Monday, September 5, 2011

Calcium Heart Controversy

A recent publication created a calcium heart controversy. Many people have little calcium in their diet and so they take a calcium supplement to help their bones.  An analysis published in the British Medical Journal suggested an increased risk of cardiovascular events, mostly heart attacks, with calcium supplements.

A huge controversy followed. Many experts have challenged the conclusion of heart risk from calcium supplements.
Have you heard about this? Has your doctor told you to reduce your calcium intake?

Now the American Society for Bone and Mineral Research has published a thoughtful response to that BMJ paper.

Many questions remain and the calcium heart controversy has not ended.
My take on this is to review each person’s dietary intake of calcium. When that intake is not adequate I recommend a calcium supplement aiming for about 800-1000 milligrams of total calcium per day. The amount I recommend depends on the individual.

Dietary calcium mostly comes from milk, cheese, yogurt, or calcium fortified juices or sardines. Other foods like broccoli are not good sources of calcium. They do not get absorbed well.

And the diet is the best way to get your calcium. But if you don't enjoy those high calcium foods or don’t eat them often, you ought to take a calcium supplement.

The lowest cost calcium supplements are in the form of calcium carbonate. There are many available calcium carbonate supplements. Most provide at least 500- 600 milligrams of elemental calcium per pill. Some people choose chewable preparations like Tums or Viactiv.
In some cases, I recommend other forms of calcium but for most people calcium carbonate works best. And you’ll need less pills or chews with calcium carbonate than the other forms of calcium.

I try to ensure that all my patients are getting enough vitamin D. Vitamin D is not just important for your bones. Once I get each person’s vitamin D level up to goal, I advise them to take 2000 units of vitamin D each day to maintain a  level of about 40 ng/ml. . Vitamin D is easily available as a supplement without a prescription.

I recommend taking the vitamin D supplement year round. Yes, even in the summer. Almost everyone I see drops down to too low a level if they stop the vitamin D supplement. Most people don't get that much sun exposure, especially in northern latitudes like Cleveland Ohio.

The calcium heart controversy has not been resolved. But the overwhelming evidence does not show a heart risk from calcium supplements. And vitamin D remains important. I encourage each of you to discuss this with you doctor. 

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