RETHINKING CALCIUM SUPPLEMENTS

The British Medical Journal published an important research study online in February 2013. Involving over 60,000 Swedish women, following their mammograms and health over 19 years, researchers found 32% of deaths were from cardiovascular disease with half being from coronary artery disease and the rest from strokes. When diet and supplemental calcium were assessed, they found increased calcium, above 1,400 milligrams per day, was associated with almost a doubling of death from coronary artery disease.

 Calcium supplements combined with high calcium in the diet increased the risk.

 This is not the first report regarding calcium supplements and increased risk of heart attacks. A recent report in JAMA Intern Med 2012, in a 12 year follow-up of nearly 400,000 men and women, showed increased risk of heart disease death in men (but not women) who took 1000 mg of calcium supplements. In the June 1012 issue of Heart; (98:920-925), researchers found dietary intake with calcium supplements increased overall cardiovascular mortality. In 2010, another BMJ article showed calcium supplements without vitamin D supplements increased the risk of heart attack.

The US Preventive Services Task Force consists of a group of experts in preventive healthcare. Their recommendations published February 2012 in the Annals of Internal Medicine stated the following:

• In men and women without osteoporosis or vitamin D deficiency, it is unclear whether they should take vitamin D and calcium supplements to prevent fractures.
• It is unclear whether postmenopausal women should take daily supplements of more than 1000 mg of calcium.
• They also report, daily supplements of 400 IU of vitamin D and 1000 mg of calcium has no effect on the incidence of fractures in postmenopausal women

So, why are so many women taking vitamin D and calcium supplements if calcium supplements do not translate to better health and fewer fractures? -And, when many studies are actually showing evidence of adverse cardiovascular effects associated with increased calcium intake? The debate on the topic of calcium supplements is ongoing, but at this time, calcium supplements are no longer broadly encouraged, unless based on unique health decisions between patient and physician.

The safest approach to this conundrum is to consult your physician, site these articles and, unless you have osteoporosis, discuss stopping calcium supplements and obtaining your calcium from foods in your diet. Dietary calcium is found in broccoli, green leafy vegetables, fortified soy milk, tofu and baked beans. Tofu, bean cake made from soy, is high in calcium. One-half cup of tofu made with calcium sulfate = 434 milligrams.

Elements of strong bones include: calcium, protein, phosphorous, magnesium, vitamin D and potassium. For years we have consumed large amounts of milk, sometimes called “liquid meat.” Cow’s milk is nutritious containing proteins, vitamin D, phosphorous and calcium.  All are needed for strong bones.  Milk also contains undesirable saturated fat and calories. Drink less milk and eat more calcium rich foods to obtain your daily calcium dietary requirements.

Vitamin D and Heart Attack: New research from the University of Copenhagen shows increased risk of heart attack and death with low levels of vitamin D. And, Vitamin D deficiency may increase blood pressure. There is no proven cause between low D and heart risk, but this correlation requires more study. The study, published in the Arteriosclerosis, Thrombosis and Vascular Biology journal, evaluated 10,000 Danes in the Copenhagen City Heart Study..

Exercise and vitamins are very important for bone health. In fact, bone strength is primarily generated during the teenage years and maintained throughout life with weight bearing exercise such as walking and a healthy diet containing about 1000 mg of calcium. Eating a healthy diet rich in calcium and vitamin D is important to long-term bone and heart health.

Talk to your medical professional about the appropriate way to meet your calcium and vitamin D needs. Ask for a vitamin D level to see if you need to eat more D foods or take a supplement. Another way to get vitamin D is through limited sun exposure on your skin to allow your body to generate vitamin D. Those who live in northern climates are often vitamin D deficient because they lack sun exposure. Sunblock, important to protect against sun damage and melanoma, limits natural vitamin D conversion and contributes to vitamin D deficiency.

In the meantime, eat a diet containing the nutrients you need. Walk more to increase bone density. Exercise correlates with longer life and better health, too.

Just as recommendations related to hormone replacement after menopause changed in the past,  science-based recommendations in the area of calcium supplements are changing. What we thought was the solution to maintaining bone density may be adding serious health risks. Studies on bone health are ongoing, so watch the media for additional information. Because so many women have reduced bone density and are on calcium supplements, these studies are very important. Coronary artery disease is the leading cause of death in both men and women. Calcium supplements are so commonly consumed, this may be a factor contributing to the high incidence of heart disease.

This is one of the many topics covered in our book, available later this month: Your Heart: Preventing and Reversing Heart Disease in Women, Men and Children.

Betty Kuffel, MD