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I'm trying to be vegan, and purely natural foods lack sufficient calcium for the Recommended Daily Intake. Links 2 to 4 (but not 1) assert a correlation between calcium supplements and disease.

[1. WebMD :] "Keep in mind that there's really not that much difference between getting calcium in a supplement and calcium in food."
"Calcium-fortified foods -- such as cereals, some juices, and soy milk -- are excellent sources of the mineral, experts tell WebMD."

[2. health.harvard.edu :] An 8-ounce portion of off-the-shelf orange juice contains about 300 mg of calcium. The calcium in fortified soy milk also compares favorably to whole milk. Breakfast cereals (which are also fortified) contain substantial amounts of calcium, especially when combined with low-fat milk. A portion of oatmeal on its own contains just 100 mg of calcium. “But if you cut up some dried figs and add it to a bowl of oatmeal with milk, you easily get about half of what you need without having any supplements,” Dr. Hauser says.

[3. NY Times Blog :] All the researchers agree that, given the widespread use of supplemental calcium, better studies are needed to clarify possible risks and benefits, and to whom they may apply.

Until such information is available, consumers seeking to preserve their bones would be wise to rely primarily on dietary sources of the mineral and to pursue regular weight-bearing or strength-building exercises, or both. Walking, running, weight lifting and working out on resistance machines is unquestionably effective and safe for most adults, if done properly.

[4. NY Times :] The institute’s expert committee, which included bone specialists, concluded that most people don’t need supplements of these critical nutrients and warned of serious health risks from the high doses some now take — including kidney stones and heart disease linked to calcium supplements, and the very falls and fractures that vitamin D is meant to protect against.

5. How and why would the calcium carbonate from calcium supplements be asserted as worse than that in the fortified foods?

6. Isn't solid calcium carbonate (e.g. in supplements) chemically the same as aqueous calcium carbonate (e.g. in fortified drinks)?

7. Are calcium supplements really worse than fortified foods with calcium?

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This is close to a personal medical question, so I'll try and be vague and avoid advice.

There's nothing inherently bad about calcium supplements, and those links and thousands of others that are easy to find tend to all say that same thing. Basically, for typical people on a typical diet, enough calcium is supplied through food that supplements are unnecessary. The problem arises when people take too many supplements, such that their intake is significantly higher than the daily recommended intake. These people can experience a number of symptoms, including kidney and heart failure. Fortified food and supplements are, as best as I can tell, no different, except that food is simpler route for intake with built-in limit-setting. That is, you can easily pop five calcium pills (BAD IDEA) but nobody is ever going to drink five containers of fortified soy "milk" on a whim.

My go-to example is that of astronauts. Astronauts who are in space for extended periods of time must take calcium supplements, in addition to a strict exercise regimen to help stem the tide of bone loss. Bone loss still occurs, however, because they can only take so much calcium before it starts to cause serious heart problems. There's nothing inherently wrong with calcium supplements but for most people they are completely unnecessary. You should talk to your primary care physician and perhaps a dietician.

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1 - probably because of regulation in the U.S. (and maybe other nations??). Nutrients added via fortification are regulated by the F.D.A essentially as foods. Nutrients in supplements are regulated essentially as manufactured goods. The difference -- despite both being ingested by us -- is a major source of concern. See http://www.fda.gov/Food/DietarySupplements/

3 - as a patient, that question is best answered by your doctor via blood sampling. My doctor found VitD deficiency in me, which can cause calcium uptake problems; but like the previous answer, people who aren't monitoring their serum levels and medicating themselves could overdose on any fortified or supplement nutrients.

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