Safety of Calcium Supplementation- New Evidence

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 GuidelineReview, 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

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