Calcium is required in plenty across all age groups due to its role in bone formation as well as maintenance. Mostly diets are lacking in the required amount of calcium unless very conscious efforts are made to include calcium rich foods. Often, calcium supplements are needed to meet daily requirements. Although calcium supplements are widely available over-the-counter, it is important to consult your physician before starting one so as to decide the dose and type best suited to your existing health status.Image for calcium supplements

There are so many types and forms of calcium supplements available in the market. Here are some questions you need to ask while choosing one-

How much calcium is there in that pill?

Calcium pill is not fully made of calcium, it contains another element as well which helps during its journey into the stomach or aids its absorption. Usually there is calcium bound to carbonates or citrates and also gluconate or lactate. They contain varying amounts of calcium:

  • Calcium carbonate (40 percent elemental calcium)
  • Calcium citrate (21 percent elemental calcium)
  • Calcium gluconate (9 percent elemental calcium)
  • Calcium lactate (13 percent elemental calcium)

This means that in a calcium tablet like for e.g. shelcal-500 – there is 1250 mg calcium carbonate, out of this only 40% is calcium so we get 500mg. The amount of elemental calcium present is of relevance because that is the actual useful fraction of the pill.

So it is important to note the serving size (no of tablets) of the given supplement to ensure that we are not taking more or less than our requirement.

Calcium is best absorbed when taken in the dose of <500mg at a time. As the concentration increases, the efficiency of absorption decreases. Taking the analogy of a sponge, less water means complete soaking whereas excess water keeps dripping off. So, if one has been recommended an intake of up to 1000mg (1g) of calcium supplement, it is best to split intake into two separate time intervals to ensure proper absorption. While starting a new supplement, start with smaller doses such as 200-300mg and gradually increase up to 500mg.

Can we all tolerate the same form of calcium?

As pointed above, calcium supplements come in several forms. Although from a manufacturer’s point of view this combination may mean lower costs, we as consumers need to know which is the most suitable for our body. The carbonate containing calcium supplements are heavy on the stomach and often cause constipation and bloating. Even then, these are the most common form of calcium supplements and also the cheapest.

Calcium citrate is the relatively more expensive form but does not require acidic conditions for its absorption.This can be particularly beneficial for those who have low stomach acids (achlorhydria) such as elderly, individuals suffering from reflux disease , etc. Also, if calcium carbonates are causing excessive gastric problems, then it is better to try citrate forms.

Can the calcium interfere with absorption of other supplements?

Often prescription supplements are all gulped down together in the night before going to bed. That is because we forget to take them throughout the day. Although it is indeed prudent to take the supplement at some time rather than totally skipping it, randomly timed ingestion often does not provide the desired results. Especially calcium has many roles to play in the cellular ionic balance and hence if taken along with medications for blood pressure, thyroid disorders, diabetes, heart ailments , antibiotics can lead to issues with absorption. In fact, even iron and calcium should not be taken together as they compete for common binding sites for absorption.   Its best to ask the physician regarding these interactions and accordingly time the intake.

Best time to take calcium?

Calcium carbonates are best taken with meals or in between meals as they require the stomach acid for breakdown whereas the calcium citrate ones can be taken with or without food.

Capsules or chewable tablets ?

Calcium supplements can be taken as capsules, chewable tablets, gums, powders, etc . there is not much difference in absorbability. Only in case of people with a compromised ability to swallow, it is better to take the chewable or liquid form.

The National Osteoporosis Foundation also recommend that an extra 200-300ml water need to be consumed for every 200-300mg dose of calcium supplement. Increasing total fluid intake can help prevent the gastric side effects that are seen with calcium supplements.

The best way to get calcium is through the dietary sources because they are natural and best absorbed. However, to compensate for poor intakes or under special circumstances of increased requirements supplements become necessary. But, just popping the pill is not enough it is important to understand the right form, dose and time in order to gain its maximum benefits.


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