The health of the skeletal system is a critical part of the overall health of the athletic population. To prevent osteoporosis and bone stress injuries in athletes, adequate calcium and vitamin D intake is necessary. Calcium works alongside vitamin D to play a protective role in bone health (density), and in turn, protects individuals against increased risk of bone and muscle injuries – often exacerbated through rigorous exercise and high impact sports.

Dietary calcium is linked to many benefits, particularly bone health, and is why adequate daily intakes for calcium have been established, known as Recommended Dose Intake Parameters, or RDIs. Too often, diets often fall short of recommended guidelines, particularly in individuals with higher needs, and thus, high quality supplementation can help address the body’s demands.  Why is this important? A crucial element of athletic performance surrounds an athletes ability to train at optimal performance states for, often, extended periods of time. While the majority of supplementation may be centred around performance enhancement, post-performance care is equally critical in ensuring that individuals are enhancing recovery protocols and not pulling resources from a depleted well a process likely to cause injury down the line.

Coupled with deficiencies in calcium, likelihood of injury is significantly exacerbated under these circumstances meaning less time doing what you love best. Deficiencies are often nutritional (due to poor intake of dairy) as well as genetic/physiological (such as hyperthyroidism), meaning they often do not resolve on their own. Data also indicates that bones are more likely to be reinjured after an initial injury (often due to underlying deficiency), reinforcing the importance of adequate levels of calcium as a preventative and supportive addition at all stages of your training regimen.

Inadequate calcium intake can lead to decreased bone mineral density, which can increase the risk of bone fractures and osteoporosis. While exercise is recommended to help support Bone Mineral Density (BMD), high intensity exercise, particularly intense seasonal (peak season/off season) sports, can result in increases in Parathyroid Hormone (PTH) which can cause increased mobilisation from calcium from bones to the bloodstream, leading to a decrease in bone density  

There are three major studies that aimed to evaluate the relationship between exercise and calcium[1]. In the first study, the major finding was that calcium supplementation before intense exercise diminished the exercise-induced increase in PTH, inducing a potential bone density protective benefit. In the second study, which followed twelve male elite athletes, it demonstrated that the burst of bone depleting activity induced by endurance exercise can be suppressed by the previous intake of calcium supplementation. Lastly, the third study aimed to evaluate the benefits on BMD between dietary calcium and calcium supplementation. The study summarised that increased calcium intake from dietary sources increased BMD by 0.6-1.0% after one year, while increased calcium intake through supplementation increased BMD by 0.7-1.4%. This indicates that supplementation of calcium is not only equivalent, but superior to dietary sources.

With a plethora of calcium supplements available on the market, it can be difficult to know which one is the ‘best’ and that will ultimately serve your needs most appropriately. With supplements, price often holds a lot of sway. However, the most important aspect to consider when supplementing with calcium is not cost, nor exclusively the amount of calcium, but rather, the form. This is because not all calcium is created equal. Different preparations of calcium have unique properties and chemical structures that affect solubility, and thus, bioavailability, as well as having unique tolerability profiles.

Calcium citrate is one of the most readily absorbed, and well tolerated forms of calcium, and constitutes as the star ingredient of PILLAR’s ELITE CALCIUM, which contains 1376mg of calcium citrate tetrahydrate (equivalent to 290mg of elemental calcium). 

Another popular type of calcium on the market, calcium carbonate, contains higher amounts of elemental calcium, but requires stomach acid for absorption and must be taken with food. This is both inconvenient, particularly for athletes with specific feeding schedules, and can often cause gastrointestinal upset, such as mild constipation or feeling bloated. Thus, when formulated in a sufficient dosage, calcium citrate serves as the superior choice given that it’s highly bioavailable, meaning it is absorbed more easily than calcium carbonate, and can be taken on an empty stomach without discomfort. 

Another distinction between PILLAR’s ELITE CALCIUM and other supplements on the market is the presence of Vitamin K. Vitamin K particularly as vitamin K2 is nearly non-existent even in a healthy western diet, and although calcium benefits are robust, some studies do suggest caution when considering supplementation due to potential cardiovascular implications, such as potential stiffening of the arteries.  That issue is remedied, however, due to a blend of high quality calcium and vitamin K2, which promotes arterial flexibility by preventing accumulation of calcium in the cardiovascular system and promotes enhanced distribution across the body.[2]Thus, calcium in tandem with vitamin K2 serves as the optimal solution for bringing necessary bone benefits while avoiding an increased risk for heart disease.

References:

[1] Barry DW, Kohrt WM. Acute effects of 2 hours of moderate-intensity cycling on serum parathyroid hormone and calcium. Calcif Tissue Int. 2007 Jun;80(6):359-65.

Barry DW, Kohrt WM. BMD decreases over the course of a year in competitive male cyclists. J Bone Miner Res. 2008 Apr;23(4):484-91.

Barry DW, Hansen KC, van Pelt RE, Witten M, Wolfe P, Kohrt WM. Acute calcium ingestion attenuates exercise-induced disruption of calcium homeostasis. Med Sci Sports Exerc. 2011;43(4):617-623.

Guillemant J, Accarie C, Peres G, Guillemant S. Acute effects of an oral calcium load on markers of bone metabolism during endurance cycling exercise in male athletes. Calcif Tissue Int. 2004 May;74(5):407-14.

[2] Maresz, Katarzyna. “Proper Calcium Use: Vitamin K2 as a Promoter of Bone and Cardiovascular Health.” Integrative medicine (Encinitas, Calif.) vol. 14,1 (2015): 34-9.