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Family Health Magazine - PHARMACY CARE

Calcium and Iron Supplements
Do you need them?

Has your doctor told you that you should take calcium for your bones? Have you ever thought about taking iron because you are tired or lacking in energy? Do you wonder if you should take Vitamin D? Why do you have to ask a pharmacist for iron?

How long do I need to take an iron or calcium supplement to notice an effect?

You may need to take an iron supplement once a day for several months before iron levels are restored. Your doctor might recommend taking iron up to three times a day for up to four weeks to restore iron levels if you have or will have surgery, or during pregnancy. Discuss the need for iron with your doctor before taking any additional supplements. Calcium supplements may be taken throughout your lifetime. If you are not meeting the recommended daily intake of calcium, talk with your health care provider about which calcium supplement is right for you.

Other uses for calcium: where else might you be getting extra calcium?

You may notice calcium is the main ingredient in your heartburn medication. Calcium carbonate works to reduce or neutralize stomach acid. Stomach acid is reduced. The esophagus (the tube to the stomach) is then less irritated when acid reflux (heartburn) occurs. Calcium carbonate is also recommended for some PMS symptoms women may experience. Discuss the use of calcium in treating PMS with your health care provider.

Many people have questions about taking calcium or iron. Your pharmacist is happy to answer your questions and provide information about supplements.

What are calcium and iron?

Calcium and iron are important elements for health that your body is not able to make on its own. Supplies of calcium and iron must be obtained from outside the body, from the food we eat or through a supplement.. Our bodies use elemental calcium and iron. However, to be available in a solid or liquid form, they are supplied in combination with another substance.

Calcium is available as calcium carbonate, calcium citrate or calcium gluconate. Iron is available as ferrous fumarate, ferrous sulphate or ferrous gluconate. When calcium or iron are combined with these to form compounds, they add weight to the element. Supplements are most often labelled with both the amount of elemental product (actual amount of calcium or iron) as well as the actual milligrams of weight contained in each dose.


Calcium is one of the most commonly purchased supplements in North America. Calcium is an essential building block of bones. It also plays vital roles in the development of strong teeth and maintenance of muscle and nerve function. It is important to remember that the recommended daily intake is an average number that may not apply to everyone. Talk with your doctor or pharmacist before taking any supplement.

Most people are able to take in enough calcium through a healthy, balanced diet. You should consider taking a calcium supplement if you are unable to or do not eat dairy products, or if you have been diagnosed with osteoporosis (fragile bones).

The two most common calcium compounds present in supplements are calcium carbonate and calcium citrate. Calcium gluconate, lactate or phosphate are also used. Calcium supplements come as tablets, chewable tablets, calcium ‘chews,’ liquid, and bubbling tablets (‘liquitabs’).

Recently the media has raised concerns about the lead content of calcium supplements. Calcium is mined from marine deposits in the ocean’s floor. These deposits contain lead from the earth’s core. Since this has been known, manufacturers have started using deposits with lower lead levels, chemically refine the deposits to reduce the lead levels, or do both. Calcium supplements currently on the market are a very minor source of lead, most of which is not absorbed by the body. Sometimes the label on the bottle will say if the supplement is low in lead or lead-free.

Calcium carbonate. Calcium carbonate is commonly produced from oyster shells (often labeled as O-Calcium). It can also be produced synthetically. Calcium carbonate is commonly found as a 1250 milligram tablet containing 500 milligrams of elemental calcium. If you wanted to supplement with 1000 to 1500 milligrams of calcium, you would take two to three tablets daily. Other strengths are also on the market. Calcium carbonate is best absorbed on a full stomach. It can cause constipation, so increase your fluid, fruit and fibre intake at the same time you begin supplementing.

Calcium carbonate is also the main ingredient in Tums™.

Calcium Citrate. The other common calcium compound is calcium citrate. The advantage to calcium citrate is that it dissolves better in low acid conditions. For instance, this compound would be recommended for elderly people or those who use medication to lower the acid in the stomach.

Since the body best absorbs 500 milligrams of elemental calcium or less at a time, it is best to split up your daily dose. A good way to get your daily calcium is to take one tablet with breakfast and one tablet with lunch. At suppertime, assess how much calcium you have received through your diet. If you need more, a third tablet can be taken with dinner.

Do not take calcium supplements if you have sarcoidosis (an immune or defence system disorder) or high blood calcium. Check with your doctor before taking calcium if you have trouble with constipation, colitis (inflamed bowels), diarrhea, or bleeding from the stomach or intestine. As well, talk with your doctor if you have kidney disease, an irregular heart beat or heart problems.

Calcium supplements can interfere with the absorption of thyroid medications, iron, tetracycline and quinolone antibiotics, and a type of osteoporosis medicine called bisphosphonates. It is essential to space your calcium intake apart from these medicines. Talk with your pharmacist for more details about how these medications react together.

Vitamin D

A discussion on calcium is not complete without also talking about vitamin D. Calcium cannot be properly absorbed into the body without an adequate supply of vitamin D. There are small amounts of vitamin D in margarine, eggs and some fatty fish. Your body also makes vitamin D in response to sunlight. As little as 10 to 15 minutes of sunshine may be enough for your daily supply. Unfortunately this is not always as easy as it sounds. Your body may not be able to make enough vitamin D from sunlight if you live in a northern climate (especially during the winter), or if you do not spend a lot of time outdoors. Using sunscreen on a regular basis (as we all should!) can also affect the amount of vitamin D you make.

Milk is fortified with vitamin D for some of these reasons. However, many people do not drink milk and are at risk of having low levels of vitamin D. Low levels may then affect the amount of calcium that the body is able to absorb. Vegetarians should remember that there is no vitamin D in plants so if you do not drink milk, you should definitely consider a supplement.

The average recommended daily dose of vitamin D is 400 International Units (IU) per day. Most multivitamins contain this amount. For some people, such as those with low bone density or osteoporosis, it is recommended to take 800 or even 1000 IU daily. Vitamin D is a fat-soluble vitamin. This means it can build up in the soft tissues of the body such as the kidney and lead to kidney damage. Do not take more than 1000 IU per day without the advice of your doctor.


Magnesium is another element that is often combined with calcium supplements. Magnesium is also thought to play a role in calcium absorption. Most people obtain enough magnesium in a balanced daily diet. Most multivitamins also have magnesium in them. Magnesium has a laxative effect, so combining it with calcium may lower the chance of constipation.


Many people also use the element of iron as a supplement. Iron is an essential part of blood and muscle and is important for the transport of oxygen in the body. People with low levels of iron may suffer from iron-deficiency anemia, where red blood cells have a decreased amount of iron. The condition is rare in healthy men and in women after menopause. It can, however, affect women of childbearing age or people with conditions that cause internal bleeding, such as ulcers or intestinal diseases.

Low energy or tiredness may be signs of iron-deficiency anemia. The symptoms are not very specific and can be caused by many other ailments. Have your doctor confirm a diagnosis of low iron with a blood test before taking action.

The best sources of iron in food are meat, fish and poultry. Small amounts of iron are absorbed from fruits, vegetables, nuts, dried beans and grain products.

If your doctor has diagnosed you with low iron, it may be recommended that you supplement with it. Most multivitamins have small doses of iron, but not enough to treat iron-deficiency anemia.

You can also purchase iron supplements by themselves. Most provinces sell these products from behind the pharmacy counter. They do not require a prescription, but are sold after talking with the pharmacist. Ideally the pharmacist should confirm that you have had low iron diagnosed with a blood test. The pharmacist can tell you how to use iron and about its potential side effects. Another important reason that iron is kept behind the counter is that it is one of the leading causes of accidental poisoning in children.

It takes very little iron to poison a child. Please make sure to store iron supplements well out of reach of your own or visiting children.

Iron is generally quite hard on the stomach. This creates a bit of a difficulty with supplements since iron is best absorbed when your stomach is empty. Most people are not able to handle iron on an empty stomach. It is generally recommended that iron be taken with food to reduce stomach upset. Iron is best absorbed when Vitamin C is present, so take iron with a glass of orange juice or a citrus fruit. Iron can also be constipating. To maintain healthy bowel movements, increase fluids, fiber intake and physical activity while taking iron. Bowel movements may be darker in colour. Since liquid iron can stain the teeth, dilute it in juice or water before swallowing.

You should not use iron if you have acute hepatitis (liver inflammation), hemolytic anemia (where red blood cells are destroyed too quickly), or conditions of high blood iron. Repeated blood transfusions are another reason to not use iron. Make sure to tell your doctor or pharmacist if you have peptic (stomach) ulcer disease, kidney or intestinal disease, inflammation of the intestines, colon, or pancreas, or hepatitis. If you consume excessive amounts of alcohol, or plan to become pregnant, it is also important to talk with your doctor before taking iron.

There are three main types of iron compounds: ferrous gluconate, ferrous fumarate, and ferrous sulfate. “Ferrous” is the Latin word for iron, which is why this word is found in all of the types. The main difference between these iron salts is the amount of elemental (actual) iron in the tablet.

Iron interacts with some of the same medicines that calcium does. Check with your pharmacist or doctor if you are taking tetracycline or quinolone antibiotics.

Calcium and iron are both available over the counter. They help develop healthy bones and teeth and keep your red blood cells healthy. Since they are available without a prescription, people may think there are no risks to taking them. Always talk to your doctor or pharmacist before deciding to use a supplement.

FAMILY HEALTH is written with the assistance of:
College of Family Physicans of Canada
Alberta College of Family Physicians
FAMILY HEALTH is written with the assistance of:
College of Family Physicans of Canada
Alberta College of Family Physicians
While effort is made to reflect accepted medical knowledge and practice, articles in Family Health Online should not be relied upon for the treatment or management of any specified medical problem or concern and Family Health accepts no liability for reliance on the articles. For proper diagnosis and care, you should always consult your family physician promptly. © Copyright 2019, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 0S1    [PC_FHc03]
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