Calcium from Food Sources is Preferred Over Supplements
You should prioritize drinking fortified almond milk and consuming other calcium-rich foods over taking calcium supplements, but supplements are appropriate when dietary intake cannot meet your needs of 1000-1200 mg daily. 1
Why Food Sources Are Superior
Calcium-rich foods and beverages are the preferred sources of calcium because they are widely available and, with the exception of lactose intolerance, are associated with few adverse effects. 1 Some evidence suggests that a greater proportion of ingested calcium is absorbed from certain dietary sources like broccoli and kale compared to calcium supplements. 1
Key advantages of dietary calcium:
- Does not increase risk of kidney stones (unlike supplements which modestly increase nephrolithiasis risk) 1
- Potentially better absorption from certain food sources 1
- Contains other beneficial nutrients beyond just calcium 2
- No concerns about cardiovascular risk that have been raised with calcium supplements 1
Estimating Your Calcium Needs
Most adults consume approximately 300 mg of calcium daily from non-dairy sources (vegetables, grains, fortified products like almond milk). 1 You need:
- 1000 mg/day if you are age 19-50 (women) or 19-70 (men) 1
- 1200 mg/day if you are a woman over 50 or a man over 70 1
- Never exceed 2000-2500 mg/day total (increases kidney stone and potential cardiovascular risk) 1
When to Use Calcium Supplements
Supplements should be considered only when dietary intake is inadequate to meet your daily requirements. 1 If you cannot obtain sufficient calcium from fortified almond milk and other food sources, supplementation becomes necessary. 1
If supplementation is needed:
Calcium citrate is the preferred supplement form because: 3, 4
- Can be taken with or without food 1, 3
- Does not require stomach acid for absorption 1, 3
- Better tolerated with less constipation and bloating 3
- Ideal if you take acid-reducing medications (PPIs, H2-blockers) 3, 4
Calcium carbonate is an acceptable alternative if: 1, 4
- Cost is a major concern (it's significantly less expensive) 3, 4
- You can take it with meals (requires stomach acid) 1, 4
- You don't take acid-suppressing medications 3
- You can tolerate potential constipation 1
Critical Dosing Rules for Supplements:
- Never take more than 500 mg of elemental calcium at one time (reduces absorption efficiency) 3, 4, 5
- Divide doses throughout the day if you need more than 500 mg daily 1, 4
- Take calcium carbonate with meals; calcium citrate can be taken anytime 1, 4
Important Caveats and Pitfalls
High calcium intake (>1500 mg/day), particularly from supplements, has been associated with increased risk of aggressive prostate cancer in men. 1, 5 Both men and women should strive to consume recommended levels primarily through food sources. 1
Recent studies have raised concern about increased cardiovascular risk with calcium supplements, though findings remain inconsistent and inconclusive. 1 This concern does not apply to dietary calcium intake. 1
If you are elderly or take acid-reducing medications, do not use calcium carbonate as absorption will be severely impaired. 3 Calcium citrate is essential in these situations. 3
Practical Approach
Calculate your current dietary calcium intake (300 mg baseline from non-dairy sources plus calcium from fortified almond milk and other foods). 1 If this falls short of 1000-1200 mg daily, first attempt to increase dietary sources. 1 Only if this is not feasible should you add supplements, using calcium citrate in divided doses of no more than 500 mg elemental calcium at a time. 3, 4