Calcium is a mineral most often associated with healthy bones and teeth, although it also plays an important role in blood clotting, helping muscles to contract, and regulating normal heart rhythms and nerve functions. About 99% of the body’s calcium is stored in bones, and the remaining 1% is found in blood, muscle, and other tissues.
In order to perform these vital daily functions, the body works to keep a steady amount of calcium in the blood and tissues. If calcium levels drop too low in the blood, parathyroid hormone (PTH) will signal the bones to release calcium into the bloodstream. This hormone may also activate vitamin D to improve the absorption of calcium in the intestines. At the same time, PTH signals the kidneys to release less calcium in the urine. When the body has enough calcium, a different hormone called calcitonin works to do the opposite: it lowers calcium levels in the blood by stopping the release of calcium from bones and signaling the kidneys to rid more of it in the urine.
The body gets the calcium it needs in two ways. One is by eating foods or supplements that contain calcium, and the other is by drawing from calcium in the body. If one does not eat enough calcium-containing foods, the body will remove calcium from bones. Ideally, the calcium that is “borrowed” from the bones will be replaced at a later point. But this doesn’t always happen, and can’t always be accomplished just by eating more calcium.
Recommended Amounts
The Recommended Dietary Allowance (RDA) for calcium for women 19-50 years of age is 1,000 mg daily; for women 51+, 1,200 mg. For pregnant and lactating women, the RDA is 1,000 mg. For men 19-70 years of age, the RDA is 1,000 mg; for men 71+ years, 1,200 mg. [1]
Calcium and Health
The reviews below specifically looked at the effect of calcium on various health conditions. Scroll down for links to more information on the health effect of specific foods rich in calcium.
Food Sources
Calcium is widely available* in many foods, not just milk and other dairy foods. Fruits, leafy greens, beans, nuts, and some starchy vegetables are good sources.
- Dairy (cow, goat, sheep) and fortified plant-based milks (almond, soy, rice)
- Cheese
- Yogurt
- Calcium-fortified orange juice
- Winter squash
- Edamame (young green soybeans); Tofu, made with calcium sulfate
- Canned sardines, salmon (with bones)
- Almonds
- Leafy greens (collard, mustard, turnip, kale, bok choy, spinach)
Signs of Deficiency and Toxicity
Deficiency
Blood levels of calcium are tightly regulated. Bones will release calcium into the blood if the diet does not provide enough, and no symptoms usually occur. A more serious deficiency of calcium, called hypocalcemia, results from diseases such as kidney failure, surgeries of the digestive tract like gastric bypass, or medications like diuretics that interfere with absorption.
Symptoms of hypocalcemia:
- Muscle cramps or weakness
- Numbness or tingling in fingers
- Abnormal heart rate
- Poor appetite
A gradual, progressive calcium deficiency can occur in people who do not get enough dietary calcium in the long-term or who lose the ability to absorb calcium. The first early stage of bone loss is called osteopenia and, if untreated, osteoporosis follows. Examples of people at risk include:
- Postmenopausal women—Menopause lowers the amount of estrogen in the body, a hormone that helps to increase calcium absorption and retain the mineral in bones. Sometimes physicians may prescribe hormone replacement therapy (HRT) with estrogen and progesterone to prevent osteoporosis.
- Amenorrhea—A condition where menstrual periods stop early or are disrupted, and is often seen in younger women with anorexia nervosa or athletes who physically train at a very high level.
- Milk allergy or lactose intolerance—Occurs when the body cannot digest the sugar in milk, lactose, or the proteins in milk, casein or whey. Lactose intolerance can be genetic or acquired (not consuming lactose in the long-term may decrease the efficiency of lactase enzyme)
Toxicity
Too much calcium in the blood is called hypercalcemia. The Upper Limit (UL) for calcium is 2,500 mg daily from food and supplements. People over the age of 50 should not take more than 2,000 mg daily, especially from supplements, as this can increase risk of some conditions like kidney stones, prostate cancer, and constipation. Some research has shown that in certain people, calcium can accumulate in blood vessels with long-term high doses and cause heart problems. Calcium is also a large mineral that can block the absorption of other minerals like iron and zinc.
Symptoms of hypercalcemia:
- Weakness, fatigue
- Nausea, vomiting
- Shortness of breath
- Chest pain
- Heart palpitations, irregular heart rate
Did You Know?
Certain nutrients and medications may increase your need for calcium because they either lower the absorption of calcium in the gut or cause more calcium to be excreted in the urine. These include: corticosteroids (example: prednisone), excess sodium in the diet, phosphoric acid such as found in dark cola sodas, excess alcohol, and oxalates (see Are anti-nutrients harmful?).
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