Antacids With Calcium Are Fine, to a Point

Aug. 23, 2000 -- You've probably seen the commercial. A person needs an antacid and chooses one brand over another because it also contains more calcium -- something, as we are reminded, everybody needs. That, in fact, is true. Calcium is a good thing. But, as the saying goes, there can be too much of a good thing.

Take the case of a 64-year-old man in Belgium. He arrived at the emergency room at Catholic University Hospital in Louvan, suffering from confusion, nausea, vomiting, and weakness. He told physicians he had stomach problems and had overcome alcoholism and mouth cancer three years earlier, along with kidney failure from medicine taken for headaches.

"None of these caused his present problems," Dominique Vanpee, MD tells WebMD. Rather, she says, the patient was suffering from milk-alkali syndrome --a disease caused by high calcium carbonate intake. In this case, the condition was brought on by the man trying to ease his stomach problem by gobbling down too many antacid tablets containing calcium carbonate

"It took us awhile to figure this out," says Vanpee. "We eventually found this out from his relatives since he had been disoriented for days." It was discovered the man had been swallowing 10 antacid tablets per day, each containing high amounts of calcium carbonate.

This case, which Vanpee wrote about in the August 2000 edition of The Journal of Emergency Medicine, illustrates the danger of antacid abuse. In the past, patients suffering from gastric reflux disease or other stomach ailments would consume large amounts of antacids containing calcium or consume a lot of milk to douse the heartburn. The combination of milk and antacids over long periods can cause calcium deposits in the kidneys and other tissues.

Vanpee says new medicines for gastrointestinal problems made cases of milk-alkali syndrome a rarity. "We're starting to see more now, since people are consuming more calcium supplements -- especially women concerned about osteoporosis and both sexes worried about fracturing brittle bones." High calcium levels can be brought on by some forms of cancer or other diseases, but the body taking in too much calcium can also cause it.

If you're not sure about how much calcium your body needs, The National Institutes of Health has issued the following guidelines for calcium consumption:

  • 1,000 mg/day for women between 25 and 50 years of age.
  • 1,200 to 1,500 mg/day for pregnant or lactating women.
  • 1,000 mg/day for postmenopausal women on estrogen replacement therapy.
  • 1,500 mg/day for postmenopausal women not on estrogen therapy.
  • 1,000 mg/day for men aged 25 to 65.
  • For all women and men over 65, daily intake is recommended to be 1,500 mg/day, although further research is needed in this age group.
  • Calcium intake, up to a total intake of 2,000 mg/day, appears to be safe in most individuals.

As a point of reference, antacid tablets can contain anywhere from 200 to 800 milligrams of calcium, depending upon whether they are regular or extra strength. All the manufacturers do list daily limits on the packaging.

The NIH notes that its guidelines are based on calcium from the diet plus any calcium taken in supplemental form, so it's important that the consumer know how much calcium is in each supplement and pay heed to suggested limits.

Of course, there are other considerations, too. Adequate amounts of vitamin D are essential for optimal calcium absorption. Daily food intake, hormones, drugs, age, and genetic factors also influence the amount of calcium required for optimal skeletal health.

The National Academy of Sciences (NAS) and the National Osteoporosis Foundation say that a healthy way to increase the amount of calcium in your diet is to eat calcium-rich foods such as low-fat milk, yogurt, and cheese. Most people who consume four cups of milk a day will receive an adequate amount of calcium, plus the proper amount of vitamin D needed to absorb it. Also, many foods such as orange juice, cereals, and breakfast bars are fortified with calcium.

Other good dietary sources of calcium include fish, primarily those where you can eat the bones, too, such as sardines, salmon, and smelt. Also on the high-calcium list: collard greens, spinach, broccoli, tahini, tofu (if calcium is added to the liquid), oats and oatmeal, seaweed, and dandelion leaves.

Nutritionists agree the preferred source of calcium is through calcium-rich foods such as dairy products. Calcium-fortified foods and calcium supplements are other means by which optimal calcium intake can be reached in those who cannot meet this need by eating conventional foods. But this is where the problems can occur. While it takes a great deal of calcium to cause hypercalcemia -- between four and 60 grams per day -- eating enough calcium and additional supplementation can easily push an adult over the recommended amount. Also, sometimes prescription medicines contain calcium. Adding antacids on top of all that can easily push someone beyond their needs.

Jan Stein Carter, MS, an assistant professor of biology at the University of Cincinnati's Clermont College, mentions the advertising of over-the-counter antacids as a source of dietary calcium. "This raises a number of important questions to consider," says Carter. "Is an antacid really the best way to get calcium? Overconsumption of calcium-alkali antacids can lead to hypercalcemia, which can adversely affect a number of organ systems, including the kidneys, bones, muscles, and pancreas."

Still, "patients with life-threatening hypercalcemia are rare," Vanpee writes. The key is to flush the system of the excess calcium. "Patients with this syndrome need at least six liters of fluid per day."

As for the man in Belgium, Vanpee says he was discharged after two weeks in relatively good shape.