Calcium supplements question

[Guest guest]

Is there any published research that shoes adverse health outcomes from

taking 1,200 mg or more of calcium in supplements per day? I've found some

info on heart disease but was wondering if there was anything else out

there.

Thanks in advance!

Shelby , MS, RD, LD

[Guest guest]

You wonder too, about vitamin D and magnesium levels in the patients in these

studies..........

   

From Heartwire

Dietary Calcium Better Than Supplements for CVD Safety, Latest Research 

Suggests

Nainggolan

May 30, 2012 (Heidelberg, Germany)— Authors of another study suggesting 

that calcium supplements might increase the risk of MI say people who do 

need more calcium should first and foremost try to up dietary intake of 

this mineral [1]. Reporting their findings in the June 2012 issue of 

Heart, Dr Kuanrong Li (German Cancer Research Center, Heidelberg, 

Germany) and colleagues conclude that calcium supplements " should be 

taken with caution. "

I wouldn't say calcium supplements are harmful, but I wouldn't say they 

are harmless.

Senior author, nutritionist Dr Sabine Rohrmann (University of Zurich, 

Switzerland), told heartwire : " I wouldn't say calcium supplements are 

harmful, but I wouldn't say they are harmless. " And while she does not 

believe there should yet be a warning not to use such supplements, 

" because more work is needed, " doctors should initially try to encourage 

anyone they feel is deficient in calcium to get what they need from 

their diet, she urges.

" My advice is that doctors should look carefully at the diet of their 

patients and try to make adjustments (recommend appropriate foods). If 

calcium intake is not high enough they should recommend a supplement 

that has a dose of a maximum of 500 mg. Even better would be a lower 

dose recommended to be taken twice a day. "

Large Boluses of Calcium Might Provide a " Spike, " Driving Atherogenesis

Both Li et al and the authors of an accompanying editorial [2]--Drs Ian 

R Reid and Mark J Bolland (University of Auckland, New Zealand), who 

have both previously published research on this topic--say they believe 

the " spike " in calcium concentrations that occurs in the blood following 

supplementation with large boluses of calcium might be the culprit in 

the increased MI risk, possibly driving or accelerating atherogenesis.

We should return to seeing calcium as an important component of a 

balanced diet and not as a low-cost panacea to the universal problem of 

postmenopausal bone loss.

In contrast, dietary calcium is taken in small amounts spread throughout 

the day, usually together with fat and protein, so as a result it is 

absorbed slowly, causing little change in serum calcium levels, they 

point out.

" Calcium supplements have been widely embraced by doctors and the 

public, on the grounds that they are a natural and, therefore, safe way 

of preventing osteoporotic fractures, " say Reid and Bolland.

" It is now becoming apparent that taking this micronutrient in one or 

two daily boluses is not natural, in that it does not reproduce the same 

metabolic effects as calcium in food. We should return to seeing calcium 

as an important component of a balanced diet and not as a low-cost 

panacea to the universal problem of postmenopausal bone loss, " they add.

" Evidence Mounting " for a Cardiovascular Effect of Calcium Supplements

Li et al analyzed epidemiological data from one of two German cohorts, 

Heidelberg, participating in the European Prospective Investigation into 

Cancer and Nutrition Study (EPIC). There were 23 980 participants aged 

35 to 64 years, free of major cardiovascular events at recruitment. A 

self-administered food frequency questionnaire (FFQ) was used to assess 

consumption of 148 food items in the 12 months before the date of 

recruitment. And in a baseline interview and follow-up questionnaires, 

participants were asked if they had regularly taken vitamin/mineral 

supplements in the past four weeks.

After an average follow-up time of 11 years, 354 MIs, 260 strokes, and 

267 cardiovascular deaths were documented. There was no association 

between calcium-supplement use and stroke or CV mortality. But users of 

any supplements containing calcium had a significantly increased risk of 

MI compared with nonusers of supplements (HR 1.86; 95% CI 1.17–2.96) 

after multivariate adjustment. This effect was even more pronounced in 

those who used calcium supplements only, as opposed to combination 

supplements containing calcium (HR 2.39; 95% CI 1.12–5.12).

While Rohrmann admits the number of events was small, just 20 MIs out of 

851 users of any supplement and just seven MIs among the 256 people who 

took only calcium supplements, compared with 256 MIs among 15 959 

nonusers of supplements, she says the findings are still valid " because 

they are statistically significant. "

Also, she says the new results add to those from several other 

observational studies and meta-analyses over the past few years that 

have hinted at a link between calcium supplementation and increased risk 

of MI.

Reid and Bolland agree in their editorial that this is another piece of 

the puzzle. " Thus, the evidence is steadily mounting for a real 

cardiovascular effect from the use of calcium supplements, raising the 

question as to whether this is large enough to abrogate the beneficial 

effects on fractures. "

That doesn't mean that calcium isn't important, but I would urge people 

to use dietary sources as an alternative to supplements.

Li et al also found that total dietary intake of calcium was somewhat 

protective against MI, although they did not observe a linear 

association, as has previously been reported. Compared with those in the 

lowest quartile of dietary and dairy calcium intake, those in the third 

quartile had around a 30% reduced risk of MI (HR of 0.69 and 0.68), 

which was significant. But while those in the highest quartile also had 

a lower risk of MI than those in the lowest quartile, this difference 

was not significant, said Rohrmann.

" I'm not an osteoporosis expert, " she says, " but people under 50 years 

of age require about 1000 mg of calcium a day and those over 50 around 

1200 mg. And what we do know from the literature is that much more than 

this doesn't add much [benefit]. Also, there are much more effective 

things to recommend [for osteoporosis prevention] than calcium, such as 

exercise and vitamin D. That doesn't mean that calcium isn't important, 

but I would urge people to use dietary sources as an alternative to 

supplements. For those who don't tolerate milk products well, broccoli, 

cabbage, and kale are rich sources of calcium, and there are mineral 

waters and orange juices available that are fortified with lower doses 

of calcium than supplements. "

Press Coverage " Okay " on the Whole, Says Researcher

Li et al's paper and the accompanying editorial generated much press 

coverage around the world last week, with a search as of today detailing 

199 articles on the topic.

Many went with the headline of calcium supplements almost doubling the 

risk of heart attack. However, many of these reports clarified in the 

text that such supplementation should be viewed with caution, rather 

than going so far as to suggest use should be abandoned. Other news 

headlines were more cautious, including the New York Times, which used 

the headline " Taking calcium may pose heart risks [3].

Some stories took a different stance, such as one on the website of the 

UK Daily Telegraph [4] entitled, " No need to panic over new calcium 

heart attack research, " which linked to a video interview with Natasha 

, a British Heart Foundation (BHF) senior cardiac nurse. She 

advised those who have been prescribed calcium supplements by their 

doctor to continue to take them but to consult their physician with any 

queries. " Don't be worried about what these results say; we need more 

research, " she noted. However, an article on the same study that also 

ran online on that website [5] yelled, " Calcium pills 'double heart 

attack risk,' " as did a headline on the story that ran on the front 

page of the print version of that newspaper. Other reports tried to tell 

both sides of the story [6], trying to tease out important messages for 

readers.

On the whole, Rohrmann told heartwire , the press coverage was " okay. We 

expected that physicians treating osteoporosis patients would be 

hesitant about our results. As a nutritionist, I would always recommend 

that people should try to get their nutrients from diet. And I believe 

that too many rely on supplements to make up for an unbalanced diet. 

However, for patients, it is important to clarify the situation with 

their physician. "

Li et al and both editorialists report no conflicts of interest.

http://www.medscape.com/viewarticle/764788?sssdmh=dm1.789603 & src=nldne

Subject: Calcium supplements question

To: rd-usa

Date: Friday, July 6, 2012, 2:12 PM

Is there any published research that shoes adverse health outcomes from

taking 1,200 mg or more of calcium in supplements per day? I've found some

info on heart disease but was wondering if there was anything else out

there.

Thanks in advance!

Shelby , MS, RD, LD

[Guest guest]

You wonder too, about vitamin D and magnesium levels in the patients in these

studies..........

   

From Heartwire

Dietary Calcium Better Than Supplements for CVD Safety, Latest Research 

Suggests

Nainggolan

May 30, 2012 (Heidelberg, Germany)— Authors of another study suggesting 

that calcium supplements might increase the risk of MI say people who do 

need more calcium should first and foremost try to up dietary intake of 

this mineral [1]. Reporting their findings in the June 2012 issue of 

Heart, Dr Kuanrong Li (German Cancer Research Center, Heidelberg, 

Germany) and colleagues conclude that calcium supplements " should be 

taken with caution. "

I wouldn't say calcium supplements are harmful, but I wouldn't say they 

are harmless.

Senior author, nutritionist Dr Sabine Rohrmann (University of Zurich, 

Switzerland), told heartwire : " I wouldn't say calcium supplements are 

harmful, but I wouldn't say they are harmless. " And while she does not 

believe there should yet be a warning not to use such supplements, 

" because more work is needed, " doctors should initially try to encourage 

anyone they feel is deficient in calcium to get what they need from 

their diet, she urges.

" My advice is that doctors should look carefully at the diet of their 

patients and try to make adjustments (recommend appropriate foods). If 

calcium intake is not high enough they should recommend a supplement 

that has a dose of a maximum of 500 mg. Even better would be a lower 

dose recommended to be taken twice a day. "

Large Boluses of Calcium Might Provide a " Spike, " Driving Atherogenesis

Both Li et al and the authors of an accompanying editorial [2]--Drs Ian 

R Reid and Mark J Bolland (University of Auckland, New Zealand), who 

have both previously published research on this topic--say they believe 

the " spike " in calcium concentrations that occurs in the blood following 

supplementation with large boluses of calcium might be the culprit in 

the increased MI risk, possibly driving or accelerating atherogenesis.

We should return to seeing calcium as an important component of a 

balanced diet and not as a low-cost panacea to the universal problem of 

postmenopausal bone loss.

In contrast, dietary calcium is taken in small amounts spread throughout 

the day, usually together with fat and protein, so as a result it is 

absorbed slowly, causing little change in serum calcium levels, they 

point out.

" Calcium supplements have been widely embraced by doctors and the 

public, on the grounds that they are a natural and, therefore, safe way 

of preventing osteoporotic fractures, " say Reid and Bolland.

" It is now becoming apparent that taking this micronutrient in one or 

two daily boluses is not natural, in that it does not reproduce the same 

metabolic effects as calcium in food. We should return to seeing calcium 

as an important component of a balanced diet and not as a low-cost 

panacea to the universal problem of postmenopausal bone loss, " they add.

" Evidence Mounting " for a Cardiovascular Effect of Calcium Supplements

Li et al analyzed epidemiological data from one of two German cohorts, 

Heidelberg, participating in the European Prospective Investigation into 

Cancer and Nutrition Study (EPIC). There were 23 980 participants aged 

35 to 64 years, free of major cardiovascular events at recruitment. A 

self-administered food frequency questionnaire (FFQ) was used to assess 

consumption of 148 food items in the 12 months before the date of 

recruitment. And in a baseline interview and follow-up questionnaires, 

participants were asked if they had regularly taken vitamin/mineral 

supplements in the past four weeks.

After an average follow-up time of 11 years, 354 MIs, 260 strokes, and 

267 cardiovascular deaths were documented. There was no association 

between calcium-supplement use and stroke or CV mortality. But users of 

any supplements containing calcium had a significantly increased risk of 

MI compared with nonusers of supplements (HR 1.86; 95% CI 1.17–2.96) 

after multivariate adjustment. This effect was even more pronounced in 

those who used calcium supplements only, as opposed to combination 

supplements containing calcium (HR 2.39; 95% CI 1.12–5.12).

While Rohrmann admits the number of events was small, just 20 MIs out of 

851 users of any supplement and just seven MIs among the 256 people who 

took only calcium supplements, compared with 256 MIs among 15 959 

nonusers of supplements, she says the findings are still valid " because 

they are statistically significant. "

Also, she says the new results add to those from several other 

observational studies and meta-analyses over the past few years that 

have hinted at a link between calcium supplementation and increased risk 

of MI.

Reid and Bolland agree in their editorial that this is another piece of 

the puzzle. " Thus, the evidence is steadily mounting for a real 

cardiovascular effect from the use of calcium supplements, raising the 

question as to whether this is large enough to abrogate the beneficial 

effects on fractures. "

That doesn't mean that calcium isn't important, but I would urge people 

to use dietary sources as an alternative to supplements.

Li et al also found that total dietary intake of calcium was somewhat 

protective against MI, although they did not observe a linear 

association, as has previously been reported. Compared with those in the 

lowest quartile of dietary and dairy calcium intake, those in the third 

quartile had around a 30% reduced risk of MI (HR of 0.69 and 0.68), 

which was significant. But while those in the highest quartile also had 

a lower risk of MI than those in the lowest quartile, this difference 

was not significant, said Rohrmann.

" I'm not an osteoporosis expert, " she says, " but people under 50 years 

of age require about 1000 mg of calcium a day and those over 50 around 

1200 mg. And what we do know from the literature is that much more than 

this doesn't add much [benefit]. Also, there are much more effective 

things to recommend [for osteoporosis prevention] than calcium, such as 

exercise and vitamin D. That doesn't mean that calcium isn't important, 

but I would urge people to use dietary sources as an alternative to 

supplements. For those who don't tolerate milk products well, broccoli, 

cabbage, and kale are rich sources of calcium, and there are mineral 

waters and orange juices available that are fortified with lower doses 

of calcium than supplements. "

Press Coverage " Okay " on the Whole, Says Researcher

Li et al's paper and the accompanying editorial generated much press 

coverage around the world last week, with a search as of today detailing 

199 articles on the topic.

Many went with the headline of calcium supplements almost doubling the 

risk of heart attack. However, many of these reports clarified in the 

text that such supplementation should be viewed with caution, rather 

than going so far as to suggest use should be abandoned. Other news 

headlines were more cautious, including the New York Times, which used 

the headline " Taking calcium may pose heart risks [3].

Some stories took a different stance, such as one on the website of the 

UK Daily Telegraph [4] entitled, " No need to panic over new calcium 

heart attack research, " which linked to a video interview with Natasha 

, a British Heart Foundation (BHF) senior cardiac nurse. She 

advised those who have been prescribed calcium supplements by their 

doctor to continue to take them but to consult their physician with any 

queries. " Don't be worried about what these results say; we need more 

research, " she noted. However, an article on the same study that also 

ran online on that website [5] yelled, " Calcium pills 'double heart 

attack risk,' " as did a headline on the story that ran on the front 

page of the print version of that newspaper. Other reports tried to tell 

both sides of the story [6], trying to tease out important messages for 

readers.

On the whole, Rohrmann told heartwire , the press coverage was " okay. We 

expected that physicians treating osteoporosis patients would be 

hesitant about our results. As a nutritionist, I would always recommend 

that people should try to get their nutrients from diet. And I believe 

that too many rely on supplements to make up for an unbalanced diet. 

However, for patients, it is important to clarify the situation with 

their physician. "

Li et al and both editorialists report no conflicts of interest.

http://www.medscape.com/viewarticle/764788?sssdmh=dm1.789603 & src=nldne

Subject: Calcium supplements question

To: rd-usa

Date: Friday, July 6, 2012, 2:12 PM

Is there any published research that shoes adverse health outcomes from

taking 1,200 mg or more of calcium in supplements per day? I've found some

info on heart disease but was wondering if there was anything else out

there.

Thanks in advance!

Shelby , MS, RD, LD