Controversy over Calcium Supplementation: What’s A Girl To Do?

As many as 10 million Americans suffer from osteoporosis and 34 million Americans have a condition called osteopenia (low bone mass), according to the National Osteoporosis Foundation. These conditions affect women more frequently than men, due to the fact that as women age, a variety of factors can cause the loss of bone mass, including low estrogen, lack of calcium, vitamin D deficiency, and a sedentary lifestyle. And, during pregnancy and breastfeeding, a woman is also susceptible to bone loss, as her nutrient stores are continually tapped to ensure the growing baby receives proper nourishment.

As a result, it is no wonder women of all ages are constantly reminded to make sure they get enough calcium. After all, calcium is famous for its ability to build bone, and also offers many lesser known health benefits. In fact, results from research studies conducted over the last several decades suggest that dietary calcium intake may help prevent hypertension, obesity and Type 2 diabetes, in addition to helping to prevent bone loss. So, unless you are absolutely certain that your diet contains at least the recommended amount of calcium (approximately 1,000 mg a day), supplementing your diet with a high-quality calcium supplement is a no-brainer.

But, if you happened to see the recent headlines about calcium supplements and heart disease, you might be a bit confused about the benefits and/or potential risks of calcium supplementation. Earlier this year, the controversial results of a study conducted by German and Swiss researchers were released, creating quite a buzz in the health world and generating some unnecessarily alarming headlines, such as Calcium Pills Linked to Heart Attack Risk.

The study, which followed 24,000 people over 11 years, was performed to evaluate the impact of calcium intake (from food and supplements) on cardiovascular disease risk. Participants were asked to report food and supplement intake from memory, using food frequency questionnaires given at specific intervals throughout the course of the study. Once all of the data was analyzed, the researches came out with some controversial conclusions. Contrary to the results of previous research suggesting that higher calcium intake protects against the development of cardiovascular disease, the German and Swiss researchers concluded that increasing calcium intake from diet does not provide significant cardiovascular benefits and calcium supplements might actually increase the risk of heart attack. The researchers went on to theorize that the reason calcium supplements might pose a threat to cardiovascular health is that calcium supplements might cause a spike in blood calcium levels, which may ultimately lead to calcium attaching itself to plaque in the walls of the arteries, leading to hardening of the arteries, a key risk factor for heart attack.

Unfortunately, these controversial results were widely disseminated and may have caused consumers some unnecessary concern about any potential risks associated with supplementing with calcium. But now that the dust has settled a bit, many health experts are pointing to serious problems with the design of this study and are raising doubt about the reliability of the conclusions that were drawn. One thing is certain: any time participants are required to self-report food and supplement intake based on memory, the results are likely to be suspect. And, even assuming that the participants reported their food intake with absolute accuracy (again, highly doubtful), it is important to put the results into the proper perspective. Only 850 of the 24,000 participants reported the use of any type of calcium supplement and dosages were not well-quantified. Among this small group of calcium users, only 40 participants had a heart attack, which equates to fewer than 4 heart attacks per year. Also, national surveys conducted in the United States suggest that nearly 11% of the population takes calcium supplements. In this study, less than 4% of the study participants used calcium supplements, suggesting that calcium use was significantly underreported in this study. The researchers themselves concede that, "It is possible that the unreported calcium supplementation would affect the accuracy of our results if identified calcium supplement users had a different cardiovascular risk profile than unidentified calcium supplement users." (Heart 2012; 98:920-925)

The moral of this story seems to be that headlines rarely tell the whole story. So, what is a girl to do about calcium supplementation? When all is said and done, the weight of the scientific evidence clearly favors ensuring sufficient calcium intake from a combination of food and supplements, especially during specific life stages, including pregnancy and lactation. If you are currently trying-to-conceive, pregnant or breastfeeding, here are five important things to keep in mind about your calcium intake:

1. Pregnancy and breastfeeding can deplete your stores of nutrients. Adequate intake of calcium is especially important during pregnancy and breastfeeding, unique times in a woman's life when her own nutritional stores are constantly tapped to ensure that her growing child is properly nourished. Taking a high-quality calcium supplement before, during and after pregnancy ensures that you maintain adequate stores of this important nutrient.

2. Bone health is just one of the reasons that calcium supplementation is important for pregnant women. Research indicates that calcium plays a role in preventing preeclampsia, a serious condition of pregnancy which causes high blood pressure and fluid retention. Ensuring optimal intake of calcium before and during pregnancy can go a long way in helping to prevent pregnancy complications, like preeclampsia.

3. Experts recommend taking no more than 500 milligrams of supplemental calcium at one time. By limiting the supplemental dose to 500 mg, you can minimize the potential "spike" in blood calcium levels that the German and Swiss researchers theorized about, reducing any chance that the calcium will end up in your arteries where it doesn't belong.

4. Calcium does not work alone. To work effectively, calcium needs both magnesium and Vitamin D: magnesium helps transport calcium into the bones and vitamin D enhances the absorption of calcium. Be sure to choose a calcium supplement that also contains magnesium and vitamin D to obtain maximum support.

5. Consider the form of calcium in your supplement. Supplemental calcium comes in a variety of forms. While calcium carbonate is the most common supplemental form, calcium citrate is thought have better absorption rates. Choose a supplement that contains a combination of calcium carbonate and calcium citrate, and be sure to take your calcium supplement with food.

6. Include calcium-rich foods in your diet. The healthiest choice is always to obtain vitamins and minerals from a variety of food sources, and to supplement when necessary. If you take a supplement containing 500 mg of calcium, you still need another 500 mg from food to meet the recommended daily amount of 1,000 mg. Low-fat dairy products (milk and yogurt) and green-leafy vegetables are excellent sources of calcium.

Fairhaven Health recently introduced the newest addition to our PeaPod line of products: PeaPod CalMag. This product was formulated to provide the optimal supplemental dose of calcium and magnesium. It contains a combination of calcium carbonate and calcium citrate, and vitamin D, to ensure optimal absorption of calcium.