New Indian Guidelines: Prioritise Dietary Calcium Over Supplements

At 56, Meena Sharma, like many health-conscious Indians, began taking a daily calcium tablet after menopause on friends' advice, without consulting a doctor. Her diet already included two glasses of milk daily and occasional vitamin D injections. Months later, a doctor informed her that her diet provided sufficient calcium, and supplements were unnecessary. This scenario reflects a common trend across India, where calcium intake is either inadequate or supplemented without medical need.

The Endocrine Society of India (ESI) has released a new consensus statement emphasising that dietary calcium should be the primary source, with supplements used only when medically indicated. The guidelines highlight that milk and dairy products are the richest sources, but also note affordable Indian alternatives such as ragi, bajra, sesame seeds, pulses, and green leafy vegetables. Sprouted ragi may improve calcium absorption by reducing phytates that interfere with mineral uptake.

For most healthy adults, the recommended dietary allowance is 1,000 mg of calcium per day, with slightly higher needs during lactation. Dr Saptarshi Bhattacharya, an endocrinologist at Indraprastha Apollo Hospital, New Delhi, and one of the authors, stated: 'We recognise that dietary diversity, affordability, low dairy intake, and regional food habits make it difficult for many individuals to meet their calcium requirements through food alone. The first step should be to assess dietary calcium intake and encourage affordable, locally available calcium-rich foods. Milk and curd remain the most important sources, but ragi, sesame seeds, soy products, pulses, green leafy vegetables and small fish consumed with bones are also valuable options. When dietary intake remains inadequate despite these measures, calcium supplements have an important role.'

The guidelines specify situations where supplementation is medically justified, including pregnancy, breastfeeding, menopause, and conditions such as osteoporosis, osteomalacia, rickets, and hypoparathyroidism. People with lactose intolerance or disorders that reduce calcium absorption may also benefit. The type of supplement matters: calcium carbonate is economical and best absorbed with meals, while calcium citrate is recommended for those taking acid-suppressing medications, with reduced stomach acid, or with kidney stone disease. The authors discourage routine use of more expensive formulations lacking strong evidence of benefit.

Additionally, the guidelines stress that calcium cannot work effectively without adequate vitamin D. They recommend correcting vitamin D deficiency alongside calcium supplementation and advise against widespread use of activated vitamin D preparations like calcitriol except in specific medical conditions. Daily vitamin D supplementation of 1,000–2,000 IU is suggested.