Calcium Acetate As A Phosphate Binder And Calcium Supplment For People With Low Stomach Acid


Jun 8, 2014
I've been trying to figure out digestible sources of calcium to recommend to my sister who I found out is only taking in about 200mg of calcium per day. She has a pretty low appetite and I suspect not great gastric acid release, so I worry she isn't even absorbing all of that 200mg.

So I've been researching and experimenting with different sources of calcium. The most promising I've found so far is calcium carbonate dissolved in distilled white vinegar to form calcium acetate. I noticed that it is also used a phosphate binder for people with kidney disorders to block absorption of dietary phosphorous to some degree.

Phosphate binder - Wikipedia, the free encyclopedia

It seems like it could be a good calcium source for people that currently don't have great gastric acid release and also want to increase their calcium to phosphorous ratio to lower PTH. Although some of the calcium isn't absorbed it should help overall to increase the serum ratio.

It doesn't taste great, but if you get the ratio of vinegar to calcium carbonate right it doesn't have a very acidic taste and you can chase it with some juice. I do about 1/4 tsp calcium carbonate powder to 1-2 tablespoons white distilled vinegar, which should be mostly acetic acid. I haven't worked out the exact amount needed to fully react with the calcium carbonate, but the chemical balance equation says you need twice as much acetic acid as calcium carbonate.

CaCO3(s) + 2CH3COOH(aq) → Ca(CH3COO)2(aq) + H2O(l) + CO2(g)

Ca(OH)2(s) + 2CH3COOH(aq) → Ca(CH3COO)2(aq) + 2H2O(l)

Has anyone tried using calcium acetate this way as a calcium supplement? Or familiar with any reasons why it may or may not be suitable as a way to boost metabolism? Some sources caution that soft tissue calcification is possible with calcium acetate, but it seems like it would be pretty safe in combination with a balance of fat soluble vitamins.


Mar 10, 2016
I'm also curious about calcium acetate as a phosphorus binder. What is its benefit for stomach acid?


Sep 10, 2014
Not Uganda
- Calcium acetate versus calcium carbonate as phosphate-binding agents in chronic haemodialysis

"There are now a number of studies comparing calcium acetate with calcium carbonate in chronic haemodialysis patients. The present study is different in its design from most of these. It is the only study to use equimolar, fixed doses of the two calcium salts, in the absence of other phosphate-binding agents."

"It also is the only randomized cross-over trial published to date, and the only study in which an attempt was made to quantify patient tolerability, beyond withdrawal rates. It is interesting that many patients who did not admit to any adverse effects with calcium acetate still showed much poorer compliance with this drug. A number of reasons for this are apparent, first and foremost the greater number of tablets which had to be taken (6 tablets daily with acetate vs 3 with carbonate). The calcium acetate formulation used has lemon meringue flavouring, and clearly one would expect differences in patients' acceptance of this. Furthermore, whilst the calcium carbonate tablets had a glazed, very smooth surface the acetate preparation tended to be chalky even when tablets were intact, making them subjectively more difficult to swallow (investigators' observation). Clearly, many of these problems should be easily remediable with new calcium acetate preparations. Whether the calcium acetate salt per se is less tolerable remains to be seen."
It works almost too well:

"In this study, mean serum phosphate was reduced considerably with calcium acetate in comparison to the same dose of carbonate. This obviously is in keeping with previous studies, which either showed a greater reduction in phosphate, or a lower dose of calcium required to achieve the same level of phosphate. The dose of calcium acetate prescribed was in the same range as that used in previous studies (ranging between 1.0 and 1.7 g elemental calcium), with the serum phosphate level being comparable to the lowest achieved in those studies not using additional aluminium hydroxide. The initial work by Sheik et al. [5] gave theoretical as well as short-term experimental evidence for reduced absorption of calcium from the acetate salt. The majority of studies since then have been in conflict with this, showing either a similar mean serum calcium level with approximately half the elemental dose of the acetate salt [8,9,11], or a higher serum calcium level and greater number of hypercalcaemic episodes for a similar dose [7,13]. Again, our findings are in keeping with these reports, and it would therefore be fair to conclude that current evidence clearly points to calcium acetate having a greater hypercalcaemic potential than calcium carbonate."

"Our study is the first to show a very significantly lower mean serum PTH level with calcium acetate."

"In conclusion, therefore, our study confirms the superior efficacy of calcium acetate over calcium carbonate in the control of hyperphosphataemia."


And it's a comparison with a form that already affects these markers.
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