Are Calcium Supplements Safe?

Are Calcium Supplements Safe?
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The unnaturally large, rapid, and sustained calcium levels in the blood caused by calcium supplements may explain why calcium from supplements, but not from food, appears to increase the risk of heart attacks.

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In 12 short years, government panels have gone from suggesting widespread calcium supplementation may be necessary to protect our bones to “Do Not Supplement”. What happened? It all started with a 2008 study in New Zealand. Short-term studies had showed that calcium supplementation may drop blood pressures by about a point. Though the effect appears to be transient, disappearing after a few months, it’s better than nothing. And excess calcium in the gut can cause fat malabsorption, by forming soap fat, reducing saturated fat absorption and increasing fecal saturated fat content. And, indeed, if you take a couple Tums along with your half bucket of KFC, up to twice as much fat would end up in your stool, and with less saturated fat absorbed in your system, your cholesterol might drop. So, the New Zealand researchers were expecting to lower heart attack rates by giving women calcium supplements. To their surprise, there appeared to be more heart attacks in the calcium supplement group.

Was this just a fluke? All eyes turned to the Women’s Health Initiative, the largest and longest randomized controlled trial of calcium supplementation. The name may sound familiar—that’s the study that uncovered how dangerous hormone replacement therapy was. Would it do the same for calcium supplements? The Women’s Health Initiative reported no adverse effects. However, the majority of the participants were already taking calcium supplements before the study started; so, effectively the study was just comparing higher versus lower dose calcium supplementation, not supplementation or no supplementation. But what if you go back and just see what happened to the women who started out not taking supplements and then were randomized to the supplement group? Those who started calcium supplements suffered significantly more heart attacks or strokes. Thus, high dose or low dose, any calcium supplementation seemed to increase cardiovascular disease risk.

Researchers went back, digging through other trial data for heart attack and stroke rates in women randomized to calcium supplements with or without vitamin D added, and confirmed the danger and most of the population studies agreed—users of calcium supplements tended to have increased rates of heart disease, stroke, and death.

The supplement industry was not happy, accusing researchers of relying in part on self-reported data—like they just ask if people had a heart attack or not rather than verifying it. And indeed long-term calcium supplementation caused all sorts of gastrointestinal distress including twice the risk of being hospitalized with acute symptoms that may have been confused with a heart attack. But no, the increased risk was seen consistently across the trials whether the heart attacks were verified or not.

OK, but why do calcium supplements increase heart attack risk, but not calcium you get in your diet? Perhaps because when you take calcium pills, you get a spike of calcium in your bloodstream that you don’t get just eating calcium rich foods. Within hours of taking supplemental calcium, the calcium levels in the blood shoot up and can stay up as long as eight hours. This evidently produces what’s called a hypercoagulable state, your blood clots more easily, which could increase the risk of clots in the heart or brain. And, indeed, higher calcium blood levels are tied to higher heart attack and stroke rates. So, the mechanism may be calcium supplements lead to unnaturally large, rapid, and sustained calcium levels in the blood, which can have a variety of potentially problematic effects.

Calcium supplements have been widely embraced on the grounds that they are a natural and, therefore, safe way of preventing osteoporotic fractures. But, it is now becoming clear that taking calcium in one or two daily doses is not natural, in that it does not reproduce the same metabolic effects as calcium in food. And furthermore, the evidence is also becoming steadily stronger that calcium supplementation may not be safe. That’s why most organizations providing advice regarding bone health now recommend that individuals should obtain their calcium requirement from diet in preference to supplements. But if we can’t reach it through diet alone, would the benefits to the bones outweigh the risks to the heart? We’ll find out, next.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

In 12 short years, government panels have gone from suggesting widespread calcium supplementation may be necessary to protect our bones to “Do Not Supplement”. What happened? It all started with a 2008 study in New Zealand. Short-term studies had showed that calcium supplementation may drop blood pressures by about a point. Though the effect appears to be transient, disappearing after a few months, it’s better than nothing. And excess calcium in the gut can cause fat malabsorption, by forming soap fat, reducing saturated fat absorption and increasing fecal saturated fat content. And, indeed, if you take a couple Tums along with your half bucket of KFC, up to twice as much fat would end up in your stool, and with less saturated fat absorbed in your system, your cholesterol might drop. So, the New Zealand researchers were expecting to lower heart attack rates by giving women calcium supplements. To their surprise, there appeared to be more heart attacks in the calcium supplement group.

Was this just a fluke? All eyes turned to the Women’s Health Initiative, the largest and longest randomized controlled trial of calcium supplementation. The name may sound familiar—that’s the study that uncovered how dangerous hormone replacement therapy was. Would it do the same for calcium supplements? The Women’s Health Initiative reported no adverse effects. However, the majority of the participants were already taking calcium supplements before the study started; so, effectively the study was just comparing higher versus lower dose calcium supplementation, not supplementation or no supplementation. But what if you go back and just see what happened to the women who started out not taking supplements and then were randomized to the supplement group? Those who started calcium supplements suffered significantly more heart attacks or strokes. Thus, high dose or low dose, any calcium supplementation seemed to increase cardiovascular disease risk.

Researchers went back, digging through other trial data for heart attack and stroke rates in women randomized to calcium supplements with or without vitamin D added, and confirmed the danger and most of the population studies agreed—users of calcium supplements tended to have increased rates of heart disease, stroke, and death.

The supplement industry was not happy, accusing researchers of relying in part on self-reported data—like they just ask if people had a heart attack or not rather than verifying it. And indeed long-term calcium supplementation caused all sorts of gastrointestinal distress including twice the risk of being hospitalized with acute symptoms that may have been confused with a heart attack. But no, the increased risk was seen consistently across the trials whether the heart attacks were verified or not.

OK, but why do calcium supplements increase heart attack risk, but not calcium you get in your diet? Perhaps because when you take calcium pills, you get a spike of calcium in your bloodstream that you don’t get just eating calcium rich foods. Within hours of taking supplemental calcium, the calcium levels in the blood shoot up and can stay up as long as eight hours. This evidently produces what’s called a hypercoagulable state, your blood clots more easily, which could increase the risk of clots in the heart or brain. And, indeed, higher calcium blood levels are tied to higher heart attack and stroke rates. So, the mechanism may be calcium supplements lead to unnaturally large, rapid, and sustained calcium levels in the blood, which can have a variety of potentially problematic effects.

Calcium supplements have been widely embraced on the grounds that they are a natural and, therefore, safe way of preventing osteoporotic fractures. But, it is now becoming clear that taking calcium in one or two daily doses is not natural, in that it does not reproduce the same metabolic effects as calcium in food. And furthermore, the evidence is also becoming steadily stronger that calcium supplementation may not be safe. That’s why most organizations providing advice regarding bone health now recommend that individuals should obtain their calcium requirement from diet in preference to supplements. But if we can’t reach it through diet alone, would the benefits to the bones outweigh the risks to the heart? We’ll find out, next.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Doctor's Note

We actually evolved getting lots of calcium—from eating lots of green leafy weeds, not popping Tums. See Paleolithic Lessons for more on this. How else can we combat osteoporosis? See my videos Prunes for Osteoporosis and Almonds for Osteoporosis.

I’ve discussed whether calcium supplements are safe, but Are Calcium Supplements Effective?

I’ve touched on calcium and bone health before:

This is a story consistent with disappointments surrounding many other supplements:

If you’re waiting on the edge of your seat for the next video (Are Calcium Supplements Effective?), maybe you shouldn’t be sitting so much! See Standing Up for Your Health

If you haven’t yet, you can subscribe to my videos for free by clicking here.

133 responses to “Are Calcium Supplements Safe?

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      1. A related question is whether getting calcium carbonate in soy milk is the same as getting calcium carbonate in a supplement. Soy milk doesn’t have much calcium naturally, so it is an additive, making soy milk calcium basically the equivalent of taking a supplement and then drinking a bunch of water. If so, then perhaps we’re safer to spread out the soy milk during the course of the day, which of course is like cutting up the supplement and taking it over the course of the day, as well.




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          1. The calcium itself is likely the same. But based on the label, one cup of fortified soy milk provides 299mg of calcium. Calcium supplements on the other hand tend to provide dosages in the range of 1000-1200mg. If calcium supplements are shown to be unsafe yet calcium fortified products are healthful, then this may imply that it’s a matter of dosage. If a smaller dose calcium supplement was sought (of about 300mg) and consumed with meals, perhaps then there wouldn’t be any adverse health effects.




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            1. Yes, that makes sense. Plus, some soy milks such as Original Silk brand has 45% of the RDA in one cup. That’s 450 grams.
              https://silk.com/products/original-soymilk. So, having a delicious two cup smoothie may be just as detrimental as that 1000 mg supplement! A 2.5-3 cup smoothie will be even worse. Dr. Greger may not be aware of how much calcium is being added to these drinks… manufacturers are obviously using this so they can claim to have “50% more calcium than milk!”




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              1. Another factor to take into account is the time it takes to consume the calcium. You probably don’t consume a 2 cup smoothie in one large gulp, so the calcium spike may not be as intense. The calcium is spread out throughout water content (further slowing down digestion), versus a chunk of calcium substance in a pill. I don’t think Dr. Greger would recommend two servings of soy milk daily anyway. Two servings of Silk Original Soymilk would contribute to an additional 220 calories. Seeing as just one glass provides 450 milligrams of calcium, that should be more than enough. There should be enough calcium coming from the remainder of the diet to meet nutritional requirements. We don’t need to obtain calcium just from a single source. Calcium fortification should act more as a boost than directly providing 100% of your calcium needs.




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                1. In a video on IGF-1, Greger said that between 3-5 servings a day of soy are safe. He considers 8 ounce of soy milk to be “a serving” (Joe Gonzales clarified this for me in a comment last month). But I’m guessing he would change his view if he knew how much calcium was being added to soy milks today. I agree with you about a chunk of calcium in a supplement being harmful if it has no fluid attached to it, but then again, I suspect the test subjects in the studies were also having a glass of water with the calcium, in which case it might be very similar to the effects of a two cup Silk soy smoothie. It would be interesting to research this. Also, I’m pretty sure I’ve read that a calcium supplement may even be harmful at lower levels, like 500 mg. Anyway, to be safe, its probably wise to keep any large calcium sources spread out through the day, and imbibed with fluids. Just common sense once you realize how big the supplement sources, and the soy milk sources actually are.




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            2. 1,000 – 1,200mg seems like a lot of calcium in a pill. I have a bottle of Solgar Calcium + Mg chelate, which provides 200 milligrams in a capsule, along with 100 milligrams of magnesium citrate (a calcium channel blocker.) I usually take this after a big meal toward the end of the day — there’s less calcium here than six ounces of milk (and it probably hits my system slower than if I was to drink soy milk, which provides even more calcium than this supplement or milk. With one 200mg supplement, I can usually bring my calcium intake up from toward 500 or 600mg. I tend to consume a fairly high amount of protein for a plant-based diet, where I’m wondering if this is a good idea / ideal way to supplement.




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      2. Very interesting — so is a diet with a relatively high amount of dietary phosphorus (~1500mg) and a low amount of dietary calcium (~200mg) a heart-healthy diet? (Eg. Whole grain oat bran, with lentils and black beans, hemp hearts, and some rice / sweet potato.)

        The recommended intake of calcium is close to 1,000mg — were any of the supplement groups using calcium supplements to reach 500 or 600mg of calcium (still well below the recommended intake), rather than using supplements to push beyond it?

        Is there a difference between consuming Calcium Carbonate vs Chelated Calcium Amino Acids vs Calcium Malate? The American Heart Association recommends dairy (low-fat) for calcium, and I’ve heard dieticians recommend eating egg shells for calcium (carbonate) — is processed soymilk out of a plastic lined contained that’s been fortified with cheap calcium and been lift to sit around on the self, oxidizing the polyunsaturated fats really a healthy way to include calcium?




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        1. We actually don’t absorb as much phosphorus from the beans and whole grains as they once thought because it has been discovered that the phytates from the high fiber actually decreases the bioavailability of the phosphorus and the actual amount absorbed is only about 50% from the plant based foods and nearly 100% from processed food additives such as phosphorus acid in coca cola.




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          1. It looks like a mere 40 gram serving of hemp hearts provides around 600 milligrams of phosphorus, which would be a 3.0 ratio of Ca to P in this sort of dietary scenario before I’ve added any other sources of phosphorus. If I recall, the ideal ratio is usually closer to 1.0 to prevent atherosclerosis / calcification (lower intakes of calcium raise PTH and increase tissue absorption)? Hemp hearts do not contain phytic acid or anti-nutrients that limit phosphorus absorption.

            When I consume beans & grains, I soak / sprout / ferment / cook them, to decrease phytate content, decrease anti-nutrients, and increase nutrient absorption.

            I believe 12oz (350+ grams) of Coca Cola might contain 90% less phosphorus than this one little 40 gram serving of hemp seed.




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          2. It looks like a 12oz can (350g+) of Coca Cola provides around 90% less phosphorus than a small 40g serving of hemp hearts. Hemp hearts are free of phytic acid, and provide around 600mg in a 40 gram serving (in this scenario, the diet would already have 3 times as much phosphorus as calcium in it, before any other sources of phosphorus have been consumed.) I believe the ideal ratio of P to Ca, with regard to heart health is <= 1.0, or no more than 2.0.

            I usually soak / sprout / ferment / cook beans and grains specifically to lower anti-nutrient (phytate) content and increase mineral absorption. The remaining phytates would also serve to decrease calcium absorption, which would not be very helpful in improving the P to Ca ratio or meeting adequate intakes of Ca.

            I believe lower intakes of calcium increase parathyroid hormone, thus increasing intracellular calcium and intake into soft tissues. The studies mentioned used Vitamin D which also serves to increase calcium absorption. It didn't mention the use of the related cofactors (vitamin A — retinol, and vitamin K2, among others.) I believe vitamin K2 has anti-coagulant properties, as does nattokinase.




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            1. Vitamin K1 has the anti-coagulant properties. Vitamin K2 (mk7, mk4) is the cofactor needed to direct absorbed calcium away from arteries and into bones. Read Cardiologist Dr. Dennis Goodman’s recent eBook at Kindle Vitamin K2: the missing ingredient for heart and bone health. Calcium in Soy and other such milks is a supplement and dangerous without vitamin K2. The industry is just learning about this. Expect K2 to soon be added (See
              http://www.vitamink2.org).




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              1. I was under the impression that Vitamin K1 has the pro-*coagulant* properties used for blot clotting. Is there a difference between Mk7 or Mk4 with regard to heart and bone health? What are the ideal dosages to supplement? It looks like the main sources are fermented cheeses and soybeans, which seem sort of evolutionarily unique / rare vitamin sources.




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        2. Michaelsson et al. 2013, cited at 2:30 in the video found increased mortality risk from total Ca intake above 1400 mg/day, however in all groups below 1400 mg/day, supplement use DECREASED mortality risk. 6% of the participants took 500 mg tablets, 20% took multivitamin with about 100 mg Ca, both demonstrated decreased mortality compared to similar total Ca intake without supplementation. The sweet spot was 800 mg/day with or without supplementation.




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      3. Hi Joseph,
        Could you be a bit clearer please. I think a supplement is a supplement. So wouldn’t drinking fortified soy milk be the same? Let me know if my thoughts are wrong. I believe the message is get your calcium from your plants.




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      4. Organic soy milk sold in health food stores has added synthetic vitamins and minerals. Same for store bought almond, rice, hemp, chia, coconut, etc. milks and yogurts. Nothing “natural” about these products when they have ground up vitamin pills blended in.




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      5. Dr. Greger does advocate against consuming cow’s milk.

        How on earth is the calcium added to soy milk (calcium carbonate) any different from that in supplements besides dosage?




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        1. Hey Geoff, please see Dr. G’s writings on cow’s milk here: https://nutritionfacts.org/topics/milk/
          Yes, Dr. G does in fact advocate against cow’s milk consumption – unless you’re a calf, of course!
          The calcium carbonate added to plant-based milk dairy substitutes is the same as you’d find in a supplement, except for the fact that the supplement may contain binders, fillers, or additives that may affect assimilation. Hope this answers your questions, and thanks for writing!




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    1. I would avoid any man-made extracted foods that are “Fortified” and “Enriched” anti-naturally. They are expensive, risky, the science, labs, factories and how they are produced is patented or a trade-secret (censored).




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  1. Thank you very much for this information. I’m a vegan breastfeeding mama. My baby is 11 months old, was breastfed exclusively up to 6 months, and he still breastfeeds a lot. I’m taking 600mg of Calcium Citrate (2 pills, 300mg each) plus 2000iu vitamin D (I live in a Northern climate…). I do drink one cup of fortified soymilk a day (sometimes two) and eat broccoli fairly often (2-3 times a week) but not every day. Is a supplement ok while I breastfeed? I thought I was protecting my future bone health there… :( Thank you very much !




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    1. I think that’s a great question, and one Dr. G will tackle in the next video. Do you mind if we wait and see if the benefit of taking Ca+ for the bone outweigh the risks to the heart? I too can’t wait to find out, as this is a popular question.




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    2. Citrate & carbonate are both powdered rocks; we should only supplement with food-based products like the raw Vitamin Code & related brands. Since these are simply powdered foods I wonder if this warning pertains to food-based supplements as well? Maybe part 2 will clarify.




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      1. So called “food based” vitamins are just USP vitamins/minerals, in this case calcium carbonate, that have been cultured with yeast. There is no good research showing that they are better utilized or safer than the original USP version, just a lot more expensive. Eat real food!




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  2. What about this post at JackNorrisRD.com and these studies cited at VeganHealth.org?
    http://jacknorrisrd.com/calcium-supplements-and-cardiovascular-disease-in-the-news/

    Calcium intake is not associated with increased coronary artery calcification: the Framingham Study.
    http://www.ncbi.nlm.nih.gov/pubmed/23134889

    Relationships between vascular calcification, calcium metabolism, bone density, and fractures.
    http://www.ncbi.nlm.nih.gov/pubmed/20641031

    Is there strong evidence that calcium supplementation aimed at achieving total intake of calcium under 1000mg is harmful? Most of the studies are done on adults and old people, what about people under 30? Can we hypothesize that calcium supplements drive artery calcification in subjects with high LDL (most people), but are fine for people with low cholesterol?

    What to do if I can’t get enough calcium through diet? My average intake is under 500mg, and it is from not so bioavailable sources, mostly from nuts, seeds and beans, while I get no more than 200mg of calcium from greens.




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    1. Great questions. Let’s wait and see what the next videos say. He left on a real cliff hanger, and many users here are asking about the risks and benefits of taking Ca+ supplements on bone health vs. heart health for those who do not get enough from the diet. I’ll reply more after we have all the facts. Thanks so much for the references let’s come back to them soon. I bet Dr. Greger even addresses them in the next video! Stay tuned…




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    2. This is from the transcript. It is about blood clots.
      “This evidently produces what’s called a hypercoagulable state, your blood clots more easily, which could increase the risk of clots in the heart or brain.”




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  3. Should we include the high-dose bottled mineral waters as being possibly harmful? Is not the calcium in these waters just ground up rock, or something material that shares the same or similar physical qualities as the calcium supplements? Maybe this is one of the reason some only drink water with a low or lower total dissolved solids (TDS) count.




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  4. Is it just the bloodstream spikes that are problematic? If one continued to supplement by crushing pills into powder and sprinkling a little bit (<100mg at a time) on food throughout the day, might that keep each addition below the threshold for hypercoagulation? And might combining the calcium with flaxseed oil or other blood-thinning supplements help neutralize the coagulation effect? Any data on whether the form of calcium (carbonate, citrate, oxide, sulfate, &c) makes a difference?




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    1. I noticed that the blood clot study used a 1,000 mg dose of calcium! So I think you have a good point–take very small doses of calcium with food. The food should further reduce the speed of absorption. Maybe the problem with supplements is that they are taken at high doses that can easily flood the bloodstream.




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      1. I hope dr. greger will do more videos on calcium supplementation and calcium metabolism. IT seems a really big deal to so many of us. I would like to take little dosage of extra calcium but still dont know how it might affect me.




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        1. Stay tuned! He’s going to tell us more about the risks vs. benefits of taking calcium supplements for bone health in the next video!




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    2. Good questions. The hyper-coagulant blood spike is just one concern, but a major one that Dr. Greger points out. I am not sure about crushing or taking in smaller doses, or adding something like flax oil, I just don’t think any studies have been done like that. I do like your thinking and pondering ways to dance around the risks, but I am just not sure it’s the right approach. The data in these studies seems to combine all calcium supplement types. One study compared the efficacy of different types of calcium supplements and found no striking differences.




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    1. Well kids under 18 tend to need more calcium (1300mg/d), per the Institute of Medicine. The most important thing to considered is if they are getting enough from their diet. Children with low parathyroid hormone may risk kidney health by taking calcium supplements. It’s best to avoid these supplements and choose dietary sources, but in Dr. Greger’s next video we’ll find out more information about the risks vs reward for taking Ca+ supplements on bone health for those not getting enough calcium from food. Let’s see if he touches on calcium supplements for children. Stay tuned…




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      1. i did that when she was younger. Now that she is 16 and knows everything and has solutions to all the problems in the world, she expects me to get nutritional advice from her. No, I don’t bring home dairy products and she can’t eat what is not there but can refuse to eat what is there, so I give her 1000 mg of calcium citrate a day, which is the reason for my question.




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        1. I know this sounds terrible, but I’ve raised three kids and what they don’t see won’t hurt them and keeps them from mouthing off. I add all sorts of stuff to my red chili and green chili sauces and they have no idea what they’re eating. They just love it, and I love my Vitamix.
          Since she knows all about nutrition try letting her watch Joy Melanie’s Carnism Video. https://www.youtube.com/watch?v=o0VrZPBskpg

          Also, let he know that Jon Stewart has become a vegetarian. She may become an annoying proselyte but she’ll eat healthy. https://www.youtube.com/watch?v=5KKp-ciSfNw




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    1. Interesting article. Today’s Dietitians is a good source and referenced. I just don’t know much about vitamin K2. It’s still believed that sources of K1 (basically found in green vegetables/fiber) is the only type of vitamin K we need. Dr. Greger addresses vitamin K2 in his Q & A.

      Calcium interacts with many other minerals and vitamins like vitamin D. Some research suggests high intake of calcium may suppress vitamin D activity. That’s one reason why men drinking more milk or using calcium supplements is associated with greater risk of advanced prostate cancer.




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      1. Traditionally, calcium fortified foods (e.g. tofu set with gypsum) have been fermented. When I make tofu or other foods containing gypsum I generally ferment them. I wonder if the fermentation has any effect on the health aspects of calcium.




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    1. PCRM.org has such good information for professionals on the consumption of whole plant foods for meeting a person’s nutritional needs, wouldn’t that be the direction to take rather than trying to adjust the consumption of a supplement that has already been shown to be unhealthy? Here is their information on calcium found in their vegetarian starter kit: http://www.pcrm.org/health/diets/vsk/vegetarian-starter-kit-calcium
      I’m not a professional and I am sure I am not qualified to answer you, Diana, so please don’t think I am trying to be rude. I just see that supplements as a whole aren’t very good for people and it’s better to teach people to eat whole plant foods rather than trying to get nutrients through supplements. Of course, I do take my B-12 several times a week.




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    2. Let’s wait and see what the next video says. He kind of left us on a cliff hanger. I’ll be able to answer this more in a few days :-) Stay tuned for Wednesday’s video!




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  5. I want to echo Roman1337’s question. Is the calcium in soy milk safe or injurious? Does it count as “getting calcium from food”, or as “getting calcium via supplements”? Should I try to find some alternative to cow’s milk that has no calcium added?




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  6. This video has me thinking that I need to break my habit of using purchased soy milk, which is normally highly fortified (with calcium) and make my own using my Soyabella machine, which works fine but requires some effort (mostly cleaning up afterwards). The EdenSoy brand does offer a 100% natural option, as well as others. Yet it is quite expensive at up to $4.00 a carton, especially considering that even using top quality organic soy beans, the cost of homemade is much lower… Just have to build back the habit of making it at home.




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  7. Not that much groundbreaking – it is a “public secret” that osteoporosis epidemic is not caused by lack of calcium, rather bad digestion (vitamin D needed), bad distribution (vitamin K2 needed), balance of calcium and magnesium and few other factors (other minerals, just enough fitness activity, etc.). Even more stupid recommendations? Eat “low-fat milk products” on a regular basis…




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    1. Sure you could, especially if eating a ton of collards, beans (calcium-set tofu, edamame) and even other foods like figs, sesame seeds (tahini), and blackstrap molasses. Here is a good calcium chart. Of course the fortified plant-milks tend to have a ton, as well. So there are many healthful choices for dietary calcium.




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  8. I have read in more than one place that women in African tribes have several children during their childbearing yrs and on the average their intake of calcium from food is 300 mg. And osteoporosis is very rare there. They take NO calcium supplements. I believe that the recommended amount of calcium to consume daily is way to high. I also believe that we need to get our vit. and min. from food – a variety of WFPB and get the proper exercise our bodies need. I used to take a lot of supplements and now i eat a starched based WFPB diet with lots of green and yellow veggies, especially kale. I feel better than i have in my life at 60.




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  9. I’m wondering about the plant based supplement, “algaecal”, derived from algae. They are saying it is absorbed better than other calcium supplements. Being a plant, would the body respond differently?




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      1. Joseph, is there any established benefit to including vinegar in the diet, as far as increasing hydrochloric acid in the gut for digestion, and other stuff like that? Or is all that stuff just anecdotal? How about any other food substances or liquids that are known to increase hydrochloric acid….are there any that you know of? Thanks. I hear that maybe a little wine with food might help, and some say salt.




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  10. Dr. Greger – thank you for this video. I stopped taking calcium for this very reason two years ago. How about providing a handy list of foods that are calcium rich for your readers?




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    1. PCRM.org is the place you wanna’ see! No really, they have some great info graphics and a list of calcium rich whole plant foods. Here is the page on calcium from their vegetarian starter kit: http://www.pcrm.org/health/diets/vsk/vegetarian-starter-kit-calcium
      One of the best things about the WFPB diet is that there are many professionals working on the same goal and hence a lot of good websites that teach you what foods are good for you like PCRM.org and how to prepare those foods like ForksoverKnives.org. These are just two sites, but there are a number other sites that have good information too.

      It is my hope that this coordinated effort will break through the din of noise that prevents people from knowing the truth about the Standard American Diet.




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  11. My concern is all the dialysis patients that are already at increased cardiac risk and are asked to take multiple doses of tums or calcium acetate with each meal just to keep phosphorus levels at bay. I wish there was another alternative however, many are unwilling to change their diet to lower their phosphorus load.




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  12. With all due respect…I do not want to eat a “ton of collard greens”. I need a more practical answer to my question of how to get enough calcium. We know that …what is it..98% ? of soy(and corn) is Genetically Modified, so that would include soy milk, tofu, edamame and seitan. And, since many female seniors are on hormones, they are advised to avoid soy. Orange juice is high in Calcium as per your recommended chart, but also very high in sugar…also advised to be avoided…so what to do?




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    1. Eat an orange, not orange juice. Eat brocolli, cauliflower, kale all packed with calcium. In fact making kale chips in the oven is a quick and easy way to eat an entire bunch of kale.

      Remember the US recommendations for calcium are sky high, nowhere else has a milk lobby so incredibly strong to boost those requirements up. The WHO is 550mg, not 1000.

      Like we’ve heard time and again, its not what you eat, it is what you absorb. You will absorb more calcium from kale than from soymilk.




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    2. You’ll find good information about dietary needs at PCRM.org. If you’re eating a WFPB diet you’re probably good when it comes to overall calcium consumption. Here a fact sheet on calcium from Physician’s Committee For Responsible Medicine: http://www.pcrm.org/health/diets/vsk/vegetarian-starter-kit-calcium

      By definition organic soy would not be GMO, so eat only organic soy products. I use soy beans in my cooking and the only retail store I have found with organic soybeans is Whole Foods. Dr. Greger has a lot of great videos about soy, here is one that I particularly like, but you can search this website for more: http://nutritionfacts.org/video/waistline-slimming-food/




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  13. Is there also a downside to magnesium supplementation? Obviously it is better to get everything from diet, but what other minerals have negative side effects?




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  14. I am a heart patient with one previous heart attack. My family doc told me to take 1500mg of calcium and 1000mg vitD daily due to osteopenia. I’m concerned about taking that much calcium. I’m also on a whole food plant based diet.




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    1. Hi Debbie. I hope your heart is strong enough to take in this piece of investigative journalism on how, for all practical purposes, the ‘disease’ osteopenia was invented by a drug company in order to sell its new drug to a whole lot of people. I don’t know if this has any relevance to your particular situation, but I wanted to post this here so that all may have a good look at how osteopenia came into existence, and for what purpose. Best wishes to you and your gentle heart.
      http://www.npr.org/2009/12/21/121609815/how-a-bone-disease-grew-to-fit-the-prescription




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    2. To “take” or “consume”, Debbie, and has your family doc made an adjustment for your diet or is he reading of some sort of recommendation based on a generic person?




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  15. This makes me wonder about calcium fortification. Fortified foods aren’t exactly “natural.” Since discovering I have low BMD, I’ve tried to increase my calcium intake by eating more greens and also incorporating gypsum into foods. While the calcium from leafy greens would be great, maybe fortifying food with calcium isn’t such a great idea. The additional calcium spike may be enough to trigger the adverse effects. However, the amount of calcium contained in a supplement versus how much you can reasonably consume from fortified foods are likely significantly different. If it’s the dosage that causes the problems, then maybe it’d be better to reduce the individual calcium supplement dosage and consume single smaller calcium supplements with meals.




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    1. Makes me wonder how “natural” the high dose B12 supplements really are? How natural is bombarding the immune system with a sudden shock of 1000% or more of a single vitamin, in such a short amount of time?




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      1. B12 supplementation has been shown to be safe though. There’s a clear mechanism for why calcium supplementation may be harmful. There’s no clear mechanism for why B12 supplementation would be harmful.

        B12 isn’t easily absorbed, which is why supplements come in mega doses. Our bodies store B12, whereas we need a regular intake of calcium.

        Perhaps future studies will show B12 supplementation to be harmful, but for the time being there’s no reason to worry. The benefit far outweighs any potential detriment (thus so far there is no known detriment).




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  16. A doctor friend of mine had a remedy for a wide variety of ailments he called “monkey blood” because of the immediate huge beneficial effect on his patients, making them get up and bounce around like monkeys. It was a very slowly administered IV with 10 cc calcium gluconate, 1 cc vitamin C, 1 cc B complex, and additional B 12 administered over about 10 minutes by his nurses. many patients received this IV daily sometimes for weeks or months with no apparent side effects except improvement in overall patient well being. Is it possible that the calcium used is the common antacid,calcium carbonate, and that it neutralizes stomach acid. It is often the case that patients’ level of stomach acid is already low or missing and that the calcium as administered exacerbates that condition, leading to complications of achlorhydria?




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  17. Isn’t osteoporosis caused by acidosis ( too much meat , fries , sugar ) resulting in the body raiding calcium ( alkali ) out of the bones to neutralise bad blood pH ?




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  18. And the increase risks might also be because they are taking {supplementing with) calcium ALONE. Some people do need and can benefit from supplemental calcium. But only if they are going to take it with an absorbable magnesium and other supportive minerals and nutrients. Here is another take on this study from Dr. Michael Murray, ND. http://doctormurray.com/calcium-heart/ As he puts it “The negative effect on magnesium levels alone may be the key explanation for the results of the study.”

    Once again, as Dr. Murray also points out in his commentary, the studies try to treat nutrients like drugs, as if they act alone, when nutrients do not and cannot act alone, because they are part of a system. It is always best to get one’s calcium from diet but if calcium supplementation is required, know what kind to take and what supplemental nutrients need to be accompanied with it.




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  19. I have an off topic question. I try to eat plant based (a plate like pcrm). After three meals of fruit, vegetables, beans, whole grain my stomach hurts and I don’t have many calories in. If I eat some refined grains to boost my calories will the beans and veggies in my meals negate the negatives of refined grains. I need higher calories because I’m a competitive powerlifter. Thanks for any input.




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      1. I do eat about 4 oz. Of nuts/seeds daily. My fiber ends up still about 60 grams daily and feels rough on my stomach should I replace more of my beans with nuts? I try for 2-3 c of beans to keep my protein up with out using tofu (not available) or supplements (don’t want to use).




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        1. What are your thoughts on vegan protein powders? I don’t go crazy and aim for 1 g of protein per lb of bodyweight like the bodybuilder say. I just want a little extra to ensure I’m getting the most out of my training.




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    1. I cannot give advice on individual supplements. I assume it has vitamin D, too? The two nutrients work together. If it’s okay let’s wait until tomorrow and see what the research says, as Dr. Greger will pick up where he left off regarding the safety of calcium supplements for bone health. As a side note, anyone taking any supplements should discuss with their health care team about the risks and benefits.




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  20. I see someone named Scott asked the same question a few hours ago. I take a raw, whole food, plant-based formula & only take about half or a third of the daily dosage recommended on the bottle. And I don’t even take it everyday – maybe 4 or 5 times /week. I eat (for the most part) a whole foods, plant based diet. For me, the calcium supplement is like filling in the cracks, so to speak, just in case I didn’t get enough in my diet. I also take a whole food B-complex, which I pretty much take everyday. I always thought the whole food vitamins were better than the synthetic ones. Am I wrong about that?




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  21. Hypercoagualanle state!
    Wow that’s something very interesting in this video that I’ve never heard before! I’ve eaten a plant based diet for 3 years. I am very active, riding my bike 100 miles per week on average. My resting heart rate is 46 bpm. This spring I developed DVT in my right leg.
    I was taking a calcium supplement every other day, just to be safe. Because everyone knows plant based diets are deficient, right?
    So is it possible that the supplement was contributing to the blood clots in my leg?




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  22. “Comment Etiquette”

    Does not exist at Youtube, so I do 99% of my commenting here and also unsubscribed from the feed there. Was just clogging up my page with redundant notices. NF.O is one of my start tabs.




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  23. Hi! Is it possible to get “too much” calcium from plant foods (dandelion, kale, bok choy, cabbage)? On cronometer, it gives an intake of nearly 1400 mg Calcium with eating many of those foods on a daily basis. That seems very high. Is this too much? Or, is calcium absorbed similarly to plant-based iron where the body takes what it needs? Thanks for any reply! (Big fan of the website.)




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    1. Elise: It’s a fair question, but I’ve never heard of getting too much calcium when it just comes naturally from your greens. To support my thought, check out this great NutritionFacts page:
      http://nutritionfacts.org/2014/09/23/will-the-real-paleo-diet-please-stand-up/
      Note how a “true paleo diet” (well, whatever that is) likely had 1000-1500.

      Also, I’ll point out that Esselstyn recommends something like 6 servings of cooked greens a day – where each “serving” is the size of your fist. That recommendation is for people with heart disease, and I’ve never heard of Esselstyn’s recommendations hurting anyone.

      Does that help?

      Here’s my thought: Rather than worrying about it, I think you should be patting yourself on the back for getting so much great nutrition in a safe/healthy way! You are doing great!




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  24. I visited a naturopathic doctor several months ago and was advised that as a vegan athlete at risk for osteoporosis that I should be definitely taking supplemental calcium (along with magnesium/boron/vitamin D and adequate protein). Here is a recent meta-analysis that shows no increase in risk of coronary artery disease or all-cause mortality with calcium supplementation: http://www.ncbi.nlm.nih.gov/pubmed/25042841
    I really do not know what to believe anymore.




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  25. Does this risk also apply to the calcium triphosphate and/or calcium carbonate found in non-dairy milks such as almond milk? Does it pose the same risk even though it’s added and not in a calcium supplement? (*Sorry, I just realized there is already a thread started)




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  26. Hi Folks. Thanks for all the great information. I have noticed since being plant based that my nails split easily. Is there something I can do to help them?




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  27. Dr Greger, Is it OK to ingest vegan calcium enriched soy milk? For example 50 mls of soy milk in tea 6 times a day? or even if it were 250 mls of calcium enriched soy milk in one go? Would that make one’s blood hypercoagulable?




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  28. While there’s some very good responses to the question of drinking fortified calcium soy milk, I’m still not reassured. I have about 75 mls of vegan “enriched calcium” soy milk in my tea (about 80mgs) and I drink about 8 cups in 24 hours, so that’s about 640mgs calcium in total. Would that be a problem? Thanks in advance.




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    1. Thanks for your comment Jasper!

      It really depends on how much calcium you’re getting from your diet through food. Guidelines for each country on how much calcium you need are very different – for instance the National Institute of Health recommends 1000mg of calcium a day for an adult, however in the UK the recommendation is of only 700mg per day. Nevertheless, according to one study, we only truly need ~741mg of calcium per day.

      Hope this answer helps!




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  29. Would you comment on the recent recommendation of 6 to 10 prunes a day for increasing bone density. I heard that although it seems to work, prunes contain insulin growth factor, that promotes cancer.




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  30. Is there a link to the “next” video he talks about at the end, or was it not made yet? I never took calcium supplements until recently after reading an article that sort of scared me into it. So I’ve been taking Garden of Life’s calcium which is a blend of calcium, magnesium, and vitamins d. It has higher levels of magnesium and vit. d than calcium. It is 80% DV of calcium in a daily serving which is between 3 tablets which for best absorption, they recommend taking with a mean 3 times a day. I’ve been taking them all at once in between meals as I’ve read about competing minerals, I didn’t want it to interfere with the absorption of iron, zinc, etc. Now I’m nervous to take them at all… would taking one tablet and getting about 25% DV be safe and beneficial if I was worried I didn’t get enough calcium that day? Also, could this small portion lead to too much calcium if I DID get enough calcium that day?
    Thanks so much for your time!




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  31. Oh, and what can I do when I have a Hyperparathyroeidisms and get a Operation in hospital to eliminationn the adenoma? Then give the Doctor higher dosage calcium. And I read you must take the calcium and Vitamin D whole life long! Later then get a stroke ..and now? What can I do?




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  32. I own a business called Osteohealth NZ that helps people with bone health. So, I try to keep up to date on studies about osteoporosis, calcium, etc. A study called “Calcium and Vitamin D Intake and Mortality: Results from the Canadian Multicentre Osteoporosis Study (CaMos)” was recently published at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5096927/ that seems to be saying that calcium from supplements leads to a reduced risk of mortality. I would be very interested in your interpretation of this study as I’m not good at interpreting data like this but I’m very wary of the group funding the study as it has a number of industry ties.




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  33. At 2:30 is a citation to Michaelsson et al. 2013, asserting that supplementation increases mortality risk. However that is NOT what this 20 year study of over 63000 participants found! Above 1400 mg/day, yes, mortality risk increased, however in all the groups and collectively below 1400 mg/day total Ca intake, supplementation was shown to DECREASE mortality risk!




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  34. Hi, I´m a 31 year-old vegan woman who has being diagnosed with osteopenia. I refused to take calcium supplements because of this information and my hearth disease family history. I have been trying to improve my diet with calcium rich foods. But I´m afraid this won´t be enough. I found a lower-than-typical supplemental calcium (200mg/pill) (from mineralized seaweed) combined with vit D3 and K2, will this be safe for heart diseases? or how could I reverse osteopenia without supplements?




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    1. Mary: I highly recommend the book: “Building Bone Vitality: A Revolutionary Diet Plan to Prevent Bone Loss and Reverse Osteoporosis–Without Dairy Foods, Calcium, Estrogen, or Drugs” https://www.amazon.com/Building-Bone-Vitality-Revolutionary-Osteoporosis-Without/dp/0071600191/ref=sr_1_1_twi_pap_1?s=books&ie=UTF8&qid=1484941539&sr=1-1&keywords=building+bone+vitality

      .
      The book is an easy read. It is primarily about nutrition, but it includes a chapter on drugs and a chapter on exercise. I highly recommend paying attention to the chapter on exercise as I believe that certain types of exercise are as key to healthy bones as nutrition. Also note that famous plant-based doctor, Dr. Klaper recommends a walking program with a weighted vest to address bone health concerns.




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  35. Hello,

    Currently not getting enough calcium from whole plant foods alone and I am going to supplement. I was wondering if you could answear a few of the following questions:

    1. Should I use a Calcium supplement or Calcium fortified foods to boost my levels? And Which is more effective?
    2. Can you give me realistic list of whole plant foods (not fortified), with the amount you would have to eat in grams, that you or I could eat in ONE DAY to reach over 1000mg of calcium per day?

    I say realistic because a lot of people say, “Oh its easy you only need to eat like 50 oranges and 500g of kale”, well maybe not that excessive but you get the point aha!




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    1. James: For your second question, I recommend getting a book that Dr. Greger recommends at the end of How Not To Die: Becoming Vegan. The Express edition not only has a section on calcium, it includes daily meal plan examples that meet the calcium RDA.

      The authors of the book Becoming Vegan stick to the USA RDA for calcium, but I agree with Dr. Greger that the evidence does not back up such high amounts. Calcium *is* in an important nutrient. The question is, how much? From what I have seen, there isn’t enough information to determine exactly how much calcium a person should take in. I think the answer is likely to depend on a number of factors, including how much weight bearing exercise one gets. After looking at the data, Dr. Greger recommends, “At least 600 mg daily via calcium-rich plant foods—preferably low-oxalate dark green leafy vegetables, which includes all greens except spinach, chard, and beet greens (all very healthy foods, but not good calcium sources due to their oxalate content).” See: http://nutritionfacts.org/2011/09/12/dr-gregers-2011-optimum-nutrition-recommendations/

      Most people who are concerned about getting adequate calcium intake are really concerned about bone health. Focusing so much on calcium for bone health is to ignore that bones are made up of something like 17 or substances, all equally important. Getting too much of one substance over the others, especially calcium, can put your body out of balance and be a problem for bone health. The book Building Bone Vitality provides an awesome big picture of what you need to know for bone health. If you are interested, this is the book: https://www.amazon.com/Building-Bone-Vitality-Revolutionary-Osteoporosis–Without/dp/0071600191/ref=sr_1_1_twi_pap_1?s=books&ie=UTF8&qid=1467668791&sr=1-1&keywords=building+bone+vitality




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      1. Hello,

        Thank you for the reply. I will take your advice and buy his book. Is this the express edition in which it details daily meals and has a section on calcium https://www.amazon.co.uk/How-Not-Die-Discover-scientifically/dp/1447282442/ref=sr_1_1?ie=UTF8&qid=1487275647&sr=8-1&keywords=how+not+to+die

        If it isn’t could you please point me in the direction of the right one, I checked the contest and it didn’t have a section on calcium or daily meals?




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        1. James: Allow me to clarify. Dr. Greger’s book is How Not To Die. Part 2 of Dr. Greger’s book is about the Daily Dozen, which includes general daily recommendations. I do highly recommend that book. But if you are interested in the book that I mentioned with meal plans and a section on calcium, that can be found in the book Becoming Vegan. There are multiple editions of the book. I have the Express edition: https://www.amazon.com/Becoming-Vegan-Express-Plant-based-Nutrition/dp/1570672954/ref=sr_1_1_twi_pap_1?s=books&ie=UTF8&qid=1487276342&sr=1-1&keywords=becoming+vegan+express+edition

          There is also a Comprehensive Edition. I don’t know which one would better meet your needs, but I can say that the Express edition meets my needs just fine.

          Does this help?




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  36. Good Evening,

    Can somebody give me a few day of eating meal examples (Breakfast,Luch,Dinner) in which I can reach my RDA of Calcium, any information would be greatly appreciated!




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    1. Annie: I don’t think the RDA for calcium is a legitimate RDA. I don’t have access to the book Building Bone Vitality at the moment, but I remember reading in that book that other cultures have much lower intakes of calcium and no bone problems. (I think one culture went as low at 400 or something like that.)
      .
      Calcium *is* in an important nutrient. The question is, how much? From what I have seen, there isn’t enough information to determine exactly how much calcium a person should take in. I think the answer is likely to depend on a number of factors, including how much weight bearing exercise one gets. After looking at the data, Dr. Greger recommends, “At least 600 mg daily via calcium-rich plant foods—preferably low-oxalate dark green leafy vegetables, which includes all greens except spinach, chard, and beet greens (all very healthy foods, but not good calcium sources due to their oxalate content).” See: http://nutritionfacts.org/2011/09/12/dr-gregers-2011-optimum-nutrition-recommendations/
      .
      Most people who are concerned about getting adequate calcium intake are really concerned about bone health. Focusing so much on calcium for bone health is to ignore that bones are made up of something like 17 or substances, all equally important. Getting too much of one substance over the others, especially calcium, can put your body out of balance and be a problem for bone health. The book Building Bone Vitality provides an awesome big picture of what you need to know for bone health. If you are interested, this is the book: https://www.amazon.com/Building-Bone-Vitality-Revolutionary-Osteoporosis–Without/dp/0071600191/ref=sr_1_1_twi_pap_1?s=books&ie=UTF8&qid=1467668791&sr=1-1&keywords=building+bone+vitality
      .
      Finally, if you are convinced that 1000 mg calcium a day is a good thing, the book Becoming Vegan (either the complete guide or the express edition) has a lot of ideas on how to meet that 1000 mg level by eating various foods. The book also includes some meal plans that meet all the RDAs. So, looking at the book may give you an idea on how to meet your goal. Also note, you can test your levels by entering data in the free website, cronometer.com
      .
      Does this help?




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  37. I have realised that foods now contain more and more calcium chloride to replace salt (low salt beans, canned tomatos, sauces, etc.) Is it safe? And if I had to choose between salt or calcium chloride, what should I take?




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  38. Speaking of which: I just got my blood results back; I’m healthy vegan of 47, eat mostly WFPB, exercise regularly. And my blood results were mostly fine, apart from my vitamin D being too low(24.3 ng/ml), ok, the weather was really bad, and my calcium (2.55mmol/l) and iron (302µg/l) being a very small bit too high… Go figure. Any recommendations apart from taking more D3? I already started that.




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  39. HBoetes,

    A high iron level could be significant, but it totally depends on getting a comprehensive blood panel, including TIBC/Ferritin/etc.

    Taking vitamin D supplementation appears appropriate, along with rechecking the calcium/vit D levels in a few weeks (5-6).

    So be patient, use the vitamin d and you should see a change in both of these parameters. If the iron levels are elevated, when you evaluate the whole panel, then take action. I suspect you will see that the overall picture is quite different when you get all the facts.

    Dr. Alan Kadish moderator for Dr. Greger




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  40. Hello Dr. Greger..I have a quick question…I’ve been taking 400mg of calcium each day for more than a year and in the past week I’ve been experiencing nausea symptoms..do you think it has something to do with the calcium supplement that I take every day ?? the supplement has 400mg calcium, 200mg magnezium and 10uq vitamin d3…should I stop taking this supplement ??




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