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

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    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

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      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

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    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

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    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

High Protein Diets and Weight Loss

Posted October 16, 2018 by Dr. Steve Chaney

Do High Protein Diets Reduce Fat And Preserve Muscle?

Author: Dr. Stephen Chaney

Healthy Diet food group, proteins, include meat (chicken or turkAre high protein diets your secret to healthy weight loss? There are lots of diets out there – high fat, low fat, Paleolithic, blood type, exotic juices, magic pills and potions. But recently, high protein diets are getting a lot of press. The word is that they preserve muscle mass and preferentially decrease fat mass.

If high protein diets actually did that, it would be huge because:

  • It’s the fat – not the pounds – that causes most of the health problems.
  • Muscle burns more calories than fat, so preserving muscle mass helps keep your metabolic rate high without dangerous herbs or stimulants – and keeping your metabolic rate high helps prevent both the plateau and yo-yo (weight regain) characteristic of so many diets.
  • When you lose fat and retain muscle you are reshaping your body – and that’s why most people are dieting to begin with.

So let’s look more carefully at the recent study that has been generating all the headlines (Pasiakos et al, The FASEB Journal, 27: 3837-3847, 2013).

The Study Design:

This was a randomized control study with 39 young (21), healthy and fit men and women who were only borderline overweight (BMI = 25). These volunteers were put on a 21 day weight loss program in which calories were reduced by 30% and exercise was increased by 10%. They were divided into 3 groups:

  • One group was assigned a diet containing the RDA for protein (about 14% of calories in this study design).
  • The second group’s diet contained 2X the RDA for protein (28% of calories)
  • The third group’s diet contained 3X the RDA for protein (42% of calories)

In the RDA protein group carbohydrate was 56% of calories, and fat was 30% of calories. In the other two groups the carbohydrate and fat content of the diets was decreased proportionally.

Feet_On_ScaleWhat Did The Study Show?

  • Weight loss (7 pounds in 21 days) was the same on all 3 diets.
  • The high protein (28% and 42%) diets caused almost 2X more fat loss (5 pounds versus 2.8 pounds) than the diet supplying the RDA amount of protein.
  • The high protein (28% and 42%) diets caused 2X less muscle loss (2.1 pounds versus 4.2 pounds) than the diet supplying the RDA amount of protein.
  • In case you didn’t notice, there was no difference in overall results between the 28% (2X the RDA) and 42% (3X the RDA) diets.

Pros And Cons Of The Study:

  • The con is fairly obvious. The participants in this study were all young, healthy and were not seriously overweight. If this were the only study of this type one might seriously question whether the results were applicable to middle aged, overweight coach potatoes. However, there have been several other studies with older, more overweight volunteers that have come to the same conclusion – namely that high protein diets preserve muscle mass and enhance fat loss.
  • The value of this study is that it defines for the first time the upper limit for how much protein is required to preserve muscle mass in a weight loss regimen. 28% of calories is sufficient, and there appear to be no benefit from increasing protein further. I would add the caveat that there are studies suggesting that protein requirements for preserving muscle mass may be greater in adults 50 and older.

The Bottom Line:

1)    Forget the high fat diets, low fat diets, pills and potions. High protein diets (~2X the RDA or 28% of calories) do appear to be the safest, most effective way to preserve muscle mass and enhance fat loss in a weight loss regimen.

2)     That’s not a lot of protein, by the way. The average American consumes almost 2X the RDA for protein on a daily basis. However, it is significantly more protein than the average American consumes when they are trying to lose weight. Salads and carrot sticks are great diet foods, but they don’t contain much protein.

3)     Higher protein intake does not appear to offer any additional benefit – at least in young adults.

4)     Not all high protein diets are created equal. What some people call high protein diets are laden with saturated fats or devoid of carbohydrate. The diet in this study, which is what I recommend, had 43% healthy carbohydrates and 30% healthy fats.

5)    These diets were designed to give 7 pounds of weight loss in 21 days – which is what the experts recommend. There are diets out there promising faster weight loss but they severely restrict calories and/or rely heavily on stimulants, they do not preserve muscle mass, and they often are not safe. In addition they are usually temporary.  I do not recommend them.

6)    This level of protein intake is safe for almost everyone. The major exception would be people with kidney disease, who should always check with their doctor before increasing protein intake. The only other caveat is that protein metabolism creates a lot of nitrogenous waste, so you should drink plenty of water to flush that waste out of your system. But, water is always a good idea.

7)     The high protein diets minimized, but did not completely prevent, muscle loss. Other studies suggest that adding the amino acid leucine to a high protein diet can give 100% retention of muscle mass in a weight loss regimen – but that’s another story for another day.

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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