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We've been worried about this for years and now it appears to have come to pass. Based on very sketchy data, manufacturers of calcium pills have touted their benefits for strong bones. And many physicians have recommended that women take extra calcium daily to prevent osteoporosis.
But Walter Willett, M.D., M.P.H., Dr.P.H., Chair, Department of Nutrition at the Harvard School of Public Health, has been telling us for years that Americans have been overdosing on calcium. The evidence that calcium actually builds bone and prevents osteoporosis is relatively modest. Although he has been cautious, we have detected an undercurrent of concern from Dr. Willett and that fed our own fears that millions of people could have been sold a bill of goods when it came to calcium.
The new research just published online in the British journal BMJ reveals a 30 percent increased risk of heart attack in people over the age of 40 who were popping down extra calcium. This study involved nearly 12,000 people and was a meta-analysis of 11 randomized controlled trials (the gold standard in research).
You will hear that the this 30 percent increased risk is actually quite small. That is true in absolute terms, but if this had been a 30 percent reduced risk of heart attack (as seen with some statins and heart attacks), it would be hyped on TV commercials as a fantastic benefit.
Bottom line, we're very concerned about this analysis. With so many millions popping down huge doses of calcium, we fear that there could excess deaths caused by this supplement. If something doesn't really help that much and might cause harm, we suggest caution. Until further clarification, we suggest getting your calcium from food rather than a pill.
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This information is disturbing to those of us who have been advised by our doctor to take a calcium supplement.
It's too general. No mention is made of amounts to be concerned about.
I'd like to know what you consider a "huge" dose, so I know what to avoid. Do you advise not taking ANY calcium in supplements? I get most of my calcium from food, but take about 500 mg./day in the form of supplements.
Thank you.
Calcium requires a lot of acid to digest, I am told. This may be why it
seems to increase my reflux problem (at age 70).
I'm not convinced by this meta-analysis by Bolland et al.
Their reference dose is 500 mg or more. Since most calcium supplements are 500 mg, it's rare for anyone to take less than 500 mg ie, they're looking at anyone taking calcium supplements. Except not so fast. They exclude people taking vitamin D with the calcium. Have you tried to buy calcium supplements without vitamin D? Near Impossible these days. SO does this paper apply to the average person taking calcium supplements?
If vitamin D is essential for absorption of calcium, then what is it that these authors are studying in those taking calcium without vitamin D? Can't be calcium because the absorption will be lower. Maybe it's the lack of calcium. How many of the papers included in their analysis included blood levels of calcium??
And I take calcium for leg cramps. If I don't take it, I get awful debilitating cramps. I was advised to do this my an Asian American physician some years ago. Works for me but should I change this habit? Of course, my calcium is combined with vitamin D and they didn't look at this...?
2 years ago my cardiologist diagnosed me with heart disease & said I had a calcium deposit in an artery. He put me on Vitorin. Ironically, the year before, he told me I should be taking more calcium as I had also been diagnosed with osteoporosis. I did not increase my calcium, but continued to take a minimum amount of calcium with twice as much magnesium, and after a week, I discontinued the Vitorin as I do not like to take prescription drugs and there was a great deal of negative publicity about Vitorin.
At the same time, I discovered a book written by a doctor who advocated a vitamin, amino acid and antioxidents regimen to prevent heart disease. I went on this and a year later, went to another cardiologist for a series of tests for the heart (EKG, stress test, etc.) and found that I did not have a heart problem at all.
I am 82 years old and in great health. Incidentally, I have also been on bio-identical HRT for the past 20+ years. We eat organic foods accompanied by a glass of red wine at dinner time, and I do 30 minutes on the treadmill 4 to 5x per week.
I appreciate these updates and do not expect an in-depth article, however, your reporting is pretty shallow and sometimes alarmist. There is nothing here to gauge the definition of how much is "too much" calcium. What is the specific age range? What dosage? How often?
Does culture make a difference i.e., British, American, Asian, Mediterranean diets and lifestyles are all very different. And what qualifies you to "suggest" getting calcium more from food (a "given" by the way) or to discontinue taking supplements which might be ill-advised for at-risk populations like older women!
I just don't think medical "sound bites" are very valuable. I used to enjoy listening to your radio program, but I have come to see this website as more of a catalog to promote your products and less a source of serious and helpful health information.
PEOPLE'S PHARMACY RESPONSE:
It is not surprising that so many visitors to this website would find our brief overview of the BMJ article disturbing. After all, Americans have been told for decades to take calcium to build strong bones. The trouble with that advice, however, was that it was not based on science.
If one really looks at the research, and there is an amazing amount of it, you will discover that the data demonstrating that calcium can be helpful in preventing fractures is exceptionally weak. Over the years more than 140 studies have examined the effects of calcium on fracture risk. About one third suggest benefit. Over half show no reduced risk (the rest were inconclusive).
Let’s take a look at epidemiology. In countries where people consume a LOT of milk, dairy products AND calcium supplements (Scandinavia, the United States and the UK), hip fractures are very common. In countries where milk and dairy consumption (and calcium pills) is low (Africa, China, New Guinea and Iran), hip fracture rate is much lower.
What about vitamin D? Many of the comments on this site have pointed out that the BMJ research was flawed because it did not include studies of vitamin D added to calcium. The meta-analysis could only analyze the studies that were available. Most of the big studies were done with calcium alone. The doses of calcium that were employed in the various studies ranged from 500 mg of calcium carbonate to 1,400 mg of calcium citrate and 2,000 mg of lactogluconate-carbonate. As for vitamin D, of the nearly 40 studies that have been published involving both calcium and vitamin D combined, roughly half showed fracture reduction and half demonstrated no benefit.
Unless there is a clear benefit from something, we are unwilling to accept a risk. Although the risk of heart attack may seem small in absolute numbers, if tens of millions of women are swallowing large doses of calcium, the number of people who may be vulnerable is actually quite substantial.
We encourage visitors to actually read the BMJ article. It is free and very comprehensive. It is also understandable.
The article specifies calcium "without co-administered vitamin D." I suspect most people who listen to your show take a couple of thousand extra vitamin D, and the calcium products I've seen in stores include some D, so are we safe?
I don't consume dairy and my mom had osteoporosis. I take calcium because I do eat some things with calcium but not many (don't eat fish often) try to have broccoli 3-4 times a week. I take 1 315 mg calcium and a multi vitamin with calcium in it too. Is that a "huge dose?"
Thank you for the informaion on calcium supplements - I had been taking Fosamax for years and stopped taking it after information came out that it was also harmful - have also been taking calcium for many years thinking that it was helping my osteoporosis - now find that it is also probably creating additional problems for me. Who can we trust and what can we do? Should I stop taking the calcium tablets with vitamin D? I hear your program on Saturday mornings and read your column in our newspaper.
I had surgery to remove calcium from my shoulder. Now I have calcium in the other shoulder. I've been on 1260 mg of Citracal +D and wonder if this built up in my shoulder. I need to know if I should stop taking the supplement. My bone density tests show I'm at high risk for spine and hip fracture and that is why my doc told me to take supplements. My mother, grandmother and aunt all had broken hips. Thanks very much.
Thank you so much for this information. Quite a few years ago I read about a study in one of the Scandanavian countries (I think) that warned about too much calcium in the body could lead to heart attacks. And although I have watched for further mention of this possibility I have heard non until now.
Thanks again and keep up your good work.
It would have been helpful if the article told us how much calcium was deemed to increase rate of heart attack by 30%: 500 mg, 1000mg, 1500mg per day; with or without an appropriate accompaniment of magnesium (250mg, 50mg, 750mg)? Or was even 250mg of calcium daily increasing heart attack by 30%? Please respond. Thank you. Dianne
What about the use of TUMS? Does the some alert apply? Thanks so much.
Would you mind telling what the book was that you are referring to? I too have concerns about calcium and heart disease. Thank you!
Re: calcium intake article.
What about the taking of antacid tablets (like Tums)? Does this contribute to the risk factor mentioned in your article concerning calcium and heart attacks?
Had stopped taking calcium and all vitamins for a period of time due to a small rash and itchy skin. Calcium has been linked to constipation which is a problem, so I found your article to be very useful. Thanks
Please provide the name of the book and the author that you reference in your comments. I would love to have it for my family.
Thank you
Many Calcium supplements just have Calcium, or Calcium and Vit D, or Calcium and Magnesium. I've heard that Calcium needs both Vit D and Magnesium to be absorbed properly. Could the problem be that we are not taking the right Calcium supplement for the Calcium to be absorbed properly?
A chiropractor gave me a Calcium, Magnesium, Potassium supplement which has the right proportions for the body (but no Vit D). When I have been in the ER with Atrial Fibrillation the doctor always tells me my Potassium is low. Could heart problems be that the minerals we take are not in proper balance for our bodies? Would supplements be OK if they were in the right balance? I would like your input on this as I am about to buy more supplements.
PEOPLE'S PHARMACY RESPONSE: CALCIUM AND MAGNESIUM DO NEED TO WORK TOGETHER. WE USUALLY ADVISE AGAINST TAKING POTASSIUM SUPPLEMENTS EXCEPT UNDER MEDICAL SUPERVISION. IT IS TERRIBLY IMPORTANT, BUT GETTING TOO MUCH IS JUST AS DANGEROUS AS HAVING TOO LITTLE. THE EVIDENCE AGAINST CALCIUM PILLS AS A SIMPLE WAY TO COUNTERACT OSTEOPOROSIS HAS BEEN GROWING FOR YEARS, BUT THE EVIDENCE OF HARM IS RECENT AND WILL NEED FURTHER STUDY. IT'S TOO SOON YET FOR US TO KNOW HOW TO ADVISE YOU ON YOUR SUPPLEMENTS.
Dr. John Diamond, Reno, Nevada,a frequent MD on the "Healthy,Wealthy & Wise program" always said "calcium strengthens bones and MAGNESIUM knows where to put it". Without magnesium, the calcium is not properly used/absorbed and deposits in the wrong places.
Drs always recommend Oscal, Citrical +D. In tests it was shown that most heart attack patients are void of magnesium. I take most of my pills in CAPSULE form to make sure they get absorbed, especially when taken acid reducers since you need acid to break down hard packed monster pills.
I take Calcium chews 500mg plus K-40mg and D-500iu, I have seen a change in the strength of my nails, and my osteopenia did not get any worse,
Thank You for all you do for our health,
I am 82 years old and have been taking calcium plus vitamin D for over a year because of low D since I avoid the sun after having had skin cancer many years ago. After reading about the dangers of too much calcium I asked my doctor about it and she said that this was OK for old people to take but the danger was greater for young persons. Your thoughts please.
PEOPLE'S PHARMACY RESPONSE: ELSE, WE THINK SHE MIGHT NOT HAVE ENOUGH EVIDENCE TO SAY THAT. NONETHELESS, THE DANGER IS PROBABLY NOT HIGH. MANY OF THE COMMENTARIES ON THIS STUDY HAVE STRESSED THAT THE PROBLEMS SHOWED UP IN PEOPLE TAKING CALCIUM TABLETS WITHOUT VITAMIN D, UNLIKE YOU.
I too have crossed the line from osteopenia into osteoporosis and am concerned about how to handle this. Is there a dose of supplementary calcium that is considered safe? Are some types of calcium less likely to build up in the body where they're not supposed to?
PEOPLE'S PHARMACY RESPONSE: THERE IS NO DATA SUGGESTING THAT CALCIUM FROM THE DIET (AS COMPARED TO FROM SUPPLEMENTS) IS A PROBLEM. VITAMIN D STATUS IS CRITICAL. MOST REPORTS ON THIS STUDY STRESS THAT PEOPLE TAKING CALCIUM SUPPLEMENTS WITHOUT D WERE AT HIGHER RISK. BUT THE STUDY DOES NOT GIVE US ENOUGH INFORMATION YET TO TALK ABOUT SAFE DOSES OR SPECIFIC CALCIUM SALTS. WE NEED MORE RESEARCH!
What happened to the thoughtful ideas from nutritionist Adelle Davis given in her book, _Let's Eat Right To Keep Fit_, Ch. 21, 22, esp. pp. 168, 175 in which she recommends a ratio between phosphorus:calcium:magnesium to be 4:2:1? I have taken calcium/magnesium pills in a 2:1 ratio for years and have no heart problems and also have an unusually high bone density for someone my age, now early in my seventh decade. To attain nutritional balance for health, this suggests to me there is a bigger picture to consider than taking calcium alone.
PEOPLE'S PHARMACY RESPONSE: ADELLE DAVIS CERTAINLY WAS AHEAD OF HER TIME IN MANY WAYS. WE'LL NEED TO SEE IF THIS SPECIFIC RATIO HOLDS UP IN RESEARCH, BUT THERE IS ALREADY EVIDENCE THAT MAGNESIUM AS WELL AS CALCIUM IS IMPORTANT FOR BONE HEALTH
This article played with numbers and left the reading audience with the wrong impression as to the heart attack relationship when using calcium supplements. While the 30% number is correct these are not the numbers one should be concerned with in my opinion. Yes the percentage went up. However, this is as dramatic as if one were to state that there was a 100% increase in something when the results went from one individual to two individuals that was out of say 10,000 individuals. What should have been shown was the change in parts per the total population such as (these were the numbers that were used in the case study):
111/8000 x 100% = 1.3875%
143/8000 x 100% = 1.7875%
This interpretation gives the incident rates per the total population and is a more representative/accurate figure. Anyone viewing these percentages would discount or conclude that taking calcium supplements is a problem as the number of participants in the study that had heart issues is very small regardless if one is taking calcium or not. The 30% figure only cites the change in number of heart attacks out of a very small part of the total population. So the 30% figure makes it look like taking calcium supplements makes a huge difference relative to having a heart attack while on calcium which it doesn't. Figures can result in false impression depending on how you use them.
PEOPLE'S PHARMACY RESPONSE: EXCELLENT POINT. HOWEVER, GIVEN THE LOW BENEFIT, EVEN A SMALL RISK MULTIPLIED OUT OVER ALL THE PEOPLE TAKING CALCIUM SUPPLEMENTS MIGHT BE TOO MUCH.
I experienced heart palpitations when I used calcium supplements. As soon as I discontinued the calcium, the palpitations stopped. The calcium also gave me leg cramps at night.
As a member of an integrative medical team, I've been noticing an increase of symptoms of magnesium deficiency... many seemingly unrelated symptoms can point at low magnesium including migraines, muscle spasms/cramps, irregular heart rhythm /atrial fibrillation, constipation, bone spurs, etc. Certainly we know that processed foods, soda pop drinks, many antibiotic and prescription drugs (metaformin, for example) can deplete the body's supply of magnesium. There is some evidence that Vitamin D deficiency may also lead to magnesium deficiency.
Over-supplementation of calcium can also lead to a dangerous imbalance in magnesium levels.
Lucky for me I can't take calcium since my heart is compromised by high b/p. Twenty years ago I WAS prescribed it and took it. I began to develop lumps on tendons, the most painful being the Achilles. After much diagnosing at university clinics, rheumatoid in particular, I luckily discovered a journal article (serendipity) about tendon lumps and calcium supplements in some people.
The lumps were gone three weeks after stopping the calcium. I drink skim milk, and eat dark greens from the garden every day; cheese, yogurt and cottage cheese. Tests for osteo are negative. I'm seventy. Not every one digests and processes non-food calcium, sending it where it needs to go.
This information leaves me puzzled. As I have osteoporosis and my doctor has recommended 1500 milligrams of calcium per day. I was taking fosamax but gave that up after reading your article that this particular drug could cause fractures and also increases the possibility of GERD. So please tell me, what amount of calcium is considered "dangerous." You left that out. It would be good to know so I can regulate my diet accordingly.
PEOPLE'S PHARMACY RESPONSE: ALL OF THE STUDIES IN THE META-ANALYSIS USED AT LEAST 500 MG CALCIUM DAILY. AS ANOTHER COMMENTER POINTED OUT, THE RISK IS EXTREMELY LOW. YOU SHOULD DISCUSS THIS WITH YOUR DOCTOR.
Years ago my holistic MD told me calcium was over-prescribed to Americans and I shouldn't take it to prevent osteoporosis (in spite of my OB/GYN's admonishments). He recommended a regimen of magnesium, I took his advice and took 400mg/day of calcium glycinate), and my X-ray bone scans have been virtually the same for the past 8 years (I'm 63).
I'd like to know how many of these people taking "calcium supplements" are actually popping down Tums for ongoing heartburn and ulcers. Such people would already be at higher risk of heart attack due to stress and a bad lifestyle. Just because two things are related does not mean they are cause and effect.
PEOPLE'S PHARMACY RESPONSE: ALL OF THE PEOPLE INCLUDED IN THE BMJ ANALYSIS WERE ACTUALLY TAKING CALCIUM SUPPLEMENTS BECAUSE THEY HAD VOLUNTEERED FOR A STUDY. YOUR POINT ON CAUSE AND EFFECT IS CERTAINLY VALID.
Regarding the comments on to much calcium raising the risk for heart attack. is it because the calcium deposits in an artery causing a blockage? I have just been told I have calcium deposits in an artery near my heart. Years ago a chest CT found a nodule in one lung. They said it was a calcium deposit and it was not a problem. My chest CT from 2009-2010 showed nodules in both lungs. Some are new and some have enlarged four times in size. Over that year I had increased my calcium with vit d from 500mg to 1,800mg daily because I do not eat dairy because of another problem.
I feel my increase in dose was the culprit and I'm just sick over it. Anyone else presented with calcium deposits and on a high dose of calcium with vit d?
It makes perfect sense! Calcium without magnesium will definitely induce a magnesium deficiency, a really important mineral that has huge health benefits for the heart! Ideally, a 2-1 ration of calcium to magnesium is perfect. It's always mystified me as to why doctors push calcium, only -- didn't they take chemistry?
Adelle Davis says it best in several of her books (here, paraphrased): "A lack of magnesium results in sensitivity to sounds, twitching, tremors, dizziness, rapid heart beat, aching muscles, fatigue, depression, irritability, insomnia, hyperactivity, anxiety, etc. When magnesium is deficient, large amounts of calcium are lost in the urine even though sorely needed by the body. The lack of magnesium indirectly becomes responsible for much rampant tooth decay, poor bone development, and slow healing of broken bones and fractures. The same high urinary losses of calcium during a magnesium shortage play a role in forming kidney stones. Such stones occur when the diet is deficient in either magnesium or vitamin B6."
I agree with the 4:2:1 ratio of Phosphorus to Calcium to Magnesium, with the addition of 'enough' vitamin D to help with absorption, as well as a small amount of vitamin K (to do what, I don't remember), AND an amount of Boron (again, to do what, I don't remember). I'm not a chemist, but reading your page on this most important topic has piqued my curiosity. I will research this combination and let you know what I find out. Thanks for your website and your radio show!
I've got several books on the body's use of both calcium and magnesium and other minerals in an effort to maintain proper PH balance. I'm wondering if the subjects of the study may have had low PH acid/alkaline that was somewhat out of whack.
This is a very interesting topic. I'd love to hear an expert discuss acid/alkaline PH balance and how it affects nutrition and health.
I take Tacrolimus, aka Prograf (immunosuppression) for heart transplant. I am advised to take calcium supplements to replace the Calcium depleted by Tacrolimus. I take 1200mg BID. Is this considered a large dosage? What would be reasonable amount to take?
This research study on calcium was done on men and women. Prominent researchers in Australia who are experts in osteoporosis say that this study is bad science, partly because men and women have different calcium requirements. Men have a greater risk for heart attacks and may have skewed the results of the study. Also, the study ignored the need for other nutrients besides calcium required to maintain a healthy heart. I can't believe that with all the variables that can lead to heart attacks, that these researchers are claiming that too much calcium alone is the culprit.
This is a very good discussion.
30% increase in risk given it is a $1.2billion industry in the US puts a lot of people at risk.
The question I would ask is - who would launch a new product which came with these risks?
The use of vitamin D seems to be something everyone is hanging their hat on - I understand there is more research coming out that will dispel that myth but regardless this argument is a little weak. Am sure Calcium with Omega 3 or any other product known to offer cardio benefits will show a better result. But that is mitigating damage – not necessarily preventing. Just like when they said aspirin with Vioxx made it ok.
This research shouldn’t surprise anyone – Calcium has long been identified as a factor in hardening arteries – all it is actually doing is reminding us that we need to meet our dietary requirements through food wherever possible. And if we are going to look for supplements – look for the natural ones that closest profile foods – not the super charged fast release bio available over processed hype that we get bombarded with.
Supplement market has fallen behind the food sector – were food is going back to wholemeal flour, brown rice and raw sugar – nutritional supplements are still serving up white flour and sugar.
Could someone tell me if calcium with D (2x day)could cause hoarseness?
I started having palpitations and after having all the tests from my doctor and finding nothing, I did some research online. I found info. that calcium channel blockers are given to some people with heart issues. So I decided to stop my calcium supplement (800 mg a day). Now I only have them once in awhile. Maybe once every few days, and only one or two at a time instead of off and on for up to two hours like they were before.