Calcium: Nutrient Combination and Ratios

Calcium is centrally important, as most people already know. Not only is it necessary for the health of bones but also for the health of the heart, nerve cells, gut microbiome, hormonal system, skin, etc and will affect such things as grip strength and fatigue. As usual, there is a lot of misinformation out there and newer information that has changed our understanding. Let me clear up the issue to the degree I can. The following represents my present understanding, based on the sources I could find.

We can store calcium when we are younger, but lose this ability as we age. On the other hand, it turns out we don’t need as much calcium as previously assumed. And too much calcium can be harmful, even deadly as can happen with hardening of arteries. In fact, the healthiest societies have lower levels of calcium. It’s not so much about the calcium itself for, as always, context matters. Calcium deficiencies typically are caused by a health condition (kidney condition, alcohol abuse, etc), rather than lack of calcium in the diet. Importantly, other nutrients determine how the body absorbs, processes, utilizes, and deposits calcium. Furthermore, nutritional imbalances involving deficiencies and excesses create a cascade of health problems.

Let me explain the interrelationship of micronutrients. There is a whole series of relationships involved in calcium processing. Vitamin B6 is necessary for absorption of magnesium; and magnesium is necessary for absorption of vitamin D3 — zinc, boron, vitamin A, bile salts, and a healthy guy microbiome are all important as well. Of course, cholesterol and sunlight are needed for the body to produce it’s own vitamin D3, which is why deficiencies in these are also problematic. Statins block cholesterol and sunscreen blocks sun; while stress will block vitamin D3 itself whereas exercise will do the opposite. Then vitamin D3 is necessary for absorption of calcium. But it doesn’t end there. Most important of all, vitamin K2 is necessary for regulating where calcium is deposited in the body, ensuring it ends up in bones and teeth rather than in joints, arteries, brain, kidneys, etc.

About on specific issue, the often cited 2-to-1 ratio of calcium and magnesium is actually on the high end indicating the maximum calcium levels you don’t want to exceed as part of your total calcium intake from both diet and supplementation. So, if you’re getting a 2-to-1 ratio in your supplements combined with high levels of calcium from food, such as a diet with plenty of dairy and/or greens, your calcium levels could be causing you harm. Speaking of magnesium deficiency is a relative assessment, as it depends on calcium levels. The body is rarely depleted of magnesium and so, on a superficial level, your body is never deficient in an absolute sense. Yet the higher your calcium levels go the greater your need of magnesium. Nutrients never act alone, such as how vitamin C requirements increase on a high-carb diet.

Here is another example of nutrient interaction. With more salt in your diet, you’ll need more potassium and magnesium to compensate. And potassium deficiency is associated with magnesium deficiency. But that isn’t to say you want to decrease sodium to increase these others, as research indicates higher salt intake is associated with greater health (Dr. James DiNicolantonio, The Salt Fix) — and I’d recommend getting a good source of salt such as Real Salt (although natural forms of salt lack iodine and so make sure to increase iodine-rich foods like seaweed, that being a good option since seaweed is extremely nutrient-dense). As an interesting side note, calcium helps your muscles contract and magnesium helps your muscles relax, which is why muscle cramps (also spasms, twitches, and restlessness) can be a sign of magnesium deficiency. Plus, excess calcium and insufficient magnesium will increase cortisol, the stress hormone, and so can interfere with sleep. There is yet another dual relationship between these two in the clotting and thinning of blood.

Macronutrients play a role as well. Higher protein ensures optimal levels of magnesium and is strongly linked to increased bone mass and density. Fat intake may also play a role with these minerals, but I couldn’t find much discussion about this. Certainly, fat is necessary for the absorption of fat-soluble vitamins. If you’re eating pastured (or grass-fed-and-finished) fatty animal foods, you’ll be getting both the protein and the fat-soluble vitamins (A as beta-carotene, D3, E complex, & K2). Even greater, with cultured, fermented and aged foods (whether from animals or plants), you’ll get higher levels of the much needed vitamin K2. Assuming you can stand the taste and texture of it, fermented soy in the form of natto is the highest known source of K2 as the subtype MK7 which remains in the body longer than other subtypes. By the way, some multiple vitamins contain MK7 (e.g., Garden of Life). Vitamin K2 is massively important. Weston A. Price called it Activator X because it controls so much of what the body does, specifically in relationship to other nutrients, including other fat-soluble vitamins. And all of the fat-soluble vitamins are central in relationship to mineral levels.

Another factor to consider is when nutrients are taken and in combination with what. Some minerals will compete with each other for absorption, but this probably is not an issue if you are getting small amounts throughout the day, such as adding a balanced electrolyte mix (with potassium, magnesium, etc) to your water or other drinks. Calcium and magnesium are two that compete and many advise they should be taken separately, but if you take them in smaller amounts competition is not an issue. Some research indicates calcium has a higher absorption rate in the evening, but magnesium can make you sleepy and so might also be taken in the evening — if taking a supplement, maybe take the former with dinner and the latter before bed or you could take the magnesium in the morning and see how it makes you feel. By the way, too much coffee (6 cups or more a day) will cause the body to excrete calcium and salt, and yet coffee is also a good source of potassium and magnesium. Coffee, as with tea, in moderate amounts is good for your health.

As a last thought, here is what you want to avoid for healthy calcium levels: taken with iron supplements, high levels of insoluble fiber, antacids, excessive caffeine. Also, calcium can alter the effects of medications and, in some cases, should be taken two hours apart. Keep in mind that many plant foods can be problematic because of anti-nutrients that bind minerals or interfere with absorption. This is why traditional people spent so much time preparing plant foods (soaking, sprouting, cooking, fermenting, etc) in order to eliminate these anti-nutrients and hence increase nutrient absorption. It is irrelevant the amount of nutrients in a food if you’re body can’t use them. For example, one of the highest concentrations of calcium is found in spinach, but the bioavailability is extremely low. Other foods, including other leafy greens, are a much better source and with any leafy greens always cook them.

This problem is magnified by the decreased nutrient content of most plant foods these days, as the soil itself has become depleted. Supplementation of many micronutrients is maybe necessary for almost everyone at this point, although great caution should be taken with supplementing calcium.

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Sometimes I write posts about diet and health after doing research for my own purposes or simply for the sake of curiosity about a topic. But in many cases, I have family members in mind, as my own health improvements have gone hand in hand with dietary changes my parents also have made, and my brothers are health-conscious as well although with a vegetarian diet quite different than my own. This particular post was written for my mother.

Just the other day she was diagnosed with osteoporosis. She had osteopenia for decades. Now looking back, she realizes that her bone loss began when she started taking fiber and antacids, both of which block calcium. And all the years of calcium supplementation were probably doing her no good because, even to the degree she was absorbing any of the calcium, it wasn’t balanced with other needed nutrients. I gathered this information in order to help her to figure out how to improve her bone health, as her doctor was only moderately informed and her recent appointment was rushed.

This was researched and written on Mother’s Day. I guess it was my gift to my mother. But I hope it is of value to others as well.

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Without Magnesium, Vitamin D Supplementation May Backfire
by Joseph Mercola

Calcium with Magnesium: Do You Need the Calcium?
from Easy Immune System Health

Expert cites risk of calcium—magnesium imbalance
from Nutritional Magnesium Association

Optimum Calcium Magnesium Ratio: The 2-to-1 Calcium-to-Magnesium Ratio
by A. Rosanoff

Nutritional strategies for skeletal and cardiovascular health: hard bones, softarteries, rather than vice versa
by James H O’Keefe, Nathaniel Bergman, Pedro Carrera-Bastos, Maélan Fontes-Villalba, James J DiNicolantonio, Loren Cordain

Why You Need To Take Vitamin K With Calcium Supplements
by Stacy Facko

For Bone Health, Think Magnesium
from Harvest Market Natural Foods

Calcium Deficiency: Are Supplements the Answer?
by Jillian Levy

Calcium to Magnesium: How the Ratio Affects Your Health
from Juvenon Health Journal

How to Correct Your Calcium-to-Magnesium Ratio
by Sandra Ketcham

Calcium & Magnesium: Finding the Right Ratio for Optimal Health
by Dr. Edward Group

Magnesium, NOT Calcium, Is The Key To Healthy Bones
by Jackie Ritz

Calcium Supplements: Things to Consider before Taking One
by Chris Kresser

How to Get Enough Calcium Without Dairy
by Katie Wells

Is The Paleo Diet Deficient In Calcium?
by Michael Ofer

Paleo & Calcium | Friendly Calcium Rich Foods
by Irena Macri

Mineral Primer – The Weston A. Price Foundation
by Sally Fallon and Mary G. Enig

The science of salt and electrolytes (are we consuming enough?)
by Will Little

13 Signs Of Magnesium Deficiency + How To Finally Get Enough
by Dr. Will Cole

Top 10 Magnesium-Rich Foods
by Rachael Link

Vitamin K2, Vitamin D, and Calcium: A Winning Combo
by Joseph Mercola

Vitamin K2: Everything You Need to Know
by Joe Leech

The Ultimate Vitamin K2 Resource
by Chris Masterjohn

Vitamin K2: Are You Consuming Enough?
by Chris Kresser

Promoting Calcium Balance Health On A Paleo Diet (Easier Than You Think)
by Loren Cordain

Calcium: A Team Sports View of Nutrition
by Loren Cordain

How To Keep Your Bones Healthy On A Paleo Diet
by Chris Kresser

On Salt: Sodium, Trace Minerals, and Electrolytes

There has been a lot of debate about salt lately. The mainstream view originated from little actual scientific evidence. It wasn’t well-supported. But research since then has been mixed.

The isn’t limited to disagreement between mainstream and alternative thinkers. Paleo advocates such as Dr. Loren Cordain (considered to be the founder of the paleo diet) continue to recommend lower salt intake. Still, there have been an increasing number of scientists and physicians coming out in favor of the benefits of salt: Dr Barbara Hendel, Dr. F. Batmanghelidj, Dr. Esteban Genoa, Dr. Eric Westman, Dr. Jeff S Volek, Dr. Stephen D. Phinney, and Dr. James DiNicolantonio. Many of these experts argue that increased amounts of salt is particularly important for a low-carb diet and that is even more true with high-protein. This relates to issues transitioning into ketosis, what is referred to as keto flu. Basically, the electrolytes temporarily get out of balance while one is adapting to ketosis. Yet Sally Fallon Morell states that it is a plant-based diet that requires more salt to increase HCL in the stomach for digestion.

All of this was brought to my attention because of Dr. DiNcolantonio’s book The Salt Fix that came out recently. His simplest advice is to salt to taste since your body (presumably under normal conditions) should know how much salt it needs. He argues that salt isn’t addictive like sugar. So, according to this view, salt cravings can be safely treated as a genuine need for salt. I haven’t read The Salt Fix, but I have skimmed a bit of one of his other books, Superfuel. In that book, he states that salt, besides maintaining healthy blood pressure, helps maintain insulin sensitivity. Also, salt goes back to the fat issue — more from the book:

“Diets very low in sodium (salt) increase adrenaline and aldosterone, and these hormones reduce activity of D6D and D5D. For this reason, low-salt diets increase the need for EPA and DHA due to the reduced desaturase enzyme activities. Another extremely common hormonal issue these days, one that interferes with conversion of the parent omega-6 and omega-3 fats into their derivatives, is hypothyroidism. Thyroid hormone is required for proper activity of D6D and D5D, so individuals with suboptimal thyroid hormone levels may benefit from consuming more EPA and DHA or taking good-quality supplements.”

There is a number of issues with sodium, potassium, and magnesium in relation to insulin, adrenaline, and aldosterone. Shifting the diet can affect any or all of these. The problem is most research has been limited to people on the standard American diet. We know very little, if anything at all, about salt intake or electrolyte supplementation with other diets. That forces people into experimentation. Anything true of high-carb diets may or may not apply to low-carb diets. Nor do we know that the same will be true between moderately low-carb diets, extremely low-carb diets, zero-carb diets, etc. Then there are other factors such as fasting, ketosis, autophagy, etc that alters the body’s functioning. It’s possible that, on low enough carb restriction, the need for electrolytes and trace minerals decreases, as is the case with vitamin C. Sounds like a great hypothesis to be tested.

Then there is the issue of what actually helps vs what might harm you. What are the potential risks and benefits of getting too few electrolytes and trace minerals vs higher levels? I’m not sure self-experimentation can exactly figure this out, although maybe some have strong enough responses to salt or its lack that they can figure out what works for them. My own experimentation hasn’t indicated anything particular, either positive or negative.

Like anyone else, I enjoy the taste of salt. But unlike sugar, I’ve never craved salt in the addictive sense (and I know what addiction feels like). According to some of what I read, the danger seems to be specifically with refined salt, as is the case with so much else that is refined. Refined salt doesn’t give your body what it needs and so throws off the balance, disallowing healthy processsing of glucose, and so according to this explanation this is why refined salt disposes you to sugar cravings. I remember reading about this sugar and salt craving cycle back in the 1990s, but apparently it only applies to refined salt, if I’m understanding the research correctly. It just so happens that processed food manufacturers love to combine refined carbs and sugar with refined salt, where taste has become disconnected from actual nutrient content because almost all nutrients have been stripped away. They also throw in addictive wheat and dairy for good measure.

I noticed that Dr. James DiNicolantonio says to worry less about sodium and instead focus on potassium. But he emphasizes natural sources of potassium. His point is that salt simply makes high-potassium foods more palatable, foods that otherwise would be more bitter. He points out that there are both animal and plant foods that have greater amounts of potassium: fish, shellfish, greens, beans, potatoes, and tomatoes. The significance of the salt is that once potassium hits a threshold the sodium supposedly will balance it out. Seafood is particularly high in these particular micronutrients, along with much else that is healthy (e.g., EPA and DHA). Many healthy populations have lived near the ocean, as observed by Weston A. Price and others. Some argue that seafood shaped human evolution, the aqauatic ape theory.

“Most animals with a sodium deficiency display an active craving for salt which, when satisfied, disappears. In humans, salt intake has little or no relation to the body’s needs. Some Inuit tribes avoid salt almost completely, while people in the Western world consume 1520 times the amount needed for health. In other works, a single African species (assuming humans have an African origin) possesses a wildly different scheme of salt management. Humans are also the only primates to regulate body temperature by sweat-cooling, a system profligate in the use of sodium. Proponents of the Aquatic Ape Hypothesis believe that sweat-cooling could not have developed anywhere except near the sea where diets contain considerable salt, in fact much more salt than the body requires.” (William R. Corliss, Our aquatic phase!)

An interesting theory to explain the unusual aspects of salt in the human species and why there is so many differences even across traditional societies. Whether or not the aquatic ape theory is correct, it’s for certain that the foods in the standard American diet are far different in numerous ways, likely including nutrient content of magnesium and potassium. It would be useful to measure the levels of micronutrients in a healthy hunter-gatherer diet, not only from salt but food sources as well. Besides seafood and certain plants, especially seaweed (Birgitte Svennevig, Did seaweed make us who we are today?), many have noted that it is a common practice among hunter-gatherers to consume blood along with organ meats and interstitial fluid, all of which are high in salt.

I wonder if this is something we overthink because dietary experts came to obsess over it, as a convenient scapegoat (as they scapegoated saturated fat). The whole debate has become polarized, those arguing for low-salt vs those for high-salt. But other factors might be more important. Besides the problems of a high-carb diet, maybe salt levels aren’t that big of an issue. Assuming there aren’t specific health conditions, most people might be perfectly safe to salt to taste or largely ignore salt if they prefer. Potassium and magnesium seem a bit different, though. Those mostly come from foods, not salt. I don’t know of research that compares people who eat foods high in these micronutrients and those who don’t. It’s another one of those confounders with the standard American diet. And even a zero-carb dieter can eat foods that are either high or low in these micronutrients. For those not using salt, it would be useful info to know which foods they eat and their micronutrient profile.

My conclusion is simply that salt tastes good and, until better science comes along to tell me otherwise, I’ll salt to taste. I’m definitely a fan of the philosophy of listening to one’s body. I self-experiment and find out what works. In my experience, there is a big difference between craving sugar and enjoying salt. One is clearly an addiction and the other not, at least in my case. I was reminded of this just moments ago. I got a glass of water. Since it was on my mind, I sprinkled some sea salt in it and a few drops of electrolytes, along with a capful of apple cider vinegar as I’m wont to do. I quickly downed it and realized how refreshing it was. Earlier this morning I had a glass of water without anything in it and it wasn’t nearly as thirst-quenching. I’m not sure why that is. Something about water with salt and trace minerals in it is so satisfying. I suppose that is why many people love Gatorade and similar drinks. They go down so easily, even though the other ingredients are horrible for your health.

My advice is this. Enjoy salt. It tastes good and makes food more satisfying. Certain trace minerals are necessary for life and health, although only small amounts are naturally found in salt. As for potential downsides, there is yet no clear evidence and no consensus. So, do as many others do, find out what works for you.

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There is a secondary issue or rather some related secondary issues. Angela A. Stanton advises against consuming rock salts that have to be mined, such as Himalayan pink salt and Real Salt (The Truth About Himalayan Salt). She gives two main reasons. First, there might be impurities, including radioactive elements and heavy metal toxins such as lead, although she mentions there are also impurities in sea salt as well. The other problem is that these natural sources of salt lack iodine, an important nutrient. So, for both reasons, she recommends a refined salt that has been purified and iodized.

Her second point is the strongest. Iodine is, without a doubt, an essential nutrient and a deficiency is serious. I’m not sure how likely deficiencies are these days for those eating an otherwise wholesome diet, but it is something to keep in mind. Of course, you could solve this problem by occasionally sprinkling on your food some seaweed, a great natural source of iodine. Her fear about impurities, though, is maybe less substantiated because the amount of impurities is so small as to be insignificant. If we are to be paranoid, impurities are almost everywhere and in almost everything — the air you breathe and the water you drink, the food you eat and supplements you take. The human body evolved to handle such miniscule exposures.

If you have health concerns with iodine deficiency, then go ahead with iodized salt. But otherwise, it probably doesn’t matter too much which kind of salt you use, as long as it comes from a high quality source. But if you want to learn more about the issue of contaminants, David Asprey has directly responded to Stanton (Is Pink Himalayan Salt Toxic?) and so has Jeremy Orozco (Is Pink Himalayan Salt Toxic? Radioactive?). There are others as well who respond to the issue more generally to the topic. There were some responses to a Quora inquiry: Is the amount of plutonium in pink Himalayan salt dangerous? (less than .001 ppm). Also, in the comments section of a piece by Harriet Hall (Pink Himalayan Sea Salt: An Update), there were useful responses:

Jeff Mink • 2 years ago
“In case it wasn’t clear from the article, Himalayan sea salt does not contain “84 trace elements”. If you follow the link to the spectral analysis, it simply lists all non-noble gas elements in the periodic table. If the concentration is “< X ppm”, that means that none of that element was detected. That leaves it with a total of 29 elements (NOT MINERALS!) detected, assuming I counted correctly. In fact, they didn’t even test for as technetium and promethium, since there’s no chance (according to our modern scientific theories) that those could be in there. None of the elements that are actually contained in the salt are radioactive (at least not that I saw), but thallium and lead are definitely not good for the human body. Of course, at the concentrations listed, you’d probably succumb to sodium poisoning long before you got a harmful dose of heavy metals.”

Mathew Taylor • 2 years ago
“There are two main parts to this article: 1) Pink Salt does not provide any health benefits, or they are overstated grossly. I concede this point.

“However, the 2nd part, that pink salt is HARMFUL appears to be wrong. You state that it is full of poisons / contaminants. Lets look at a few of them;

“Arsenic – <0.01 ppm – There is more arsenic in some foods than this. In fact, local authorities limit arsenic concentrations in some seafood to 2mg/kg, thats 2ppm, orders of magnitude more than in pink salt and in something you would consume an order of magnitude more of.

“Mercury – .03 ppm in pink salt. Contrast that with Tuna, where levels are at least TEN TIMES higher, and the volume you would consume in a serving is many orders of magnitude higher.

“Lead – .1 ppm – There is lead in a variety of foods, but usually lower concentrations than this. Remember that salt is not used in massive quantities, unlike vegetables. The target for blood lead levels is less than 10 mcg/dl, or approx 500 mcg total. To get that much lead from pink salt, you’d have to consume 5 kilograms of the stuff. Good luck with that.

“Uranium – <0.001 ppm – Lots of food has uranium in it. Mushrooms can have over 100 μg U/kg (Dry mass).

“So don’t use it if you don’t want to, but don’t make out like this stuff is bad for you, it is, after all, 97.3% table salt.”

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If you want further info about salt, here is a somewhat random collection of articles and videos, all of them bringing new perspectives based on the latest research:

The Salt of the Earth

Salt: friend or foe?

Why Salt Is Good For You, But Some Salt is Better Than Others

Dr. James DiNicolantonio On Sodium-Potassium Balance

The Potassium Myth

The Importance of Potassium and Sodium for Fertility Health

On Keto Flu and Electrolyte Imbalances

Leveraging basic physiology to prevent ‘keto-flu,’ ‘Atkins-flu,’ and ‘adrenal fatigue.’

How much sodium, potassium and magnesium should I have on a ketogenic diet?

Salt