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The Risks and Benefits of Calcium Supplements

There has been an assumption for decades that as a natural element, calcium supplements must intrinsically be safe. But, as I explore in my video Are Calcium Supplements Effective?, calcium supplementation is neither natural nor risk-free. The same could be said, however, for all medications, yet doctors continue to write billions of drug prescriptions every year hoping the benefits outweigh the risks.

So, what about the benefits of calcium supplements versus the risks they pose for heart attacks and strokes? Having a heart attack or stroke can be devastating, but so can a hip fracture. In the months after a hip fracture, risk of dying shoots up, with about one in five women passing away within a year. The odds are even worse for men, with hip fractures having the potential to shorten lifespan by an average of four or five years. Unfortunately, these dismal statistics haven’t been getting much better.

Even if calcium supplements caused a few heart attacks and strokes, it could be argued that if they prevented many more hip fractures, then the risk-benefit ratio might be favorable. But how effective are calcium supplements in preventing hip fractures? We’ve known that milk intake doesn’t appear to help, but maybe that’s because any potential benefit of the calcium in milk may be overshadowed by the increased risk of fracture and death associated with the galactose sugar in milk. (See Is Milk Good for Our Bones? for more on this.) Then what about the calcium in a calcium supplement alone? Calcium intake in general does not seem to be related to hip fracture risk at all. When people have been given calcium supplements, they saw no reduction in hip fracture risk but rather an increased risk was possible. In fact, the randomized controlled trials suggested a 64 percent greater risk of hip fractures with calcium supplementation, compared to a placebo sugar pill.

So where did we get the idea that taking calcium supplements might help our bones? An influential 1992 study found that a combination of vitamin D and calcium supplements could reduce hip fracture rates by 43 percent. However, the subjects in the study were institutionalized women, living in places like nursing homes, who were vitamin D deficient. They weren’t getting sufficient sun exposure. So, if you’re vitamin D deficient and then you take vitamin D and calcium, it’s no surprise your bones get better.

For postmenopausal women living independently in the community, the latest official recommendation for calcium and vitamin D supplementation to prevent osteoporosis is unambiguous: We should not supplement. Why? Because “[i]n the absence of compelling evidence of benefit, taking supplements is not worth any risk, however small.” This is not to say that these supplements don’t play a role in treating osteoporosis or that vitamin D supplements might not be good for other things. But, if you’re just trying to prevent fractures, women living outside of institutions should not take them—and this might even apply to those who live within them.

In a 2012 study, instead of giving nursing home residents vitamin D and calcium supplements, researchers randomized them so one group received sunlight exposure and the other took calcium supplements. Those in the calcium pill group had significantly increased mortality, living shorter lives than those in the sunshine group.

Although calcium supplements don’t appear to prevent hip fractures, they may reduce overall fracture risk by approximately 10 percent. If you’re wondering whether this means it could be worth taking them, here’s how the risk-benefit shakes out: If 1,000 people took calcium supplements for five years, we would expect 14 excess heart attacks—that is, 14 people having heart attacks who would not have had heart attacks if they hadn’t started taking the calcium supplements. They were effectively going to the store and buying something that gave them a heart attack. We also would expect 10 strokes and 13 deaths that otherwise would not have happened. An expected 14 heart attacks, 10 strokes, and 13 deaths compared with preventing only 26 fractures. Of course, it’s no fun falling down and breaking your wrist, but most people would probably look at the risk-benefit analysis and conclude that calcium supplements are doing more harm than good.

Dietary calcium, on the other hand, has not been associated with an elevated risk of heart attacks. Given these findings, individuals should be discouraged from taking calcium supplements and advised to obtain calcium from their diet instead. How much dietary calcium should we shoot for then?

Interestingly, unlike most other nutrients, there’s not an international consensus on how much to take. For example, in the United Kingdom, the recommendation for adults is 700 mg per day. Across the pond in the United States, it’s up to 1,200 mg per day. Whenever I see that kind of huge discrepancy between government panels, I immediately think scientific uncertainty, political maneuverings, or both.

Newer data based on calcium balance studies where researchers made detailed measurements of the calcium going in and out of people suggest that the calcium requirements for men and women are lower than previously estimated. They found that calcium balance was highly resistant to change across a broad range of intakes, meaning our body is not stupid. If we eat less calcium, our body absorbs more and excretes less. And if we eat more calcium, we absorb less and excrete more to stay in balance.

Therefore, current evidence suggests that dietary calcium intake is not something most people need to worry about. This may explain why in most studies, no relationship has been found between calcium intake and bone loss anywhere in the skeleton because the body just seems to take care of it.

Don’t push it too far, though. Once you get down to just a few hundred mg per day, you may get significantly more bone loss. Though there may not be great evidence to support the U.S. recommendations, the United Kingdom may have the right idea shooting for 500 to 1,000 mg per day from dietary sources. This applies unless you’ve had gastric bypass surgery or have another reason for needing supplementation. For most people, though, calcium supplements cannot be considered comparatively safe or effective for preventing bone fractures. 


What’s this about calcium supplements and heart attacks and strokes? You can learn more about it in my Are Calcium Supplements Safe? video. And be sure to watch Should Pregnant Women Take Calcium Supplements to Lower Lead Levels? and Lead in Calcium Supplements

As mentioned above, for a more in-depth discussion on the milk-fracture relationship see my Is Milk Good for Our Bones? video.

All of this is not to say that these supplements cannot play any role in treating osteoporosis or that vitamin D supplements might not be good for other things. I do advise vitamin D supplementation for those not getting enough sun. (See my recommendations here.) For background on how I arrived at my recommended dose and more information on vitamin D, check out:

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Discuss

Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.


101 responses to “The Risks and Benefits of Calcium Supplements

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  1. There seem to be so few cases where people have managed to ‘outsmart’ or optimize ourselves more effectively than our bodies and millions of years of evolution have already managed to. It seems like the recipe really is as simple as unprocessed plant foods and regular/consistent movement.

    Can anyone think of any solidly evidence-based examples other than b12 and algae delivered omega 3s?

  2. Thank you for this post. Good info.

    Since this is a nutrition blog, would it make sense to provide the dietary homework for the topic at the end, e.g., “To get 500-1,000 mg of dietary calcium per day, eat x cups of collard greens and x cups of almonds”?

    1. Chessie

      I found out the hard way that Collard Greens have oxalic acid which does cause kidney stones. But Collard Greens are okay to eat as long as not too much.

      1. Sydney, I thought collards were okay on that score, but I see that you’re right. I’ve been using them for smoothies and avoiding spinach and beet greens and such due to the issue with oxalic acid. Apparently collards have lower levels of oxalates than other greens, but not none. Argh. I guess raw is not always best.

  3. Good point about not being in a calcium deficit. I think I’ve read that when that happens the body (trying to maintain stasis) steals from the stored calcium in the body (bones for instance.)

    A healthy body is constantly remodeling bone through osteoclast/osteoblast activity but when that destruction/construction of bone gets out of balance, skeleton weakens.

    1. Follow up to the above. I read long ago that astronauts in space would stand on a vibrating pad of some sort to create the effect of “pounding the pavement.”

      That caused me to purchase a foot vibrator that I’ve recently taken out of storage, to use while I’m sitting at my desk writing.

      I have no idea if it keeps my bones remodeling (and thus growing stronger as the micro fractures are healed) or not, but it does make my feet feel good. ‘-)

      1. Lonie, Vibration is one of the things the astronauts did use, and they did have studies, The studies revealed that astronauts who spent months in space stations lost 1
        to 2% of bone each month. Standing on a vibrating plate for 10 to 20 minutes per day helped them is what their studies said, but Toronto did a study with women who used a vibrating pad for a year and it didn’t help them.

        Vibrating pads are one of the things they tried for brain plasticity and some people get relief from them, but long use and long term use might have contraindications.

        What I noticed is that places like Harvard who studied vibrating insoles aren’t doing that research anymore. You can still buy the insoles on-line, but I have pondered a few of the studies and wonder about it.

        1. Some of the people on-line who I looked at their sites swear by it. There is a man who had a serious brain injury who has a web-site Adventures in Brain Injury and it is one of his “favorite” things.

          I chose the MicroPulse ICES instead, because he had before and after photos of animals whose bone grew back. That was another originally for NASA device.

          I also bought a cold laser, based on studies like this:
          https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5599844/ but cold laser is more “site specific” and I felt like I could “wear” the MicroPulse ICES device, but had to hold the cold laser for a long time, trying to hit every site, but chiropractors would do that for you.

          I also bought infrared bulbs and vie light, because they increase circulation and there is a link between circulation and bone health and there is a link between heart health and bone health:

          https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2781192/

          It makes it that going Vegan SUPERWFPB to unblock the arteries ASAP seems the way to go,

          1. There is a $25 intranasal light on Amazon for sinuses and you can get an infrared heat lamp bulb for $7 or the self-hackers get a Infrared LED security camera light and use that.

            Because it is related to circulation, I think cold laser would do excellent. I say that, because there is a Dr. Burke from Harvard (I think. It was a year or two ago, when I did the gadget studies) he showed before and after photos of Cold Laser and one of the photos was feet with gangrene, where the foot was black as black could be and after months of cold laser therapy, the skin color started coming back. He showed people who had previously had amputations and they were scheduled for more amputations of things like fingers, but after a few months, the fingers were healed instead of being amputated.

            That makes it excellent for circulation in my mind.

            Chiropractors and Laser Centers have them. I just don’t know how many hours you would have to spend there. That is why I bought my own, but I bought a flash light kind and I would rather have what Dr. Burke was using on the horses.

              1. But the NASA researcher who sells the MicroPulse ICES says that his device is more efficient than any electrical gadget, because it has to pass through the skin.

                What I liked about him is that he answers his emails and gives very long detail-oriented explanations of things.

                He has the absolute worst web-site for believing in his product, but I looked him up and he really was a fireman and really works where he says and the NASA studies really did happen. What I liked most about how his mind thinks is that he trying to figure out how to make medical devices as inexpensive and efficient as possible.

                I laugh though, because I watched his interviews and immediately liked him, and was seriously drawn to his product and to the price, but his page is more like: I am not recommending you using this product on human beings oriented.

                I can only tell you that it healed my ankle after something like 7 years of continuous pain and I like gadgets enough to want to try to pre-re-grow my knee cartilage before I lose it all the way. Not sure how that will work, but it is a two year concept and I have already had it heal so many things that I am not afraid of using it for two years.

                But if the researcher is not pushing it on people, I really can’t.

                I just like it.

                1. TG

                  I once had a friend who had a job making up titles to books,
                  and then someone else would write the book. I have no knowledge
                  of electric currents and bones, but “The Body Electric” sounds like such a book.

                  1. Yes, I think the famous science fiction writer Ray Bradbury wrote an anthology of stiries, which was also called the Body Electric.

                    I read Becker;s book years ago though – a fascinating read.

                2. Thanks Tom. I will look into it.

                  My ankle was in pain for something like 7 years and I used the Micropulse ICES on it one time. Just once on my ankle and it is like it is still healing. No pain at all. Much sounder. No limp anymore.

                  It didn’t work as quickly on my back, so I am guessing it must have been inflammation that went down.

                  I used it to stimulate my vagus nerve while watching videos here to try to change my emotional relationship with food, based on studies and it worked beyond my wildest dreams.

                  It is a research gadget and the inventor isn’t into money and I alreadu know that I am lucky he sold them at all.

                  I say it, because I could use TMS to accomplish some of what I used it for, but that would have cost ten thousand dollars and I couldn’t just ask a doctor to give me a prescription.

                  I am so grateful that vegan gets rid of pain and inflammation, too, so I can stay away from doctors as much as possible.

      2. I think that you have to stand on them to get a whole body effect. Otherwise, with just sitting and restng your feet on them, I suspect that your feet and lower legs only will benefit.

        Some people use the time on these vibration plates to do some other exercises (eg dumbells, stretching etc) to get the maximum benefit from the time spent.

        However, I gather that the evidence doesn’t support claims that these machines are effective in stopping bone loss. According to Harvard

        “Results of a clinical trial published in the Annals of Internal Medicine showed that older women who stood on a vibrating platform for 20 minutes a day experienced just as much bone loss over the course of the year-long trial as women who didn’t use the platform.

        The results are a disappointment for older women and men looking to strengthen their bones without exercising, not to mention to the companies that have sprung up to sell whole-body vibration platforms as an easy way to halt osteoporosis, the age-related loss of bone.”
        https://www.health.harvard.edu/blog/whole-body-vibration-doesnt-slow-bone-loss-201111173820

        1. Yeah Tom, I’m actually doing it now more for the muscle tone in my lower legs as I don’t do as much outside now as I normally do.

          Not too worried about my bone density as I eat dried plums (prunes) on a daily basis.

          I’ve read research that suggested that eating 6 prunes a day maintains bone health. Reasonably sure it wasn’t the Plum people funding it, but even if it were, eating plums whether fresh or dried is not a bad thing.

          My favorite way of eating them is with a mouth full of unadulterated peanut butter.

  4. The studies quoted apparently did not look at Magnesium. Manganese, K1 and K2. I believe it is silly and irresponsible to do studies on Calcium and bones with out looking also at Mg, Mn, K1 and K2.

    Having survived six weeks in a nursing home, I can attest to the deficient diets people are fed. The 1st few days there I was COLD. I realized I was not getting enough iodine so I had my friend smuggle in extra eggs which did warm me up. (but what about everybody else?) I convinced staff I needed extra K and they did cook me spinach and Broccoli with did help, but again what about everybody else? Only when I left the nursing home did I put on muscle mass and regain weight.

    The point is: How can studies in a nursing home be valid with such poor diets.

    BTW: I haven’t eaten dairy since 1980.

      1. Hi I’m an RN health support volunteer with Dr. Greger. Thanks for your great question. Calcium is found in all sorts of healthy plant based foods, especially dark leafy greans. You really don’t need to add any fortified foods to get adequate calcium intake if you are eating everything on Dr. Greger’s daily dozen:
        https://nutritionfacts.org/video/dr-gregers-daily-dozen-checklist-2/

        There is more information in this link-
        https://nutritionfacts.org/topics/calcium/

        All the best.
        NurseKelly

    1. Leafy greens are a very good source as are beans IIRC. Almost all whole plant foods have it. Go to cronometer.com and log your diet to see your nutrition. Except for B12 and D, it would be almost impossible to eat a WFPB diet and be deficient in anything.

    1. Hi P H! I think this article will help to answer your questions. Dark green leafy vegetables are a good source of calcium, and if you meet the Daily Dozen recommendations of 2 servings of greens, 1 serving of cruciferous vegetables, and 2 servings of other vegetables, you should easily meet the recommended 600mg/day!

      1. It may look good on cronometer, but bioavailability is key. You’d have to eat 25 pounds of spinach to get enough calcium because the bioavailability rate is only at around 5%.

        A lot of people make light of this subject and make it sound easy to get enough calcium, getting even 600 mg a day is quite a task (if you don’t drink or eat fortified food).

        I inserted into cronometer a Gregers Daily Dozen and ended up with 902 mg/calcium, but after taking into consideration bioavailability it is likely around 300-400. And that included Chia and Sesame seeds, which are very high in calcium.

        Black/Red/White Beans, Chia/Sesame, Bok Choy/Kale/Chinese Cabbage. These are some of the best sources. But you will have to eat a lot of it. To put it into perspective, if you were to get it from Bok Choy, which is the best source when taking into account bioavailability (53.8% absorption) and calories. You’d have to eat 7 cups of it to reach 600 mg/day.

        So please research it on your own to learn more as this is more complicated than it may seem.

  5. Great article very helpful. I’ve recently been diagnosed with osteoporosis followed suit with the prescription of Teva Alendronate 70g weekly combined with recommendation of Calcium and Vit D. I live in a location which sun is limited for pretty much 7-8 months of the year, so taking Vit D is required however my intake of Calcium from food non dairy nut milks in addition to nuts and veggies etc should cover my Calcium intake after reading through your blog.
    However, I do have some reservations about taking Alendronate; would you have any feedback in regards to prescribed medications for osteoporosis?

    1. wendy, there is a discussion of the benefits and side-effects of Fosmax, (alendronate), on the Harvard Health site.
      Can find by putting “What’s the Story with Fosamx” in your search engine.
      Read the whole article for the pros and cons.
      Ignore the advice to take all that calcium, wouldn’t be absorbed anyway, and you need more than 800iu vit D.

        1. Thank-you very much TG, I will take a read. This is fantastic, all you folks taking the time to provide resources. Very much appreciated.

      1. Thank-you so much for info Marilyn. I’ll take a look. I’m taking 2000iu Vit D3 daily as was prescribed. Hopefully it isn’t too much vit D. I really do need to find out more about the Vit D3 vegan, didn’t know it was available.

    2. Hi I’m a RN health support volunteer with NutritionFacts. Sorry to hear about your osteoporosis. Dr. Greger has several videos /posts about this you might like:
      https://nutritionfacts.org/topics/osteoporosis/
      https://nutritionfacts.org/video/prunes-for-osteoporosis/
      https://nutritionfacts.org/video/almonds-for-osteoporosis/

      He hasn’t done much on osteoporosis medications. This is something Dr. McDougall (another fighter in the plant based nutrition battle and mentor of Dr. Greger’s) has spoken a lot on. I would look into some of his information:
      https://www.youtube.com/results?search_query=dr+mcdougall+osteoporosis+
      https://www.drmcdougall.com/health/education/health-science/hot-topics/medical-topics/osteoporosis/

      Hope that helps.
      NurseKelly

    1. Hi Robert. Thanks for your comment!

      As Dr. Greger said, “calcium supplementation is neither natural nor risk-free”, I think those disadvantages mention above also applied for children. However, I could found an interesting methanalysis addressing this issue:

      Calcium supplementation for improving bone mineral density in children.

      AUTHORS’ CONCLUSIONS: (…) The results do not support the use of calcium supplementation in healthy children as a public health intervention. These results cannot be extrapolated to children with medical conditions affecting bone metabolism.

      Here’s another one very useful: Optimizing bone health in children and adolescents.

      You can also watch Dr. Greger video and more info about suplements here: https://nutritionfacts.org/video/are-calcium-supplements-safe/

  6. Susan, the algae-cal has too much lead for me, check it out first.

    I had a parathyroid tumor that was removed in 2016 that had been disrupting my calcium metabolism for about 10 years. It caused osteoporosis in my arms and was heading that way for my hips. Fortunately for me, I started with strong bones, so the damage was not what it could be. Hyperparathyroidism pulls calcium out of your bones to keep levels too high in your blood. It’s bad news for both your bones and your cardiovascular health. Pay attention to your calcium level in annual blood tests – high calcium is not a good thing, and this is not a rare condition.

    This has left me with instructions from the endocrinologists to take a calcium supplement to get my bones back to normal. I use cronometer and take only enough to bump me up to 1000mg/day, plus K2 (both mk-4 and mk7 forms) and vitamin D3. My hope is that I am directing a reasonable dose of calcium to my rebuilding bones and keeping it away from my cardiovascular system.

    It’s important to note that K2 is not the same as the vitamin K in greens, and that we are extremely poor converters of K to K2 as we age. I would like to hear Dr. Greger discuss K2 and calcium metabolism in the future. I have tentatively concluded that K2, like B12, is a vitamin that vegans should supplement.

  7. Another thing to throw in there: vegans and others often prefer the K2 mk-7 form because it persists in the body longer and can be sourced from natto (fermented soy beans). However, the mk-7 form of K2 is rare in the natural diet, and can cause heart palpitations in some people who are genetically programmed to clear it from their body more slowly. The mk-4 form of K2 was a natural part of our diet when people ate small quantities of wild, grass-fed meat or grass-fed dairy. Modern meat and dairy is not a good source. We are probably all deficient. K2 mk-4 is the form that our body synthesizes from K1 in greens (if only it could do enough of that long enough). K2 mk-4 is the form that the research in Japan has shown to reverse osteoporosis.

    So I am updating my statement: I have tentatively concluded that K2 mk-4 is a vitamin like B-12 that vegans should supplement. And I would really like to hear Dr. Greger talk about all of this.

    1. Annie

      Do I understand you correctly?:

      However we get K2 mk-4, it will reverse osteoporosis.

      K2 mk-4 is made in our bodies from K1 if there is enough K1 available.

      K2 mk-4 is also available from 100% grass fed beef and lamb

      QUESTION: Is the 100% grass fed beef and lamb that is currently available close enough to wild pre-agricultural revolution beef and lamb to give us similar amounts of K2 mk-4?

      QUESTION: Is K2 mk-4 also available from egg yolks?

      Can you supply a link for the Japanese research you mentioned?

      Anecdotally speaking: My osteoporosis has improved to osteopenia by eating foods rich in both K1 and K2 and taking supplements of Calcium Carbonate, Magnesium Gluconate, Manganese Gluconate and D.

  8. I take a mere 200 to 400 mg a day of cal citrate always with mag citrate, both in powdered form. I drink some plant milks as well. I take K2 a few times a week. I don’t want to stop supplementing. I have Celiac Disease and struggle with safe eating factors and malabsorption problems. And yes, I have mild osteoporosis.

    1. Bebe:

      An endocrinologist told me to not take Calcium and Magnesiun at the same time
      as they interfere with each other’s absorption.

      1. Yes, they compete for uptake by the body. I recall reading somewhere that high magnesium consumption can lead to calcium deficiency.

        It is probably worth consulting a pharmacist on dosing and timing if Bebe wishes to continue with these supplements.

  9. Look to Japan, where they use 45mg vitamin K2, MK-4 form, to treat osteoporosis regularly. K2 is chronically deficient in the USA, and many in the nutrition-health field are pointing out the way it works, but few in the medical literature are paying any attention. It seems to take 50 or more years for anyone to read anything outside a narrow band of research, even if the results are so good they are standard practice elsewhere. I get the orthodoxy view but when a country is practicing medicine mainline using something, it would make sense to at least investigate it.

    1. It is my understanding that the Japanese derive K2 as MK-4 directly from natto consumption.  It is found in grass-fed meats and dairy and does not remain in the body for very long.  It therefore requires copious amounts of the supplement throughout the day  which can be very expensive.  The supplement is also not as bioavailable as the MK-7 version.

      1. MK7, not MK4, is found in natto. Why the japanese doctors are using MK4 is not clear to me, but that’s what they use. It is produced synthetically. MK7 has longer half life, quite a bit, so has a big effect at a miniscule dose compared with MK4, and many are using MK7. When tested, a dose of 360mcg (not mg) of MK7 fully carboxylated (activated) MGP, and was used in a test to see if this dose of mk7 could reverse coronary calcium buildup. The results are not yet out. The debate about MK7 vs MK4 goes on and on, but it may not matter which form. Those selling each claim theirs is best, of course.

  10. I am strict vegan who is very close if not at osteoporosis. Should I supplement with k2. Is it available without calcium? I am very confused and concerned. Please help!!

    1. U Bridges:

      If I understand correctly a post by Anne, your body will make all the K2 mk-4 you need IF you have plenty of K1 from ORGANIC: Parsley flakes, kale, broccoli, etc.

    2. Some of these articles may help

      http://www.theveganrd.com/vegan-nutrition-101/vegan-nutrition-primers/protecting-bone-health-on-a-vegan-diet/

      http://www.todaysdietitian.com/newarchives/0216p24.shtml

      Note that none of them mention vitamin K. The evidence for K2 supplemetation on bone (and cardiovascular) health appears mixed, All the studies showing K2 benefits on bone health appear to come from one country only (Japan) so the jury is still out on this one I think.

      In the interest of full disclosure, though, I should say that I personally take a D3/K2 supplement. Dr Greger recommends vitamin d supplements and I figure, correctly or incorrectly, that adding K2 may help. I get 120 vegetarian capsules for less than US $8 so it’s financially easy decision.

    3. U – There are so many factors with osteoporosis. There should be a check list way beyond Calcium. I honestly got overwhelmed two nights ago, by how much information there is.

      Beyond Animal Products:

      Osteoporosis is linked to:
      Cancers and Cancer treatments, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3783531/
      Heart Problems https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2781192/
      High Blood Pressure https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3258724/
      Diabetes, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4094869/
      Thyroid problems, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4314789/
      Heavy Metal Toxicity https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5153379/
      Cell Phone and WIFI exposure https://saveourbones.com/3-secrets-improve-bone-density/
      Air Pollution Exposure http://www.techtimes.com/articles/215588/20171113/air-pollution-linked-to-increased-risk-for-osteoporosis-and-bone-fractures-study.htm
      Crohn’s and Celiac https://www.bones.nih.gov/health-info/bone/osteoporosis/conditions-behaviors/celiac
      Mitochondrial Problems (Low Co-Enzyme Q10) https://www.sciencedirect.com/science/article/pii/S0005272815001085
      Sedentary lifestyle
      Lack of deep enough sleep in a dark enough room / Lack of Melatonin https://www.ncbi.nlm.nih.gov/pubmed/27823720
      https://clinicaltrials.gov/ct2/show/NCT01152580
      Low levels Glutathione https://glutathioneforhealth.wordpress.com/2011/12/24/low-glutathione-levels/
      High levels of Cortisol from stress https://www.ncbi.nlm.nih.gov/pubmed/18710063
      Lack of sun exposure / Vitamin D3 deficiency https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4520343/
      Inflammation https://www.ncbi.nlm.nih.gov/pubmed/18240539
      Alcohol https://www.webmd.com/osteoporosis/features/alcohol#1
      Sugar and fat and white flour intake https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5452236/
      Smoking https://www.bones.nih.gov/health-info/bone/osteoporosis/conditions-behaviors/bone-smoking

      I ran out of time doing this part, I will try to do more later, but I wanted to make the point that your bones are about way more than Calcium.

        1. My second list had everything from
          Sodium Intake,
          to Drinking demineralized waters
          to RoundUp,
          to Gut Microbiome,
          to Saturated Fats
          to high cholesterol
          to high blood pressure
          to Lactose Intolerance
          to anorexia
          to kidney problems
          to soda for some abstract reasons
          to asthma (corticosteroid use)
          to other drugs like SSRI/s
          to living in a high altitude
          to fluoride in water
          to eating the wrong proteins and wrong amount of proteins
          to acrylamide from burning food
          to having low levels of choline (get your choline from plant sources, don’t fuel Cancer)
          to low carnitine

          I hate that I lost my whole list with all of the links, but I just wanted people to know if they have osteoporosis, they have to look for the cause and not just supplement.

          That being said, there are some excellent ways to help, things like broccoli sprouts and amla and turmeric etc.

          https://saveourbones.com/ has a nutrition section to look at.

          1. Genuinely, the list of things, which cause it and which help it BOTH are so much longer than what I am able to reproduce again.

            Look at https://saveourbones.com/ for a lot of information. There is even more out there than this, but it is almost two in the morning and I am going to try to get some sleep. Doesn’t usually happen, but losing my whole list makes me want to.

    4. Hi I’m a RN health support volunteer with NutritionFacts. Sorry to hear about your situation. You can get Vitamin K supplements without calcium if you are so inclined, but from what I have seen, the evidence of Vitamin K for osteoporosis in is not real strong-
      https://www.ncbi.nlm.nih.gov/pubmed/15320745
      https://www.ncbi.nlm.nih.gov/pubmed/24090644

      A great source of both vitamin K and calcium is your leafy green vegetables.

      Here is some more information that Dr. Greger has which may help guide the difficult decision you are facing:
      https://nutritionfacts.org/video/are-calcium-supplements-effective/
      https://nutritionfacts.org/video/prunes-for-osteoporosis/
      https://nutritionfacts.org/video/almonds-for-osteoporosis/
      https://nutritionfacts.org/video/is-milk-good-for-our-bones/

      Dr. McDougall, another fighter in the plant based nutrition battle and mentor of Dr. Greger’s, has spoken a lot about osteoporosis. You might like to check out some of that information:
      https://www.drmcdougall.com/health/education/health-science/hot-topics/medical-topics/osteoporosis/
      https://www.youtube.com/results?search_query=dr+mcdougall+osteoporosis+

      All the best to you.
      NurseKelly

  11. There’s solid evidence-based example of algae delivered omega 3’s doing good? Would really like to read that study.
    Thanks, Mark

    1. A Harvard team conducted a systematic review and meta analyisis of trials and studies of algal oil, that was published back in 2011 in The Journal of Nutrition. The link won’t post here but you can Google the title:

      A Meta-Analysis Shows That Docosahexaenoic Acid from Algal Oil Reduces Serum Triglycerides and Increases HDL-Cholesterol and LDL-Cholesterol in Persons without Coronary Heart Disease

  12. “All of this is not to say that these supplements cannot play any role in treating osteoporosis”. Could you elaborate on that for those of us who are concerned with all the facts?

    1. Hi I’m a RN health support volunteer with NutritionFacts. Thanks for your questions. Here are several videos Dr. Greger did specifically on calcium supplements. If you click on “sources cited” at the bottom, you can find all the references where the information came from.
      https://nutritionfacts.org/video/are-calcium-supplements-effective/
      https://nutritionfacts.org/video/are-calcium-supplements-safe/

      NurseKelly

  13. When I worked for a vitamin supplier I read research on the various forms of calcium supplements and their uptake into the body. Calcium carbonate – chalk – was at the bottom of the list although it was the one most recommended by doctors. I never found any noticeable improvement in takers of Caltrate. I was well aware of the negative side effects of taking Caltrate and such products and advised against them in the years of Osteoporosis fever and bone density measuring fads in pharmacies etcetera. I did however find much evidence of bone density improvement in taking the herb Horsetail Grass – Equisetum. Its high silica content appeared to assist the thyroid and para thyroid glands to regulate calcium more efficiently in the body and stimulate bone repair.

  14. I’d like to hear what level of calcium supplementation was associated with the various outcomes in this article. I’m a vegan with osteopenia and I choose to supplement just 100-200 mg calcium (plus other minerals, K2, D3) daily as a little ‘insurance’. Have low levels of calcium supplementation or mixed supplementation been studied?

    1. Hi VegeMarian,

      I am a volunteer for Dr. Greger. Thank you so much for your question.

      The calcium supplements in the studies listed are often between 500-1000 mg. So taking 100-200 mg calcium will likely not increase your risk of cardiovascular disease very much. However, assuming you are getting a sufficient dietary intake of calcium (regular consumption of green leafy vegetables should do the trick), as well as getting adequate vitamin D, you shouldn’t need to worry about any “insurance” intakes of calcium. I don’t believe we have data on very low-level calcium supplements and cardiovascular risk. In a meta-analysis looking at all the studies in subjects taking less than 500 mg of calcium supplementation, the study found that they may be 18% more likely to suffer from a cardiovascular event, but the sample size was so small, that this was NOT statistically significant.

      Overall, you shouldn’t need to take a calcium supplement given that your diet is adequate. However, taking such a small amount of calcium in the form of supplement will either have no effect or such a small effect that it would be nearly impossible to determine the risk.

      I hope this helps!

  15. https://www.ncbi.nlm.nih.gov/pubmed/25063690

    This pubmed abstract says that boron is essential in bone health. I noticed that there are a number of doctors on the internet who say that boron should be included with the K-2, and vitamin D3 for improved bone health. They say that boron acts in a similar way to K-2 in that it helps to make sure that calcium is not collected in soft tissues such as the arteries. I am sure that the gate keeper of this forum will disagree with this.

  16. https://youtu.be/Z8EMfIe5pfU

    This is an interesting 3 minute video on YouTube that shows the recovery of a young man who was paralyzed from the chest down from an accident. Because you can only have clinical trials in the U.S. with stem cells, he was forced to travel to India. In India he made dramatic improvement with stem cell therapy. However, I am sure that there are some people on this forum who will disagree with this young man’s recovery because he went to India. God forbid….he went to a foreign country like India or maybe even Panama. https://youtu.be/Z8EMfIe5pfU

  17. https://youtu.be/NM_YOiJ0Mks
    Dr. Sarrah Stancic is a new and upcoming medical doctor who is shouting the whole plant food diet from the roof tops. She overcame M.S. by eating a whole plant food diet. Check out her testimony. Ooops….I forgot there are people on this forum who say that she is just anecdotal evidence and we should not pay any attention to her. What they want is a million dollar triple blind study before they are going to believe this woman was really cured of M.S.

    https://youtu.be/NM_YOiJ0Mks

    1. Sorry Bill but you should try doing some research before making such absolute statements about other other people’s views. On the other hand, yes, persnaol statements and testimonies are meaningless – not least because you can often contradictory testimonials from other people.

      If you had done some reserach on ms and diet though, you might for example have read this on the PCRM website

      http://www.pcrm.org/health/health-topics/treating-multiple-sclerosis-with-diet-fact-or

    2. From an article by Dr. McDougall, there have been doctors treating MS and low fat vegan diets since the 1950’s.

      Roy Swank, M.D., former head of University of Oregon’s neurology department and now a practicing physician at Oregon Health Sciences University, observed that MS patients improved on this forced low-fat diet. In the 1950s, Swank began treating his own patients with such a diet. He got excellent results, so for the next 35 years he treated thousands of MS patients in this way. By any medical standard, his results have been remarkable: patients’ conditions improved by as much as 95 percent.6 Patients fared better if they had detected the disease early and had had few attacks, but even long-time MS sufferers experienced a slowdown of the disease’s progression. Originally Swank was most concerned with limiting saturated fat, but over the years he has become more attuned to the dangers of all kinds of fat. His MS diet is now about 20 percent fat by calories.

  18. So, Tom Goff, maybe we should discount any personal testimonies that you have to offer. Dr. Sarrah Stancic, is a medical doctor. She is a vegan. She claims that a whole food plant diet cured her of M.S. and you say that her testimony does not count. You are more narrow minded than can be imagined. I don’t think you even listened to her testimony.
    https://youtu.be/NM_YOiJ0Mks

    Just to bring you up to logical thinking, testimonies and anecdotal experiences are the first step in doing scientific research. If you only believe what is written down on a piece of paper that has the label science stamped over it, then you need to do more research. Most scientific papers have some kind of bias to them. Research is driven by money, or haven’t you noticed that. Now, if you were open minded you would listen to this vegan doctor’s testimony. If you were living at the time of Galileo you would be the first one to accuse him of being wrong….or Copernicus.

    1. Bill, I watched the video and paid attention. That’s how I know that here first name is “Saray” – you on the other hand keep referring to her as “Sarrah”. Did you really watch that video?

      What do you do when you have various people offering personal testimonials and anecdotal reports that are all different and even contradictory?

      In any case, it was Dr Mirkin who noted that celebrity endorsements, testimonies etc are meaningless. I agree with him. What about all those cigarette adverts from years ago with doctors endorsing cigarettes and offering personal testimonies of benefits?

      And if you think testimonials are so wonderful, perhaps you ought to be drinking your own urine
      https://www.youtube.com/watch?v=V8Tv5LDEqvY

  19. Tom Goff — lots of people are giving anecdotal experiences with vibrating plates, taking supplements, doing different exercises and you never chastise them for giving anecdotal evidence. All of Dr. Greger’s videos have readers and viewers giving different anecdotal stories of how different things have helped them. But, NO….a vegan doctor gives her anectodal story on how a whole plant food diet has cured her of MS and you put on your white jacket and say NO no no we can’t have her testimoney because we can only accept science. Who’s science are you talking about, FDA science, Big Pharma Science, Big Agriculture science, Aryan race nazi science, global warming science, Chinese herbal science, Indian Aryvedic science. You rant and rave about people believing in God and ask which God should I believe, the pagan god? The hindu god? the Apache God? Maybe you should have a near death experience and see if their is an after life, but then, it would only be your testimony wouldn’t it?

    1. Hi Bill

      Don’t be shy and don’t beat about the bush. Tell us what yiu really think and don’t hold back. Please.

      Venting is reputed to be very good for you. I hope that you feel better now.

  20. Read your article with interest – thank you for all you do. I take 4 capsules of a natures garden bone supplement that contains calcium from certified organic algaeCal.
    Also contains lots of various mushroom, vit d , k and c, magnesium and alma berry but its the calcium that I’m concerned about as I have osteoporosis. Eat almonds but also have hashi so mindful of the goitregenic nature of those.
    Again thank you – from grateful reader in UK.

  21. Has Dr. Greger ever discussed how to take vitamins and supplements? I am thoroughly confused about which ones to take when and which ones need to be taken separately from others. It would be such a valuable tool to have such an index. Does anyone know of a truly reliable source that addresses this issue? Since I take a good many vitamins and supplements I worry that I may not be taking them properly for greatest efficacy.

      1. Steven, Thank you for your input.  I think I may have worded my request poorly.  I am aware of Dr. Greger’s recommendations (although on  the site you suggested he doesn’t mention vitamin K2).  I am fairly confident in the choices of vitamins and supplements that I have made.  What I need to know is when it is best to take some of these and which should be taken together or separately for greater efficacy.  The reason for my confusion, for instance, is that some sources indicate that D3 and K2 should be taken together while other sources say to separate them because when taken together one will diminish the effects of the other.  Confusion reigns.

      2. Steven, As an afterthought, what I am hoping for is some sort of a chart similar to those that show how much fiber in different foods for instance.  This one, however, would list the vitamins, herbs, supplements that are most commonplace and then indicate how much to take, when to take them, etc.  It would also indicate which vitamins/supplements must be separated by time so that one doesn;t diminish the effect of the other.Pipedream?

  22. My doctor recommended calcium supplements because of my slight post-menopausal bone density decrease. I knew from my holistic background that this was problematic, but when I wanted to discuss, he was adamant that more calcium meant stronger bones. While I enjoyed your article and references to studies, I believe doctor would take it to hear without study citations.

  23. What if you take calcium with magnesium? You should never take single minerals unless you have a specific deficiency because they work in proportions. They compete with one another for absorption. Too much of one interferes with the absorption of others.

    1. This is exactly why I need a reliable and  authoritative source regarding vitamin and mineral supplements.  Is anyone on the forum able to recommend?  How I wish Dr. Greger would be interested in writing on this subject.

  24. Does anyone know if red marine algae calcium supplements carry the same risk? I am hoping Dr. Greger will address this in the future.

  25. I like that natural sources of vitamins are advocated but why not just add where the plant based sources of vitamins found.

  26. Not sure if this correction has already been made or not. But this statement is NOT true: “For postmenopausal women living independently in the community, the latest official recommendation for calcium and vitamin D supplementation to prevent osteoporosis is unambiguous: We should not supplement.”

    The current official recommendation (USPSTF) is for all community-dwelling adults at increased risk for falls SHOULD BE taking a Vit D supplement, which has been shown to reduce falls: https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/vitamin-d-and-calcium-to-prevent-fractures-preventive-medication

    In addition, the current guideline is in the process of being updated: https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/vitamin-d-calcium-or-combined-supplementation-for-the-primary-prevention-of-fractures-in-adults-preventive-medication

    One can quibble about whether the Vit D supplement is to prevent osteoporosis (not evidence-based) or prevent falls (evidence-based), but I believe the statement by Dr. Greger is misleading as it suggests older folks shouldn’t be taking Vit D. This research is not (yet) “unambiguous”.

    1. So – watching the video referenced suggests you agree. Will you update/correct the “Risks and Benefits of Calcium Supplements” video?

  27. Just curious what your takes are on this? It does not seem feasible to reach 600 or 1000 mg/day without supplementation due to the low absorption rate, unless there is some way to tweak it that I’m unaware of. I just find it odd that everyone says we don’t need to supplement when in theory it will be extremely very difficult to get enough.

    For example, broccoli is considered a good source of calcium with great absorption rate 61.3%, and you’d have to eat 16 cups (2.5 kg) to reach 600 mg/day.

    It just doesn’t seem to make sense.

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