You may have wondered why calcium is not on the list of nutritional supplements I advocate, despite being one of the few nutrients that conventional physicians advise patients to take, especially females since they are at greater risk for osteopenia (mild bone thinning), osteoporosis (more severe bone thinning), and bone fractures. There is no doubt that calcium is an essential mineral that participates in numerous physiologic processes and is crucial for health, including bone health. If blood levels of calcium are low, for instance, a situation called “tetany” develops in which dangerous involuntary muscle spasms can occur. Low calcium can also cause heart rhythm abnormalities and seizures, some of which are fatal.

Under normal circumstances, your body, especially parathyroid hormone and vitamin D, tightly regulate blood levels of calcium: not too high, not too low. If blood calcium is trending downward (hypocalcemia), your body reacts by increasing the release of parathyroid hormone (PTH) from the parathyroid glands (near the thyroid) to mobilize calcium stored in bones, while also reducing loss of calcium in urine and increasing absorption of calcium from the small intestine. If calcium is too high (hypercalcemia), PTH is suppressed to reduce the amount of calcium mobilized from these organs. If vitamin D deficiency is present, it causes increased PTH levels that, in turn, can lead to bone thinning and kidney stones. We also lose calcium every day in urine and stool. Because the human body does not manufacture calcium, we therefore rely on dietary intake.

If this mineral is so important for health, why isn’t calcium supplementation part of my programs? There are a number of reasons for why you will not see advice to add calcium supplements for anyone on my programs:

    • When you eliminate wheat and grains from the diet, you eliminate grain-sourced phytates that bind calcium, causing you to pass about 50% of dietary calcium into the toilet. Eliminating wheat and grains thereby significantly increasing calcium absorption.
    • The gluten from wheat and related proteins from other grains cause calciuria, i.e., urinary loss of calcium. In one study, increased wheat consumption increased urinary calcium loss by 63%. Elimination of gluten sources therefore decreases urinary loss of calcium.
    • Vitamin D is the master control factor over calcium absorption in the small intestine. Without vitamin D, intestinal calcium is not absorbed. Vitamin D supplementation  increases intestinal calcium absorption from foods such as broccoli, nuts, and legumes. Vitamin D restoration is therefore front and center in may programs, dosing designed to achieve what I believe is an ideal level of 60-70 ng/ml of 25-OH vitamin D.
    • Beneficial “probiotic” GI species increase intestinal calcium absorption. This includes numerous species of Lactobacillus, Bifidobacteria, Clostridia, and Streptococcus. Conversely, small intestinal bacterial overgrowth (SIBO) impairs calcium absorption and is therefore commonly associated with bone thinning and fractures. Efforts to restore a healthy GI microbiome are therefore a major component of my programs.
    • Prebiotic fiber ingestion (galactooligosaccharides, fructooligosaccharides, inulin, others), as we do in my programs, increases intestinal calcium absorption. This also leads to increased production of intestinal butyrate that adds further to enhancing intestinal calcium absorption. The inclusion of fermented foods—kimchi, kefir, fermented veggies—in my programs increases intestinal butyrate that also facilitates calcium absorption.
    • Calcium supplementation has little to no effect on increasing bone density nor reducing osteoporotic fractures.
    • There is preliminary (epidemiological observational) evidence that “bolus” dosing of calcium, i.e., taking it in large doses all at once as a nutritional supplement, rather than the small episodic intake of calcium in foods consumed over the course of a day, increases cardiovascular events and cardiovascular death, with evidence also suggesting that calcium supplements increase the likelihood of increased coronary artery calcium.

We also supplement magnesium that increases bone density. We restore the lost GI microbe, Lactobacillus reuteri, that, through increased oxytocin release from the brain, has been demonstrated to dramatically reduce bone loss and preserve bone density.

You can see that the idea of just supplementing calcium is wildly overly-simplistic and neglects many other factors entering into the equation. Supplementing calcium as bolus doses over and above that of dietary intake is not only minimally effective or ineffective, it may also be dangerous. The lifestyle that I advocate of avoiding all wheat and grains and thereby gluten and related proteins, supplementing vitamin D to achieve a 25-OH vitamin D blood level of 60-70 ng/ml, rebuilding a broken microbiome and correcting SIBO, ensuring vigorous prebiotic fiber intake, including fermented foods, supplementing magnesium, and restoring L. reuteri at very high counts yields powerful synergistic effects on maintaining, even rebuilding bone health. By engaging in these strategies, you have gone far beyond the simplistic idea of supplementing calcium that, in this context, is simply unnecessary.