Calcium citrate with vitamin d side effects

Calcium citrate is an over-the-counter (OTC) calcium supplement. Calcium is a mineral essential for healthy teeth and bones. It is also important for blood vessels, muscles, and nerve health and supports hormone function.

Calcium supplements are typically sold in the form of calcium carbonate or calcium citrate. Calcium citrate is more easily absorbed than calcium carbonate. Your body doesn't need stomach acid to absorb calcium citrate, making it the better choice for people who take heartburn medication or have digestive issues.

Calcium citrate comes in tablets, powder, and gummies. It can be taken on an empty stomach. However, it works best when taken with food.

This article discusses calcium citrate, its uses, and how to take it. It also details potential side effects and dosage.

Dietary supplements are not regulated in the United States, meaning the Food and Drug Administration (FDA) does not approve them for safety and effectiveness before products are marketed. When possible, choose a supplement that has been tested by a trusted third party, such as USP, ConsumerLabs, or NSF.

However, even if supplements are third-party tested, that doesn’t mean that they are necessarily safe for everyone or effective in general. It is important to talk to your healthcare provider about any supplements you plan to take and to check in about any potential interactions with other supplements or medications.

Supplement Facts

• Active ingredient(s): Calcium citrate
• Alternate name(s): Tricalcium citrate, tricalcium dicitrate, acicontral
• Legal status: OTC
• Suggested dose: 500 milligrams (mg)
• Safety considerations: May interact with some medications, including Dovato and Tivicay (dolutegravir), Synthroid and Levoxyl (levothyroxine), lithium, and quinolone antibiotics

Uses of Calcium Citrate

Supplement use should be individualized and vetted by a healthcare professional, such as a registered dietitian, pharmacist, or doctor. No supplement is intended to treat, cure, or prevent disease.

Calcium is an essential mineral that supports multiple systems throughout the body. You must maintain adequate calcium levels for your heart, nervous system, and muscles to function properly.

Calcium is probably best known for making strong bones. But beyond bones, calcium supplementation's possible benefits include potentially reducing the risk of cancer, heart disease, preeclampsia, and metabolic syndrome. It may also help some people maintain a healthy weight. Research supports some of these uses more than others.

Bone Health

Due to calcium's known role in establishing healthy, strong bones, some research has focused on whether calcium supplementation could prevent age-related bone mineral density (BMD) loss and fractures. Unfortunately, the research has had mixed results.

For example, a 2021 study evaluated the association between dietary calcium intake and BMD in older adults using data from the National Health and Nutrition Examination Survey (NHANES, 2001-2006). In 2,904 participants, researchers found that higher dietary calcium intake was associated with greater lumbar (vertebrae of the lower spine) BMD. Researchers found this benefit only in women but not in men.

On the other hand, a 2019 study on calcium intake and bone loss in postmenopausal people with osteopenia (low bone density) found no impact on bone loss. In an analysis of observational data obtained from a randomized controlled trial, researchers compared bone mineral density (BMD) and bone mineral content (BMC) in participants who took calcium supplements and those who took a placebo. Researchers found no relationship between bone loss and calcium intake.

FDA-Approved Claim

The FDA has approved health claims that adequate vitamin D and calcium intake may reduce the risk of osteoporosis.

Cancer

Due to calcium's protective effect on cells, some research has explored its potential to reduce cancer risk. However, overall, the research is mixed.

For example, a 2017 study evaluated calcium and vitamin D supplementation's effect on cancer incidence in older women. The four-year, double-blind, placebo-controlled, population-based randomized clinical trial split 2,303 postmenopausal participants into a treatment (2,000 IU/day of vitamin D3 and 1,500 mg/day of calcium) or placebo group. The treatment group did not have significantly lower cancer risk at four years compared with the placebo.

However, another older 2007 study suggested calcium plus vitamin D does have benefits. The randomized controlled trial compared the effect of calcium supplementation alone to calcium and vitamin D supplementation on cancer risk. Researchers randomized 1,179 postmenopausal participants into groups receiving 1,400-1,500 mg calcium/day alone, calcium plus 1,100 IU vitamin D3/day, or placebo. Cancer incidence was lowest in the calcium+D group.

Heart Disease

Calcium's ability to reduce lipid absorption has led to some research on its ability to reduce cardiovascular disease risk. However, the results have been mixed, with some research indicating no effects.

For example, a 2015 study evaluated 1999–2010 NHANES data on calcium intake and hypertension (high blood pressure) in adults with obesity. Among 14,408 adults, researchers found that calcium intakes were 10% lower in those with hypertension and obesity.

However, some studies have found that calcium supplementation increases the risk of heart disease. For example, a 2021 meta-analysis of clinical trials investigated the association between calcium supplements and cardiovascular disease risk. In the 13 double-blind, placebo-controlled RCTs, calcium supplements significantly increased the risk of heart disease by 15% in healthy postmenopausal people.

Health Experts' Position

The National Osteoporosis Foundation and American Society for Preventive Cardiology determined that calcium (with or without vitamin D) has no beneficial or harmful relationship to the risk of developing cardiovascular disease.

Other

In addition to the potential health benefits listed above, some people use calcium for:

• Preeclampsia
• Weight loss
• Metabolic syndrome
  

Calcium Deficiency

Some people may develop a calcium deficiency when their intakes are lower over time than recommended levels, they have a specific risk factor for lower than normal levels, or there is a particular reason they are unable to digest or absorb calcium.

What Causes a Calcium Deficiency?

When you don't get enough calcium from outside sources, such as food or supplements, or you don't absorb calcium well, your body uses calcium in your bones to keep blood levels up. Over time, pulling calcium from your bones weakens them and increases the fracture risk.

People most at risk of calcium deficiency are postmenopausal people and those who do not eat dairy.

How Do I Know If I Have a Calcium Deficiency?

A calcium deficiency may need to be properly identified and diagnosed by a healthcare provider through specific lab tests. However, certain symptoms and health conditions may signify a deficiency. These include:

• Reduced bone strength
• Osteoporosis
• Osteopenia
• Fractures
• Rickets in children
• Bone disorders in adults
  

For women over age 50, a bone density screening is an excellent way to assess bone status. If you're unsure whether you're meeting your calcium needs, a dietitian may be able to help.

What Are the Side Effects of Calcium Citrate?

Your healthcare provider may recommend you take calcium citrate for bone health. However, consuming a supplement like calcium citrate may have potential side effects. These side effects may be common or severe. 

Common Side Effects

Common side effects from calcium include:

• Gas
• Bloating
• Constipation

Most of the time, you can reduce the symptoms by taking smaller doses throughout the day or taking your supplement with a meal.

Severe Side Effects

Rarely, calcium supplementation is associated with more severe conditions, including:

• Heart disease
• Gastrointestinal disease
• Kidney stones
• Age-related macular degeneration 
• Metabolic syndrome

Controversy exists over the benefits of calcium supplements. Some researchers suspect calcium supplements aren't effective at reducing bone fractures and may cause other issues.

Precautions

If you have a history of kidney disease, kidney stones, cancer, high calcium blood levels, or parathyroid gland disorder, talk to your healthcare provider before taking calcium citrate supplements.

In addition, calcium supplements may interact with certain medications, including:

• Dovato, Tivicay (dolutegravir)
• Synthroid, Levoxyl (levothyroxine)
• Eskalith, Lithobid (lithium)
• Quinolone antibiotics, such as Cipro (ciprofloxacin), Factive (gemifloxacin), and Avelox (moxifloxacin)

Be sure to discuss calcium citrate supplementation with a healthcare provider and ask a pharmacist if you're unsure about possible interactions.

Dosage: How Much Calcium Should I Take?

Always speak with a healthcare provider before taking a supplement to ensure that the ingredients and dosage are appropriate for your individual needs. 

When it comes to calcium supplements, recognizing the exact dosage can be confusing. That's because pure calcium (elemental calcium) is mixed with a filler when manufacturing supplement pills.

For instance, calcium carbonate is 60% carbonate and 40% elemental calcium. Calcium citrate is technically just 21% calcium. Read the label to identify how much pure calcium is provided per pill.

The recommended dietary allowance (RDA) for calcium is as follows:

• 200 milligrams: Birth to 6 months
• 260 milligrams: 7 to 12 months
• 700 milligrams: 1 to 3 years old
• 1,000 milligrams: 4 to 8 years old
  
• 1,300 milligrams: 9 to 18 years old
• 1,000 milligrams: everyone 19 to 50 years old; males 51-70
• 1,200 milligrams: females over age 50 and males over age 70
  

What Happens If I Take Too Much?

As with any dietary supplement, taking more calcium than needed may do more harm than good. So, only take a supplement if you know you aren't getting enough from food and beverages and after consulting with a healthcare provider.

To avoid toxicity, be aware of the appropriate recommended dosages (above) and keep the upper limit in mind. For calcium, the safe upper limit established by the Food and Nutrition Board is as follows:

• 0-6 months: 1,000 mg
• 7–12 months: 1,500 mg
• 1–8 years: 2,500 mg
• 9–18 years: 3,000 mg
• 19–50 years: 2,500 mg
• 51+ years: 2,000 mg
  

If you consume more than this amount or more than what is recommended by a healthcare provider, you may want to seek medical attention.

How To Store Calcium Citrate

Store calcium in a cool, dry place. Keep it away from direct sunlight. Discard after one year or as indicated on the packaging.

Sources of Calcium and What To Look For

Calcium is vital for people of all ages. Children and teens are still forming their bones and should be mindful of getting sufficient calcium. Sitting down with a healthcare provider to review your dietary habits can help determine whether your intake is adequate.

Calcium is readily available in foods. Food sources are optimal because they absorb best in the body. However, supplements can also help meet daily requirements when you cannot meet your needs through food sources alone.

Food Sources of Calcium

Most people can obtain adequate calcium through food. Foods that are high in calcium include:

• Broccoli
• Calcium-fortified orange juice, soymilk, tofu, and breakfast cereal
• Cheese
• Chia seeds
• Cow's milk
• Dark, leafy greens (like kale, spinach, and turnip greens)
• Salmon or sardines canned with bones
• Yogurt

Calcium Citrate Supplements

Calcium citrate is available over the counter. Supplements usually contain 200-300 mg or 500-600 mg when combined with vitamin D. Calcium citrate can be taken on a full or empty stomach at any time of the day.

Calcium absorption is highest in lower doses of calcium. For example, you absorb around 36% of a 300 mg dose, whereas, in a 1,000 mg dose, you absorb only 28%.

Summary

Calcium is essential for strong bones, teeth, and muscles. Calcium citrate supplements can help you reach the recommended daily value, especially if you have difficulty absorbing calcium. For most people, it's possible to get enough calcium through food alone. Some people take calcium citrate for bone health and to reduce the risk of cancer and heart disease. However, the research on those benefits is mixed.

Frequently Asked Questions

• What is calcium citrate used for?

  Calcium citrate is a form of calcium supplement. Some people take calcium citrate for bone health and to prevent cancer and heart disease. However, research is mixed on most of these uses.

• What is the difference between calcium carbonate and calcium citrate?

  Calcium carbonate and calcium citrate are the two most common calcium supplements. Calcium citrate absorbs better when taken with a meal. In addition, calcium carbonate is 40% calcium by weight, whereas citrate is 21%.

• When should I take calcium citrate?

  Calcium citrate can be taken in single doses or spaced throughout the day. It is recommended to take it with a meal for the best absorption. However, it does not need to be taken with food. It just works better when you do.

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