Dietary Guidelines Advisory Committee. Similarly, in a follow-up study an average of 55 months after administration of 1,200 mg/day calcium, 1,000 IU (25 mcg)/day vitamin D3, or both for 3 to 5 years in 1,121 participants, supplements had no effect on risk of recurrent adenomas [55]. Accessed Oct. 18, 2020. The American Journal of Clinical Nutrition 2008;87:792-. How to take Other sources Summary Calcium phosphate is a compound that contains both calcium and phosphorus. . Microcrystalline hydroxyapatite (MCH) could affect serum Ca concentrations less than conventional Ca supplements, but it There are several differences to note: 2. However, in analyses of results for various sources of calcium, only calcium from dairy foods was significantly associated with prostate cancer risk (2.9 times higher in men with intakes greater than 696 mg/day than in those with intakes less than 354 mg/day); calcium intakes from non-dairy sources were not significantly associated with prostate cancer risk. Metabolic syndrome is a set of at least three risk factors for heart disease, stroke, and diabeteslarge waistline, high triglyceride level, low high-density lipoprotein cholesterol level, high blood pressure, and high fasting blood sugar level. Systematic review of the potential adverse effects of caffeine consumption in healthy adults, pregnant women, adolescents, and children. As a result, absorption of calcium is only 5% for spinach, whereas it is much higher, at 27%, for milk [3]. Calcium supplements cause few, if any, side effects. about your interest in, questions about, or use of dietary supplements and what may be best for your overall health. It's described on your label as 'calcium from calcium carbonate ' or calcium citrate. Osteoporos Int 2014;25:2047-56. Allergol Immunopathol (Madr) 2019;47:544-50. Yulia Reznikov/Getty Images. Sterculia. In contrast, an analysis of baseline data from a randomized trial in Australia in 1,994 women older than 65 years whose average dietary calcium intake was 886 mg/day found no association between quintile of calcium intake and BMD at any site, even after adjustment for such factors as age, physical activity, height, and weight [31]. J Natl Cancer Inst 2008;100:1581-91. Other Cancers. A systematic review of the evidence. Prepregnancy and early pregnancy calcium supplementation among women at high risk of pre-eclampsia: a multicentre, double-blind, randomised, placebo-controlled trial. For a general overview of Calcium, see our consumer fact sheet on Calcium. Click here for an email preview. Calcium intake and bone mineral density: systematic review and meta-analysis. Other forms of calcium in supplements include gluconate and lactate. [, Hofmeyr GJ, Manyame S, Medley N, Williams MJ. Constipation is more likely with high doses of calcium and with calcium supplements in the form of calcium carbonate, especially if you take calcium carbonate on an empty stomach. Your body doesn't produce calcium, so you must get it through other sources. All varieties of calcium supplements are better absorbed when taken in small doses (500 mg or less) at mealtimes. Limited evidence for calcium supplementation in preeclampsia prevention: a meta-analysis and systematic review. Adults may have low bone mass, which is a risk factor for osteoporosis. Preeclampsia However, a systematic review and meta-analysis of four RCTs (not including the 2013 study by Cauley and colleagues) found that daily supplementation with 1,200 to 2,000 mg elemental calcium for 36 to 60 months reduced the likelihood of recurrent adenomas by 11%, although the supplements had no effect on risk of advanced adenomas [56]. Nutritional status and food intake of children with cow's milk allergy. More severe signs and symptoms can include renal calcification or injury, brain calcification, neurologic symptoms (e.g., depression and bipolar disorder), cataracts, congestive heart failure, paresthesia, seizures, and, in rare cases, coma [22,24]. Calcium intake from diet and supplements and the risk of coronary artery calcification and its progression among older adults: 10-year follow-up of the Multi-Ethnic Study of Atherosclerosis (MESA). Dietary supplements verification program. Calcium supplements cause few, if any, side effects. Clinical trials have also not shown that supplemental calcium alone or combined with vitamin D has an impact on risk of mortality from all cancers. [, Magee LA, Pels A, Helewa M, Rey E, von Dadelszen P. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy: executive summary. In the United States, people make 2.5 million visits to the doctor for constipation every year. [. The 6 Best Calcium Supplements of 2023 - Verywell Health Jama 2017;318:2466-82. 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]. An analysis of data on 132,823 participants in the Cancer Prevention Study II Nutrition Cohort, who were followed for an average of 17.5 years, found no association between total dietary and supplemental calcium intakes and risk of cancer-related death or death from lung, colorectal, breast, or prostate cancer in men or women [47]. [, Bove-Fenderson E, Mannstadt M. Hypocalcemic disorders. 1-2 teaspoons 1-2/day. Natural Medicines. Constipation can occur from a high-fibre diet if insufficient water is consumed. Levothyroxine An inverse relationship exists between calcium intake and absorption. They are based on observational evidence from the WHI showing a link between higher intakes of supplemental calcium (1,000 mg/day for 7 years) and a greater risk of kidney stones [96,97]. Archives of Internal Medicine 2007;167:893-902. Br J Nutr 2006;95:539-45. Evidence on dose-response relationships between calcium intakes and risk of stroke or stroke mortality was inconsistent. The RDA for vitamin D is 600 international units (15 micrograms) a day for most adults. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Join the ODS Email List. [, Marshall K, Teo L, Shanahan C, Legette L, Mitmesser SH. In addition to spinach, foods with high levels of oxalic acid include collard greens, sweet potatoes, rhubarb, and beans [1]. The calcium RDA is 1,200 mg for women older than 50 years (vs. 1,000 mg for younger women) to lessen bone loss after menopause [1]. Additional well-designed randomized trials are needed to determine whether dietary or supplemental calcium intakes increase, decrease, or have no effect on risk of cancer in general or of specific types of cancer, or on cancer mortality. For children aged 219, mean daily intakes of calcium from foods and beverages range from 965 to 1,015 mg [18]. [, Weaver CM, Alexander DD, Boushey CJ, Dawson-Hughes B, Lappe JM, LeBoff MS, et al. Calcium Hydroxyapatite: Calcium Hydroxyapatite is a more easily absorbable, whole mineral form of calcium. Nutrients 2017;9. Am J Clin Nutr 2016;103:886-94. Intake recommendations for calcium and other nutrients are provided in the Dietary Reference Intakes (DRIs) developed by the Food and Nutrition Board (FNB) at the National Academies of Sciences, Engineering, and Medicine [1]. Accessed Oct. 18, 2020. Accessed Oct. 18, 2020. Aust N Z J Obstet Gynaecol 2015;55:e1-29. Preeclampsia is defined as hypertension and proteinuria or thrombocytopenia during pregnancy, usually after 20 weeks gestation [74]. https://www.bones.nih.gov/health-info/bone/bone-health/nutrition/calcium-and-vitamin-d-important-every-age. Best Pract Res Clin Endocrinol Metab 2018;32:639-56. We encourage you to talk to your health care providers (doctor, registered dietitian, pharmacist, etc.) [, Chen M, Pan A, Malik VS, Hu FB. Support for such a link comes from an analysis of 20012006 NHANES cross-sectional data on 2,904 adults aged 60 and older (54.6% women) showing an association between higher dietary calcium intakes and greater lumbar spine BMD, but only in women [30]. [, World Health Organization. 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]. In spite of the observational evidence supporting an association between higher calcium intakes and lower colorectal cancer risk, clinical trials investigating calcium supplements for prevention of colorectal cancer or adenomas have had mixed results. Clinical trials and meta-analyses of RCTs assessing the impact of calcium supplements or increased intakes of calcium from dairy products on prevention of weight gain or promotion of fat loss or weight loss have had mixed results [88-92]. Some studies have shown that high calcium intake from dairy products and supplements may increase risk, whereas another more recent study showed no increased risk of prostate cancer associated with total calcium, dietary calcium or supplemental calcium intakes. But when the analysis was restricted to trials with 4,000 or more women, the effect was no longer statistically significant. The large WHI study described above also found no benefit of supplemental calcium and vitamin D on cancer incidence [42]. Calcium carbonate appears to cause more of these side effects than calcium citrate, especially in older adults who have lower levels of stomach acid [1]. Dietary supplements An RCT in 1,355 women in Argentina, South Africa, and Zimbabwe also found that 500 mg/day calcium supplementation starting before conception made no difference in the risk of preeclampsia [80,81]. Fosamax (alendronate) works by inhibiting osteoclasts which are responsible for breaking down and reabsorbing bone (by a process known as bone resorption). [, Calderwood AH, Baron JA, Mott LA, Ahnen DJ, Bostick RM, Figueiredo JC, et al. Dietary calcium intake and adiposity in children and adolescents: Cross- sectional and longitudinal results from IDEFICS/I.Family cohort. Obstet Gynecol 2013;122:1122-31. [, Bristow SM, Bolland MJ, MacLennan GS, Avenell A, Grey A, Gamble GD, et al. This is a fact sheet intended for health professionals. Includes a variety of vegetables, fruits, whole grains, fat-free or low-fat milk and milk products, and oils. 1. If you take 1,000 mg/day of calcium from supplements, for example, it is better to take a smaller dose twice a day than to take it all at once. Vitamin D is required for calcium to be absorbed in the gut by active transport and to maintain adequate calcium levels in blood [1]. Dietary calcium intake and bone loss over 6 years in osteopenic postmenopausal women. Seek care from your doctor if you experience recurrent or chronic episodes of constipation. Calcium absorption varies by type of food. Dietary calcium intake and the risk of metabolic syndrome: a systematic review and meta-analysis. Calcium Carbonate vs Calcium Citrate: Which Form Is Best? - Verywell Health However, in subgroup analyses, calcium had no effect on femoral neck BMD. Colorectal Cancer. Hypercalcemia and hypercalciuria can cause poor muscle tone, renal insufficiency, hypophosphatemia, constipation, nausea, weight loss, fatigue, polyuria, heart arrhythmias, and a higher risk of CVD mortality [1,4,48]. [, Anderson JJ, Kruszka B, Delaney JA, He K, Burke GL, Alonso A, et al. Calcium supplements might cause gas, bloating, and constipation in some people. Mayo Clinic on Incontinence - Mayo Clinic Press, Mayo Clinic on Hearing and Balance - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Nutritional Supplements at Mayo Clinic Store. Conclusion. Nutr Metab Cardiovasc Dis 2015;25:623-34. [, Kays MB, Overholser BR, Mueller BA, Moe SM, Sowinski KM. Lancet 2019;393:330-9. A post-hoc analysis of data from a double-blind, randomized controlled trial (RCT) of 1,000 mg elemental calcium in the form of calcium carbonate and 400 International Units (IU) (10 microgram [mcg]) vitamin D3 daily or placebo in 36,282 women aged 5079 years enrolled in the Womens Health Initiative (WHI) found that the supplementation did not prevent height loss after a mean follow-up period of 5.9 years [32]. A substantial proportion of people in the United States consume less than recommended amounts of calcium. Metabolic syndrome When people eat many different types of foods, these interactions with oxalic or phytic acid probably have little or no nutritional consequence. NSF International. [, Hidayat K, Chen GC, Zhang R, Du X, Zou SY, Shi BM, et al. The Dietary Guidelines for Americans describes a healthy eating pattern as one that: This fact sheet by the National Institutes of Health (NIH) Office of Dietary Supplements (ODS) provides information that should not take the place of medical advice. Risk of heart failure among postmenopausal women: a secondary analysis of the randomized trial of vitamin D plus calcium of the women's health initiative. According to 20092012 NHANES data, rates of calcium inadequacy (intakes below the EAR) are higher among non-Hispanic Blacks and non-Hispanic Asians (4748%) than among Hispanics (30%) and non-Hispanic Whites (24%) in the United States [19]. [, Myung S-K, Kim H-B, Lee Y-J, Choi Y-J, Oh S-W. Calcium supplements and risk of cardiovascular disease: a meta-analysis of clinical trials. Check the ingredient list to see which form of calcium your calcium supplement is and what other nutrients it may contain. An analysis of 20072010 data from the National Health and Nutrition Examination Survey (NHANES) found that 49% of children aged 418 years and 39% of all individuals aged 4 and older consume less than the EAR for calcium from foods and supplements [17]. For breast cancer, observational studies have had mixed findings on whether higher calcium intakes are associated with a lower risk. Because of its ability to neutralize stomach acid, calcium carbonate is contained in some over-the-counter antacid products, such as Tums and Rolaids. What Are the Dangers of Calcium Aspartate Anhydrous? Accessed Oct. 18, 2020. Estimated Average Requirement (EAR): Average daily level of intake estimated to meet the requirements of 50% of healthy individuals; usually used to assess the nutrient intakes of groups of people and to plan nutritionally adequate diets for them; can also be used to assess the nutrient intakes of individuals. Some individuals who take calcium supplements might experience gastrointestinal side effects, including gas, bloating, constipation, or a combination of these symptoms. J Obstet Gynaecol Can 2014;36:416-41. Your body must be able to absorb the calcium for it to be effective. U.S. Department of Health and Human Services and U.S. Department of Agriculture. [, Song I, Borland J, Arya N, Wynne B, Piscitelli S. Pharmacokinetics of dolutegravir when administered with mineral supplements in healthy adult subjects. The results showed that calcium supplementation alone had no effect on risk of hip fracture, and supplementation with both calcium and vitamin D had no effect on risk of hip fracture, nonvertebral fracture, vertebral fracture, or total fracture. The forms of calcium in supplements contain varying amounts of elemental calcium. The World Health Organization recommends 1,5002,000 mg/day calcium for pregnant women with low dietary calcium intakes to reduce preeclampsia risk [82]. Average daily calcium intakes from both foods and supplements are 1,156 mg for men, 1,009 mg for women, and 968 to 1,020 mg for children [18]. Calcium phosphate: What is it and what are the risks? - Medical News Today In addition, calcium supplements had no effect on body weight or body fat. information and will only use or disclose that information as set forth in our notice of Vitamin D, calcium, or combined supplementation for the primary prevention of fractures in community-dwelling adults: evidence report and systematic review for the US Preventive Services Task Force. For instance, if you have a health condition that causes excess calcium in your bloodstream (hypercalcemia), you should avoid calcium supplements. Am J Clin Nutr 2007;85:1586-91. Hypercalciuria, too much calcium in your urine, is associated with 90 percent of kidney stone cases. Implications for implementing national strategies of calcium fortification. All rights reserved. NIH Osteoporosis and Related Bone Diseases National Resource Center. Common calcium supplements may be labeled as: The two main forms of calcium supplements are carbonate and citrate. Colorectal cancer rates did not differ between groups. The labels approved by the FDA for dolutegravir advise patients to take dolutegravir 2 hours before or 6 hours after taking calcium supplements [101,102]. So can using a fiber supplement with psyllium seed or methylcellulose. Nutr Rev 2006;64:S53-6. [, Wongdee K, Rodrat M, Teerapornpuntakit J, Krishnamra N, Charoenphandhu N. Factors inhibiting intestinal calcium absorption: hormones and luminal factors that prevent excessive calcium uptake. Maturitas 2018;107:7-12. J Womens Health (Larchmt) 2018;27:561-8. It is a naturally occurring mineral that is a large component of bones and teeth.. J Bone Miner Res 2015;30:1758-66. An expert panel convened by the National Osteoporosis Foundation and American Society for Preventive Cardiology determined, on the basis of moderate-quality evidence, that calcium intakes with or without vitamin D from foods or supplements neither increase nor decrease the risk of CVD or CVD mortality [73]. October 6, 2022 More evidence, including from well-designed clinical trials, is needed to determine whether higher intakes of calcium can reduce the risk of metabolic syndrome. Hypocalcemia (serum calcium level less than 8.5 mg/dL [2.12 mmol/L] or an ionized calcium level below 4.61 mg/dL [1.15 mmol/L]) is usually a result of a vitamin D or magnesium deficiency, impaired parathyroid hormone (PTH) production leading to hypoparathyroidism, impaired bone resorption of calcium, critical illness, or use of certain medications (e.g., bisphosphonates, cisplatin, or proton pump inhibitors) [22,23]. Fosamax: 7 things you should know - Drugs.com Calcium in the prevention of postmenopausal osteoporosis: EMAS clinical guide. Heaney RP. A Calcium Supplement That Does Not Constipate | livestrong Independent associations of dairy and calcium intakes with colorectal cancers in the Adventist Health Study-2 cohort. Br J Nutr 2013;110:1384-93. [, Yang B, Campbell PT, Gapstur SM, Jacobs EJ, Bostick RM, Fedirko V, et al. Calcium fact sheet for professionals. History of changes to this fact sheet, U.S. Department of Health & Human Services, Division of Program Coordination, Planning, and Strategic Initiatives, Strengthening Knowledge and Understanding of Dietary Supplements, My Dietary Supplement and Medicine Record, Analytical Methods and Reference Materials (AMRM), NIH Consortium for Advancing Research on Botanical and Other Natural Products (CARBON) Program, Computer Access to Research on Dietary Supplements (CARDS) Database, Dietary Supplement Ingredient Database (DSID), ODS Participation in NIH Funding Initiatives, Administrative Supplements for Research on Dietary Supplements, Administrative Supplements for Validation Studies of Analytical Methods, Frequently Asked Questions About ODS Grants & Co-funding, Resources for Investigators Submitting Natural Products Research Grant Applications, Staff Bios, Publications, and Presentations, Federal Working Group on Dietary Supplements, NIH Dietary Supplement Research Coordinating Committee, Food Labeling: Revision of the Nutrition and Supplement Facts Labels, Small Entity Compliance Guide: Health Claims on Calcium and Osteoporosis; and Calcium, Vitamin D, and Osteoporosis, Sardines, canned in oil, with bones, 3 ounces, Tofu, firm, made with calcium sulfate, cup***, Salmon, pink, canned, solids with bones, 3 ounces, Tofu, soft, made with calcium sulfate, cup***, Breakfast cereals, fortified with 10% of the DV for calcium, 1 serving, Frozen yogurt, vanilla, soft serve, cup, Chinese cabbage (bok choi), raw, shredded, 1 cup, Apple, golden delicious, with skin, 1 medium. What is third-party certification? The body's ability to absorb calcium and other minerals may decline with age, however, the minerals in hydroxyapatite are bioavailable and may be well absorbed. Nutr Cancer 2011;63:827-41. [, Sempos CT, Durazo-Arvizu RA, Fischer PR, Munns CF, Pettifor JM, Thacher TD. [, U. S. Preventive Services Task Force, Grossman DC, Curry SJ, Owens DK, Barry MJ, Caughey AB, et al. This information is important if you have any health or dietary concerns. Endocrine 2019;64:284-92. Should You Take Calcium and Magnesium Together? | livestrong Several large observational studies have shown an association between lower calcium intakes and higher risk of hypertension, stroke, and atherosclerosis. In 12 trials in 2,334 women, doses of less than 1,000 mg/day (usually 500 mg/day) reduced the risk of high blood pressure by 47% and of preeclampsia by 62%. What to Do When Calcium Supplements Cause Constipation - Pharmacy Times In spite of the importance of calcium in bone health, observational evidence is mixed on the link between calcium intakes and measures of bone strength in older adults. This amount rises quickly after birth, reaching about 1,200 g in women and 1,400 g in men by adulthood [1]. Calcium plus vitamin D supplementation and the risk of postmenopausal weight gain. [, Nappo A, Sparano S, Intemann T, Kourides YA, Lissner L, Molnar D, et al. The U.S. Preventive Services Task Force (USPSTF) concluded with moderate certainty that daily doses of less than 1,000 mg calcium and less than 400 IU (10 mcg) vitamin D do not prevent fractures in postmenopausal women and that the evidence on larger doses of this combination is inadequate to assess the benefits in this population [40]. This content does not have an English version. Public Health Nutr 2017;20:2577-86. Can a lack of vitamin D cause high blood pressure? Diagnosis and management of hypocalcemia. What people with celiac disease need to know about osteoporosis. Circ Heart Fail 2015;8:49-56. Am J Clin Nutr 2021;114:231-7. Calcium intake and cardiovascular disease risk. information highlighted below and resubmit the form. Osmotic agents. High levels of calcium can cause: constipation. At birth, the body contains about 26 to 30 g calcium. Too Much Supplemental Rock Calcium The most common type of calcium and the one that causes the most gastrointestinal discomfort is from rock. information is beneficial, we may combine your email and website usage information with The effect of calcium plus vitamin D on risk for invasive cancer: results of the Women's Health Initiative (WHI) calcium plus vitamin D randomized clinical trial. So why do we persist in stocking it, prescribing it and taking it if our bodies struggle to process and utilise it? However, be aware that adults only tend to absorb about 15 to 20 percent of the calcium found in food . An RCT in 5,292 adults aged 70 years or older (85% women) in the United Kingdom compared the effects of 1,000 mg calcium, 8,000 IU (200 mcg) vitamin D3, both, or placebo for 24 to 62 months [49]. [, Candelas G, Martinez-Lopez JA, Rosario MP, Carmona L, Loza E. Calcium supplementation and kidney stone risk in osteoporosis: a systematic literature review. Calcium - Health Professional Fact Sheet - Office of Dietary [, Khan B, Nowson CA, Daly RM, English DR, Hodge AM, Giles GG, et al. Adv Clin Chem 2017;82:1-46. [. Endocrine 2020;69:485-95. 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 [107]. Calcium supplements are generally made with one of two sources of elemental calcium: calcium carbonate or calcium citrate. What Is Calcium? Until more is known about these possible risks, it's important to be careful to avoid excessive amounts of calcium. Postmenopausal women Cancer Prev Res (Phila) 2019;12:295-304. Those who avoid dairy products because of allergies or for other reasons can obtain calcium from non-dairy 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]. Effect of increasing dietary calcium through supplements and dairy food on body weight and body composition: a meta-analysis of randomised controlled trials. Nutrients 2020;12. [, Kahwati LC, Weber RP, Pan H, Gourlay M, LeBlanc E, Coker-Schwimmer M, et al. For example, postmenopausal women who took 1,000 mg calcium and 400 IU (10 mcg) vitamin D daily for 3 years in the WHI whose daily intakes were less than 1,200 mg calcium at baseline were 11% less likely to gain 1 kg of weight or more than those who took placebo during this period [90]. Quinolone antibiotics [, Booth AO, Huggins CE, Wattanapenpaiboon N, Nowson CA. While this supplement is rich in calcium and is also cheap, it causes constipation more frequently than other supplement types. Milk, yogurt, and cheese are rich natural sources of calcium [1]. J Clin Endocrinol Metab 2012;97:614-22. As with the evidence on the link between increased calcium intakes and reductions in BMD loss, the findings of research on the use of calcium supplementation to prevent fractures in older adults are mixed. [, Jones BJ, Twomey PJ. Calcium carbonate is more often associated with constipation, bloating, and flatulence. Ask ODS On average, women lose approximately 1% of their bone mineral density (BMD) per year after menopause [25]. Calcium can be found in a variety of foods, including: To absorb calcium, your body also needs vitamin D. A few foods naturally contain small amounts of vitamin D, such as canned salmon with bones and egg yolks. Amounts of calcium in supplements vary widely; multivitamin/mineral supplements commonly contain about 200 to 300 mg, and common amounts in calcium or calcium plus vitamin D supplements are 500 or 600 mg [14]. Effects were greatest in adults younger than 35 years and with doses higher than 1,500 mg/day calcium. Comparison shop if cost is a factor for you. Br J Nutr 2015;114:924-35. J Clin Endocrinol Metab 2019;104:3576-84. For example, an analysis of 19992010 NHANES data from 14,408 adults (mean age 54 years) with obesity found that calcium intakes were 10% lower in adults with obesity and hypertension than in those without hypertension [62]. The following groups are among those most likely to need extra calcium. It's what your body absorbs for bone growth and other health benefits. 1. For instance, some calcium supplements may also contain vitamin D or magnesium. Nutrients 2017;9. The societies therefore concluded that calcium intakes that do not exceed the UL are safe "from a cardiovascular standpoint.". Calcium Hydroxyapatite and How to Best Protect Your Bones A Cochrane review of 16 trials in 3,048 adults with a median follow-up period of 3.5 months found that calcium supplementation (typically 1,000 to 2,000 mg/day) reduced systolic blood pressure by 1.43 mmHg and diastolic blood pressure by 0.98 mmHg [67]. Psyllium (multiple formulations and additives) Per packet* - two teaspoons 1-3/day.
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