Laura Schoenfeld: Calcium is a supplement that I don’t think most people need. I really don’t think people need to have much more than 600 to 800 milligrams of calcium in the diet to have good bone health. There are a lot of things that affect bone health much more significantly than calcium. There’s a lot of research that has come out in the last couple of months showing that calcium intake doesn’t really prevent fractures or loss of bone density over the course of time. We do need calcium to build our bones, and you can’t necessarily not have any calcium, but it’s not the most important factor when it comes to bone health, especially once the bones have been fully formed. If you think about it, an adult is just maintaining their bone density as opposed to growing new bone, whereas a child is growing new bone and needs a little bit more dietary calcium to help do that.
Now, as far as supplementation, yes, we agree that calcium is something that you should be really cautious with if you’re going to supplement. However, there are some potential cases where calcium supplementation, at least short term, may make a difference for someone’s health or may actually make sense. You have to think about calcium supplementation as being on a scale. You could do 100 or 200 milligrams of calcium supplements on top of a calcium-rich Paleo diet and get that person up to, like, again, 600 milligrams per day, and that would be fine. A lot of people on a Paleo diet could potentially be at risk of low calcium intake, which again I don’t think has so much to do with bone health as it does with calcium balance, and there are a lot of things, like muscle contraction, that use calcium, so if somebody is getting a lot of cramps, they might actually do better with a little bit of extra calcium. But a lot of calcium supplements contain way more calcium than people need. Usually you see these calcium supplements, for women especially, that contain 1,000 or 1,200 milligrams a day. That’s way too much, and you definitely don’t need that. Usually if I’m going to do any sort of calcium supplementation with someone, it’s going to be maybe 200 milligrams per day on top of adding some foods in that are calcium rich. I do have clients that don’t eat dairy and they don’t eat a lot of green vegetables, necessarily, which are arguably not a super source of calcium anyway, and maybe they won’t eat bone-in fish like canned salmon, canned sardines, that kind of thing. Mostly it’s a lot of plant food and then bone-in fish and dairy that would be providing the calcium. If somebody is getting leg cramps a lot or if they do have osteoporosis and maybe they aren’t getting a decent amount of calcium in their diet, then it’s possible that a little bit of calcium supplementation could be helpful.
Now, I would also make sure that they’re getting balanced fat-soluble vitamins if they’re going to be supplementing with calcium. Make sure their vitamin D status is good. Make sure they’re getting adequate vitamin A either through their diet or through a supplement. K2 is especially important here. If you’re going to give a calcium supplement to someone, you definitely need to be supplementing with K2. That’s kind of like not even an option, and that’s because K2 is really important for keeping calcium where it’s supposed to be in the bones and the teeth as opposed to in the arteries. One of the reasons Chris does not like to supplement with calcium for most people is because of the risk of calcification in the arteries with excess calcium intake, and having plenty of K2 in the diet or in the supplement regimen that your patient is doing will help prevent the arterial calcification that could happen from calcium supplementation.
I think the podcast you’re talking about, Julie, was fairly old. I want to say we did that a couple of years ago, so we may need to update that, but I do think that a little bit of calcium supplementation for certain people is fine as long as their fat-soluble vitamins are balanced. Also you want to make sure they’re getting magnesium with that. You don’t want to just be giving pure calcium in large doses without balancing it with magnesium. Normally I’ll do a 1:1 supplementation with calcium and magnesium. I’ll do a combo supplement, and maybe it’s 100 or 200 milligrams per pill that I’m giving that person, and again, usually about 200 milligrams is my max.