How Your Calcium-to-Phosphorus Impacts Your Health
Unveil how a hidden imbalance in everyday foods may be covertly extracting crucial minerals from your bones, weakening your body's foundation, and how you can restore balance for enduring health.
By: Ashley Armstrong
STORY AT-A-GLANCE
Many people have an imbalanced calcium-to-phosphorus ratio (Ca:P), consuming high levels of phosphorus and low levels of calcium, which can be detrimental to optimal health
Western diets typically provide ample phosphorus due to high levels in meat, grains, beans, and processed foods, but often lack sufficient dietary calcium
An ideal Ca:P ratio is close to or above 1:1; however, many popular diets, including dairy-free and carnivore diets, often result in ratios well below this, such as 0.3:1
Inadequate dietary calcium can lead to the body mining calcium from bones and teeth, and maintaining elevated parathyroid hormone levels, which are associated with systemic inflammation and accelerated aging
Simple dietary adjustments, like tracking nutrient intake through apps and adjusting food choices, can help restore a balanced Ca:P ratio
One of the biggest lessons along my health journey is that health is not found at the extremes, and that finding balance is not only more sustainable, but also more health-promoting.
This applies to exercise — balancing working out and providing your muscles with an effective stimulus to elicit change, with enough recovery, food, rest and relaxation. And to food choices, like macronutrients (for ex. balancing protein with enough carbs) and micronutrients (like mineral balance).
Today, I want to briefly touch on why we should consider balancing dietary calcium and phosphorus for optimal long-term health.
From my own experience, working with clients, and course students, many people have very imbalanced calcium to phosphorus ratios. Meaning, they consume very high levels of phosphorus, and low levels of calcium — which is not promoting optimal health.
Western Diets Are High in Phosphorus
It is very easy to get phosphorus in Western diets, as phosphorus is high in meat, grains, and beans. Plus, inorganic phosphorus is high in a lot of preservatives and packaged food (which has a 100% absorption rate1). And so many individuals eat packaged food daily!
“In many Western communities, phosphorus intake is high whereas calcium intake might be low ... These types of dietary habit may lead to the lower dietary Ca:P ratios that were recently observed in many countries.
Furthermore, recent evidence from Poland revealed that among 10% of young girls and boys, the dietary Ca:P ratio was lower than 0.25. These results support previous findings among young women in the USA.” ~ Kemi, V. and Lamberg-Allardt, C., 2006
This does “not” make meat and grains “bad” foods (I eat meat and sourdough bread). But we believe these phosphorus-rich foods should be balanced with sufficient dietary calcium. Ideally, the calcium to phosphorus ratio (Ca:P) is close to 1 or above (Ca:P >= 1).
And many people are consuming a Ca:P < 1, especially now that “dairy-free” is all the rage and is promoted as “healthy.”
On one extreme, the carnivore diet, which is an all meat diet, the Ca:P is very imbalanced, as meat is a phosphorus-rich food. On the other extreme, a grain-based diet, the Ca:P is again very imbalanced as grains are another phosphorus-rich food.
Then, searching through more of the “mainstream” (where dairy is “bad”), I searched “dairy-free meal plan” on DuckDuckGo and the first thing that came up was this “1,200 Dairy-Free” meal plan from a popular website, EatingWell. I have so many issues with this meal plan (such as — no one should be eating 1,200 calories).
But after inserting all the meal ingredients into Cronometer, I calculated a Ca:P = 0.3:1, and the total calcium content was just 600 mg! Most people are “not” consuming enough calcium, and have imbalanced Ca:P ratios.
Low Dietary Calcium Leaches Calcium From Your Bones
Calcium gets a lot of bad rep these days, and some fear eating too much of it due to the fear of calcification (a buildup of hardened calcium deposits in tissues that can interfere with function).
But dietary calcium is not the cause of calcification. Instead, low-dietary calcium can be one of the contributing factors. Calcium is so vital for proper function that the body tightly regulates the blood calcium concentration.
“Ca and P have opposite effects on serum PTH (S-PTH) concentration, as dietary P has been found to increase S-PTH concentrations by decreasing serum-ionised Ca concentration and by directly affecting PTH secretion ... while Ca administration has been demonstrated to decrease S-PTH ... continuous excessive PTH secretion increases bone turnover and releases Ca and P from bone.” ~ Kemi et al., 2009
With inadequate dietary calcium to satisfy the body's calcium needs, the parathyroid glands release parathyroid hormone (PTH) into the blood to bring calcium level back up to normal by increasing calcium absorption from our food and by dissolving calcium from the teeth and bones. When we don't consume enough dietarily, calcium gets mined from our skeleton.
Plus, when PTH is elevated from low-calcium intake, we are in a systemic, proinflammatory state that can accelerate the degenerative aging process.2
“It is extremely important to realize that calcium deposits in soft tissues become worse when the diet is low in calcium ... It is counterproductive to eat a calcium-deficient diet, since that leads to an increase in intracellular calcium at the expense of calcium from the bones.” ~ Dr. Ray Peat
While there is plenty of literature documenting the human health benefits of a dietary Ca:P >= 1,3 it is not discussed in mainstream or many “alternative” health communities. However, it is well-known, often discussed and well-documented that this Ca:P should remain balanced for other animals such as:
The “Nutrient Requirements of Dogs and Cats”9 published textbook recommends a Ca:P ratio of 1.2:1. And the Merck Vet Manual recommends a 1.2-1.5:1 for dairy goats.10
My Personal Experience
I personally saw an improvement with oral health after reversing out of a carnivore diet (very high in phosphorus and usually low in calcium). I not only re-added carbs, but I also added in dairy over time to ensure a Ca:P > 1.
During carnivore (and “dairy-free” keto) days, I would frequently develop hard plaque (aka tartar or calculus) on the inside of my bottom row of teeth. And I would pluck this off my teeth, daily.
Looking back, this was a clear sign that my body was borrowing calcium from the skeleton to maintain calcium homeostasis since we didn't consume enough dietarily to balance all of that phosphorus. The calcium was “mined” and then released into my saliva. And guess where saliva pools in our mouths? Right on the back side of your front, bottom teeth.
With a balanced Ca:P intake, I no longer get that plaque buildup! These type of dietary changes won't necessarily be “felt” in the short-term. But they can have profound implications on long-term health. And please don't let this overwhelm you!
How to Normalize Your Ca:P Balance
There are very simple solutions to regaining Ca:P balance. Here are my top tips:
Track a typical day of eating in a food tracking app such as Cronometer. The app will tell you your total phosphorus and calcium intake. Divide your total calcium intake by your total phosphorus intake to get your calcium to phosphorus ratio. Ideally this ratio is close to or slightly above 1.
You may be eating too much meat! Not because of saturated fat. Not because of cholesterol. But meat is a phosphorus-rich food, and we believe it should be balanced with sufficient dietary calcium. So, it can be beneficial to swap some of your meat intake for some dairy to still ensure you eat enough protein while maintaining a balanced Ca:P.
It's not about avoiding foods that are higher in phosphorus. It's about including foods higher in calcium to make the overall ratio in balance.
Currently can't tolerate dairy? There are other ways to boost your calcium intake! Other favorites include homemade eggshell powder, well-cooked collard greens, pearl powder, or bone meal powder from a trusted source.
I completely understand that keeping track of these type of nutrient ratios can get overwhelming. But if you are looking for additional information on the Ca:P ratio, calcium-rich foods, and how to make sure these minerals remain in balance, check out our course!
In the Nutrition section of our course, Rooted in Resilience, we include over 100 meal plan options, all of which contain balanced calcium to phosphorus ratios — making it easy to implement these important nutrition principles into your busy schedule. We also include an entire module on calcium, the Ca:P ratio, and tips to reintroducing dairy.
Of course, it's never one thing. Calcium is not the only nutrient that works to suppress the anti-metabolic parathyroid hormone (PTH). We also need adequate levels of magnesium and vitamin D (25-D) to keep the PTH levels in check. Plus, vitamin K2 to ensure calcium goes to the right places (like bones and teeth). It can be overwhelming, but it doesn’t have to be complicated.
Eating real, whole foods, tuning into cravings, and providing adequate fuel is a pretty fool proof formula for regaining control of your health.
Transform Your Health — One Step at a Time
Ashley and her sister Sarah have put together a truly groundbreaking step-by-step course called “Rooted in Resilience.” They have compiled what clearly is the best application of Dr. Ray Peat’s work on Bioenergetic Medicine that I have ever seen.
It is so good that I am using the core of their program to teach the many Health Coaches that I am in the process of training for the new Mercola Health Clinics I am opening this fall. It took these women working nearly full-time on this project for a year to create it.
This has to be one of the absolute best values for health education I have ever seen. If you want to understand why you struggle with health problems and then have a clear program on how to reverse those challenges, then this is the course for you.
It is precisely the type of program I wish I would have had access to when I got out of medical school. I fumbled around for decades before I reached the conclusion they discuss in the course and share with you so you can restore your cellular energy production and recover your health.
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Learn more about Rooted in Resilience here.
About the Author
Ashley Armstrong is the cofounder of Angel Acres Egg Co., which specializes in low-PUFA (polyunsaturated fat) eggs that are shipped to all 50 states (join waitlist here), and Nourish Cooperative, which ships low-PUFA pork, beef, cheese, A2 dairy and traditional sourdough to all 50 states. Waitlists will reopen shortly.
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Factors that affect calcium absorption
In addition to the two canonical calciumtropic hormones, namely parathyroid hormone and 1,25-dihydroxyvitamin, there are other endocrine and paracrine factors, such as prolactin, estrogen and insulin-like growth factor. which are known to directly stimulate intestinal calcium absorption.
There are certain factors that can affect its absorption, causing it to be reduced, among them are:
1) Age: the efficiency of calcium absorption decreases with age, so calcium requirements increase in people over 70 years of age.
2) Oxalates (oxalic acid) and phytates (phytic acid): are components that are found, in the case of oxalates in vegetables such as spinach and in the case of phytates in cereals, legumes or nuts. Both are capable of forming insoluble complexes with minerals such as calcium, reducing their absorption and bioavailability.
3) The calcium/phosphorus ratio: a ratio greater than 1.5 in the diet determines greater renal calcium elimination. In milk this ratio is between 1 and 1.51.
4) Insoluble fiber: despite its multiple benefits, it seems to affect the bioavailability of minerals such as calcium, reducing it.
5) Excess fat also negatively affects the absorption of this mineral.
6) Excessive consumption of caffeine and alcohol can also affect the decrease in calcium absorption. However, the effects of caffeine on its absorption are not noticeable at doses lower than 400 mg/day, and are compensated with the adequate intake of milk or dairy derivatives1.
7) Stress: Stress can have a negative effect on the production of HCl in the stomach and on the body's normal digestive behavior and therefore can have a negative effect on calcium absorption.
8) Caffeine, drugs such as anticoagulants, cortisone and thyroxine reduce the absorption of calcium in the body.
9) Lack of exercise and vitamin D deficiency cause decreased calcium absorption.
On the contrary, certain factors can help increase calcium absorption, such as:
1) Vitamin D: this vitamin, present in some foods and produced by the body when exposing the skin to the sun, increases the absorption of this mineral. Accompany K2. Exercise along with the intake of vitamin D helps the absorption of calcium, thus strengthening bones.
2) Parathyroid hormone: increases calcium transport across the membrane of intestinal cells.
3) Acidic environment: Hydrochloric acid secreted in the stomach during the digestion process is necessary for the absorption of calcium in the duodenum. Calcium supplements can be taken with magnesium before bed or between meals due to the acidic environment needed in the stomach to assimilate calcium. Always consult a doctor before starting a new supplement regimen.
4) Milk Lactose: favors absorption in infants. The intestinal microbial flora acts on lactose to form acid, which causes a reduction in pH, making calcium more soluble.
5) Amino acids: Supplemental calcium is often chelated, or combined with protein molecules called amino acids, to help the body absorb them during digestion. Lysine and arginine increase calcium absorption.
6) The acidic pH, as occurs in yogurt, causes calcium and phosphorus to pass into the soluble phase, which can favor their absorption.
7) Prebiotics also have repercussions on the absorption of certain minerals, thus favoring an increase in the availability of calcium. These effects seem to be a result of the type of carbohydrate, the degree of fermentation caused by the intestinal microbiota and the dose ingested.
8) Casein (major protein in milk) has the ability to promote intestinal absorption of calcium. This is because in the gastrointestinal tract casein is digested, forming compounds capable of binding calcium that increase its absorption through the intestine1.
9) Lactose, in addition to providing energy for the body, facilitates the intestinal absorption of calcium1.
10) Vitamin C, for its part, can also increase the absorption of this mineral.
Milk is an excellent source of calcium not only because of the amount contained, but also because its nutrient composition favors its absorption. Thus, of the calcium provided by milk, more than 85% is available for absorption.
https://www.lybrate.com/topic/factors-affecting-calcium-absorption-024e/c90f1bea04e46f8ecd0857f6b6d0f99c .----
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3989396/ .----
https://jps.biomedcentral.com/articles/10.1007/s12576-019-00688-3 .---
https://academic.oup.com/nutritionreviews/article/79/12/1307/6118465 .---
Above all balance and good food. Calcium and phosphorus metabolism are interconnected with effects on parathyroid hormone (PTH), 1,25-dihydroxyvitamin D (1,25(OH)2D), serum and urinary calcium and phosphorus concentrations, including absorption intestinal, urinary excretion and skeletal actions. Many studies have shown that increased phosphorus (P) intake can have negative effects on the skeleton, while calcium (Ca) intake can have a protective effect. As there may be an optimal balance between nutrients in relation to bone health, interest has focused on the dietary Ca:P ratio. Research data in both animals and humans indicate that a low Ca:P ratio has a negative impact on the skeleton, but there is also evidence to suggest that if P intake is high, it may have negative health effects. High dietary phosphorus has been implicated in several processes related to accelerated aging: for example, increased risk of fractures, cancer proliferation, cardiac and skeletal muscle dysfunction, and vascular calcification. Currently, dietary phosphorus is estimated to exceed the RDA by 1.5 to 2 times, which is of particular concern for people with cardiovascular disease. Both high and low dietary phosphorus can cause adverse health effects and impair longevity, and it may be important to consider implementing phosphorus analysis as a routine measurement in clinical practice.
https://link.springer.com/chapter/10.1007/978-1-4939-6566-3_10 (2017).--
https://www.mdpi.com/2072-6643/12/10/3001 (2020).--
These documents list the calcium and phosphorus content of a 1-cup serving of each food. Proper bone health and development depends not only on adequate amounts of calcium, but also on an adequate ratio of calcium and phosphorus. Feeding a variety of foods helps minimize nutrient imbalances or deficiencies. In general, leafy green vegetables are the best food for most herbivorous animals. Items from the “Ideal Ratio” list can be fed generously, along with items from the “High Ratio” list (preferred foods are IN BOLD). Items from the “Moderate Ratio” list can be used. Minimize items on the “Poor Ca/P Ratio” list, especially items in the bottom half of that list; These are foods very poor in calcium.
https://irp-cdn.multiscreensite.com/cc78ef9e/files/uploaded/Vegies-Ca-P-contents-REVISED.pdf
A GOOD CA:P RATIO IS IMPORTANT FOR THE HEALTH OF ALL ANIMALS
CHARTS:
1) Vegetable Chart -- vitamin C, calcium, phosphorus, Ca:P ratio -- PRINT
2) Fruit Chart -- vitamin C, calcium, phosphorus, Ca:P ratio -- PRINT
3) Vitamin C -- high/low ordered list -- PRINT
4) Calcium -- high/low ordered list -- PRINT
5) Calcium:Phosphorus Ratios -- high/low ordered list -- PRINT
6) Oxalic Acid -- both alphabetic and high/low ordered lists of select vegetables -- PRINT
7) Calcium/Phosphorus Ratio EXCEL Calculator -- enter weight in grams and generate a calcium:phosphorus ratio for a day's worth of foods
https://www.guinealynx.info/diet_ratio.html