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Health See other Health Articles Title: Dutifully Taking Your Calcium Pill? It May Be Too Much While many people aren't getting enough calcium, new research cautions that some people may have the opposite problem: They could be getting too much. Americans spend more than $1 billion a year on calcium supplements in hopes of staving off osteoporosis, the brittle bone disease that cripples many elderly women and some men. Yet recent studies link calcium supplements to a higher risk of heart attacks and kidney stones. Last month, the U.S. Preventive Services Task Force issued a draft recommendation against taking calcium and vitamin D, saying there wasn't enough evidence of benefit to justify the risk. Americans have been exhorted to drink milk and take calcium supplements to maximize bone health. Now the U.S. Preventive Services Task Forces says there's no evidence that calcium helps, and a few studies show that calcium may raise the risk of heart disease. Melinda Beck explains on Lunch Break. For generations of Americans who grew up exhorted to drink their milk to maintain strong bones, the reports raised troubling questions: Is calcium not so important after all? Are the supplements unsafe? And how much is too much? "It's gotten very confusing but it doesn't need to be," says Ethel Siris, director of the Toni Stabile Osteoporosis Center at Columbia University Medical Center in New York. The links to heart attack and kidney stones involved calcium supplements, not calcium from food sources, Dr. Siris and other experts note. Many other studies have not found such health risks, so more research is needed to understand what levels, if any, might be hazardous. More on Calcium and Osteoporosis Yes, You Are Getting Shorter Sept. 20, 2011 Triple That Vitamin D Intake, Panel Prescribes Nov. 30, 2010 Saving Bones, Hard Choices Sept. 16, 2009 Here's a Chart for Estimating Your Calcium Intake Meanwhile, experts say they are still more concerned that too many Americans aren't getting enough calcium, since the body can't make it on its own. "Unless you take in enough calcium, by mouth, every day, you have to keep borrowing it from your skeleton, so over your lifetime, you need to get enough," says Dr. Siris. "If you have low bone mass, or are at risk for fractures, you want to minimize any need to take calcium from the skeleton." Enlarge Image image image How much calcium people need varies by age and gender. Adults generally need 1,000 milligrams daily, rising to 1,200 mg for women over 50 and men over 70, according to guidelines issued in 2010 by the Institute of Medicine, an independent advisory group. Children need 1,300 mg daily during the peak growing years of 9 to 18. People also need sufficient levels of vitamin D to absorb the calcium. The IOM recommends 600 international units a day for most adults, and 800 daily after age 70, although many physicians recommend more. It is difficult to take in that much vitamin D from food sources, and prolonged sun exposure, the best source of vitamin D, can lead to skin cancer, so experts say many people should take vitamin D in supplement form. $1 billion Amount Americans spend each year on calcium supplements 2,000 mg Maximum daily level of calcium that is safe for adults Source: Institute of Medicine Getting adequate calcium from food is easier. For example, 8 ounces of milk or 6 ounces of yogurt has 300 mg of calcium, and one cup of spinach has 270 mg. But studies show on average, Americans get only about 750 mg of calcium from their diets. Many of the more than 30 million Americans who are lactose intolerant don't get enough calcium or rely on calcium supplements. "For people who can't or won't get more in their diet, it's better to fill that gap with supplements than to stay on the low side," says Bess Dawson-Hughes, director of the Bone Metabolism Laboratory at the USDA Nutrition Center at Tufts University. Consuming too little calcium can contribute to osteoporosis, a thinning of the bones that causes more than 2 million fractures a year. Once osteoporosis sets in, taking extra calcium and vitamin D won't prevent fractures. But not getting enough of the nutrients can make bone loss worse. [image] Associated Press The Got Milk campaign started in 1993 and included celebrities like Brooke Shields. On the other hand, it is easy to consume more than the 2,000 mg a day that the IOM considers the safe upper limit for adults. "A number of health-care providers say, 'Oh, the requirement is 1,200 mg daily, so take 1,200 mg in supplements,' regardless of what the patient is consuming in food," says Dr. Dawson-Hughes. "If you have a bowl of Total in the morning and a yogurt and a glass of milk for lunch, you can get to 2,000 mg easily." Multivitamins also contain calcium in widely varying amounts. Chewable chocolate, caramel and gummy-bear varieties have made calcium supplements as appealing as candy. In general, any vitamins or minerals the body can't absorb are simply excreted. But studies linking calcium supplements to heart attack and kidney stones have made experts more wary of excess calcium than before. In a 2006 report from the Women's Health Initiative, a large government study, women who took 1,000 mg of calcium daily had 17% more kidney stones than those who got a placebo. But subjects were allowed to eat their usual diet, and take calcium supplements on their own, no matter what group they were in, so their total calcium intake was unknown. In the 12-year Nurses' Health Study of 90,000 women, those who consumed a high level of calcium in food had fewer kidney stones than those who consumed less. Studies linking calcium intake and heart-attack risk are similarly confusing. A study of 24,000 Germans published in the journal Heart last month, found that those who consumed about 820 mg of calcium a day had a 31% lower risk of heart attack than those who consumed much less. But those who got their calcium exclusively from supplements were more than twice as likely to have a heart attack as those who took no supplements. In 2010, researchers in New Zealand analyzed 11 clinical trials involving 12,000 people, and found that those taking calcium supplements had a 30% higher risk of heart attack than those who didn't. However, the studies didn't include people taking vitamin D, which some researchers believe is protective for the heart. Exactly how calcium supplements might contribute to heart attacks baffles cardiologists. "Nobody has associated the calcium in your bloodstream with calcification in your arteries," says Nieca Goldberg, medical director of the Joan H. Tisch Center for Women's Health at New York University Langone Medical Center. Still, she says she now urges patients get their recommended calcium from food than from supplements to avoid possible problems. Osteoporosis experts also urge patients not to take more than the recommended amount of calcium. "Women should definitely stop taking two big calcium supplements a day," says Dr. Dawson-Hughes. Even if the risks remain unclear, taking more than the body can absorb doesn't benefit bones, "so it's not worth any risk—real, imaginary, uncertain, possible or probably," she adds. Write to Melinda Beck at HealthJournal@wsj.com Poster Comment: With so much fortification of Ca in food products, should be no need for pills, except perhaps magnesium. Post Comment Private Reply Ignore Thread
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