Can You Take Calcium with Strontium?

(In a letter from one of Dr. T's readers) Marilee asks:

Every article I've read says to take strontium away from calcium or it won't be absorbed, yet the supplement that supports healthy bones that you recommend puts them both in the same product. So, which is true?

Also, must strontium be taken on an empty stomach and must you wait an hour to eat? That is what I was told, but a friend was told to take it with food.

My Answer

These are excellent questions, but much more complex than it seems. I will also address 2 other questions also asked about combining strontium and calcium in a bone-support supplement:

1. Why in my book I recommend a specific bone-support product but go on to say that strontium ranelate is what should be used, but then that product contains strontium carbonate.
2. Why the calcium is carbonate? Is there a reason for the choice of strontium carbonate and calcium carbonate?

These are excellent questions, but much more complex than they seem at first glance. There are a few key issues to factor in:

1. Both calcium and strontium are absorbed by the same mechanism in the bowels, so there is some competition. It is estimated that one will absorb twice as much calcium as strontium when combined. Because there are high levels of strontium in the bone-support supplement I recommend relative to the diet (which has 1-5 mg/day) and too much strontium may inhibit bone formation, I am OK with the drop in strontium absorption. Though the 680 mg/day used in some studies seemed safe over the 3 years of follow up, I doubt these very high levels are either needed or optimal, and my recommendation over time has been to lower the dosing.
   
   Strontium

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2. A bigger concern is taking high levels of strontium without adequate calcium intake. This is the main time the strontium could be bone inhibiting. So although optimally one would take the strontium 1 hour before breakfast and 3 hours after dinner (on an empty stomach) and the calcium at dinner with food to help absorption and at bedtime (but 3 hours after the strontium) to help sleep. As you can see, it becomes a full time job juggling this and most people would not be able to stay with it or would miss the calcium or strontium doses—causing their own problems.
3. Strontium also inhibits calcium absorption by decreasing the conversion of 1 type of vitamin D (25 OHD) to another (1,25 OHD). In our society, especially in CFS/Fibromyalgia, 1,25 OHD is already too high relative to 25 OHD (stimulated by chronic infections) causing an immune system imbalance that is problematic. By taking the high dose Vitamin D in the Bone Health with the strontium, one can optimize Vitamin D while decreasing excess conversion to 1,25 OHD and still maintaining excellent calcium absorption.

   Because of this, though a classic approach would be to take strontium on an empty stomach away from calcium, in real life this is often impractical (most people are lucky to remember a 1 a day birth control pill!). Because of this, I prefer to combine everything to be taken morning and night (I prefer this for almost all therapies—just put it by your toothbrush) and then to adjust the dosing of the individual nutrients in the supplement to compensate for this. This makes it simpler, improves compliance, and makes it more likely to work in the long run.

4. In the book, I note that all forms of strontium work but the ranelate has mildly better absorption. It is, however, more expensive and you can get the same effect at a significantly lower cost by simply upping the dose a bit, so we do it that way.

5. There are numerous conflicting studies over which form of calcium is best absorbed, with the usual result being that it is the brand that is made by the company who paid for the study (same thing as is seen with pharmaceuticals). I do not think the form of calcium is very important except that many (if not most) tablets do not dissolve and get NO absorption. That's why in my book, Pain Free 1-2-3!, I talk about the key issue with calcium being that it be a powder, liquid, or chewable so that it dissolves and is absorbed, and this is the case the bone-support supplement that I recommend.