcium supplementation. J Am Coll Nutr. 2001;20:239–246. [PubMed] [Google Scholar]

48. Recker RR, Bammi A, Barger-Lux MJ, Heaney RP. Calcium absorbability from milk products, an imitation milk, and calcium carbonate. Am J Clin Nutr. 1988;47:93–95. [PubMed] [Google Scholar]

49. Armas LA, Hollis BW, Heaney RP. Vitamin D2 is much less effective than vitamin D3 in humans. J Clin Endocrinol Metab. 2004;89:5387–5391. [PubMed] [Google Scholar]

50. Kamen DL, Cooper GS, Bouali H, et al. Vitamin D deficiency in systemic lupus erythematosus. Autoimmun Rev. 2006;5:114–117. [PubMed] [Google Scholar]

51. Harvey JA, Zobitz MM, Pak CY. Dose dependency of calcium absorption: a comparison of calcium carbonate and calcium citrate. J Bone Miner Res. 1988;3:253–258. [PubMed] [Google Scholar]

Calcium/Vitamin D Requirements, Recommended Foods & Supplements

Calcium and vitamin D are essential to building strong, dense bones both when you’re young and as you age. The information included here will help you learn all about calcium and vitamin D – the two most important nutrients for bone health.

It is equally important to continue getting enough calcium and vitamin D to prevent further bone loss if you are prescribed a medication to prevent bone loss or fractures.

What is Calcium and What Does it Do?

A calcium-rich diet (including dairy, nuts, leafy greens and fish) helps to build and protect your bones.

Calcium is a mineral that is necessary for life. In addition to building bones and keeping them healthy, calcium enables our blood to clot, our muscles to contract, and our heart to beat. About 99% of the calcium in our bodies is in our bones and teeth.

Every day, we lose calcium through our skin, nails, hair, sweat, urine and feces. Our bodies cannot produce its own calcium. That’s why it’s important to get enough calcium from the food we eat. When we don’t get the calcium our body needs, it is taken from our bones. This imbalance causes bones get weak and easier to break.

Too many Americans fall short of getting the amount of calcium they need every day and that can lead to bone loss, low bone density and even broken bones.

How Much Calcium Do You Need?

The amount of calcium you need every day depends on your age and sex.

*This includes the total amount of calcium you get from food and supplements.

How Much Calcium Do You Eat?

Use the International Osteoporosis Foundation’s Calcium Calculator to find out.

Sources of Calcium

Calcium-Rich Food Sources

Food is the best source of calcium. Dairy products, such as milk, yogurt, and cheese are high in calcium. Certain green vegetables and other foods contain calcium in smaller amounts. Some juices, breakfast foods, soymilk, cereals, snacks, breads and bottled water have added calcium in fortified foods. If you consume soymilk, other nut based milks ( i.e.: almond or oat milk) or another liquid that is fortified with calcium, be sure to shake the container well as calcium can settle to the bottom.

A simple way to add calcium to many foods is to add a single tablespoon of nonfat powdered milk, which contains about 50 mg of calcium. It is easy to add a few tablespoons to almost any recipe.

Reading Food Labels – How Much Calcium Am I Getting?

To determine how much calcium is in a particular food, check the nutrition facts panel for the daily value (DV). Food labels list calcium as a percentage of the DV. This amount is based on 1,000 mg of calcium per day. For example:

• 30% DV of calcium equals 300 mg of calcium.
• 20% DV of calcium equals 200 mg of calcium.
• 15% DV of calcium equals 150 mg of calcium.

Calcium Supplements

The amount of calcium you need from a supplement depends on how much you get from food. Try to get the daily amount recommended from food and only supplement as needed to achieve the recommend daily allowance. In general, you shouldn’t take excess supplements that you don’t need. If you get enough calcium from foods, you may not need to take a supplement. There is no added benefit to taking more calcium than you need. Doing so may even carry some risks such as constipation, kidney stones and perhaps excess heart calcification.

Calcium supplements are available without a prescription in a wide range of preparations (including chewable tablets, gummy preparations, powders and liquid) and in varying amounts and sizes. The best supplement is the one that meets your needs for tolerability, convenience, cost, and availability. When choosing a supplement, keep the following in mind:

• Choose brand-name supplements with proven reliability. Look for labels that state “purified” or have the USP (United States Pharmacopeia) symbol. The “USP Verified Mark” on the supplement label means that the USP has tested and found the calcium supplement to meet its standards for purity and quality.
• Read the product label carefully to determine the amount of elemental calcium, which is the actual amount of calcium in the supplement, as well as how many doses or pills you have to take. When reading the label, pay close attention to the “amount per serving” and “serving size.”
• Calcium is absorbed best when taken in amounts of 500 – 600 mg or less. This is the case for both foods and supplements. Try to get your calcium-rich foods and/or supplements in small amounts throughout the day, preferably with a meal. While it’s not recommended, taking your calcium all at once is better than not taking it at all.
• Take (most) calcium supplements with food. Eating food produces stomach acid that helps your body absorb most calcium supplements. The one exception to the rule is calcium citrate, which can absorb well when taken with or without food.
• When starting a new calcium supplement, start with a smaller amount to better tolerate it. When switching supplements, try starting with 200-300 mg every day for a week, and drink an extra 6-8 ounces of water with it. Then gradually add more calcium each week.
• Side effects from calcium supplements, such as gas or constipation may occur or worsen. If increasing fluids in your diet and obtaining enough fiber does not solve the problem, try another type or brand of calcium. It may require trial and error to find the right supplement for you, but fortunately there are many choices.
• Talk with your healthcare provider or pharmacist about possible interactions between prescription or over-the-counter medications and calcium supplements.

What is Vitamin D and What Does it Do?

Vitamin D is a fat soluble vitamin and plays an important role in protecting your bones, both by helping your body absorb calcium and by supporting muscles needed to avoid falls. Children need vitamin D to build strong bones, and adults need it to keep their bones strong and healthy.

How Much Vitamin D Do You Need?

**According to the National Academy of Medicine and National Institutes of Health the safe upper limit of vitamin D is 4,000 IU per day for most adults. These recommendations are for the general healthy adult population.

Sources of Vitamin D

There are three ways to get vitamin D:

• Sunlight
• Food
• Supplements

Sunlight

Your skin makes vitamin D in reaction to sunlight and stores it in fat for later use. How much vitamin D your skin can produce depends on time of day, season, latitude, skin pigmentation, age, and other factors.

There are many reasons people do not have enough vitamin D. As we age, our skin loses its ability to generate vitamin D. People who live in cities or in institutional settings like nursing homes spend too little time outdoors. Even people who spend time outdoors often use sunscreen to prevent skin cancer. Sunscreen with an SPF as low as 8 reduces vitamin D production by 95 percent.

Vitamin D in Food

Vitamin D is found in very few foods. Sources include fatty fish like wild-caught mackerel, salmon, and tuna. Vitamin D is added to milk and other dairy products, orange juice, soymilk, and fortified cereals.

Check the food label to see if vitamin D has been added to a particular product. One eight-ounce serving of milk usually has 25% of the daily value (DV) of vitamin D. The DV is based on a total daily intake of 400 IU of vitamin D. So, a serving of milk with 25% of the DV of vitamin D contains 100 IU.

It is often difficult to get all the vitamin D you need from sunlight and food alone. Some people with underlying conditions may need to take vitamin D supplements to support bone health.

Vitamin D Supplements

Healthy adults with no vitamin D deficiency should be able to get adequate amounts of vitamin D from sunlight and by consuming a well-balanced diet. People with osteoporosis and low bone mass should discuss their vitamin D levels with their healthcare provider to ensure they are getting an optimal amount.

Before adding a vitamin D supplement, check to see if any of the other supplements, multivitamins, or medications you take contain vitamin D. Many calcium supplements also contain some vitamin D.

There are two types of vitamin D supplements. They are vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol). Both types are good for bone health.

Vitamin D supplements can be taken with or without food and the full amount can be taken at one time. While your body needs vitamin D to absorb calcium, you do not need to take vitamin D at the same time as a calcium supplement. If you need help choosing a vitamin D supplement, ask your healthcare provider to recommend one.

Vitamin D Deficiency: Are You at Risk?

Vitamin D deficiency occurs when you are not getting the recommended level of vitamin D over time. Certain people are at higher risk for vitamin D deficiency, including:

• People who spend little time in the sun or those who regularly cover up when outdoors;
• People living in nursing homes or other institutions or who are homebound;
• People with certain medical conditions such as Celiac disease and inflammatory bowel disease;
• People taking medicines that affect vitamin D levels such as certain anti-seizure medicines;
• People with very dark skin;
• Obese or very overweight people; and
• Older adults with certain risk factors.

Talk to your healthcare provider if you have any of these risk factors. If you have osteoporosis, low bone mass or another medical condition that can lead to bone loss and also have a vitamin D deficiency, your healthcare provider may recommend vitamin D supplement to bring you up to a healthy 25-hydroxy vitamin D level which is generally agreed upon by medical societies to be between 30-60 ng/ml.

A Guide to Calcium-Rich Foods

We all know that milk is a great source of calcium, but you may be surprised by all the different foods you can work into your diet to reach your daily recommended amount of calcium. Use the guide below to get ideas of additional calcium-rich foods to add to your weekly shopping list.

*The calcium content listed for most foods is estimated and can vary due to multiple factors. Check the food label to determine how much calcium is in a particular product.

Resources

–Show More +

• Calcium and Vitamin D Supplement Safety Fact Sheet
• Just the Facts: Latest Evidence-Based Research on Calcium from the National Institutes of Health (NIH) Office of Dietary Supplements (ODS)

Last Reviewed 5/23/2023

What vitamin ensures the absorption of calcium in the body

THERE ARE CONTRAINDICATIONS. SPECIALIST CONSULTATION IS REQUIREDVitamin DB group vitaminsCalciumMagnesiumZinc

Contents of the article

• What effect does calcium have on the human body?
• Which vitamin ensures the absorption of calcium in the body?
• Which foods are best for calcium absorption
• What foods flush calcium out of the body
• Sources

Calcium (Ca) is one of the few elements that almost every cell needs. Without it, the full formation of tissues and the normal course of biochemical processes are impossible. The body cannot synthesize Ca on its own. Food and special additives provide its replenishment.

But in order to replenish the reserves, it is not enough to receive the necessary doses of the microelement. You also need to create conditions for its assimilation. A number of useful substances contribute to this process. What vitamin ensures the absorption of calcium and what is the role of this nutrient?

What effect does calcium have on the human body?

The distribution of Ca in the body is uneven – 99% of the element is contained in the teeth and bones, and only 1% is distributed to other organs. The substance comes in from the outside, and its excretion is provided by the kidneys and intestines.

Functions performed by Ca:

• Balances the processes of excitation and inhibition in the cerebral cortex
• Necessary for bone formation and mineralization of teeth
• Affects the heart rhythm and blood clotting
• Participates in the formation of many hormones and enzymes;
• Helps to strengthen the immune system

The substance provides bone strength. At the same time, bone tissue acts as a kind of depot for its storage. With a deficiency of an element, the body begins to use these reserves. Prolonged removal of the mineral from the bones leads to osteoporosis, deterioration of the central nervous system (CNS) and heart, tooth decay, and the development of allergic reactions.

In a child’s body, calcium deficiency is manifested by metabolic disorders, pathological formation of the musculoskeletal system and teeth, and poor sleep.

Mineral requirements vary with age. In addition, gender, lifestyle, and the presence of diseases matter. Large doses of the nutrient (up to 1500 mg) are necessary for women during pregnancy, breastfeeding, postmenopausal women.

However, an excess of the substance can also lead to health problems. The use of more than 2.5 mg of calcium per day causes a deterioration in appetite, constipation, increased blood pressure (BP), convulsions, and increases the risk of calculus formation. Therefore, the mineral should enter the body only in the required quantities. And for its full assimilation, it is necessary to take preparations additionally enriched with other vitamins and microelements.

Which vitamin ensures the absorption of calcium in the body?

Ca absorption is a complex process, for which vitamin D is primarily important. It improves the absorption of the mineral in the small intestine and helps strengthen bones. With a lack of vitamin, calcium can be poorly absorbed even when taken in the right quantities.

Additionally, vitamins act as a support group:

• C – accelerates the maturation of collagen, which acts as a natural support for bone tissue, skin, blood vessels. Protects blood vessels and the heart, prevents the development of allergies.
• B6 – improves the absorption of magnesium, necessary for the full functioning of the central nervous system.
• K1 – prevents osteoporosis. Together with vitamin D, it is involved in the synthesis of osteocalcin, which helps to retain calcium. Reduces the risk of fractures.

Minerals are also needed for better absorption of Ca: magnesium (Mg), phosphorus (P), zinc (Zn), iodine (I).

Fully provide the body’s need for calcium and its maximum assimilation of such combined preparations as Calcium D-3 Nikomid-Forte, Calcemin, Osteogenon. But you can take them only as prescribed by a doctor. In the absence of the opportunity to consult with a specialist, stocks can be replenished with food.

All products Ascorbic acid

10 reviews

All products Pyridoxine (Vitamin B6)

20 reviews

All products Iodine

20 reviews

From which foods calcium is best absorbed

Many foods are rich in calcium. To replenish the body with a mineral, you need to include in the diet:

• Sesame seeds – most Ca contains seed coats, so you need to use unpeeled seeds. Peeled sesame seeds practically do not bring benefits.
• Milk and dairy products – the element is best absorbed from pasteurized milk. UHT and sterilized dairy products contain much fewer substances that help good absorption of Ca.
• Greens, vegetables, nuts, berries and fruits – compared to milk, they have less calcium. The element is best absorbed from raw vegetables and fruits.

Combining these products, you can provide the body with the necessary amount of the substance. However, Ca is easily washed out. Therefore, it is necessary not only to saturate the body with a mineral, but also to prevent its leaching.

All products Calcemin

20 reviews

All products Calcium-D3 Nycomed

20 reviews

All products Osteogenon

20 reviews

contribute to its leaching from the bone tissue. These include:

• Palm oil – prevents the absorption of calcium and many useful substances.
• Coffee – flushes Ca and other minerals from the body. No more than 4 cups of coffee with a capacity of 30 ml are allowed per day.
• Sweets – disrupt the intestinal microflora, in which all useful substances are absorbed.
• Sweet water – also disrupts the functioning of the intestines and interferes with the absorption of the trace element. Some drinks contain caffeine, which washes away beneficial elements.

In addition, products with a high salt content, animal fats, and all alcoholic beverages interfere with the absorption of the mineral and contribute to its leaching.

If you think you need extra calcium, see your doctor and have your Ca tested. Do not use special additives without the appointment of a specialist. Even the most harmless at first glance, vitamins and minerals can be harmful to health. Their dosage, method and duration of use is determined only by a doctor.

THERE ARE CONTRAINDICATIONS. SPECIALIST ADVICE NEEDED

Resources

• Vitamins and minerals: Calcium, NHS UK
• Calcium, US National Institutes of Health
• Calcium Supplements & Absorption, Medical University of South Car Olins

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What foods are required to restore calcium in the body?

Find out which foods are rich in calcium and how to use them correctly for the best replenishment of this important mineral for bones and health. Here you will find a list of products and tips for preparing them.

Calcium is one of the most important elements for healthy bones, teeth, muscles and the nervous system. A lack of calcium can lead to osteoporosis, dental caries, and a tendency to fracture. To avoid these problems, you need to make sure you are eating enough calcium-rich foods.

One of the main sources of calcium is dairy products: milk, cottage cheese, cheese, yoghurts. You can also replenish calcium by eating fish and seafood, nuts, legumes, pumpkin and sunflower seeds, green vegetables and fruits, as well as some types of bread and cereal.

When choosing foods, take into account their digestibility by the body. So, calcium from milk and dairy products is absorbed better than from vegetables, so these foods should be consumed more. In addition, for better absorption of calcium, it is necessary to consume a sufficient amount of vitamin D, which is found in fish oil, egg yolk, fish oil, and mushrooms.

What foods restore calcium in the body?

Calcium is one of the most important minerals for our body, because it is responsible for the health of bones, teeth, muscles and other tissues. To strengthen your body and restore the level of calcium in your bones and teeth, you need to include foods rich in this mineral in your diet.

The first food to consume is dairy products. They contain large amounts of calcium and phosphorus, which interact with each other and help strengthen bones and teeth. In addition, protein foods such as cottage cheese, cheese and yogurt contain casein, an element that helps improve calcium absorption in the intestines.

Vegetables and fruits are another group of foods rich in calcium. In particular, these are broccoli, cabbage, spinach, beans, radishes, apricots, dates and oranges. They contain vitamin D and other elements that promote better absorption of calcium.

Among fish, scallops and other seafood, many species contain calcium, phosphorus and vitamin D. For example, mackerel, salmon and pink salmon are especially beneficial for nutrition, as they are rich not only in calcium, but also in omega-3 fatty acids, which are needed for heart health.

It is important to understand that the restoration of calcium in the body is a process that takes time and the right approach. It is necessary to include a variety of foods in the diet, monitor your health and supplement nutrition with vitamin complexes containing calcium and other necessary elements.

Dairy products:

Dairy products are a good source of calcium. It can be various types of cheeses, milk, yogurt, kefir, cottage cheese.

Milk is one of the easiest and most affordable sources of calcium. One glass of milk (250 ml) contains about 300 mg of calcium.

cheeses are an excellent source of calcium. Fatty cheeses are especially useful, as they contain more calcium. Cheeses such as processed, parmesan, ricotta, mozzarella, roquefort and cheddar contain 200 to 700 mg of calcium per 100 grams.

Yoghurt and kefir are useful even for those who do not tolerate dairy products well. They contain up to 400 mg of calcium in 200 grams of the product.

Cottage cheese is a source of not only calcium, but also other useful substances such as protein, fat and trace elements. 100 grams of cottage cheese contains about 120 mg of calcium.

Dairy products are not only a great example of calcium-rich foods, but they are also highly digestible and tasty, making them an excellent choice for daily nutrition.

Fish and seafood:

Fish and seafood are among the best sources of calcium. Some types of fish, such as salmon, sardines, and tuna, are high in calcium. This makes fish and seafood an excellent choice for those looking to restore calcium levels in the body.

There are also other seafood that contain calcium. Shrimps, oysters, crabs and other seafood are also rich sources of calcium. At the same time, they contain a lot of protein and other nutrients, making them beneficial for human health.

Fish and seafood rich in calcium: FoodCalcium content, mg per 100 g

restore calcium in the body, it is recommended to avoid large amounts of fat and salt. Canned fish products may contain more salt, so we recommend choosing fresh fish and seafood or canned fish with less salt.

Vegetables and herbs:

Broccoli. Broccoli is a rich source of calcium, vitamin C, K and antioxidants. It is recommended to eat raw, baked or boiled.

Spinach. Spinach is one of the best sources of calcium and contains a whole complex of vitamins: A, C, E, K, B1, B2, B6. It is recommended to eat in green salads or stew, but not infrequently mixed with other vegetables.

Cabbage. Cabbage contains calcium, iron, folic acid and B vitamins. Recommended as a baked snack, boiled or salad.

Fresh herbs. Parsley, dill, basil, arugula and onion feathers contain calcium, vitamin K and magnesium. It is recommended to add fresh green herbs to salads, pancakes and soups.

Carrot. Carrots, in turn, are rich in carotene and pectin fibers, and also contain calcium. It is recommended to eat as a raw snack, baked in the oven or added to soups and vegetable salads.

By including these vegetables and greens in your diet, you will provide additional intake of calcium, which is so necessary for healthy bones, teeth and the healthy functioning of the body as a whole.

Fruits and berries:

Fruits and berries are a valuable source of vitamins, minerals and antioxidants. Some of them contain calcium, which is necessary for healthy bones and teeth, as well as for the proper functioning of muscles and the nervous system.

Figs are among the fruits rich in calcium. One fig contains about 20 mg of calcium. Pomegranates, grapes, prunes and apricots are also rich in calcium.

Berries, in turn, are also a rich source of calcium. Particularly beneficial for bone health are currants, cranberries, hawthorn, and black currants. In addition, berries contain many other beneficial substances, such as vitamins C and E, folic acid, and anthocyanins.

Diversify your diet, eat fruits and berries every day and get the maximum benefit for your health!

Nuts and seeds:

Nuts and seeds are an excellent source of calcium and other minerals needed for healthy bones and teeth. Among them stand out:

• Almonds – contains a huge amount of calcium, magnesium and vitamin E, which strengthens bones and teeth. It also contains protein, which is needed for tissue growth and repair.
• Hazelnut – rich in calcium, phosphorus, magnesium, iron and vitamins B and E. It also contains phytochemicals that help prevent bone and tooth decay.
• Pumpkin seeds are an excellent source of calcium, magnesium and iron. They also contain vitamins B and E, which help strengthen bones and teeth.
• Hazelnut – rich in calcium, magnesium, zinc and vitamin E. It also contains protein, which is needed for tissue growth and repair.

Adding nuts and seeds to your diet can help strengthen bones and teeth and prevent bone loss.

Cereals and Grains:

Oatmeal is one of the best foods to eat if you need to restore calcium levels in your body. Oatmeal contains a lot of phytoestrogens that help in this process.

Buckwheat is also rich in phytoestrogens and calcium. It consists of granules that contain the smallest particles, vigilantly monitor the health of bones and actively participate in their restoration.

Rice is an indispensable product in the diet to restore calcium levels, it has a high amount of nutrients. Rice contains minerals such as magnesium, potassium, iron and calcium.

Semolina is another calcium rich food. It also contains vitamin D, which is essential for better absorption of calcium in the body.

Wheat contains not only calcium, but also many other useful substances, such as iron, vitamin B, magnesium and zinc.

In general, those who want to restore calcium in the body should not forget about cereals and cereals, which contain many useful minerals and vitamins.

Protein Products:

Proteins are one of the body’s most important building blocks and are involved in many processes, including tissue repair and the formation of hormones and enzymes. Protein-rich foods will help restore calcium levels in the body, as calcium is a necessary component for protein synthesis.

1. Meat and poultry: chicken, beef, pork, turkey, fish.
2. Dairy products: milk, yogurt, cheese, kefir, cottage cheese.
3. Eggs: egg white contains about 6 grams of protein and is an excellent source of calcium.
4. Legumes: beans, peas, lentils, soybeans.

However, proper protein synthesis also requires adequate intake of vitamin D, which promotes calcium absorption. So be sure to fortify your diet with vitamin D blocking foods like fish oil, cod liver oil or egg yolks.

Brown bread and cereal baked goods:

Brown bread and cereal baked goods are a valuable source of calcium, especially when whole grain flour is used. Whole grain bread contains all the valuable fiber, vitamins and minerals found in wheat grains. It is also rich in protein, iron and zinc, the main food components that are essential for health.

When choosing bread, make sure it contains calcium. Bread with added milk or yogurt usually contains more calcium than regular bread. Many retail chains also offer special bread enriched with calcium and other trace elements.

In addition, various buns, pies and other products can be made from grain products. But do not forget that we are talking about the main component – flour. Look out for pasta, cereals, and other grains, as these too can contain calcium and other important nutrients.

Juices and drinks:

Milk is one of the most popular sources of calcium, especially for children. It also contains vitamin D, which helps calcium absorption even better. Although milk is too high in calories, it can be replaced with low-calorie kefir or yogurt.

Juices and drinks is another way to get the calcium you need. Juices from fresh fruits and vegetables are rich in many beneficial substances, including calcium. But be aware that many bottled juices are high in sugar and can be very high in calories. It is best to drink natural juices or water with the addition of lemon to get calcium and other beneficial vitamins and minerals.

Tea and coffee also contain some calcium. However, excessive consumption of coffee and tea can reduce the absorption of calcium in the body. Therefore, it is recommended to limit the amount of coffee and tea you drink and replace them with other drinks.

Mineral water is another source of calcium. Some brands of mineral water contain a high concentration of calcium. Check the ingredients on the label to make sure your mineral water contains enough calcium.

Sports Drinks is another way to get calcium and other health benefits. But you need to be careful, as many sports drinks contain a lot of sugar and additives that are not very good for our body. It is best to choose natural drinks and water with added electrolytes.

Mineral water:

Mineral water is a mineral-rich drink that helps restore calcium in the body. It is known that the location and composition of the source affect the amount and type of minerals contained in the water.

• Sulphate mineral water: contains an increased amount of sulphates, which improve blood circulation and calm the nervous system. It also helps to remove toxins.
• Chloride mineral water: rich in chlorides, which have an antiseptic effect and help fight infectious diseases.
• Hydro-carbonate mineral water: contains hydrocarbons, which contribute to the normalization of the acid-base balance of the body.

Mineral water is an excellent source of calcium, essential for maintaining healthy bones and teeth. Regular consumption of mineral water will help fill the calcium deficiency in the body and prevent the development of bone diseases such as osteoporosis.

Tea and coffee:

Tea and coffee are beverages that many people drink every day. However, if you want to restore the level of calcium in the body, you should limit their intake.

Black tea, green tea and coffee contain tannins, substances that can increase urinary calcium loss. In addition, coffee also contains caffeine, which can cause calcium to be depleted from bones.

If you are not ready to give up tea and coffee completely, include other calcium-rich foods in your diet to compensate for the losses. For example, dairy products, nuts, green vegetables, and fish are rich in calcium and can help fill in calcium.

• Limit tea and coffee intake to restore calcium in the body
• Black tea, green tea and coffee contain tannins that can remove calcium from the bones
• Coffee contains caffeine, which can cause calcium to be removed from the bones
• eating other foods rich in this mineral

Ice cream and sweets:

Although ice cream is not a major source of calcium, it may contain small amounts of this important mineral. However, eating a lot of sweets can lead to a decrease in the concentration of calcium in the body.

With a large consumption of sweets, especially with the addition of chocolate, coffee and tea, an increase in the excretion of calcium in the urine is observed in the body, which can lead to the development of bone diseases.

If you can’t resist treats like sweets and ice cream, it’s a good idea to opt for less unhealthy options like popsicles, sorbets, and natural fruits and berries for a sweet snack.

Fermented milk drinks:

Kefir. Kefir is one of the most useful sources of calcium. It contains more calcium than most other dairy products due to the fermentation process. Kefir also contains probiotics, which help improve digestion.

Curd. Cottage cheese contains a large amount of calcium. It is also rich in proteins, which make it easier for calcium to be absorbed. Cottage cheese pairs easily with other foods, such as vegetables or fruits, so it’s easy to add to your diet.

Yogurt. Not only kefir, but also yogurt contain a sufficient amount of calcium. Especially when yogurt is made with skim milk. Yogurt also contains probiotics and vitamins that are good for bone health.

Yogurt. Curdled milk is a rich source of calcium, which also contains many beneficial bacteria after fermentation. These will be probiotics that will help improve the functioning of the digestive system and, accordingly, improve the absorption of calcium.

Ryazhenka. Ryazhenka is also a fermented milk product that contains a large amount of calcium. In addition, fermented baked milk contains bifidobacteria, which are considered beneficial for digestion, so this is a good choice for strengthening bones and overall human health.

Food additives:

Calcium preparations. The main sources of calcium in the human body are dairy products, nuts, fish and green vegetables. However, in case of a lack of calcium in the body, some people prefer to take calcium supplements. Calcium is most readily absorbed in the body in the form of calcium carbonate, calcium lactate, or gluconate.

Vitamin D. This vitamin helps the body absorb calcium and is essential for maintaining healthy bones. It also plays a role in protecting the nervous system and the immune system. Vitamin D can be obtained from certain foods, such as fish liver oil, egg yolks, and mushrooms. Vitamin D is also added to some calcium supplements.

Magnesium preparations. Magnesium plays an important role in calcium absorption. It is also essential for regulating heart rate and maintaining a healthy nervous system. Magnesium can be obtained from foods such as nuts, green vegetables, and whole grains. If necessary, you can take magnesium supplements.

Phosphates. Phosphates also help the body absorb calcium as part of bone tissue. Phosphates can be obtained from meat, fish and dairy products. However, excess phosphate can impair calcium absorption, so it should be consumed in reasonable amounts.

Micronutrient complexes. Micronutrient complexes may contain calcium, magnesium, phosphate, vitamin D, and other minerals and vitamins needed to maintain healthy bones and the body as a whole. However, before taking such drugs, you should consult with a specialist and make sure they are safe and effective.

Urbechi and oils:

Urbechi or crushed seeds contain vitamin D and calcium, making them an excellent source for restoring calcium in the body. They can be added to various dishes such as oatmeal, yogurt or smoothies.

There are many types of oils that contain calcium. For example, flax seed oil contains about 7% calcium per teaspoon, while sesame oil contains over 1% calcium per serving.

Oils that include fortified supplements such as vitamin D or calcium can also be a good source of calcium. They help restore calcium, especially in those people who are deficient in this important nutrient.

• How to choose oils and urbech?
• Buy natural products free of additives and preservatives.
• Look for calcium and vitamin D content on labels.
• Remember to learn how to use these foods in your cooking to get the most health benefits.

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Q&A:

What foods should be consumed in case of calcium deficiency?

Calcium-rich foods such as milk, yogurt, cheese, cottage cheese, green vegetables (broccoli, spinach), seeds and nuts (hazelnuts, almonds), soft-boned fish (sardines, salmon) should be consumed.

Can vitamin supplements replace calcium?

Yes, you can, but it is important to consider that calcium-rich foods are preferable because the nutrients in foods are better absorbed by the body.

Why is greens good for calcium absorption?

Greens contain vitamin K, which is involved in the process of bone formation and improves the absorption of calcium and other nutrients.

What foods should be excluded from the diet in case of calcium deficiency?

Limit your intake of foods that can reduce calcium absorption, such as coffee, salt, sugar, alcohol, and sodas.

Can thyroid problems lead to calcium deficiency?

Yes, a lack of thyroid can lead to reduced absorption of calcium and other nutrients. In this case, it is important to consult a doctor and take the recommended medications.

Can gluten-containing foods be consumed if calcium is deficient?

Yes, you can, as gluten does not interfere with calcium absorption. However, for people with celiac disease or gluten sensitivity, gluten-free foods should be chosen.

Can additional nutritional supplements increase calcium absorption?

Yes, there are supplements that can help increase calcium absorption. For example, vitamin D, magnesium, and boron help the body absorb calcium better.

Spices and herbs:

Herbal products contain many trace elements that help calcium absorption. These include spices and herbs. For example, cinnamon, ginger, and turmeric contain manganese, which plays an important role in mineral metabolism in the body. Also, dill and parsley contain magnesium, which promotes the absorption of calcium.

In addition, garlic, basil and rosemary contain silicon, which not only strengthens bones, but also promotes their growth and healing. It also reduces the risk of osteoporosis and other diseases of the musculoskeletal system.

• Cinnamon – rich in manganese, promotes calcium absorption;
• Ginger – contains manganese, which helps strengthen bones;
• Turmeric – rich in manganese, facilitates the absorption of calcium;
• Dill – contains magnesium, which helps the absorption of calcium;
• Parsley – rich in magnesium, helps to strengthen bones and teeth.

Silicon content in some herbs and spices: Herb\SpiceSilicon content, mg per 100 g