Should We Take Calcium Supplements?

Written by Dr. Steve Chaney on . Posted in Calcium Supplements, Exercise, Food and Health, Healthy Lifestyle

Clearing Up The Calcium Confusion

Author: Dr. Stephen Chaney

should we take calcium supplementsShould we take calcium supplements?  You have every right to be confused about calcium supplementation. There have been a lot of conflicting headlines in recent months.

It has seemed like a no-brainer for years that calcium supplementation could help post-menopausal women and men over 50 avoid the debilitating effects of osteoporosis.

After all:

  • >99% of adults fail to get the USDA recommended 2.5-3 servings/day of dairy products.
  • 67% of women ages 19-50 and 90% of women over 50 fail to meet the RDA recommendations for calcium intake from diet alone.
  • Men do a little better (but only because we consume more food). 40% of men ages 19-50 and 80% of men over 50 fail to meet the RDA recommendations for calcium intake from diet alone.
  • Inadequate calcium intake over a lifetime is considered a major risk factor for osteoporosis.
  • Osteoporosis is serious business. It doesn’t just cause bone fractures. It can result in chronic pain, disability, long term nursing home care, and even death.

It’s no wonder that some experts have predicted that supplementation with calcium and vitamin D could save over $1 billion per year in health care cost savings. It is also why health professionals have recommended calcium supplementation for years, especially for postmenopausal women and men over 50.

However, recent headlines have claimed that calcium supplementation doesn’t really increase bone density or prevent osteoporosis (more about that later). Other headlines have suggested that calcium supplementation is actually bad for you. It may increase your risk of heart disease.

That’s why the general public, and even many doctors, are confused.  Should we take calcium supplements?  Everyone wants to know the answer to two questions:

  • Do calcium supplements work?
  • Are calcium supplements safe?

I will start with the second question first.

Are Calcium Supplements Safe?

are calcium supplements safeI have discussed the issue of calcium supplements and heart disease risk in a previous issue of Health Tips From the Professor. Briefly, the initial studies suggesting that calcium supplementation might increase the risk of heart attacks and cardiovascular disease were good studies, but they were small, short-term studies.

The initial studies raised an important question, so the scientific community stepped up to the plate and conducted larger, longer term studies to test the hypothesis. Both of those studies concluded that calcium supplementation posed no heart health risks.

Now a third major study on the subject has just been published (Raffield et al, Nutrition, Metabolism & Cardiovascular Disease, doi: 10.1016/j.numecd.2016.07.007). The study followed 6236 men and women ages 45-84 for an average of 10.3 years. The subjects were from four different race/ethnicity groups and came from 6 different locations in the United States. More importantly, there were 208 heart attacks and 641 diagnoses of cardiovascular disease during the study, so the sample size was large enough to accurately determine the relationship between calcium supplementation and heart disease.

The results were pretty straight forward:

  • The authors concluded: “[This study] does not support a substantial association of calcium supplement use with negative cardiovascular outcomes.” If you would like the plain-speak version of their conclusion, they were saying that they saw no increase in either heart attacks or overall cardiovascular disease in people taking calcium supplements.
  • If anything, they saw a slight decrease in heart attack risk in those taking calcium supplements, but this was not statistically significant.

In summary, the weight of evidence is pretty clear. Three major studies have now come to the same conclusion: Calcium supplementation does not increase the risk of either heart attacks or cardiovascular disease.

Of course, once information has been placed on the internet, it tends to stay there for a very long time – even if subsequent studies have proven it to be wrong. So the myth that calcium supplementation increases heart attack risk will probably be with us for a while.

So, should we take calcium supplements?  Let’s first investigate a little further.

 

Do Calcium Supplements Work?

do calcium supplements workAs I mention above, recent headlines have also suggested that calcium supplementation does not increase bone density, so it is unlikely to protect against osteoporosis. I analyzed the study behind those headlines in great detail in two previous issues of Health Tips From the Professor.

In Part 1 Calcium Supplements Prevent Bone Fractures  I pointed out the multiple weaknesses in the study that make it impossible to draw a meaningful conclusion from the data.

 

In Part 2 Preventing Osteoporosis  I discussed the conclusion that the study should have come to, namely: Adequate calcium intake is absolutely essential for strong bones, but calcium intake is only one component of a bone healthy lifestyle.

The bottom line is that calcium supplementation will be of little use if:

  • You aren’t getting adequate amounts of vitamin D and all of the other nutrients needed for bone formation from diet and supplementation.
  • You aren’t getting enough exercise to stimulate bone formation.
  • You are consuming bone dissolving foods or taking bone dissolving drugs.

Conversely, none of the other aspects of a bone healthy lifestyle matter if you aren’t getting enough calcium from diet and supplementation.

The bottom line is that you need to get adequate calcium and have a bone healthy lifestyle to build strong bones and prevent osteoporosis, and calcium supplementation is often essential to make sure you are getting adequate calcium.

 

Should We Take Calcium Supplements?

should we take calcium supplements nowShould we take calcium supplements?  If you are one of the millions of Americans who aren’t meeting the RDA guidelines for calcium from diet alone, the answer is an unqualified yes.  Calcium supplementation is safe, and it is cheap.  Osteoporosis is preventable, and it is not a disease to be trifled with.

However, you also need to be aware that calcium supplementation alone is unlikely to be effective unless you follow a bone healthy lifestyle of diet, exercise and appropriate supplementation to make sure you are getting all of the nutrients needed for bone formation.

Of course, it is always possible to get too much of a good thing. The RDA for calcium is 1,000 – 1,200 mg/day. The suggested upper limit (UL) for calcium is 2,000 – 3,000 mg/day.  I would aim closer to the RDA than the UL unless higher intakes are recommended by your health care professional.

 

The Bottom Line

 

  • 80% of men and 90% percent of women over 50 do not get enough calcium from their diet.
  • Consequently, doctors have consistently recommended calcium supplementation to prevent osteoporosis, and 50% of men and 60% of women over 60 currently consume calcium supplements on a regular basis.
  • Some small, short term studies suggested that calcium supplementation might increase the risk of heart disease, and warnings about calcium supplementation have been widely circulated on the internet. This hypothesis has been evaluated by three larger, longer term studies that have all concluded that calcium supplementation does not increase heart disease risk.
  • A recent study claimed that calcium supplementation was ineffective at increasing bone density, and that report has also been widely circulated. However, there are multiple weaknesses in the study that make it impossible to draw a meaningful conclusion from the data.
  • If you are one of the millions of Americans who aren’t meeting the RDA guidelines for calcium from diet alone, you should consider calcium supplementation.  It is safe.  It is effective when combined with a bone healthy lifestyle of diet, exercise, and appropriate supplementation.  Finally, it is cheap. Osteoporosis is preventable, and it is not a disease to be trifled with.
  • Of course, it is always possible to get too much of a good thing. The RDA for calcium is 1,000 – 1,200 mg/day. The suggested upper limit (UL) for calcium is 2,000 – 3,000 mg/day. I would aim closer to the RDA than the UL unless higher intakes are recommended by your health care professional.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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Comments (6)

  • Jennifer

    |

    Calcium supplements were the wrong thing for me, I recently learned. I am hyperparathyroid, due to a tumor on one or more parathyroid glands. The calcium level in my blood had risen to 12.5 due to the malfunction of the parathyroid gland that regulates calcium in the bones, and more. I had osteoporosis—so all the more reason to take calcium? Wrong. For years, I faithfully took calcium, until this year. For years, doctors mused over my high blood calcium levels, above 10. However, due to thinning bones, every one recommended calcium supplements. Now that the tumor and malfunction is discovered, I halted all calcium and I’m preparing for surgery to remove the tumor(s) on my parathyroid gland(s), the only cure. One should not assume that thin bones are the only marker to take calcium.

    Reply

    • Dr. Steve Chaney

      |

      Dear Jennifer,
      You are correct in saying that calcium supplements won’t help if you are hyperparathyroid. However, I must wonder how your doctor’s missed that diagnosis. With thinning bones and high blood calcium levels, they should have tested you for hyperparathyroidism – not muse about it.
      Dr. Chaney

      Reply

  • Jeanie Porter

    |

    Dr. Chaney, I would like additional information on where magnesium fits into the calcium/osteoporosis equation and in what ratio it should be included. Also, the same for strontium – how important is it for bone health and in what ratio?
    Thank you. Jeanie Porter

    Reply

    • Dr. Steve Chaney

      |

      Dear Jeanie,
      You should certainly aim for RDA intake of magnesium (300-310 mg/day for women and 400-420 mg/day for men. I have seen recommendations for a 2:1 ratio of calcium to magnesium. What many people neglect to say is that holds only up to RDA levels of calcium (which would correspond to 400-500 mg/day of magnesium. It is also important to know that excess magnesium can cause diarrhea. If you are taking a magnesium supplement, you get one that is sustained release.
      Strontium is more complicated. There is a form, strontium ranelate, that is prescribed to help increase bone density in women with osteoporosis in Europe. However, it has not been approved for use in this country, and the strontium supplements used in this country are unrelated to strontium ranelate. Unfortunately, there has been very little research on strontium supplements in this country. In short, strontium supplements may help increase bone density, but we have no idea what kind or how much would be beneficial.
      Dr. Chaney

      Reply

  • Ruth wood

    |

    Hello Dr. Chaney.
    I’m interested in information regarding the effect of calcium supplementation on development of kidney stones.

    Reply

    • Dr. Steve Chaney

      |

      Dear Ruth,
      Some forms of kidney stones do contain calcium, but if your calcium intake is less than 4,000 mg/day, the kidney stones are probably not caused by excess calcium. Kidney stones are more likely caused by inadequate water intake, too little magnesium, too little B6, too much vitamin D, or hormone imbalances. If you are getting adequate water, magnesium, and B vitamins and still suffer from recurrent kidney stones, you should probably get a full workup by your physician.
      Dr. Chaney

      Reply

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Latest Article

Best Diet For Heart Disease Prevention

Posted July 9, 2019 by Dr. Steve Chaney

Are The American Heart Association’s Recommendations Correct?

Author: Dr. Stephen Chaney

 

What is the best diet for heart disease prevention? 

diet for heart disease preventionHeart disease is a killer. It continues to be the leading cause of death – both worldwide and in industrialized countries like the United States and the European Union. When we look at heart disease trends, it is a good news – bad news situation.

  • The good news is that heart disease deaths are continuing to decline in adults over 70.
  • The decline among senior citizens is attributed to improved treatment of heart disease and more seniors following heart-healthy diets.
  • The bad news is that heart disease deaths are starting to increase in younger adults, something I reported in an earlier issue, Heart Attacks Increasing in Young Women of “Health Tips From the Professor.”
  • The reason for the rise in heart disease deaths in young people is less clear. However, the obesity epidemic, junk and convenience foods, and the popularity of fad diets all likely play a role.

Everyone has a magic diet for reducing heart disease risk. The American Heart Association tells us to avoid fats, especially saturated fats. Vegans tell us to avoid animal protein. Paleo and keto enthusiasts tell us carbs are the problem. Who is correct?

Of course, we don’t eat fats, carbohydrates, or proteins. We eat foods. That is why a recent study (T Meier et al, European Journal of Epidemiology, 34: 37-45, 2019) is so important. It reported which foods increase and which decrease the risk of premature heart disease deaths.

How Was The Study Done?

diet for heart disease prevention studyThe authors of the current study analyzed data from the “Global Burden of Diseases (GBD) Study”, a major world-wide effort designed to estimate the portions of deaths caused by various risk factors.

The current study focused on the impact of 12 dietary risk factors on heart disease deaths between 1990 and 2016 for 51 countries in four regions (Western Europe, Central Europe, Eastern Europe, and Central Asia).

The dietary risk factors were:

  • Diets low in fiber, fruits, vegetables, legumes, nuts and seeds, polyunsaturated fatty acids, omega-3 fatty acids, and whole grains.
  • Diets high in sodium, processed meats, sugar-sweetened beverages, and trans fatty acids.

Saturated fat and meat were not explicitly included in the GBS Study data. However, diets low in polyunsaturated fats and omega-3 fats are likely high in saturated fats. Similarly, diets low in fruits, vegetables, whole grains, and legumes are likely higher in meats. The study also did not include dairy, and some recent studies suggest that some dairy foods may decrease heart disease risk.

For simplicity I will only consider the findings from Western Europe because their diet and heart disease death trends are similar to those in the United States.

 

Best Diet for Heart Disease Prevention?

plant-based diet bestThe study found that in 2016 (the last year for which data were available):

  • Dietary risk factors were responsible for 49.2% of heart disease deaths.
  • 6% of all diet-related heart disease deaths occurred in adults younger than 70, and that percentage has been increasing in recent years.

When they looked at the contribution of individual foods to diet related heart disease deaths, the percentages were:

  • Diets low in whole grains = 20.4%
  • Diets low in nuts and seeds = 16.2%
  • Diets low in fruits = 12.5%
  • Diets high in sodium = 12.0%
  • Diets low in omega-3s = 10.8%
  • strong heartDiets low in vegetables = 9.0%
  • Diets low in legumes = 7.0%
  • Diets low in fiber = 5.7%
  • Diets low in polyunsaturated fats = 3.7%
  • Diets high in processed meats = 1.6%
  • Diets high in trans fatty acids = 0.8%
  • Diets high in sugar-sweetened beverages = 0.1%

So, what is the best diet for heart disease prevention?

In short, this study concluded:

  • A primarily plant-based diet is the best protection against premature death due to heart disease.
  • All plant-based food groups (whole grains, nuts and seeds, fruits, vegetables, and legumes) play an important role in reducing heart disease deaths.
  • Meat was not included in the analysis, but it is likely that most people’s diets in this region of the world contained some meat. The most likely take-away is that meat does not affect heart disease risk in the context of a primarily plant-based diet.
  • Dairy was not included in the analysis either, but some studies suggest dairy, particularly fermented dairy foods, reduce heart disease risk.
  • Finally, the study concluded: “Compared to other…modifiable risk factors (physical inactivity, drug and alcohol abuse, tobacco smoking, obesity, etc.), an altered diet is the most effective means of preventing premature deaths from cardiovascular disease in Western Europe.”

While every study has its weaknesses, this study is consistent with multiple previous studies showing that primarily plant-based diets are best for reducing heart disease risk. You will find a more complete discussion of these studies in my book “Slaying The Food Myths.”

 

Are the American Heart Association’s Recommendations Correct?

With this study’s results in mind we can now ask whether the recommendations of the American Heart Association and other popular diets are correct. Are they likely to reduce heart disease deaths?

  • The American Heart Association Recommends a dietary pattern that emphasizes a variety of fruits and vegetables, whole grains, nuts and legumes, skinless poultry and fish, and low-fat dairy products. This study supports those recommendations.
  • This study also supports the heart-health benefits of the Mediterranean and DASH diets.
  • Meat and dairy were not explicitly considered in this study. Thus, the results of this study are also consistent with vegan and semi-vegetarian diets.
  • However, low carb diets like Paleo and keto eliminate some of the key food groups (whole grains, fruits, and legumes) that appear to be essential for reducing heart disease risk. 40% of the heart-health benefits in this study came from those 3 food groups. Thus, this study does not support claims that those two diets are heart-healthy long term.

 

The Bottom Line

 

Everyone has a magic diet for reducing heart disease risk. The American Heart Association tells us to avoid fats, especially saturated fats. Vegans tell us to avoid animal protein. Paleo and keto enthusiasts tell us carbs are the problem. Who is correct?

A recent study provides some important clues. It looked at dietary patterns associated with reduced risk of premature death from heart disease in Western Europe. The study concluded:

  • A primarily plant-based diet is the best protection against premature death due to heart disease.
  • All plant-based food groups (whole grains, nuts and seeds, fruits, vegetables, and legumes) play an important role in reducing heart disease deaths.
  • Meat did not appear to affect heart disease risk in the context of a primarily plant-based diet.
  • Dairy was not included in the analysis, but some studies suggest dairy, particularly fermented dairy foods, reduce heart disease risk.
  • Finally, the study concluded: “Compared to other…modifiable risk factors (physical inactivity, drug and alcohol abuse, tobacco smoking, obesity, etc.), an altered diet is the most effective means of preventing premature deaths from cardiovascular disease.”

While every study has its weaknesses, this study is consistent with multiple previous studies showing that primarily plant-based diets are best for reducing heart disease risk. You will find a more complete discussion of these studies in my book “Slaying The Food Myths.”

With this study’s results in mind we can now ask whether the recommendations of the American Heart Association and other popular diets are correct. Are they likely to reduce heart disease deaths?

  • The American Heart Association Recommends a dietary pattern that emphasizes a variety of fruits and vegetables, whole grains, nuts and legumes, skinless poultry and fish, and low-fat dairy products. This study supports those recommendations.
  • This study also supports the heart-health benefits of the Mediterranean and DASH diets.
  • Meat and dairy were not explicitly considered in this study. Thus, the results of this study are also consistent with vegan and semi-vegetarian diets.
  • However, low carb diets like Paleo and keto eliminate some of the key food groups (whole grains, fruits, and legumes) that appear to be essential for reducing heart disease risk. 40% of the heart-health benefits in this study came from those 3 food groups. Thus, this study does not support claims that those two diets are heart-healthy long term.

For more details read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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