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Metabolic Panel: Low Calcium

Free Book Excerpt: Your Blood Never Lies by James LaValle
August 1, 2016 (Updated: August 3, 2021)
James LaValle

An excerpt from the book, “Your Blood Never Lies: How to Read a Blood Test for a Longer, Healthier Life” by James B. LaValle, RPh, CCN, ND. Read additional excerpts or buy the whole book.

There are numerous causes of hypocalcemia, or low blood calcium, but the most common is a condition known as hypoalbuminemia. Albumin is a protein in the blood that acts as a carrier for calcium, so when levels are low, blood calcium also sharply decreases. This condition is usually seen in patients who have been hospitalized with acute injuries, illness, or malnutrition. Other causes of hypocalcemia include:

  • Age
  • Diet low in fat and high in fiber
  • Excessive alcohol or caffeine consumption
  • High intake of phosphorus, which is found primarily in carbonated beverages, meats, seafood, cheese, milk, whole grain bread, and many snack foods
  • Hypoparathyroidism (underactive parathyroid glands)
  • Intestinal malabsorption conditions, such as Celiac’s disease
  • Kidney disease or kidney failure
  • Low intake of magnesium, protein, and/or vitamin D
  • Malnutrition
  • Medications
  • Pancreatitis (inflammation of the pancreas)
  • Pregnancy

Medications and Hypocalcemia

Sometimes, low blood calcium is not caused by diet or an underlying health issue, but by prescription medication. The following drugs may affect the level of calcium in your body and lead to hypocalcemia.

  • Aluminum and magnesium antacids
  • Antacids or anti-ulcer drugs, such as proton-pump inhibitors (PPIs) like Prilosec and histamine receptor blockers like Tagamet (cimetidine)
  • Antibiotics, including aminoglycosides, fluoroquinolones, tetracycline, and isoniazid
  • Anticonvulsants such as carbamazepine (Tegretol), phenytoin (Dilantin), and phenobarbital (Solfoton)
  • Antiretroviral drugs, which are used in the treatment of HIV
  • Bile acid sequestrants, like cholestyramine (Questran), to lower cholesterol
  • Bisphosphonates, such as alendronate (Fosamax)
  • Colchicine, a gout medication
  • Corticosteroids
  • Digoxin, which is used to treat congestive heart failure and associated symptoms
  • Diuretics, loop (furosemide, or Lasix) and potassium-sparing (triamterene, or Dyazide and Maxide)
  • EDTA, a chelating agent
  • Levothyroxine, a hormone replacement to treat an underactive thyroid
  • Mineral oil
  • Phosphate enemas
  • Salicylates
Low blood calcium is linked to a number of health issues, so treatment is usually necessary. Reduced levels can lead to irregular heartbeat, or heart arrhythmia, which may increase the risk of a cardiovascular event, including congestive heart failure. It can also lead to seizures and lung spasms. The condition that is most strongly correlated with chronic low-grade hypocalcemia is osteoporosis, or the gradual thinning of bone and bone tissue. This problem mainly affects women, especially as they age, so it’s essential that older women get enough calcium in their diet. Complications of osteoporosis include curvature of the spine, loss of height, and brittle bones, which may result in frequent fractures.


Symptoms may not occur with hypocalcemia, especially in the early stages. As the condition worsens, people may experience abdominal discomfort, anxiety, tingling sensations in their fingers, and muscle cramps or spasms. Irritability, lethargy, and frequent bone fractures—a symptom of osteoporosis—are also possible. Such symptoms should be brought to a doctor’s attention so that the appropriate tests can be ordered.


A doctor must evaluate any case of hypocalcemia, as even slightly low levels can signal that something is amiss in the body. Various treatments for the condition are highlighted in this section.


Nutritional supplementation has proven to be an effective approach for treating mild hypocalcemia when guided by a physician. While calcium supplements are beneficial, there are a few other substances that may be needed to help boost your calcium level. The importance of consulting a health-care professional about nutritional supplements cannot be stressed enough. Before using any substance listed in the table below, ask your medical provider about potential side effects and interactions. In addition, you should have your blood tested before taking any substance so that your doctor can determine a dose appropriate to your health needs and goals.

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Supplements for Low Calcium
Supplement Dosage Considerations
Calcium 500 mg one to three times a day Take a highly absorbable form of calcium, such as calcium aspartate, citrate, or hydroxyapatite. If using calcium to help sleep problems, take one 500-mg dose at bedtime.
Magnesium 250 to 500 mg twice a day Use magnesium aspartate, citrate, taurate, glycinate, or any amino acid chelate. Supports bone building and balances calcium intake. The ratio of calcium-tomagnesium intake should be between 1 to 1 and 2 to 1. This supplement is reported to improve blood vessel function and insulin resistance, in addition to decreasing LDL cholesterol, total cholesterol, and triglycerides. Also essential for phase-I liver detoxification. If you experience loose stools after taking magnesium, cut your dose in half and gradually increase over the course of a few months. Consult your health-care provider for dosage advice.
Vitamin D (Vitamin D3, or cholecalciferol) 1,000 to 4,000 IU once a day Vitamin D is necessary for proper calcium absorption. Inform your doctor if you are taking any drug that can deplete vitamin D, such as anticonvulsants, cholesterollowering medications, anti-ulcer drugs, or mineral oil. People with kidney disease or atherosclerosis should not take vitamin D. Excessive intake can increase the risk of hardened arteries and high blood calcium levels. People with sarcoidosis, tuberculosis, hyperparathyroidism, and lymphoma should use vitamin D only as directed by a physician. The tolerable upper limit for vitamin D intake is 4,000 IU per day. Higher dosages may be used to treat vitamin D deficiencies, but must be short-term and medically supervised.


Whether hypocalcemia is mild or acute, there are certain dietary guidelines that should be closely followed for better blood calcium management.

  • Avoid foods that are high in fiber, including beans, collards, chocolate, rhubarb, soybeans, spinach, and sweet potatoes. Such high-fiber foods contain oxalates (oxalic acid) and phytates (phytic acid), which bind to calcium and inhibit its absorption in the body.
  • Consume more calcium-rich dairy products, such as milk, buttermilk, cheese, cottage cheese, and yogurt. Choose organic products that do not contain hormones and antibiotics typically found in regular brands.
  • Eliminate caffeinated drinks, including coffee and tea, from your diet. Excessive caffeine intake is associated with hypocalcemia.
  • Lower your consumption of dietary phosphates (phosphoric acids). These are commonly found in carbonated beverages, cheese, milk, meats, seafood, whole grain bread, and many snack foods. Your total daily intake should be no more than 400 to 800 mg per day, so pay attention to nutrition labels on foods that you buy.
  • Snack on nuts and seeds, which are good sources of calcium and magnesium.

Additionally, if bone health is a concern, you should cut out refined sugars and carbohydrates, as they increase blood acidity and can cause bone calcium depletion. Also, increase your intake of fruits and vegetables, especially green leafy vegetables. These foods are excellent sources of calcium and potassium, a vital mineral that reduces blood acidity and protects calcium in the bones.

You should also make sure that your overall lifestyle is just as healthy as your diet. This means exercising, getting out in the sun, managing stress effectively, and throwing away your cigarettes if you’re a smoker. Remember, sunlight exposure boosts vitamin D levels, which are essential for optimal calcium absorption. Additionally, a combination of weight-bearing and aerobic exercises strengthens your bones, slowing down any bone loss that may result from low blood calcium. Finally, adopt strategies—for example, yoga, meditation, or other relaxation exercises—to reduce your stress level. Chronic stress often interferes with hormone regulation, which can lead to bone problems, particularly if estrogen or cortisol levels become imbalanced. Low estrogen is connected to bone loss, while high cortisol in the blood can hinder the function of osteoblasts—cells responsible for making and maintaining the bones.


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