Without calcium, you’d be a shell of yourself—literally. Calcium is one of the primary minerals that builds your bones. In fact, 99 percent of the calcium in your body is found in your bones and teeth, where it supports their structure and hardness.

Your body also uses calcium to regulate your heart rhythm and blood vessel contraction and dilation, to transmit nerve impulses that contract your muscles, and to enable your blood to clot. When you don’t have enough, your body dips into your bones (the body’s calcium bank) to take what it needs. If that trend continues long enough, you end up with low bone density or even osteoporosis—literally porous bones, which are vulnerable to fractures and breaks.

So, sufficient calcium is important, and it’s unfortunately something that many of us don’t get. The 2015 to 2020 Dietary Guidelines for Americans labeled calcium one of the “shortfall nutrients” that are of public health concern, because of the increased risk for osteoporosis. The CDC’s NHANES What We Eat in America survey data of people in the U.S. found that more than 40 percent of us don’t meet our daily requirement for calcium.

That’s bad because it’s easy to fall short and not know it—until your bone health takes a hit. Because again, your body takes what it needs to operate from your skeleton, which you’ve built over the course of your life. So actual hypocalcaemia (where there’s too little calcium in the blood) is pretty rare, says sports nutritionist Leslie Bonci, M.P.H., R.D., owner of Active Eating Advice.

“There are numerous signs of hypocalcaemia, but you won’t experience those unless you have an actual calcium deficiency,” Bonci says. Those signs (some of which may also be symptoms of other conditions) include:

• Muscle spasms, aches, cramps
• Memory loss
• Tingling in hands, feet and sometime face
• Weak/brittle nails
• Bones that fracture more easily
• Confusion
• Memory loss
• Fatigue
• Dry skin
• Alopecia
• Coarse hair
• Eczema
• Psoriasis
• Osteopenia/osteoporosis
• More severe PMS
• Tooth decay
• Brittle teeth
• Gum disease

So the best approach is to make a concerted effort to meet your daily requirements for this essential nutrient, she says, noting “people who are at higher risk for calcium being a shortfall nutrient include vegans, people who avoid dairy, those on very low-calorie diets, and people with inflammatory bowel disease.”

Women in the menopause transition are also at increased risk of running low in calcium because oestrogen helps with calcium absorption and as oestrogen levels drop, more calcium is lost.

How to Get Enough Calcium

The Recommended Dietary Allowance is 1 000 milligrams a day for most adults. After age 50, the recommended amount increases to 1 200 mg a day for women. After age 70, the amount increases to 1 200 mg a day for everyone.

Getting those amounts through food alone is fairly easy. One cup of plain yogurt has 415 mg. Add a cup of milk (dairy or fortified soy) and you have about another 300 mg. A bowl of fortified cereal with milk brings the daily total to right about 1 000 mg to hit your daily allowance.

For those who are strictly plant based and/or don’t eat dairy, you can get the calcium you need through fortified soy milk (300 mg per cup), tofu (250 mg per cup), fortified orange juice (350 mg per cup), fortified cereal (130 mg per serving), and soybeans, which have 130 mg per ½ cup.

Approach calcium supplements with caution. Too much calcium supplementation, especially when you’re getting what you need from your diet, is not only not helpful it may be harmful. After reviewing the literature, the U.S. Preventive Services Task Force concluded that calcium supplementation didn’t prevent fractures in vulnerable populations like postmenopausal women. Worse, some research suggests that calcium supplements may increase the risk of cardiovascular events like heart attack, a risk that isn’t seen when you get your calcium through foods in your diet. (It’s always best to talk with a registered dietitian or medical professional before starting on any supplements.)

If you’re concerned about your skeletal health, chat with a medical professional, who may recommend a bone density test, otherwise known as a dual-energy X-ray absorptiometry (DEXA) scan, or DXA scan. The test estimates the density of your bones and your chances of breaking a bone, and is the best test out there to do so.

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