Supplemental calcium intake and keto acids

Most of us associate calcium with bone health, not protein supplements.

Keto analogues are not stable unless converted to a different form like calcium, magnesium, sodium, and so on.  This is why calcium shows up in your protein supplement. 

In the past, amino acid/keto analogue blends were all calcium-based. This goes back to Dr. Walser’s work started in the 1970’s.  At the time it was thought that high doses of supplemental calcium were harmless to kidney patients.  However, this data is now 50 years old. 

Past recommendations from the National Kidney foundation were up to 2,000 mg of calcium per day from all sources.  It was thought that consuming 1,000 mg of calcium from diet and another 1,000 mg of calcium from supplements was an acceptable approach.  I will say it again for good measure, this is 1970’s and 1980’s research that supported this approach.

What does current 2020 medical research say about the safe amount of daily calcium intake?

Over the past decade, virtually every country and medical organization in the world has lowered the amount of daily calcium intake that is considered safe.  The range of current safe daily calcium intake from all sources is 500 mg to 1,200 mg per day.  All sources mean dietary intake, intake from calcium-based phosphorus binders, supplemental calcium pills, calcium based keto analogues, antacids, and so on.  Everything counts toward the upper limit of 1,200 mg of calcium per day.

The USDA estimates that the average American consumes 1,029 mg of calcium per day as a reference.  The average person is already getting the recommended daily amount and does not need to supplement calcium. 

Now we know that 1,200 mg is the upper safe limit, with 800 to 1,000 mg being the normal recommendation.  We also know that we get about 1,000 mg of calcium from our normal diet.  We can now look at the calcium content of different protein supplements.

How much calcium is present in different protein supplements or protein foods:

Type Calcium amount
Amino acids 0 mg
Calcium based keto amino acid blends 660 to 1,200 mg
Albutrix S3 0 mg
Albutrix S4 190 mg
Albutrix S5 459 mg

*at max dosage

As you can see, the amount of calcium varies between 0 and 1,200 mg per day. Keep in mind this is just from the protein supplement, not from diet or other medications/supplements.

Let’s look at it from a dietary restriction point of view.   How can we stay at or below the maximum 1,200 mg of calcium per day if we take high calcium supplements?


 Type 
Calcium content
Dietary restriction of calcium
Amino acids 
0 mg
none
High Calcium keto analogues 660 to 1,200 mg extreme/impossible
Albutrix s3 0 mg none
Albutrix s4 190 mg none or very small
Albutrix s5 459 mg medium

 

Again, the choice of protein supplements determines how strict our diet has to be so we don’t exceed the recommendations. 

Note:  The Stopping Kidney Food Diet averages 600 to 700 mg of dietary calcium per day to allow patients on Albutrix S5 to stay under the maximum recommended amount of 1,200 mg per day. 

This approach allows patients to consume 741 mg of calcium per day from diet and still comply with all of the current recommendations for calcium intake.   

Calcium-based keto acids  with calcium amounts greater than 500 mg will require extreme dietary calcium restrictions to stay under the 1,200 safe limits.  We found it very hard , well almost impossible to restrict dietary calcium intake below 600 mg and still eat normal foods.  It may be impossible to get calcium down to 500 mg or below each day as needed to comply with the recommended amounts.

Now that we know the numbers, we can look at the current research to see if large doses of supplemental calcium are safe for us.

First, let’s see what the equivalent of the Food and Drug Administration in countries other than the United States has to say about using calcium-based keto analogue blends which contain large amounts of supplemental calcium.

20+ countries have restricted the use of calcium-based amino/keto analog blends to patients with a GFR between 5 and 20.  Use is not recommended  if GFR is greater than 15 in most cases.

I am not privy to the decision-making process of each country, so I can’t say the exact reason for each country's decision. I can say that, as a kidney patient,  it frightens me.  I can also tell you what I was told personally.  My GFR was not low enough for the risks associated with high dose calcium-based keto analogues and in addition my family history of heart disease made it a double ‘no.’

 Here’s what Johns Hopkins and the Jornal of the American Heart Association said:

“After analyzing 10 years of medical tests on more than 2,700 people in a federally funded heart disease study, researchers at Johns Hopkins Medicine and elsewhere conclude that taking calcium in the form of supplements may raise the risk of plaque buildup in arteries and heart damage, although a diet high in calcium-rich foods appears [to] be protective.”


This matters greatly to us, since heart disease caused by vascular calcification is the number one killer of kidney patents. We are the highest risk group for heart disease/vascular calcification ever studied. 

Quotes from the National Institute of Health and AARP study on over 300,000 adults:

“Among patients with end stage renal disease, daily ingestion of calcium as [a] phosphate-binding agent is positively correlated with coronary artery calcification.”

Supplemental calcium intake is also related to :

  • Increased risk or number of kidney stones
  • Increased risk of mortality in some studies
  • As stated, increased risk of heart attack

In 2020, Kidney Disease Outcomes Quality Initiative (KDOQI) from the National Kidney Foundation and American Academy of Nutrition and Dietetics (AND) changed guidelines from 2,000 mg of calcium per day to 800 to 1,000 mg per day from all sources.

In 2020, zero debate exists on this issue, with the exception of marketing information by companies selling supplements to kidney patients.  Everywhere we look we find the same evidence from dozens of countries and multiple trustworthy organizations.  Dietary calcium from food sources like greens is good for us with no limits.   However, supplemental calcium may incur risks we don’t need or want to take.   The excess calcium or calcium overload ends up being deposited in our arteries or other parts of our bodies like kidney stones.    


For us, one rule can simplify the calcium issue:

We should always take the lowest calcium protein supplements we can safely take unless a doctor prescribes a high dose calcium supplement for other reasons.

Going against these recommendations goes against guidelines from the following organizations and countries:

  • Organizations:
    • Johns Hopkins 
    • Journal of the American Heart Association
    • National Institutes for Health
    • National Kidney Foundation
    • American Academy of nutrition and dietetics
  • Countries:
    • Germany 
    • France
    • Italy
    • South Korea
    • Poland
    • Romania
    • India
    • Czech Republic
    • Russia
    • Turkey
    • Brazil
    • Colombia
    • Mexico
    • Pakistan 
    • Egypt
    • Philippines
    • Malaysia
    • United Arab Emirates
    • Portugal
    • Bulgaria
    • Hungary
    • Kuwait
    • … among others

If there is any population in the world that needs to limit supplemental calcium intake, it is kidney patients.

Read the label for calcium milligrams.

A good rule of thumb is if supplemental calcium in a protein supplement is above 200 mg per day, it is only for patients with a GFR of 20 or below and who are  on a calcium-restricted diet.  If the amount of supplemental calcium is above 600 mg per day, it is likely impossible to stay below the maximum recommended daily intake of 1,200 mg when dietary intake is factored in. 

Milligrams of calcium per serving is listed on the label of every reputable product for kidney patients.  However, you can always call/email  the company if it is not listed on the label and ask for testing results.