Discussion Board

Thanks for another great newsletter (January 2012). I do have a question about the comment that calcium citrate causes the intestines to absorb more aluminum. In looking at the abstract for the article you referenced it says, "All citrate-containing preparations are totally contra-indicated in chronic renal failure patients ingesting Al-containing compounds." Another related article, http://www.ncbi.nlm.nih.gov/pubmed/8453325, says, "Thus, calcium citrate given alone without aluminum-containing drugs does not pose a risk of aluminum toxicity in subjects with normal or functioning kidneys, when it is administered on an empty stomach at a recommended dose of 20 mmol calcium/day."

My interpretation is the increased aluminum absorption is only a problem if the person is also ingesting aluminum containing supplements (e.g. aluminum hydroxide). Since I only looked at the abstracts, maybe the full articles clarify this. Is calcium citrate ok when taken without aluminum supplements?

People with kidney disease die quickly from the aluminum.

Those with normal kidneys just get slow chronic aluminum accumulation and poisoning.

John McDougall, MD

Dr. McDougall - Thanks for the response. I understand the absorption of aluminum is a problem. However, the question I had is if a person is not ingesting aluminum in their diet it would seem the calcium citrate would be a non-issue. As I mentioned in my first post, the referenced article seems to say the problem is taking calcium citrate along with aluminum containing supplements.

If calcium citrate is a problem by itself, wouldn't any foods containing citrate and calcium (such as calcium fortified orange juice) also be a problem?

If you can give me a reference to an article that clarifies the issue that would be great!
Thanks!

Aluminum is in everyone's diet and more so in those who cook with aluminum pots and eat certain prepared foods.

The first sentence of the abstract is: "It is well known that Al absorption is markedly enhanced by citrate."


John McDougall, MD

As H. Gilbert Welch might say, to state that the Al absorption is markedly enhanced doesn't have much meaning unless you know where you are starting from. My question is whether consuming citrate from dietary sources or supplements will be a problem and this leaves it still unclear.

In "Aluminum Exposure and Metabolism" 1997, Vol. 34, No. 5 , Pages 439-474 http://informahealthcare.com/doi/abs/10.3109/10408369709006422, they state, "Typically gastrointestinal absorption of aluminum from diets is <1%." Still, not clear how much this 1% is! From this it would appear to me the risk of Al absorption is normally low if a person is not cooking with aluminum and not taking Al in supplements. Then the danger citrate would pose on Al toxicity would likely be low. Since I don't have access to the full journal articles, my investigation is hampered by only reading the abstracts...maybe one of the articles actually gives the absolute levels of absorption, but I didn't find it.

On another topic, the presentations by H. Gilbert Welch last weekend were both great! Haven't watched all the weekend videos yet, but looking forward to the always great folks you bring in for these weekends!
Thanks again.

I've been wondering weather I should be taking a calcium citrate supplement as I am a female in my 60s and have mild osteopenia. Colin Campbell's website quotes PCRM's recommendation for citrate vs carbonate. I guess this is why I'm confused by opinions of all of these well-respected doctors/researchers:

"If you decide to add extra calcium, calcium-fortified orange juice is a good choice. It contains more calcium than milk, and it is in the form of calcium citrate, which is much more readily absorbed than that in milk or in calcium carbonate supplements." --PRCM in Women's Health topic on T.Colin Campbell Foundation website