Should You Supplement with Calcium?


Headlines concerning the use of calcium supplements sway back and forth like palm trees in the wind. The reason behind this confusing phenomenon has to do more with irresponsible media jumping on the latest news release with a desire to grab as much attention as possible than with evidence provided by sound studies.

After years of hearing about the importance of supplementing with calcium from doctors and other experts concerned about the “silent epidemic” of osteoporosis, a meta-analysis published in the British Medical Journal in 2010 raised the concern that supplementation with the mineral, having been associated by the researchers with admittedly modest increases the risk of cardiovascular disease, ”might translate into a large burden of disease in the population.”1

The meta-analysis, which evaluated data from 8,151 participants in 15 trials, found that, of 296 subjects who had heart attacks, 166 were receiving calcium and 130 received a placebo, resulting in a 27% increase in the relative risk in those receiving calcium.

The journal subsequently published letters received, concerning the conclusions of the researchers involved in the analysis, while other sources of information, including Life Extension®, published their own analysis of the findings and offered possible explanations, such as a lack of co-supplementation with vitamin D, exclusion of trials that found reductions rather than increases in cardiovascular disease in association with calcium supplementation, and other potential factors. Yet the damage had been done, the public had read the popular news media headlines.

Why is Calcium Important?

Calcium is an essential mineral, meaning that it is necessary to human life and health. Unlike some vitamins, minerals are not made in the body and must be obtained in the diet. Also unlike some vitamins, minerals do not readily wash out of the body and can accumulate to undesirably elevated levels if too much is consumed over a prolonged period.

Calcium is also used every second of our lives to maintain the proper pH of the blood. It is the most abundant mineral of the body and forms a major part of the bones. It also forms a part of atherosclerotic plaques that narrow the arteries.

It has been known for some time that the bones need more than just calcium, and that magnesium, and vitamins D and K, are needed to keep calcium in the skeleton and out of the arterial walls. Therefore, adding these nutrients is recommended for those who supplement with calcium.

The Research on Calcium

A more recent meta-analysis published in 2016 that included 22 randomized controlled trials and 4,071 participants found a decrease in low-density lipoprotein (LDL) and an increase in high-density lipoprotein (HDL) cholesterol in association with calcium supplementation with or without vitamin D, thereby reducing major risk factors for cardiovascular disease and heart attack.2

A study of postmenopausal women who received calcium citrate supplements found lower LDL, higher HDL and greater HDL to LDL ratios after a year.3 "As a result, calcium citrate may reduce the incidence of heart attacks and angina in postmenopausal women,” commented lead researcher Ian R. Reid, who is a professor at the University of Auckland’s Department of Medicine. “Based on our data, one could predict that calcium citrate supplements may help otherwise healthy postmenopausal women reduce cholesterol, improve heart health and possibly even reduce the rate of cardiovascular related events by 20 to 30 percent. These data provide reason to encourage the more widespread use of calcium supplementation in postmenopausal women.”

Notably, among 34,486 postmenopausal women who participated in the Iowa Women’s Healthy Study, those whose total calcium intake was among the top 25% of subjects had a 33% lower risk of death from ischemic heart disease than those whose intake was among the lowest 25%.4 The risk reduction in association with high calcium supplement intake but low dietary calcium intake was 34%.

In 2014, the American Journal of Clinical Nutrition reported the results of a study that followed participants in the Diabetes Heart Study for an average of 9.4 years. Computed tomography (CT) scans of the coronary and carotid arteries, and abdominal aorta failed to find an association between any measure of calcified plaque and calcium intake from supplements or diet.5 In fact, calcium supplementation among women was associated with a 38% lower adjusted risk of mortality from any cause over a 9.4 year average follow-up period. "Studies have raised concerns that calcium supplementation may have the unintended negative consequence of increasing cardiovascular disease risk," authors Laura M. Raffield and her colleagues observed. "In this study, we did not observe any negative cardiovascular disease impacts of differing calcium intakes from diet and supplements in contrast to some previous reports. Instead, calcium supplement use was associated with lower all-cause mortality risk in women."

The Bottom Line

In October 2016, the National Osteoporosis Foundation and the American Society for Preventive Cardiology issued a new evidence-based guideline stating that calcium from supplements or food that doesn’t exceed the tolerable upper intake level is safe for the heart.6 In an article in the Annals of Internal Medicine titled, “Lack of Evidence Linking Calcium With or Without Vitamin D Supplementation to Cardiovascular Disease in Generally Healthy Adults: A Clinical Guideline From the National Osteoporosis Foundation and the American Society for Preventive Cardiology,” S. L. Kopecky and colleagues announce that, “In light of the evidence available to date, calcium intake from food and supplements that does not exceed the tolerable upper level of intake (defined by the National Academy of Medicine as 2000 to 2500 mg/day) should be considered safe from a cardiovascular standpoint.”

The new guideline was released simultaneously in the journal with the outcome of a systematic review and meta-analysis of four randomized trials and 27 observational studies.7 According to authors M. Chung and colleagues, “The trials did not find statistically significant differences in risk for CVD events or mortality between groups receiving supplements of calcium or calcium plus vitamin D and those receiving placebo. Cohort studies showed no consistent dose-response relationships between total, dietary, or supplemental calcium intake levels and cardiovascular mortality and highly inconsistent dose-response relationships between calcium intake and risks for total stroke or stroke mortality.”

There are other studies such as these. Other studies demonstrate the benefit of calcium supplementation for protection against osteoporosis, colorectal cancer and more. However, if you choose to supplement with calcium, make sure that you stay below the tolerable upper level of calcium intake from supplements and diet combined, and add a healthy amount of magnesium, vitamin D and vitamin K. Calcium may be one of the few nutrients for which it is not necessary to exceed the current recommended dietary allowance to achieve optimal nutrition.

References:

  1. 1. Bolland MJ et al. BMJ. 2010 Jul 29;341:c3691.
  2. 2. Chen C et al. J Cardiovasc Nurs. 2016 Nov 18.
  3. 3. Reid IR et al. 2002 Apr 1;112(5):343-7.
  4. 4. Bostick RM et al. Am J Epidemiol. 1999 Jan 15;149(2):151-61.
  5. 5. Raffield LM et al. Am J Clin Nutr. 2014 Oct;100(4):1029-35.
  6. 6. Kopecky SL et al. Ann Int Med. 2016 Oct 25.
  7. 7. Chung M et al. Ann Intern Med. 2016 Oct 25.

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2 comments :

J Larson said...

If the outcome is strong healthy bones, it is a multi-variable complex equation. Bones are living tissue that need 20+ nutrients plus load bearing exercise to be strong. In a sense, bones are like stiff muscles.

The RDA calcium etc. recommendations are age and gender averages. Hard training athletes may need more (Kleges et al, Lappe et al).

The mineral matrix is quite brittle; collagen is what makes bone resilient.

See http://blogs.creighton.edu/heaney/2014/07/25/the-paradox-of-osteoporosis-irreversibility-2/

In recent AF work, roughly 21% of young women and 6% of young men entered recruit training iron anemic. Correcting the anemia reduced injuries dramatically.

So, bones need calcium, magnesium, collagen, D, K, iron, good fats, etc. with load bearing exercise to get bigger and stronger.

Be strong; be healthy.

Life Extension said...

J Larson - Thanks for the information!

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