A previous blog on calcium supplementation raised concerns about reports that supplemental, non-dietary, calcium was linked to a greater incidence of cardiovascular, cerebral vascular and all-cause mortality. It seemed odd to think that the metabolic and physiologic machinery of the human body could determine the source of ingested calcium. Nonetheless, reports caused a thoughtful pause in how and whether supplemental calcium should be taken.
Fortunately, this question has been clarified by the expert panel convened by the National Osteoporosis Foundation and the American Society for Preventive Cardiology and authored by Chung, M et.al. and published as a Clinical Guideline, Review, and Editorial. The panel reviewed the findings of an updated evidence report by Tufts University.
Based on this guideline the groups recommended that a total calcium consumption less that the tolerable upper level of intake (2000-2500 mg daily), sourced from food or supplements, should be considered safe from a cardiovascular standpoint. This recommendation was based upon moderate-quality evidence (B level) that calcium with or without vitamin D has no relationship with the risk for cardiovascular disease, cerebral vascular disease or all-cause mortality.
The guidelines went on to comment that food source calcium was preferred but that supplemental calcium can be used safely to fill the gaps.
Here’s some info on food sourced dietary calcium from the NIH
Table 2: Selected Food Sources of Calcium [2] | ||
Food | Milligrams (mg) per serving |
Percent DV* |
Yogurt, plain, low fat, 8 ounces | 415 | 42 |
Mozzarella, part skim, 1.5 ounces | 333 | 33 |
Sardines, canned in oil, with bones, 3 ounces | 325 | 33 |
Yogurt, fruit, low fat, 8 ounces | 313–384 | 31–38 |
Cheddar cheese, 1.5 ounces | 307 | 31 |
Milk, nonfat, 8 ounces** | 299 | 30 |
Soymilk, calcium-fortified, 8 ounces | 299 | 30 |
Milk, reduced-fat (2% milk fat), 8 ounces | 293 | 29 |
Milk, buttermilk, lowfat, 8 ounces | 284 | 28 |
Milk, whole (3.25% milk fat), 8 ounces | 276 | 28 |
Orange juice, calcium-fortified, 6 ounces | 261 | 26 |
Tofu, firm, made with calcium sulfate, ½ cup*** | 253 | 25 |
Salmon, pink, canned, solids with bone, 3 ounces | 181 | 18 |
Cottage cheese, 1% milk fat, 1 cup | 138 | 14 |
Tofu, soft, made with calcium sulfate, ½ cup*** | 138 | 14 |
Ready-to-eat cereal, calcium-fortified, 1 cup | 100–1,000 | 10–100 |
Frozen yogurt, vanilla, soft serve, ½ cup | 103 | 10 |
Turnip greens, fresh, boiled, ½ cup | 99 | 10 |
Kale, raw, chopped, 1 cup | 100 | 10 |
Kale, fresh, cooked, 1 cup | 94 | 9 |
Ice cream, vanilla, ½ cup | 84 | 8 |
Chinese cabbage, bok choi, raw, shredded, 1 cup | 74 | 7 |
Bread, white, 1 slice | 73 | 7 |
Pudding, chocolate, ready to eat, refrigerated, 4 ounces | 55 | 6 |
Tortilla, corn, ready-to-bake/fry, one 6″ diameter | 46 | 5 |
Tortilla, flour, ready-to-bake/fry, one 6″ diameter | 32 | 3 |
Sour cream, reduced fat, cultured, 2 tablespoons | 31 | 3 |
Bread, whole-wheat, 1 slice | 30 | 3 |
Broccoli, raw, ½ cup | 21 | 2 |
Cheese, cream, regular, 1 tablespoon | 14 | 1 |