A simple way to estimate one's daily intake of dietary calcium is to multiply the number of dairy servings consumed each day by 300 mg. One serving equals 8 oz of milk or yogurt, 1 oz of hard cheese, 16 oz of cottage cheese, or 2 cups of broccoli.
Taking calcium carbonate with meals to help ensure optimal absorption. On the other hand, some evidence indicates that such supplementation with meals reduces iron absorption from food by about 50 percent. Thus, patients should consider taking calcium carbonate with a low-iron meal such as breakfast to avoid possible iron deficiency.
For elderly people who may absorb calcium carbonate less readily (because of less acid in the stomach), physicians recommend preparations of calcium citrate.
Taking chewable preparations of calcium carbonate (eg, Tums™) or calcium citrate since many natural calcium carbonate preparations (eg, bone meal, oyster shells) are poorly soluble. In addition, there is evidence that most of the natural calcium carbonate preparations have lead contamination. Therefore, we currently recommend either Tums or Citracal (a calcium citrate preparation).
In addition, patients should be aware of the following:
The daily intake recommendations described above apply to "elemental calcium." More specifically, calcium carbonate is 40 percent elemental calcium. Therefore, 500 mg of calcium carbonate contains 200 mg of elemental calcium.
Calcium supplementation in excess of 500 mg/day should be taken in divided doses. Single doses above this level may cause a "plateau" in calcium absorption, thus preventing attainment of a positive calcium balance.
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