Aluminium rarely causes vitamin D-resistant osteomalacia, erythropoietin-resistant microcytic anemia, and central nervous system changes. People with kidney insufficiency are at a risk the most. Chronic ingestion of hydrated aluminium silicates may result in aluminium binding to the things in the intestines. It also increases the removal of other metals, like iron or zinc. Really high doses (>50 g/day) can cause anemia.