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Calcium Is Killing Women Too

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A week ago we sent out a health alert about the dangers of calcium supplements for men. That was because of an article in JAMA Internal Medicine (online, February, 4, 2013) reporting that men taking more than 1500 mg of calcium daily in the form of supplements were at increased risk for cardiovascular disease death. The size of the study (over 200,000 men) and the length of the follow-up (12 years) suggested that this was unlikely to be due to chance.

There was one confusing result, however. The women who participated in this National Institutes of Health-AARP Diet and Health Study were NOT at increased risk for death. The nearly 170,000 women who were included in the research seemed to avoid the small but significant risk that calcium seemed to pose for men. The authors concluded:

"We found a significant interaction by sex. Elevated CVD [cardiovascular disease] mortality with increasing supplemental calcium in-take was observed only in men; however, we cannot rule out the possibility that supplemental calcium intake may be associated with cardiovascular mortality in women."

Now, a brand new study published in the BMJ (online, February 13, 2013) suggests that women may indeed be vulnerable to complications from high doses of calcium in supplements. The Swedish government has been tracking the health of all its residents since 1952. In this most recent research, investigators analyzed data from 61,443 Swedish women who were followed for an average of 19 years. (They were born between 1914 and 1948.)

Over the nearly two decades they were tracked, about 12,000 women died (17%). One third of the deaths were attributed to cardiovascular disease. Now here's where it gets interesting. Women who consumed more than 1,400 mg of calcium from their diets had a higher risk of cardiovascular disease mortality (about 50% greater) than women who consumed 600 to 1000 mg of calcium from their food. If you add in calcium supplements (as pills) on top of dietary calcium (from food), however, the risk jumps dramatically. In their own words:

"Women who had a high dietary intake of calcium exceeding 1400 mg/day and additionally used calcium supplements had a higher mortality rate than women with a similarly high intake of calcium but without taking supplements. Thus, among calcium tablet users (500 mg calcium per tablet), a high dietary calcium intake (>1400 mg/day) conferred a multivariable adjusted hazard ratio of 2.57 for all cause mortality compared with a dietary calcium intake of between 600 and 999 mg/day."

In the world of epidemiology, a greater than two-fold increased risk of death is considered serious and not likely to be caused by chance. Add this study to other research and a pattern starts to emerge.

• A study last spring involving nearly 24,000 German adults found that those taking calcium supplements were more likely to have heart attacks during the 11 years of follow-up (Heart, online May 23, 2012).


A study of American women from the Women's Health Initiative (WHI) involved 16,000 women over the age of 40. Those who were randomized to receive calcium and vitamin D (vs. placebo) were about 20% more likely to experience heart attacks or other vascular problems.


Speaking of vitamin D, many women have assumed that vitamin D would somehow protect them from the problems of too much calcium. Here is what the Swedish investigators found:

"Vitamin D intake did not significantly modify the associations between calcium intake and the rate of deaths from all causes, cardiovascular disease, or ischaemic heart disease."

That said, the Swedish researchers propose that too much calcium in the diet plus supplemental calcium pills could suppress vitamin D levels, and lead to inflammation and hypertension as well as elevated triglycerides, hardening of arteries and atherosclerosis. They also suggest that too much calcium in the blood can increase the risk of clots due to a "hypercoagulable state." Other researchers have also proposed that excess calcium might increase blood coagulation and lead to "stiffness" in the arterial wall. They have also proposed that:

"One plausible biological mechanism through which calcium may exert a harmful effect on cardiovascular health is vascular calcification--the deposit of calcium phosphate in cardiovascular structures...Emerging evidence has linked calcification of coronary arteries with increased atherosclerotic plaque burden, risk of coronary heart disease and mortality."


BOTTOM LINE:

Although calcium is crucial for good health, the body is well equipped to regulate levels of this essential element. For reasons that are not entirely clear, many health professionals hopped on the calcium bandwagon and started recommending very high doses in the form of pills. Commercials on TV also encouraged women to take extra calcium. It is not unusual for a woman to be told to take 1000 mg or more of elemental calcium on top of dairy products and other foods high in calcium. At last count nearly two-thirds of American women take calcium supplements.

Based on several recent studies and the most recent Swedish research, it would appear that this advice might well have been misguided. When women consume lots of calcium from their diets and add calcium supplements to that, there is a significant increase in the risk of cardiovascular death.

So, what's a woman to do, given all the conflicting information of the last several decades? The Swedish researchers did NOT find any increased risk of death when daily dietary calcium intake ranged between 600 mg and 1,400 mg. That could well be the sweet spot. A glass of milk, a carton of low-fat (unsweetened) yogurt and lots of dark green leafy vegetables are likely to accomplish this goal. From where we sit, getting a moderate amount of calcium from food makes a lot of sense. Basically, we're back to grandma's wisdom: moderation in all things!

We welcome your comments below. Here are some that were posted to a previous link.



Twenty years ago at age 52, I decided to take calcium because of the bone loss associated with menopause. After several months, I developed large, painful, palpable lumps on my Achilles tendons making it painful to walk. My Dr. sent me to an arthritis clinic at a nearby teaching hospital. The first diagnoses was anklyosing spondolythyasis which was disproved with further blood work.

It took over a year to find out the lumps which were appearing around other joints by this time, were caused from taking calcium. This was not discovered by a Dr., but by accident in an article in a medical journal. The lumps disappeared in a couple of months when the calcium was stopped. The body does not seem to like the addition of minerals not ingested from food.
DB

++++++++++++++++++++++

This situation is very confusing. What to do? What to do? Would you please do a program very soon devoted to the subject of calcium. My bone density is below what it should be. I stopped Foxamax because of its side effects and have been taking calcium regularly. Is it possible to get all the calcium we need from our diet? Thanks.
Mary

PEOPLE'S PHARMACY RESPONSE: You may be interested in a show we did a couple of years ago on Bone Vitality.


++++++++++++++++++

It's great to see someone shedding light on health issues related to calcium supplements. Several years ago, a family member was suffering from kidney stones, and her doctor suggested that they were caused by too much calcium. That's what prompted me to do extensive research into nutritional supplements. There's no doubt in my mind that the best source of calcium is good old-fashioned food.
M.A.L.

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Please comment below on your experience with calcium supplements.

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I have to wonder what the results would be if analyzed based on the type of supplement: What valence, whether chelated, whether balanced with Mg, etc, and whether alkaline and therefore affecting stomach acidity and digestion.

Shouldn't the people have been taking magnesium with their calcium? Maybe there might have been a better outcome if they had.

Perfect timing. I recently had another Dexa Scan that showed more bone loss due to post menopause. I am very conflicted about taking even more calcium "horse" pills in addition to a "bone-building" prescribed pharmaceutical. I am not interested in the later as I tend to be very sensitive to most medications. I plan to copy and send this to my practitioner. Thanks.

I'm curious if anyone has researched whether the type of calcium compound has any influence at all on these findings. Calcium carbonate? Calcium citrate? and all the other forms of calcium available.

I wonder if the calcium added to almond milk and other vegetarian sources is a problem.

The explanation for this "mystery" has been known for some time.

The cause of the problems with calcium is vitamin K2 deficiency. Vitamin K2 is necessary for activation of the enzymes that remove calcium from soft tissues (arteries, tendons etc), where its NOT supposed to be, and places it in bones and teeth, where its supposed to be.

Most americans are deficient in vitamin K2.

Read this book to learn more:
http://www.amazon.com/Vitamin-K2-Calcium-Paradox-Little-Known/dp/1118065727/ref=sr_1_1?ie=UTF8&qid=1360723197&sr=8-1&keywords=vitamin+k2+and+the+calcium+paradox

Very interesting...

The results of the studies of women are very confusing. Almost all women over sixty are warned about bone density loss and are recommended to take Calcium supplements. Many over this age are victims of hip fractures, vertebrae fractures, and other bone problems. Hip fractures very often lead to early death, as the victim just never returns to normal health. The immediate cause of death in these situations may be heart failure or strokes, but was Calcium supplements a major contributing factor?

Have any of the studies looked at mortality of users and non-users of Calcium supplements segregated by age?

For info purposes I am going to tell you about my 52 yr old daughter. She had all 4 of her para glands (which lie on the Thyroid gland but have nothing to do with thyroid) removed due to benign tumors. This action threw her into Hypoparathyroidism or HPTH... this means her body can not regulate the use of calcium.

Calcium taken thru food is miniscule compared to what is needed to keep the body operating properly. When the calcium in the body gets too low your body begins to twitch, then twist, and then seizures which can kill you immediately. All bodily functions can stop. Many a night she has been in the ER at the VA hospital with these symptoms.

On one visit they thought she was a drug user and refused to infuse her with calcium. She nearly died before a nurse recognized her and got what was needed into her. She was a breath from death.

She now has a permanent port to get calcium. She is a member of an International group trying to get research done for HPTH. It is considered a rare disease. They meet in the DC area every year or two and come from all around the world. Thru this group she met a doctor doing research in Columbia Hosp in NY. She flew there every couple of weeks, and took part in a test treatment. It helped.

From taking so much calcium (liquid mostly) her bone density is way over which can be just as dangerous as too little density. She now has particles of calcium crystals in her kidney (she has only one) and in her breasts. The problems are endless and very life threatening.

The public needs to be aware of the problems with too little or too much calcium. My daughter who was a vibrant active woman when this hit 10 years ago is now a totally disabled, very ill person.

Thank God she was a veteran with VA benefits because her medical bills are in the multi-millions. The public also needs to be aware of the para glands when having thyroid surgery. The paras should not be removed unless they are diseased. There is a form of HPTH that is in born, but surgical intervention is dangerous to the para glands.

Have any studies been done regarding the balance of potassium, magnesium, and K2 in regard to calcium intake and its effects?

Thank you for keeping us all up to date. The NP at my physician's office kept insisting I take high doses of cal/mag supplements due to my being 60 years old; however, I'm happy that I was feeling my 'gut' response saying, "get it from your food, the way God intended".

What about the use of Tums? Do they count as calcium supplements, even if I am using them for indigestion and heartburn?

I also have no parathyroid glands, due to thyroid cancer and a careless surgeon. It has been 11 years of increasing ill health. Three more cancers and only one kidney. It got a stone, the x-rays revealed that it and its sister both had cancer, different cancers. I still have the one that had a stone; several months ago the stone walked its way out of my body; absolutely horrid pain. We without paras cannot hold onto calcium, so take vitamin D in hormone forms and levels. I choose to take more of the med, called calcitriol, and less calcium, as a supplement. I do take mag with my calcium, am thinking about K2. I do not monitor my dietary calcium.

I wish that research would be 100% accurate before the unsuspecting public is given what turns out to be wrong advice.

And I wish that medical professionals would treat us as if we were members of their families.

Helen

I appreciate raising the concern for women taking calcium. Heart disease is of great concern for women, especially after menopause. There are many cautionary notes to what you have written. Number one, it is extremely irresponsible for you to draw conclusions and predict that all the studies combined indicate how bad calcium is. Unless all of the study criteria were identical for all study participants, across all studies, you cannot assume anything. You do not know the ages of the women, T-scores before and during the study, doses taken of medications and supplements, exercise performed, alcohol consumption, smoker/nonsmoker, etc. The type of calcium (citrate or caltrate) and dose of calcium given daily as well as if it was given with D and magnesium is also important in determining outcomes.

Many women are only going to read the headline and stop taking calcium.

Men do not experience bone loss the way women do because they do not experience pregnancy, menopause, or the hormone shifts that women experience monthly during menstruation before menopause. Women are at the greatest risk for bone loss during menopause. Bone loss actually occurs a little bit every day decades before menopause. If the body does not receive the right amounts of nutrients it will steal the calcium from the bones as needed when women are young.

Bone loss, like many other diseases, begins decades before the symptoms are diagnosed. Medicine is not finite. It is evolving on a daily basis. Medicine is shifting from a reactive (treat what's wrong) mindset to a proactive (prevent disease/illness) mindset.

Are bisphosphonates also known as Osteoporosis medications as effective today as we thought they were a decade ago? No. Do women need to stay on them forever? We don't know, some studies say yes, some say no. Will eating right and exercise help bone loss? Maybe. Same with calcium.

If a patient is having a greater bone turnover rate and the osteoclast and osteoblast activity is not in harmony and new bone cannot be rebuilt than the body will pull nutrients from all sources, bone, blood, etc to try and fix the problem.

It is never just one problem. If one domino falls the others will follow. At the end of the day, Calcium is a vital nutrient required by many body systems to function properly... until more replicative studies are conducted to validate and prove reliability across time it would be presumptive to blame calcium for heart disease.

I would like to hear a People's Pharmacy broadcast in which the effect of Vitamin K2 on cardiovascular health is discussed. Some research has been reported on the National Institutes of Health website (http://www.ncbi.nlm.nih.gov/pubmed?db=PubMed) where researchers have studied the ability of K2 to direct calcium away from the cardiovascular system and into the bones. It would be good to hear the experts' opinions about this research.

I take warfarin, yet another cardiovascular clogger. I have been supplementing with calcium, magnesium and K2. (Although some research states that K2 does not help to reduce clogged arteries when taking warfarin, it is said to regulate the INR. I have found that to be true; my INR is very stable and in range.) I would like to hear more about the effect of calcium, other minerals, K2, and warfarin on bone health and cardiovascular disease. Maybe coming soon in a future broadcast or newsletter?

I chew calcium antacid tablets to counteract acid reflux, easily 3000 mgs a day, every day, in addition to a healthy diet with calcium mainly from dairy products. I take Vit D supps. I have been dxed with osteopemia but have not suffered any fractures. I am in my early 70's, average wt, non-smoker. Family history of heart disease. I asked my primary MD if chewable calcium posed a risk to my arteries, and he said no. Are there any studies about the impact of routine use of chewable calcium?

For years I did as my doctors recommended and took their prescribed doses of Cacium citrate + D to strengthen my weakening bones. I also took Magnesium citrate. Throughout the next 15 years, despite eating lots of dairy foods all my life + all these pills, my bone scans worsened every year... little by little. I've always been active and exercised regularly walking, doing aerobics, and some jogging as well.

I took Fosamax a couple years on top of all this. Still my bones worsened. Then a couple of years ago my dentist warned me about the hazards of taking Fosamax and I started seeing articles about the connection with calcium intake and heart attacks. I quit taking both right then.

My blood was tested for Vitamin D levels and was found to be low. This doctor increased Vit. D quite a lot. A year later I had my Dexa scan.... low and behold I was putting on new bone. Huzzah! So, for me keeping track of my D level, plenty of walking and a good diet have worked for me. Just as the Graedons have recommended often, be sure you have your Vit D level checked often.

I stopped supplemental calcium three years ago and went to half a cup of yogurt every day just to be sure there was a sure supply in my system. There have been warnings about calcium deposits affecting the heart for some time and I heeded the first ones.

I have been looking at some food labels just now and find that for calcium they only give the daily recommended percentage for a serving, but NOT the number of milligrams. How does that translate?

I am 73 year old Asian male. I take homeopathic Calcarea carb 200C and Silicea 200C one dose a month. I have no bone density issues and have most of mine natural teeth in-tact. I do not depend on Calcium supplements.

The explanation for this "mystery" has been known for some time.

The cause of the problems with calcium is vitamin K2 deficiency. Vitamin K2 is necessary for activation of the enzymes that remove calcium from soft tissues (arteries, tendons etc), where its NOT supposed to be, and places it in bones and teeth, where its supposed to be.

Most americans are deficient in vitamin K2.

Read this book to learn more:
http://www.amazon.com/Vitamin-K2-Calcium-Paradox-Little-Known/dp/1118065727/ref=sr_1_1?ie=UTF8&qid=1360723197&sr=8-1&keywords=vitamin+k2+and+the+calcium+paradox

For those of us with lactose intolerance, how are we to get the calcium from food?

Re: Too much calcium. I am going to my yearly dr. exam in a week. A year ago on my last exam, I had quit taking calcium supplements. I did eat yogurt three times a day. My doctor informed me that my bone density had gone up 10%. He did not know that I had quit taking the supplements. Since then I started taking calcium supplements. My legs started bothering me and it was hard to go and work out on the treadmill. Sometimes just walking would bother me. A week ago, I stopped and my legs feel a lot better.

It will be interesting to see what all my results are next week for my yearly. As of this date, I do not take any prescribed medicines and hopefully will not for a time. Thank you for sharing all this information! I appreciate.

My husband and I have been taking calcium supplements for years on the advice of our Dr. We have quit taking them after seeing these studies. By the way, our dexa scans have gone from Osteoporosis to Osteopenia, not because of the calcium but because of regular exercise which for him is walking daily in the park and the gym three times a week for me.

Also, our diet includes a salad each night with green leafy vegetables, broccoli, cauliflower, etc., so we are probably getting all the calcium we need from our food. Many thanks to the Peoples' Pharmacy for the good work you do!

Could it be possible to get too much calcium from eating salmon bones? I get them from fish mongers, steam them for about an hour and then blend them with tomato sauce and add a tablespoon full to stews, soups, and salads. I have done this off and on for the last thirty years and I am in very good health at 72 years of age.

Since it takes a lot of time to prepare the blend, I go for several months between batches. I take no dairy except ice cream occasionally. Eat lots of leafy greens and generally follow Dr Joel Fuhrman's Eat to Live program. I got the idea from eating the soft bones in canned salmon.

I would say Yes.

I'm with you Dana. Getting what we need from food is always much safer without side affects. I had a sister who took calcium supplements and ended up having to have her gallbladder removed because it was full of gall stones. The doctor her that she also had some kidney stones as well. She feels they were caused by the calcium supplements. She is now just taking Vit. D for her bones keeping it within the tolerable limit.

I'm 66 and have been off calcium supplements for a couple of years, but have been on 5000 IU of Vitamin D. My bones are fine. I suspect the D does what the calcium supplements were supposed to do.

So, please, please, tell us what to do to prevent the report from the doctor after taking a bone density test saying, "You now have osteoporosis". I am age 71, have tried to eat sensibly, use soy products (until I read that was bad), take calcium as recommended by my doctor, magnesium, vitamin E and D. All the stuff we are told to do. NOW YEESH! What are we to do?

The book "Vitamin K2 And The Calcium Paradox" by Kate Rhéaume-Bleue, ND explains why calcium supplementation causes an increase in cardiovascular deaths.

Vitamin K2 is necessary for proper calcium metabolism. Vitamin K2 is necessary for activating the enzymes that removes calcium from arteries (and other soft tissues) and depositing it in bone, where its supposed to be.

Most americans are very deficient in vitamin K2. Vitamin K2 comes from grassfed animal products, like grassfed beef, liver, milk, chickens and eggs.

If calcium is supplemented by someone who is vitamin K2 deficient, the enzymes are not able to remove the excess calcium from arteries. The result is arterial calcification and inflammation, leading to cardiovascular deaths.

PP, if you are lactose intolerant, you can buy Lactaid tablets at any pharmacy without a prescription. (They provide the enzyme you lack to break down the milk sugar.) Also many big drug chains have their own brand of lactase enzyme, that may cost less and be just as effective. Good luck!

The Lactaid tablets sound like a great idea, but they don't help me at all in regard to lactose intolerance. I've tried many times, with different brands of Lactase. Anybody else?

Thank you, GM. Yes, I keep Lactase or similar products on hand for when I get into social situations where not eating dairy is not an option or would "create a scene." But all they do is stop the gas, and when I see the end product, I don't think much nutrition is absorbed from whatever is eaten.

Thank you though, for the suggestion.

I recall discussion of this by David Wolff in his Longevity Series about a year ago. He mentioned calcium carbonate and associated inflammatory problems. I think this is important to follow up on and include in the discussion.

All of this could have been avoided if we listened to Harvard scientist Walt Willett in 2001. He showed convincingly how osteoporosis was extremely prevalent in countries with HIGH calcium intake and, paradoxically, low in countries with LOW calcium intake.

Didn't anybody see
http://www.health.harvard.edu/fhg/updates/Do-we-really-need-all-that-calcium.shtml

PEOPLE'S PHARMACY RESPONSE: You might be interested in our interview with Dr. Willett on this topic:
http://www.peoplespharmacy.com/2010/09/04/752-bone-vitality/

I would appreciate some guidance for those of us who are *allergic* to milk. I am a 52-year-old woman with an adult-onset allergy to milk. 21 years ago, my milk problems began with lactose intolerance. I was able to eat dairy products for the next 10-15 years, along with lactase tablets. When the tablets stopped working, I got off dairy products completely.

Approximately 3 years ago, I was diagnosed with the alpha-gal allergy. Alpha-gal is found in mammalian cells, so I am now allergic to milk as well as red meat. I can tolerate only tiny amounts of milk (such as a small amount of cream in my coffee). For the past 6 years, at least, I have been taking a low daily dosage of calcium citrate (500mg) with magnesium, and 1400 i.u. vitamin D3. (I also have low vitamin D levels.) I know that my calcium dosage is below the recommended daily amount of calcium, but I am worried about the studies cited above, and also find it hard to take so many pills every day.

@ MI --- I no longer take calcium tablets. I switched to just taking Vit D3.

If you are lactose intolerant, coconut milk and almond milk are available and both are delicious. They are probably better for adults than cow's milk anyway.

"Save Our Bones" by Vivian Goldschmidt is an excellent online resource.

I too drink unsweetened Almond Milk, in my coffee, cereal and anything else that requires milk. I feel a whole lot better.

I have to disagree somewhat with the statement regarding calcium and kidney stones. They did used to say to limit calcium because it contributed to calcium oxalate kidney stone formation. However, more recently some are now saying somewhat the opposite. In fact my doctor told me that taking a calcium supplement WITH meals could help prevent calcium oxalate stone formation. Calcium in the diet actually binds to oxalate and prevents it from ending up in the urinary tract and forming stones. (See http://kidney.niddk.nih.gov/kudiseases/pubs/kidneystonediet/index.aspx#calcium)

RV - I feel this is true as well. I have a sister that never drank any milk her whole life. She just had her gallbladder removed (65 yrs.) It was filled with stones.

Thanks, but gallstones are not the same thing as kidney stones. They are made up of an entirely different composition and involve totally different dietary implications not involving calcium.

@ RV - thanks so much for the added information. I researched a little more after your comment and found that gallstones are formed by cholesterol. Very helpful to know. My sister has kidney stones, as well as the stones that were in her gallbladder. The doctor said the kidney stones were not causing her any problems at this time. He just removed her gallbladder.

I too stopped taking calcium about 1 1/2 years ago due to these reports. (about 1400 mg per day from Calcium citrate) along with vitamin D3 and magnesium ea day. I am just confused as to what to take. Am on Coumadin so don't know about taking Vitamin k, -- what to do??.

My Dr. said to get more calcium from food which I am doing. How much is enough, how much is too much? I have been dx with osteopenia about 7 -8 years ago, recent dexa shows no worsening of the bone density. Also how about the calcium carbonate and tricalcium phoshate added to some of the non-dairy milk drinks?. What to do???

People's Pharmacy response: It sounds as though you are doing well by getting your calcium from food since your bone density is still the same.

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