Image

Calcium + Vit D3 + Vit K2

Calcium with Vit D to improve absorbability, and Vit K2 to target the calcium to your bones. Calcium citrate form is also used so it is less dependent on stomach acid for absorption.

Get your vivaBALANCE subscription

Calcium makes up much of the structure of bones and teeth and allows normal bodily movement by keeping tissue rigid, strong, and flexible. The small ionized pool of calcium in the circulatory system, extracellular fluid, and various tissues mediates blood vessel contraction and dilation, muscle function, blood clotting, nerve transmission, and hormonal secretion 

A lack of calcium may be involved in: 

  • bone health in older adults,
  • cancer, 
  • cardiovascular disease (CVD), 
  • preeclampsia, 
  • weight management, and 
  • metabolic syndrome.


*This fact sheet by vivaLAB is for information purposes only and should not take the place of medical advice. These statements have not been evaluated by the Therapeutic Goods Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

The following groups are among those most likely to need extra calcium. 

Postmenopausal women
Menopause leads to bone loss because decreases in estrogen production reduce calcium absorption and increase urinary calcium loss and calcium resorption from bone [1]. On average, women lose approximately 1% of their bone mineral density (BMD) per year after menopause [25]. Over time, these changes lead to decreased bone mass and fragile bones [1]. About 30% of postmenopausal women in the United States and Europe have osteoporosis, and at least 40% of those with this condition develop at least one fragility fracture (a fracture that occurs after minor trauma, such as a fall from standing height or lower) [26].

Individuals who avoid dairy products
People with lactose intolerance, those with an allergy to milk, and those who avoid eating dairy products (including vegans) have a higher risk of inadequate calcium intakes because dairy products are rich sources of calcium [1,27]. Options for increasing calcium intakes in individuals with lactose intolerance include consuming lactose-free or reduced-lactose dairy products, which contain the same amounts of calcium as regular dairy products [1,3]. Those who avoid dairy products because of allergies or for other reasons can obtain calcium from nondairy sources, such as some vegetables (e.g., kale, broccoli, and Chinese cabbage [bok choi]), canned fish with bones, or fortified foods (e.g., fruit juices, breakfast cereals, and tofu) [1]. However, these individuals typically need to eat foods fortified with calcium or take supplements to obtain recommended amounts [28].

References:

  1. Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press; 2011.
  2. Weaver CM, Heaney RP. Calcium. In: Ross AC, Caballero B, Cousins RJ, Tucker KL, Ziegler TR, eds. Modern Nutrition in Health and Disease. 11th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2014:133-49.
  3. Tai V, Leung W, Grey A, Reid IR, Bolland MJ. Calcium intake and bone mineral density: systematic review and meta-analysis. BMJ 2015;351:h4183. [PubMed abstract]
  4. Cano A, Chedraui P, Goulis DG, Lopes P, Mishra G, Mueck A, et al. Calcium in the prevention of postmenopausal osteoporosis: EMAS clinical guide. Maturitas 2018;107:7-12. [PubMed abstract]
  5. Boaventura RM, Mendonca RB, Fonseca FA, Mallozi M, Souza FS, Sarni ROS. Nutritional status and food intake of children with cow’s milk allergy. Allergol Immunopathol (Madr) 2019;47:544-50. [PubMed abstract]
  6. Bakaloudi DR, Halloran A, Rippin HL, Oikonomidou AC, Dardavesis TI, Williams J, et al. Intake and adequacy of the vegan diet. A systematic review of the evidence. Clin Nutr 2021;40:3503-21. [PubMed abstract]

Almost all (98%) calcium in the body is stored in the bones, and the body uses the bones as a reservoir for, and source of, calcium to maintain calcium homeostasis [1]. More than 99% of calcium in the body is in the form of calcium hydroxyapatite, an inorganic matrix of calcium and phosphate that is stored in the bones and teeth [1,4,5]. Unlike teeth, bone undergoes continuous remodeling, with constant resorption and deposition of calcium into new bone [4]. Bone remodeling is required to change bone size during growth, repair damage, maintain serum calcium levels, and provide a source of other minerals [4].

A  lack of calcium may play a role in the following health conditions and diseases: bone health in older adults, cancer, cardiovascular disease (CVD), preeclampsia, weight management, and metabolic syndrome.


References:

  1. Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press; 2011.
  2. Heaney RP. Calcium. In: Coates PM, Betz JM, Blackman MR, et al., eds. Encyclopedia of Dietary Supplements. 2nd ed. London and New York: Informa Healthcare; 2010:101-6.
  3. Weaver CM, Heaney RP. Calcium. In: Ross AC, Caballero B, Cousins RJ, Tucker KL, Ziegler TR, eds. Modern Nutrition in Health and Disease. 11th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2014:133-49.
  4. Weaver CM. Calcium. In: Marriott BP, Birt DF, Stallings VA, Yates AA, eds. Present Knowledge in Nutrition. 11th ed. Cambridge, Massachusetts: Wiley-Blackwell; 2020:321-48.
  5. Wawrzyniak N, Suliburska J. Nutritional and health factors affecting the bioavailability of calcium: a narrative review. Nutr Rev 2021. [PubMed abstract]

Key sources of calcium include: 

  1. Milk, yogurt, and cheese are rich natural sources of calcium. 
  2. Non-dairy sources include canned sardines and salmon with bones as well as certain vegetables, such as kale, broccoli, and Chinese cabbage (bok choi). 
  3. Most grains do not have high amounts of calcium unless they are fortified. However, they contribute to calcium intakes, even though they contain small amounts of calcium, because people consume them frequently.
  4. Foods fortified with calcium include many fruit juices and drinks, tofu, and ready-to-eat cereals.

Calcium has the potential to interact with certain medications, and several types of medications might adversely affect calcium levels. A few examples are provided below. Individuals taking these and other medications on a regular basis should discuss their calcium status with their health care providers. 

Dolutegravir
Dolutegravir (Dovato, Tivicay) is an HIV integrase inhibitor used in adults and children. Concomitant use of calcium supplements and dolutegravir can reduce blood levels of dolutegravir substantially, apparently through chelation [1,2]. The labels approved by the FDA for dolutegravir advise patients to take dolutegravir 2 hours before or 6 hours after taking calcium supplements [3,4]. 

Levothyroxine 
Calcium carbonate supplements can interfere with the absorption of levothyroxine (Synthroid, Levoxyl, and others), a thyroid hormone used to treat hypothyroidism and thyroid cancer [5-7]. The FDA-approved label for this medication instructs patients taking calcium carbonate supplements to avoid taking levothyroxine within 4 hours of taking the supplement [8]. 

Lithium 
Long-term use of lithium (Eskalith, Lithobid), a treatment for bipolar disorder, can lead to hypercalcemia, and use of both lithium and calcium supplements could increase this risk [9]. 

Quinolone antibiotics 
Simultaneous use of calcium supplements and quinolone antibiotics—such as ciprofloxacin (Cipro), gemifloxacin (Factive), and moxifloxacin (Avelox)—can reduce the absorption of quinolones [10-11]. Taking the antibiotic 2 hours before or 2 hours after calcium supplements prevents this effect [8]].


References:

  1. Song I, Borland J, Arya N, Wynne B, Piscitelli S. Pharmacokinetics of dolutegravir when administered with mineral supplements in healthy adult subjects. J Clin Pharmacol 2015;55:490-6. [PubMed abstract]
  2. Jalloh MA, Gregory PJ, Hein D, Risoldi Cochrane Z, Rodriguez A. Dietary supplement interactions with antiretrovirals: a systematic review. Int J STD AIDS 2017;28:4-15 [PubMed abstract]
  3. U.S. Food and Drug Administration. Tivicay Labelexternal link disclaimer. 2020.
  4. U.S. Food and Drug Administration. Dovato Labelexternal link disclaimer. 2019.
  5. Morini E, Catalano A, Lasco A, Morabito N, Benvenga S. L-thyroxine malabsorption due to calcium carbonate impairs blood pressure, total cholesterolemia, and fasting glycemia. Endocrine 2019;64:284-92. [PubMed abstract]
  6. Singh N, Singh PN, Hershman JM. Effect of calcium carbonate on the absorption of levothyroxine. Jama 2000;283:2822-5. [PubMed abstract]
  7. Schneyer CR. Calcium carbonate and reduction of levothyroxine efficacy. Jama 1998;279:750. [PubMed abstract]
  8. U.S. Food and Drug Administration. LEVO-T Labelexternal link disclaimer. 2017.
  9. Jones BJ, Twomey PJ. Requesting patterns for serum calcium concentration in patients on long-term lithium therapy. Int J Clin Pract 2009;63:170-2. [PubMed abstract]
  10. Pletz MW, Petzold P, Allen A, Burkhardt O, Lode H. Effect of calcium carbonate on bioavailability of orally administered gemifloxacin. Antimicrob Agents Chemother 2003;47:2158-60. [PubMed abstract]
  11. Kays MB, Overholser BR, Mueller BA, Moe SM, Sowinski KM. Effects of sevelamer hydrochloride and calcium acetate on the oral bioavailability of ciprofloxacin. Am J Kidney Dis 2003;42:1253-9. [PubMed abstract]

Always read the label. Follow the directions for use. If symptoms persist, consult your healthcare professional. Vitamin supplements should not replace a balanced diet. If you have any pre-existing conditions, or are on any medications always talk to your health professional before use. Store your daily packs below 25°C in a cool, dry place, away from humidity and direct sunlight.