Reader’s Question:** I am often confused about which calcium to take. There are so many of them out there. Which one is best? Does it matter if I buy the cheap generic one? How much should I take? I get side effects, what should I do?**
Dr. Gonter’s Response: These are common questions that everyone has and I will try to clarify them.
Calcium plays an important role in maintaining bone. Calcium is best obtained through the diet. However, it is extremely difficult to do this especially with the high fat content of dairy products and the increasing incidence of lactose intolerance. Although calcium cannot be used alone to prevent or treat osteoporosis, it is an important part of any comprehensive prevention or treatment program.
The best supplement for each person is dependent on many factors. These include tolerance, convenience, cost and availability.
Types of Calcium Supplements
There are many different types of calcium.
- Calcium Carbonate. This is the** most common and the cheapest.** It is found in the brands,** Tums**,** Caltrate** and** Oscal**. It requires extra stomach acid for better absorption; hence, it is best taken with meals.
- Calcium Citrate is the best absorbed supplemental form of calcium. The most common brands areCitracal and** Solgar**. It does not have any regulations in terms of stomach acid for absorption. Therefore, it can be taken anytime during the day, even on an empty stomach. This may be better for people on acid-blocking medications.
- Dolomite, Bone Meal or Oyster Shell: These naturally occurring calcium pills may contain heavy metal or lead. They are best avoided unless they are tested for purity.
- Calcium Gluconate and Calcium Lactate: Often needs many tablets to meet daily requirements.
- Coral Calcium: Usually calcium carbonate. Likely not much better then others.
- One of the most important differences between the types of calcium is the amount of elemental calcium in each pill. This is the amount of calcium available to your body to absorb. This varies by the type of calcium used. Many calcium supplements list the amount of elemental calcium on the label. However, some brands list only the total weight in milligrams (mg) of each tablet. If this is the case, one has to look at the Nutrition Facts label. For calcium, the Percent Daily Value (% DV) is based on 1,000 mg of elemental calcium, so every 50 percent in the Daily Value column represents 500 mg of elemental calcium (0.50 x 1,000 mg = 500 mg). If a calcium supplement contains 60% of the Daily Value, it contains 600 mg of elemental calcium (0.60 x 1,000 mg = 600 mg).
Absorbability: Another important factor to consider is the absorbability of the calcium. Unfortunately, the calcium supplement that many patients take may end up not being absorbed. If you don’t want to worry about this, stick to brand names. If you are using generic products, you can check how well your pill dissolves by placing them into warm water or vinegar for 30 minutes and stirring it occasionally. If it hasn’t dissolved within this time, it probably will not dissolve in your stomach. Chewable and liquid calcium supplements dissolve well because they are broken down before they enter the stomach.
Calcium is absorbed best by the body when it is taken several times a day in amounts of 500 mg or less.
Purity: This may be a problem with non brand name calcium. One should look for labels that state “purified” or have the USP (United States Pharmacopeia) symbol. The “USP” on the label indicates that the calcium pill meets the USP standards.
Tolerance: This is frequent excuse for not taking proper calcium supplementation. This includes difficulties with gas or constipation. Simple measures such as increasing intake of fluids and high-fiber foods may eliminate the problem, but if they don’t one should try a different form of calcium. There are many available forms and types and one should stop by their local health food store and find one they can tolerate.
In summary, calcium supplementation needs to be individualized for each person. One has to carefully evaluate the type of calcium, observe the label for serving size and quality, and evaluate their own diet for the need for supplementation.
Dr. Neil Gonter is a rheumatologist in Teaneck, New Jersey and is affiliated with multiple hospitals in the area, including Hackensack University Medical Center and Holy Name Medical Center. He wrote for HealthCentral as a health professional for Osteoporosis.