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In the News: Confusion About Calcium Supplements


By +Mary Hartley on Aug 03, 2010 10:00 AM in Tips & Updates

The motto of this cautionary tale: More is not necessarily better. 

In a meta-analysis published in the British Medical Journal (BMJ) last week, researchers said the risk of heart attack increased modestly in the women who took calcium supplements in large research studies.  Around 40 percent of American women are currently taking calcium supplements.  Even a modest risk could be a big problem for anyone.

Background: Calcium today

Calcium is well known for its role in building and preserving strong bones.  A calcium deficiency is thought to contribute to osteoporosis; optimum calcium intake has been associated with denser bones.  Indeed, the FDA backs the relationship between "calcium and a reduced risk of osteoporosis,” and before bestowing their coveted backing, they require a significant body of scientific literature to support a health claim.  

In the US, osteoporosis is seen as a major public health threat.  Of people age 50 and older, 55 percent have low bone mass or osteoporosis.  Calcium intake in the United States is well-documented by NHANES (National Health and Nutrition Examination Survey) data to be suboptimal.  Presently, only 40 percent of women, ages 20 to 40 years, meet the calcium intake recommendation, and in women age 50 and older, only 27% of achieve that goal.   

For doctors, it is de rigor to discuss calcium intake with women of all ages.  (Note: men need calcium too.)  Doctors often tell women to take calcium supplements and many women can recall receiving that advice.  But qualified nutritionists always say that it is better to get nutrients from food. In fact, the FDA suggests this model claim for food and supplement producers: "Adequate calcium throughout life, as part of a well-balanced diet, along with physical activity, may reduce the risk of osteoporosis."   They did not mention calcium supplements.

A closer look at intake

In the BMJ study, research subjects ate between 406 to 1,240 milligrams of calcium a day.  Calcium requirements are set between 1,000 – 1,300 milligrams a day, depending on gender and age.  Dietary calcium is found in many foods, not only in dairy products.  Salmon, black beans, almonds, broccoli, and others are naturally high in calcium, and in recent years, many foods have been fortified with extra calcium to increase sales.  Calcium-fortified foods include juices, cereals, bars, waffles, soy milk, and rice milk, to name a few.  Indeed, Whole Grain Total cereal contains 1,000 mg in three-quarters of a cup.

But calcium has a Tolerable Upper Intake Level (UL) of 2,500 milligrams a day set by the Institute of Medicine.  If the UL is consistently exceeded, blood levels of calcium may rise and that could impair kidney function and reduce the absorption of other minerals.  BMJ researchers speculated that supplemental calcium increased the rate of heart attacks by increasing vascular calcification.  The researchers did not say that heart attack victims had too much calcium, but given their reported dietary intakes, the question should be asked.  Overall, the Institute of Medicine makes it clear: calcium intake should not exceed the UL, regardless of source.

Who's your daddy?

Everyone needs to establish a baseline calcium intake before adding supplements - and Calorie Count makes it easy to do just that.  To find your baseline, keep food logs without changing your intake for three or more days (two weekdays and one weekend day is good), and then compare the amount you typically eat to the amount you personally need.  Click the Analysis tab under the My Account section to find your "Calorie Count Recommended Values" for calcium and other nutrients.  Supplement with only the amount you need to reach your personal RDA.  It’s that easy to be safe with Calorie Count.


Your thoughts...

Are you mega-dosing on calcium?



Comments


***QUESTION FOR Ms Mary_RD, the writer of this article:

Where did you find this stat:

"Around 40 percent of American women are currently taking calcium supplements"?

Really? This sounds unlikely-way too high.  

Please provide us your credible source, please.

Thank you,

t. heretic



In the below Harvard School of Public Health study,  cancer risks have been associated with high calcium. And bone health is more then just calcium.  Women on calcium supplements might want to think about strength training and leafy green vegetables.

http://www.hsph.harvard.edu/nutritionsource/what-should-you- eat/calcium-and-milk/



For heretec:

Here are two references:

Americans are not meeting current calcium recommendations
American Journal of Clinical Nutrition, Vol. 85, No. 5, 1361-1366, May 2007

  • Using data from the 1999–2002 National Health and Nutrition Examination Survey, we assessed dietary and supplemental calcium consumption among US men and women according to risk of osteoporosis and stratified by sex, race/ethnicity, and socioeconomic status.
  • Forty-eight percent of the entire sample reported taking calcium supplements.

Barriers to Supplemental Calcium Use Among Women in Suburban Family Practice: A Report from the Cleveland Clinic Ambulatory Research
Network (CleAR-eN)

J Am Board Fam Med. 2008;21(4):293-299

  • 185 women, ages 20 to 64, presenting consecutively for care at 6 suburban community-based family medicine practices within the Cleveland Clinic Ambulatory Research Network (CleAR-eN).
  • of our 185 respondents, of whom 69 (37.2%) were presently taking calcium supplements

Thanks for reading our blog and for commenting. 

 



I take a calcium supplement, per doctors orders.  I don't have it in front of me, but IIRC, I take two 1000 mg pills a day; one in the morning, the other in the evening.  I don't think this is a "mega" dose, but I probably wouldn't take it if she had not insisted (I'm in my 50s, BTW).

Lots of heart disease in my family, so this is a bit troubling.  OTOH, both my great-grandmother and grandmother had dowager's humps; my grandmother's developed the last 20 years of her life.  I always thought that being African-American and obese were contra-indicators to this condition, but aparently that isn't true (although my great-grandmother was never fat).  BTW, the GGM died at 96, my GM died at 87; both lived into my adulthood.

I don't eat a lot dairy, but I do hit the weight room and run.  Unfortunately, I'm on a permanently calorie controlled diet.  I don't know that I will ever regularly eat enough to insure I will get enough nutrients from food alone. 

Mary

 

 

 



I have decided to discontinue my calcium supplements.  For several years, as I am over 50, I have been taking and extra 1,000 mg per day.  Since Calorie Count now gives us a separate total for calcium, I know the supplements may not be necessary.  Yesterday I added my multivitamin in as an entered food, and since it adds 400 mg, I see from the "average" chart that I get enough from it plus my food. What a relief!

On days when my total is lower, I will take a supplement.  I am grateful to c-c, because I can be confident of this decision, and it will save me money.  Sadly, I still have a very large container of the stuff. 



Best to do your research on the type of calcium you are taking, the amount may just be a number if your body can't absorb it.  I take a low dose calcium formula that includes magnisium and silica.  (osteo  RX) and I base how much I take on my diet for that day.  Regarding the type of calcium, if you want your body to absorb it look for one combined or chelated with amino acid so that your body can use and retain it.  Chelated minerals provide 3 to 10 times greater absorption than non chelated.  I'm no expert, but if I have to swallow a pill to catch up, I am going to make sure it's doing something. 

 



The supplement that I buy has Vitamin D3 and my multi also has 1000 mg Vit D3.  We need a lot more analysis.

From the published report:

Conclusions Calcium supplements (without coadministered vitamin D) are associated with an increased risk of myocardial infarction. As calcium supplements are widely used these modest increases in risk of cardiovascular disease might translate into a large burden of disease in the population. A reassessment of the role of calcium supplements in the management of osteoporosis is warranted.



Does the addition of Vitamin D in the Calcium Supplement make it any less onerous? I take a light supplement that has added Vit. D., but I am not megadosing by any means. Osteoporosis runs in my family and my doctor has recommended the supplement.

 



Oops! I meant 1000 IU. not mg.



Many of us probably are overdosing because the food industry puts it in so many different foods.

breakfast cereal, milk, bread etc



Ms Mary RD, i have several questions, but first-Laughing

Thank you for replying so quickly.  You are very welcome--it's a pleasure to read a site devoted to the cause of health which doggedly seeks to subvert the omnipresent obesity demon (esp. prevalent in N. America).

Second, though not less in importance, I must indeed agree with you that Americans are not meeting current calcium recommendations.  Most of my female friends and family are certainly not getting enough Ca+, (although, anecdotal evidence inside ANY large female population [i.e., women in the USA] does not an argument make).

I must ask you this, however:  Please consider that when making blanket statements like, "Forty-eight percent of the entire sample reported taking calcium supplements", you have UNFORTUNATELY  left out some extremely, important, relevant data - that is, what is the sample size in the study? HOW MANY PEOPLE? (And, it makes a reader wonder, was this on purpose or by accident?)

MS Mary RD, tell us, please: 

 Forty eight percent of...how many people?  Forty eight percent of fifty people? Three hundred people? Or, as you unbelievably claimed, forty-eight percent of the 1.5 million-plus women in the entire USA???!

Um, how could you leave that data bit out and expect any educated or critically thinking reader to miss it?

Since you obviously are an intelligent, university-educated woman, you know that accurate journalism/reporting data from an empirical (scientifically controlled/measured) study must include any fact, especially major ones, which impact produced results.  

Therefore, you must know that sample size is a major factor in any study - esp. empirical (scientifically conrtrolled) ones.

Therefore, you clearly have no grounds to say that approx. 40% of the female population of the US takes calcium supplements.  

Your data is not based on 40% of the US population.

And, how many uneducated, low income, illegal immigrant, and many other kinds of women now make up our entire US feminine population?

Who exactly do you think DOES regularly take calcium supplements? That is, what age groups, what ethnicities, what socioeconomic stratas, what demographics? 40%? Perhaps the upper class, the whites, the upper class African Americans? certainly not the entire 40% of US women, my dear woman. And your data certainly does not suppport 40% of over 1.5 million people.  Seriously. we on calorie count are not that dumb. Please don't insult us by misusing stats like this.

I eagerly await scientific evidence cited with relevant facts (such as how many people were part of each study).

Else, retract your statement for being specious and unscientific.

  • Forty-eight percent of the entire sample reported taking calcium supplements.

Barriers to Supplemental Calcium Use Among Women in Suburban Family 

Thank you for your veracity and truth in reporting.

 

j heretec.

ny



Original Post by: cavaliertoby

Many of us probably are overdosing because the food industry puts it in so many different foods.

breakfast cereal, milk, bread etc


If you bother to read further into the study... calcium in food is absorbed differently.  Here is a quote from an interview with Dr. Reid:

"When you take calcium supplements, your blood calcium level goes up over the following four to six hours and goes up to the top end of the normal range," he said.

"That doesn't happen when you have calcium to eat in your diet because the calcium from food is very slowly absorbed and so the blood calcium level hardly changes at all." Dr. Reid

 



understand, but does this/yr comment address

1.) is the Ca+ enough to meet dietary needs or not?

2) how does comment relate to the original assertion?

or is it just hanging out there by itself, not related to these questions?

 



For heretec:

The data for the first study (Americans are not meeting current calcium recommendations. American Journal of Clinical Nutrition, Vol. 85, No. 5, 1361-1366, May 2007) was from NHANES (National Health and Nutrition Examination Survey), the nutrition survelience system of the Centers for Disease Prevention and Control.  NHANES has run continuously since the early 1960s. It produces nutrition-related health statistics for the Nation.  The most recent NHANES contains data for a random sample 33,994 persons ages 2 months and older who participated in the survey.

I have included a copy of the original study for those of you interested in the specifics.  Also note that my response is in relation to articles in the news with simple titles such as "Taking calcium supplements might cause heart attacks". 

I hope this helps.  Thanks for reading.

Mary



Original Post by: heretec

Ms Mary RD, i have several questions, but first-Laughing

Thank you for replying so quickly.  You are very welcome--it's a pleasure to read a site devoted to the cause of health which doggedly seeks to subvert the omnipresent obesity demon (esp. prevalent in N. America).

Second, though not less in importance, I must indeed agree with you that Americans are not meeting current calcium recommendations.  Most of my female friends and family are certainly not getting enough Ca+, (although, anecdotal evidence inside ANY large female population [i.e., women in the USA] does not an argument make).

I must ask you this, however:  Please consider that when making blanket statements like, "Forty-eight percent of the entire sample reported taking calcium supplements", you have UNFORTUNATELY  left out some extremely, important, relevant data - that is, what is the sample size in the study? HOW MANY PEOPLE? (And, it makes a reader wonder, was this on purpose or by accident?)

MS Mary RD, tell us, please: 

 Forty eight percent of...how many people?  Forty eight percent of fifty people? Three hundred people? Or, as you unbelievably claimed, forty-eight percent of the 1.5 million-plus women in the entire USA???!

Um, how could you leave that data bit out and expect any educated or critically thinking reader to miss it?

Since you obviously are an intelligent, university-educated woman, you know that accurate journalism/reporting data from an empirical (scientifically controlled/measured) study must include any fact, especially major ones, which impact produced results.  

Therefore, you must know that sample size is a major factor in any study - esp. empirical (scientifically conrtrolled) ones.

Therefore, you clearly have no grounds to say that approx. 40% of the female population of the US takes calcium supplements.  

Your data is not based on 40% of the US population.

And, how many uneducated, low income, illegal immigrant, and many other kinds of women now make up our entire US feminine population?

Who exactly do you think DOES regularly take calcium supplements? That is, what age groups, what ethnicities, what socioeconomic stratas, what demographics? 40%? Perhaps the upper class, the whites, the upper class African Americans? certainly not the entire 40% of US women, my dear woman. And your data certainly does not suppport 40% of over 1.5 million people.  Seriously. we on calorie count are not that dumb. Please don't insult us by misusing stats like this.

I eagerly await scientific evidence cited with relevant facts (such as how many people were part of each study).

Else, retract your statement for being specious and unscientific.

  • Forty-eight percent of the entire sample reported taking calcium supplements.

Barriers to Supplemental Calcium Use Among Women in Suburban Family 

Thank you for your veracity and truth in reporting.

 

j heretec.

ny


Did you read the links posted? browsing through the first one quickly showed that the study was done with over 9,000 people.

- Subjects and Methods heading under Study Sample bullet

"The 1999–2002 NHANES included 5094 men and 5760 women aged 19 y. After we limited the sample to participants with dietary data determined by NHANES to be "reliable and meeting minimum criteria," 4477 men and 5000 women remained and represented the base sample for our analysis."



Ah! Thank you, the math does settle it.

9,000 people constitute way fewer/less than 1% of the total US female population. Even being generous (rounding up to 9,500 people),

(9,500/1,000,000  = ~.0095 or ~.95% or still less than 1% of the popluation)

Which is nowhere near your claim of, ""Around 40 percent of American women are currently taking calcium supplements"

I reiterate my case against unsupported claims like this. The scientific basis for your statement is a mystery. You've had two chances to explain it, but so far no evidence supports the evidence.

Thank you kindly,

Yours in the scientific method,

h.

 

 

 



Original Post by: heretec

Ah! Thank you, the math does settle it.

9,000 people constitute way fewer/less than 1% of the total US female population. Even being generous (rounding up to 9,500 people),

(9,500/1,000,000  = ~.0095 or ~.95% or still less than 1% of the popluation)

Which is nowhere near your claim of, ""Around 40 percent of American women are currently taking calcium supplements"

I reiterate my case against unsupported claims like this. The scientific basis for your statement is a mystery. You've had two chances to explain it, but so far no evidence supports the evidence.

Thank you kindly,

Yours in the scientific method,

h.

 

 

 


Couldn't agree more - very misleading the way it is written



Original Post by: chiefsfan4life

Original Post by: heretec

Ah! Thank you, the math does settle it.

9,000 people constitute way fewer/less than 1% of the total US female population. Even being generous (rounding up to 9,500 people),

(9,500/1,000,000  = ~.0095 or ~.95% or still less than 1% of the popluation)

Which is nowhere near your claim of, ""Around 40 percent of American women are currently taking calcium supplements"

I reiterate my case against unsupported claims like this. The scientific basis for your statement is a mystery. You've had two chances to explain it, but so far no evidence supports the evidence.

Thank you kindly,

Yours in the scientific method,

h.

 

 

 


Couldn't agree more - very misleading the way it is written


You two are missing the whole point.  The point is not what percentage of women take the supplements, but what is supplementation doing. 

Also why are those studies with higher blood level of vitamin D showing fewer MIs. 

Of course the sample sizes of these studies are even lower than 9000, so why should you two bother following this discussion at all?



@heretec:

The paper clearly mentions that 40% of the entire sample reported taking calcium supplements (see here). 10k people may not be the biggest sample ever assembled, but that's what the variance calculation is for.

Apart from all of the above, I have to wonder about your motive. For the sake of letting our staff continue to serve our community, please let it go and apply yourself in a more meaningful way. You won't see any further responses from us on this topic.



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