Calcium Orotate: How It Compares to Other Calcium Supplements

Calcium orotate is the most highly absorbed calcium supplement. Extensive research by the late German doctor Hans A. Nieper, M.D. found that orotate molecules are the most efficient carriers of calcium, magnesium, lithium, and other ions in the body. Orotates can cross the cell membrane, delivering the mineral ion to the innermost layers of the cell, reaching the mitochondria and nucleus. Other calcium supplements, such as calcium carbonate, citrate, gluconate, lactate, malate, and phosphate, cannot penetrate into the membranes as orotates can, or are broken up in the digestive tract.^{[1, 2]}

What Is Calcium Orotate?

Calcium orotate includes a calcium molecule bonded to two molecules of orotic acid. The orotate protects the calcium from stomach acid, allowing the molecule to remain intact until it reaches the intestines. In the gut, the calcium enters the bloodstream where it can be effectively delivered where it’s most needed, such as bone and other tissues. In this form, 90 percent to 95 percent of calcium gets absorbed by the body.^[3]

What Does Calcium Do In the Body?

Calcium is necessary for healthy hair, nails, and teeth, but it is also important for heart health and basic metabolism. The effects of depleted calcium levels span far beyond the scope of weakened bones. Calcium plays a major role in many bodily functions, including cellular metabolism. However, only 32 percent of Americans are getting the levels of calcium required for proper body function as of 2006, the latest available data.^[4]

Having optimal levels of calcium in the body is important at all ages, from the youth who seem invincible to the elderly who are at risk for osteoporosis. Without enough of this mineral, a calcium deficiency can arise, causing the body to extract it from the bones for use in metabolic processes. Calcium also requires vitamin D and magnesium for its optimal absorption and use in the body.

Is Calcium Orotate the Best Form of Calcium?

Calcium orotate is the most highly absorbed, most effective calcium supplement especially for bone conditions and bone health. It helps to restore normal bone, cartilage, and tooth mineral concentrations. Below I have listed how calcium orotate compares to other forms of calcium, as well as the specific health benefits of calcium orotate.

Calcium Orotate vs. Calcium Carbonate

Calcium carbonate is the most common calcium supplement sold today, but it is essentially the same as chalk. Your stomach is not able to digest calcium carbonate unless it is taken with food because there is not enough stomach acid to break it down. As a result, some healthcare providers have even found lodged, undigested calcium carbonate tablets in the intestines.^[5] Absorption of calcium carbonate averages 31 percent but can be lower if not taken with food.^[6] Because of the low absorption and need to take with food, calcium orotate provides a better option for your supplement needs.

Calcium Orotate vs. Calcium Citrate

Calcium citrate is the second most common form of calcium citrate. Absorption is better than with calcium carbonate, but still not as high as calcium orotate. The advantage of calcium citrate over calcium carbonate is that you can take it without food because stomach acid can break the calcium apart from the citrate molecule. Nevertheless, calcium citrate only has an absorption of around 39 percent.^[6] Calcium orotate provides even better absorption — 90 percent to 95 percent — since it can penetrate cell membranes and deliver calcium directly to the mitochondria and nucleus of each cell.

Calcium Orotate vs. Calcium Acetate

Calcium acetate is typically used as a medicine for kidney patients. The minerals calcium and phosphorus will reach a homeostasis with one another in the body; when one of these minerals get too high, taking the other brings the other one down. With chronic kidney disease, patients often get high phosphorus levels, and doctors may prescribe calcium acetate to lower phosphorus levels.^[7] Studies found calcium acetate more effective than calcium carbonate at lowering phosphorus levels in blood serum for dialysis patients.^[8] No studies have compared calcium orotate with calcium acetate for chronic kidney conditions.

Calcium Orotate vs. Calcium Aspartate

Calcium aspartate is more readily absorbed than calcium carbonate and calcium citrate but not as well as calcium orotate. Like calcium orotate, calcium aspartate has the advantage of being acid resistant.^[9] That means it survives stomach acid without the calcium being dissociated from the acetate molecule. Aspartate molecules effectively way to bring calcium to bone tissues, especially when experiencing a loss of bone mineral density^[10], but still only has an absorbability of 45 percent compared to 90 percent to 95 percent for calcium orotate.^[9]

Calcium Orotate vs. Other Forms of Calcium

There are a few less commonly sold forms of calcium, including 2-AEP (aminoethyl-phosphate). According to research by Dr. Hans Nieper, this calcium supplement best support your nerves and nervous system. If you are specifically looking for nerve cell or nervous system support, look for calcium 2-AEP. For bone support and most other uses, I recommend calcium orotate. Another form, calcium hydroxyapatite, comes from cow bone, which I don’t recommend because of its animal source. I prefer vegan, plant-sourced, pure supplements like calcium orotate from non-animal sources.

Benefits of Calcium Orotate

Most people know calcium helps bone health, but did you know calcium also plays a vital role in your mental health and your metabolism? Calcium fulfills several essential functions in your body, which I explain below. Because of its high bioavailability, calcium orotate is the best way for you to maximize these health benefits.

Promotes Strong Bones

It has been well established that calcium supplements can work as preventative measures against bone loss and osteoporosis. While many forms of calcium supplement may aid in the prevention of this loss, Hans A. Nieper's studies showed that calcium orotate gave the bones more usable calcium per milligram consumed. Overall, calcium is well-known to support bone, cartilage, and teeth health throughout life but especially as women lose calcium after menopause.^[11]

May Assist With Weight Control

Calcium orotate was also shown to reduce food cravings. Nieper's studies found that by supplementing the diets of chronic overeaters with calcium orotate, cravings were reduced significantly. Other studies have linked calcium supplementation with lower weight gain over time.^{[11, 12]}

Enhances Mood

Calcium orotate has been linked to mood-enhancement and overall cognitive enhancement. Calcium plays a role in hormone signaling in the body, so getting enough of this mineral helps ensure you have hormonal balance, which supports your mood.^[11]

Protects the Heart

Calcium aids cardiac muscles and assists the nervous system in keeping optimal blood pressure levels in the arteries. Calcium decrease how much fat is absorbed in the intestines, lowering blood cholesterol, and in turn reducing the risk of cardiovascular conditions. However, while some studies have found calcium decreases the risk of heart conditions, others have found no effect, and some have found levels of calcium supplementation above the recommended doses may even increase heart disease risk.^[11]

Normalizes Premenstrual Symptoms

Adequate amounts of calcium stop the release of hormones related to premenstrual mood-related disorder, including anxiety, depression, and irritability. Calcium supplementation is important for women athletes or other extremely thin women who have ceased having regular menstrual periods, or they may experience bone loss or stress fractures.^[11]

Calcium Orotate Safety Considerations

Some studies have linked excess calcium supplementation to cardiovascular disease. The studies are inconsistent, however. Some studies found calcium supplementation has a positive effect on the heart, others showed no effect, and a few that showed people — particularly men — who took over 1000 mg/day of calcium had a 20 percent greater risk of developing heart disease.^[13]

Taking calcium in supplemental form (but not from dietary sources) in excess of the upper recommended limits may lead to hypercalcemia, which is excess calcium in the blood. It’s important to ensure that you get as much of your calcium from your diet as possible, but look for plant-based sources. While everyone needs calcium, there’s no benefit to taking more than the recommended dose, and in fact, some studies have linked taking more than 1,000 mg daily for multiple years with a higher risk of developing kidney stones.^[11]

As with any calcium supplement, the most common side effect is mild stomach discomfort or occasional constipation. These side effects can be remedied by taking the supplement with food and eating a high-fiber diet. Less common side effects include nausea or vomiting, headache, tiredness, unexpected weight loss, or mood changes. If you experience any of these symptoms when taking calcium, please see your healthcare provider.

Best Calcium Orotate Supplement

I recommend a calcium orotate supplement for optimal bone, brain, and metabolic support. Look for a high-quality supplement that is vegan and GMO-free. IntraCal™ which includes both calcium orotate and magnesium orotate. Magnesium is a cofactor required for your body to use calcium with maximum bioavailability.

How Much Calcium Do You Need

If you take calcium supplements, you have to hit the sweet spot of taking enough but not too much for optimal health benefits and safety. The Food and Nutrition Board (FNB) of the Institute of Medicine of the National Academies developed Recommended Dietary Allowances (RDA) for Calcium, listed in the table below.

Recommended Dietary Allowances (RDA) for Calcium^[11]

Age	Male	Female	Pregnant	Lactating
0-6 months*	200 mg	200 mg	N/A	N/A
7-12 months*	260 mg	260 mg	N/A	N/A
1-3 years	700 mg	700 mg	N/A	N/A
4-8 years	1,000 mg	1,000 mg	N/A	N/A
9-13 years	1,300 mg	1,300 mg	N/A	N/A
14-18 years	1,300 mg	1,300 mg	1,300 mg	1,300 mg
19-50 years	1,000 mg	1,000 mg	1,000 mg	1,000 mg
51-70 years	1,000 mg	1,200 mg	N/A	N/A
71+ years	1,200 mg	1,200 mg	N/A	N/A

The Food and Nutrition Board also established upper limits for your daily calcium intake. During pregnancy, women need to increase their dosage to ensure adequate intake for both the woman and the developing baby. The maximum dose that you should take at a given time is 500 mg of elemental calcium, mainly because the body does not absorb doses higher than that as efficiently. However, you can take more than 500 mg per day, if you divide up the dose and take it at different times.

Tolerable Upper Intake Levels (ULs) for Calcium^[11]

Age	Male	Female	Pregnant	Lactating
0-6 months*	1,000 mg	1,000 mg	N/A	N/A
7-12 months*	1,500 mg	1,500 mg	N/A	N/A
1-8 years	2,500 mg	2,500 mg	N/A	N/A
9-18 years	3,000 mg	3,000 mg	3,000 mg	3,000 mg
19-50	2,500 mg	2,500 mg	2,500 mg	2,500 mg
51+ years	2,000 mg	2,000 mg	N/A	N/A

When analyzing supplements, it’s important to understand how the recommended daily value is calculated. Supplement manufacturers are required to report “elemental calcium” on the label for consumers. The term "elemental" describes the calcium separately from whatever carrier molecule is bonded to the mineral, such as orotate, carbonate, or citrate. The DV will always be calculated based on the weight of calcium only, regardless of the total weight of the calcium compound (calcium orotate, or calcium carbonate, for example).

If the total weight of calcium orotate (calcium plus orotic acid) is 790 milligrams and that contains 90 milligrams of elemental calcium, you can calculate your daily value by dividing 90 mg elemental calcium by 1000 mg calcium. That equals 9 percent of your recommended daily value. There is no DV for any specific form of calcium (i.e., calcium carbonate), but only for elemental calcium.

Points to Remember

Calcium orotate has the highest bioavailability of any calcium supplement form at around 90 percent to 95 percent, compared to 20 percent to 45 percent for other forms, like calcium orotate and calcium citrate. Studies by the late Dr. Hans Nieper found that the orotate molecule effectively carries the calcium through cell membranes, allowing for the most efficient use of this essential mineral.

References (13)

1. Lanphier L, Sharpe E. "Orotates and Mineral Transporters – Fact or Fiction." Lanphier L. 13 Aug 2018. Oasis Advanced Wellness Health.
2. Nieper A. "Recalcification of bone metastases by calcium diorotate." Agressologie. 1970;11(6),495-500.
3. "Types of calcium supplements." Health Sciences Institute. Accessed 28 Aug. 2018.
4. Bailey RL, et al. "Estimation of Total Usual Calcium and Vitamin D Intakes in the United States." J Nutr. 2010;140(4),817–822.
5. Kmiec M. "Should You Be Afraid Of Your Calcium Supplements? Or The 'Research' Telling You To Be?" Online Holistic Health. 1 Dec. 2014. Accessed 28 Aug. 2018.
6. Harvey JA, et al. "Superior calcium absorption from calcium citrate than calcium carbonate using external forearm." J Am Coll Nutr. 1990 Dec;9(6),583-7.
7. Taksande SR, Worcester EM. "Calcium supplementation in chronic kidney disease." Expert Opin Drug Saf. 2014;13(9),1175-85.
8. Wang Y, et al. "Calcium acetate or calcium carbonate for hyperphosphatemia of hemodialysis patients: a meta-analysis." PLoS One. 2015;10(3),e0121376.
9. Muhammad MV, et al. "Mineral Transporters—The Novel Approach in Management of Bone Health and Osteoporosis." Orthopedics Today 2010;12(1),1-6.
10. Calcium Aspartate. "Product Writeup." Minerals Inc. Accessed 28 Aug. 2018.
11. "Calcium: Fact Sheet for Health Professionals." National Institutes of Health Office of Dietary Supplements. Updated 2 Mar. 2017. Accessed 29 Aug. 2018.
12. Davies KM, et al. "Calcium intake and body weight." J Clin Endocrinol Metab 2000;85(12):4635-8.
13. Xiao Q, et al. "Dietary and Supplemental Calcium Intake and Cardiovascular Disease Mortality." The National Institutes of Health–AARP Diet and Health Study. JAMA Intern Med. 2013;173(8),639-646.

†Results may vary. Information and statements made are for education purposes and are not intended to replace the advice of your doctor. If you have a severe medical condition or health concern, see your physician.