Calcium supplements: the way to go?

Q. Should people take calcium supplements?

A: I recommend that people get enough calcium in their diet, but I recognize that a lot of people aren't going to get enough from foods that naturally contain calcium. So that leaves you with fortified foods or supplements.

Q. Are some calcium supplements absorbed better than others?

A: Most chemical forms of calcium--carbonate, citrate, lactate, or phosphate--are absorbed the same. The only one that's superior is calcium citrate malate. On average, people absorb 35 percent of the calcium in calcium citrate malate, compared to about 30 percent of the calcium in calcium carbonate and other supplements.

Q: Is calcium citrate malate mostly in juices?

A: Yes. It blends with their flavor because citric acid and malic acid occur naturally in juice. It's in juices made by Tropicana, Gerber, and Beechnut. It's also in Sunny Delight with Calcium, which is five percent juice. Only GNC (General Nutrition Centers) is licensed to make supplements with it.

Q: Does calcium citrate malate have less calcium per pill than calcium carbonate?

A: Yes, the amount of calcium per weight is lower in calcium citrate malate. It's 20 percent calcium. Carbonate is 40 percent. So carbonate is usually a better buy.

Q. What about calcium citrate without the malate?

A: I've seen some studies that claim that calcium citrate is superior to other calcium supplements, but I'm not convinced. I have questions about the methods the studies used.

Q. Does calcium carbonate cause constipation, bloating, or gastric irritation?

A: Those reports are anecdotal. I've never seen a peer-reviewed study on adverse effects. People could try it and switch to another form of calcium if they have problems.

Q. Calcium carbonate is also an antacid. Is it safe to take every day?

A: Trace minerals like zinc and iron may be less well-dissolved and absorbed if you chronically take an antacid that lowers the acidity in your stomach. But if you're only taking enough antacid to get the recommended calcium levels, it shouldn't be a problem.

Q. So people shouldn't worry?

A: No. Calcium carbonate is a cheap source of calcium and taking it is better than not getting enough calcium.

Q. Should people take calcium supplements that also contain other nutrients?

A: It's a good idea to make sure you're getting the recommended levels of magnesium, zinc, and vitamin D because our intakes tend to be borderline and because they're also good for bone. It doesn't matter if you take them with the calcium or in another supplement. If you eat calcium-rich foods, you may get them automatically. Other good sources include green leafy vegetables, whole grains, and nuts (for magnesium) and whole grains and seafood (for zinc).

Q: Does it matter when you take a calcium supplement?

A: It's better-absorbed with meals. Food slows the transit time through the gut, so the calcium has more time to be absorbed.

And you absorb more from divided doses than if you take a high dose--more than 500 mg--all at once. But you have to fit it into your lifestyle. If taking calcium at breakfast and dinner or at every meal works for you, that's fine. If you're only going to take a supplement once a day, that's better than nothing.

Q: What is chelated calcium?

A: Chelate [KEY-late] means claw-like. If you shape your hand like a claw, you can imagine the chelated mineral sitting inside it. The claw is usually an amino acid.

If calcium is in the middle of the claw, an inhibitor like phytic acid in cereals or oxalates in spinach can't bind it up and make it harder to absorb.

Q: Should people buy chelates?

A: I don't recommend it. Generally, chelates improve the absorption of minerals by about five or ten percent, but they cost five times as much.

Q: It sounds like calcium citrate malate and calcium carbonate are the best options.

A: Yes. Calcium citrate malate is low in lead and it's absorbed the best. But it's more expensive and--unless you drink it in fortified juice--you'd have to take more pills than calcium carbonate.

A calcium carbonate supplement like Turns is cheap and concentrated into few pills. It's low in lead, and we have no evidence that it's harmful because it's an antacid.

RELATED ARTICLE: GET THE LEAD OUT

Lead is a toxin that may raise the risk of high blood pressure and heart disease. It's especially unsafe for pregnant or breastfeeding women because it could harm the nervous system of a fetus or infant.

Last year, the non-profit Natural Resources Defense Council (NRDC) and the California Attorney General's office sued several companies that sold calcium supplements with lead levels higher than California's limit--0.5 micrograms per maximum daily dose. (The FDA has proposed a similar--though not identical--limit for products sold nationally, but until it's final, supplements can exceed that level.)

That's no reason to stop taking calcium--supplements rarely have high levels. But why not choose brands with the least lead? According to the NRDC, Children's Mylanta, Leiner Your Life, Posture-D, and Turns are already low, as are store brands from the following chains:

A&P               K-Mart         Rite Aid   Venture

Albertson's       Longs          Safeway    Walgreen's

American Stores   Lucky Stores   Sam's      Wal-Mart

CVS or Eckerd     PriceCostco    Target     Winn-Dixie

RELATED ARTICLE: THE BOTTOM LINE

Calcium

* To get 1,000 to 1,200 mg of calcium a day from food, eat three low-fat dairy products (you get about 200 mg from miscellaneous foods). For each calcium-rich food you don't eat, get 300 mg of calcium from a supplement or a healthy fortified food like calcium-fortified orange juice.

* All forms of calcium in supplements are well-absorbed. The differences: Calcium citrate malate is best absorbed, but calcium carbonate is the most concentrated, so you get more per tablet.

* If it's convenient, take your calcium supplements with meals, ideally in doses of 500 mg or less.

* For more information, check out the National Academy of Sciences' home page (www.nas.edu/newsrpt).

Vitamin D

* Make sure you get enough vitamin D from the sun, a multivitamin or other supplement, and/or milk (each cup has 100 IU).

* If you're 50 or younger, shoot for a total of 200 IU of vitamin D a day. If you're 51 to 70, shoot for 400 1U. If you're over 70, shoot for 600 IU. Don't exceed 2,000 IU a day.

* To get vitamin D from the sun, expose your non-sunscreened hands, face, and arms for 10 to 15 minutes--or less if you might burn--two to three times a week between 8 a.m. and 4 p.m. Unless you live south of the line running between Atlanta and Los Angeles, you can't get vitamin D from the sun in the winter.

Exercise

* Choose a weight-bearing exercise that you enjoy, and try to do it for at least 30 minutes on most days. (Except for swimming and cycling, most activities are weight-bearing.)