Calcium Supplements

Vitamin D and Calcium Supplements May Reduce Cancer Risk, Study Shows

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Experts explain how the combination could be a double-edged sword, though.

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  • Vitamin D and calcium supplementation may reduce risk of cancer but increase risk of cardiovascular disease, new study shows.
  • The study, which looked at postmenopausal women, showed that the combination of supplements had no effect on death from any cause.
  • Experts explain the findings.

Calcium and vitamin D supplements are often recommended for postmenopausal women to prevent bone loss. New research shows that it may do even more, reducing the risk of cancer. But, could it also increase the risk of cardiovascular disease?

A study published in Annals of Internal Medicine analyzed data from the Women’s Health Initiative trial, which looked into the effects of taking calcium and vitamin D supplements in more than 36,000 postmenopausal women.

Researchers found that taking calcium and vitamin D supplements lowered a woman’s long-term risk of dying from cancer by 7%, but increased the risk of death due to heart disease by 6%. The study also found that overall, the combination of supplements had no significant effect on early death overall.

Many people know the link between calcium and how it’s important for bone health and bone growth. But, a lesser-known benefit of the nutrient is that it’s important for blood clotting and may lower blood pressure, says Melissa Prest, D.C.N., R.D.N., national media spokesperson for the Academy of Nutrition and Dietetics and member of the Prevention Medical Review Board. Vitamin D is also important for bone health and regulating how much calcium is needed by the body, she adds. “Vitamin D has been reported to play a role in supporting lung function, cardiovascular health, insulin regulation and glucose metabolism, and immune health.”

Some research has found that low blood levels of vitamin D are associated with an increased risk of cardiovascular disease, says Prest. Also, calcium may reduce the risk of some cancers like colorectal cancer, she notes. Still, “the evidence exploring the relationship between dietary calcium or supplemental calcium and the risk of cancer is mixed,” Prest explains.

So, why are these results important? Oncologists prescribe a class of drugs called Aromatase Inhibitors (called anastrozole, letrozole, and exemestane) taken daily for five years to prevent breast cancer recurrence in certain women, says Madhu Shetti, M.D., oncologist and founder of Balmere. “Many women are scared to take the medicine, or they do not finish the five year course because of bone health concerns. It is critical to consider options like vitamin D/calcium supplementation so we can give everyone the best chance to protect their bone health and prevent cancer recurrence,” she explains.

This study confirmed findings from other studies concerning reducing cancer risk and increasing cardiovascular risk from calcium and vitamin D supplements, says Prest. “However, the authors did report that their study and findings had some limitations so we cannot blanketly say that supplementation of calcium and vitamin D may not be appropriate in post-menopausal women with heart disease.” More exploration is needed to understand the association between calcium and vitamin D supplementation and cardiovascular risk, she notes.

Dr. Shetti also points out that given the study design, we are unable to distinguish the benefits of calcium and Vitamin D individually versus together. “Many individuals may take calcium or vitamin D but not both, so they may not have the same benefits as study participants,” she notes.

The bottom line

So, is a vitamin D or calcium supplement right for you? Typically, we want to reserve supplementation for people who are unable to meet their needs through food sources or those who are deficient and need the extra boost from a supplement, says Prest.

That said, every person should speak with their physician and discuss their individual risks and benefits for adding vitamin D and/or calcium supplements, suggests Dr. Shetti. Individuals at a higher risk for developing osteopenia (a loss of bone density that weakens bones but not low enough to meet the criteria for osteoporosis) or osteoporosis (a bone disease that develops when bone density and bone mass decreases) may consider supplementation after discussing with their doctor, notes Keri Gans, M.S., R.D., registered dietitian and author of The Small Change Diet. “Risk factors include white or Asian descent, smaller body frame, family history of osteoporosis, post-menopausal, and history of amenorrhea (absence of menstruation),” she explains.

Dietary supplements are products intended to supplement the diet. They are not medicines and are not intended to treat, diagnose, mitigate, prevent, or cure diseases. Be cautious about taking dietary supplements if you are pregnant or nursing. Also, be careful about giving supplements to a child, unless recommended by their healthcare provider.

Vitamin D-calcium supplement effect on tibia similar to that of placebo

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U.S. Army recruits taking a daily calcium and vitamin D supplement during basic training had no change in tibial microarchitecture compared with placebo, according to study data published in Bone.

“A calcium and vitamin D fortified food product prevented increases in biochemical markers of bone resorption, but there were no significant changes in tibial density or microarchitecture in men and women after military training,” Erin Gaffney-Stomberg, PhD, RD, division chief of the combat feeding division at the U.S. Army Research Institute of Environmental Medicine in Natick, Massachusetts, and colleagues wrote. “In addition, markers of bone formation increased, and parathyroid hormone decreased equally in both groups over the course of training.”

Vitamin D Pills

Researchers conducted a randomized controlled trial of 50 male and 50 female U.S. Army recruits aged 17 to 42 years in basic training at Fort Jackson in South Carolina between April and June 2015. Participants had not been pregnant or breastfeeding in the 6 months before the study and had no self-reported history of endocrine or bone-modifying disorders, kidney disease, renal calculi or glucocorticoid prescription within 2 years. Participants were randomly assigned to an intervention group receiving a snack bar fortified with 1,000 mg of calcium and 1,000 IU of vitamin D daily, or a control group receiving a placebo snack bar. A background questionnaire was conducted at baseline to obtain demographic information. Anthropometric measurements and fasting blood samples were collected at baseline and at an 8-week follow-up. High-resolution peripheral quantitative CT was conducted at baseline and follow-up to measure density, microarchitecture and strength at the distal metaphyseal and diaphyseal regions of the tibia.

There were 93 recruits who completed the study, including 45 in the supplement group and 47 in the placebo group. At 8 weeks, increases in total volumetric bone mineral density, trabecular volumetric BMD, trabecular number, trabecular thickness, and trabecular bone volume/total volume, and a decrease in trabecular separation were observed for all participants. Women had changes in all bone parameters, and men had a change in all parameters except for trabecular number and separation.

All participants experienced increases in stiffness and failure load at the distal metaphyseal site, with no significant difference between the supplement and placebo groups. Stiffness and failure load did not change among women, but men had increases in stiffness of 1.3% and failure load of 3.4% at 8 weeks compared with baseline. (P < .05).

Increases in cortical perimeter and cortical volumetric BMD were observed in both groups at 8 weeks compared with baseline, but there were no other parameter changes at the diaphyseal site. Women experienced a decrease in cortical porosity and cortical volumetric BMD at 8 weeks, but there was no difference between the supplement and placebo groups. Men in both groups had an increase in cortical perimeter and decrease in cortical volumetric BMD at 8 weeks. Small increases in stiffness and failure load at the diaphyseal site were observed in women for both groups, but not in men.

“These results indicate that bone density and microarchitecture were not impacted by calcium and vitamin D supplementation at the doses tested,” the researchers wrote. “However, post hoc power analysis indicated that the current study achieved 35.8% power to detect a difference by group, and 106 volunteers per group would be required to detect a statistically significant difference if one exists. Thus, underpowering cannot be excluded as a possibility.”

The researchers said studies powered to examine stress fracture outcomes along with bone density and microarchitecture changes at varying doses of calcium and vitamin D are needed to better understand the effects of supplementation. They said future studies should also involve diverse groups of participants and take place during different times of the year.

Calcium supplements may damage the heart.

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Taking calcium in the form of supplements may raise the risk of plaque buildup in arteries and heart damage, although a diet high in calcium-rich foods appears be protective, say researchers at conclusion of their study that analyzed 10 years of medical tests on more than 2,700 people.
More than half of women over 60 take calcium supplements — many without the oversight of a physician — because they believe it will reduce their risk of osteoporosis, researchers estimate.

After analyzing 10 years of medical tests on more than 2,700 people in a federally funded heart disease study, researchers at Johns Hopkins Medicine and elsewhere conclude that taking calcium in the form of supplements may raise the risk of plaque buildup in arteries and heart damage, although a diet high in calcium-rich foods appears be protective.

In a report on the research, published Oct. 10 in the Journal of the American Heart Association, the researchers caution that their work only documents an association between calcium supplements and atherosclerosis, and does not prove cause and effect.

But they say the results add to growing scientific concerns about the potential harms of supplements, and they urge a consultation with a knowledgeable physician before using calcium supplements. An estimated 43 percent of American adult men and women take a supplement that includes calcium, according the National Institutes of Health.

“When it comes to using vitamin and mineral supplements, particularly calcium supplements being taken for bone health, many Americans think that more is always better,” says Erin Michos, M.D., M.H.S., associate director of preventive cardiology and associate professor of medicine at the Ciccarone Center for the Prevention of Heart Disease at the Johns Hopkins University School of Medicine. “But our study adds to the body of evidence that excess calcium in the form of supplements may harm the heart and vascular system.”

The researchers were motivated to look at the effects of calcium on the heart and vascular system because studies already showed that “ingested calcium supplements — particularly in older people — don’t make it to the skeleton or get completely excreted in the urine, so they must be accumulating in the body’s soft tissues,” says nutritionist John Anderson, Ph.D., professor emeritus of nutrition at the University of North Carolina at Chapel Hill’s Gillings School of Global Public Health and a co-author of the report. Scientists also knew that as a person ages, calcium-based plaque builds up in the body’s main blood vessel, the aorta and other arteries, impeding blood flow and increasing the risk of heart attack.

The investigators looked at detailed information from the Multi-Ethnic Study of Atherosclerosis, a long-running research project funded by the National Heart, Lung, and Blood Institute, which included more than 6,000 people seen at six research universities, including Johns Hopkins. Their study focused on 2,742 of these participants who completed dietary questionnaires and two CT scans spanning 10 years apart.

The participants chosen for this study ranged in age from 45 to 84, and 51 percent were female. Forty-one percent were white, 26 percent were African-American, 22 percent were Hispanic and 12 percent were Chinese. At the study’s onset in 2000, all participants answered a 120-part questionnaire about their dietary habits to determine how much calcium they took in by eating dairy products; leafy greens; calcium-enriched foods, like cereals; and other calcium-rich foods. Separately, the researchers inventoried what drugs and supplements each participant took on a daily basis. The investigators used cardiac CT scans to measure participants’ coronary artery calcium scores, a measure of calcification in the heart’s arteries and a marker of heart disease risk when the score is above zero. Initially, 1,175 participants showed plaque in their heart arteries. The coronary artery calcium tests were repeated 10 years later to assess newly developing or worsening coronary heart disease.

For the analysis, the researchers first split the participants into five groups based on their total calcium intake, including both calcium supplements and dietary calcium. After adjusting the data for age, sex, race, exercise, smoking, income, education, weight, smoking, drinking, blood pressure, blood sugar and family medical history, the researchers separated out 20 percent of participants with the highest total calcium intake, which was greater than 1,400 milligrams of calcium a day. That group was found to be on average 27 percent less likely than the 20 percent of participants with the lowest calcium intake — less than 400 milligrams of daily calcium — to develop heart disease, as indicated by their coronary artery calcium test.

Next, the investigators focused on the differences among those taking in only dietary calcium and those using calcium supplements. Forty-six percent of their study population used calcium supplements.

The researchers again accounted for the same demographic and lifestyle factors that could influence heart disease risk, as in the previous analysis, and found that supplement users showed a 22 percent increased likelihood of having their coronary artery calcium scores rise higher than zero over the decade, indicating development of heart disease.

“There is clearly something different in how the body uses and responds to supplements versus intake through diet that makes it riskier,” says Anderson. “It could be that supplements contain calcium salts, or it could be from taking a large dose all at once that the body is unable to process.”

Among participants with highest dietary intake of calcium — over 1,022 milligrams per day — there was no increase in relative risk of developing heart disease over the 10-year study period.

“Based on this evidence, we can tell our patients that there doesn’t seem to be any harm in eating a heart-healthy diet that includes calcium-rich foods, and it may even be beneficial for the heart,” says Michos. “But patients should really discuss any plan to take calcium supplements with their doctor to sort out a proper dosage or whether they even need them.”

According to the U.S. Centers for Disease Control and Prevention, coronary heart disease kills over 370,000 people each year in the U.S. More than half of women over 60 take calcium supplements — many without the oversight of a physician — because they believe it will reduce their risk of osteoporosis.

Taking Calcium Supplements Causes Brain Lesions

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Taking Calcium Supplements Causes Brain Lesions

Taking calcium supplements — even at low doses — linked to brain lesions in the first study of its kind. 

Most calcium supplements are just plain bad news. The idea of taking calcium in pill or tablet form to “keep the bones strong” just doesn’t make that much sense given, first, that we are designed to get our calcium from food. Second, our bone is a living tissue, which requires vitamin C, amino acids, magnesium, silica, vitamins D and K, etc., not to mention regular physical activity, just as much as it does calcium. Taking calcium to the exclusion of these other critical factors doesn’t make sense; nor does it make sense to look at osteoporosis as a deficiency of calcium supplements!

As we have reported on extensively in the past, not only is consuming limestone, bone, and the shells of oysters and eggs not a good idea because the calcium can deposit in our soft tissues leading to heart attacks and strokes, but even the goal of maintaining bones as dense as a 25-year old late into life (known as the T-score) is fraught with danger, including a farhigher breast cancer risk for those with the highest bone density. Instead of pathologizing aging, and focusing on making the bone denser by any means necessary, the focus should be on bone quality and agility and bodily self-awareness late into life, which helps the elderly prevent the falls that lead to fracture in the first place. In other words, simply having a gait or vision disorder can be at least as an important factor in fracture risk as bone mineral density.

The problem with poor quality, inorganic, calcium supplements, however, does not stop with their contribution to cardiovascular disease risk. A combination of factors including low magnesium, vitamin K2 and the presence of fluoride in the water and diet can lead to pineal gland calcification, as well as the calcification of other brain structures, which recently has beenhypothesized to be a contributing factor in the pathogenesis of Alzheimer’s disease.

British Nutrition Journal: Brain Calcium Lesions

A truly provocative study on this topic published last year in the British Journal of Nutritionsomehow slipped through the cracks, because not only did we miss it but we do not recall it being reported elsewhere. Titled, “Elevated brain lesion volumes in older adults who use calcium supplements: a cross-sectional clinical observational study,” the study looked at the possibility that since calcium supplements have now been linked in multiple studies with vascular pathologies associated with cardiovascular diseas they may also be associated with the occurrence of brain lesions (known on MRI scans as hyperintensities) in older adults. These brain lesions, visible as brighter spots in MRI scans, are known to be caused by lack of blood flow (ischemia) and subsequent neurological damage.

Brain Scan: MRI, Hyperintensities

According to the study,

“Brain lesions,also known as hyperintensities, are areas of damage observed on brain MRI (See Above). These lesions are common in older adults and increase the risk of devastating health outcomes, including depression, cognitive decline, dementia, stroke, physical disability, hip fracture and death. Postmortem studies have determined that these lesions form primarily due to ischemia, especially larger lesions (.3mm) and lesions found in depressed individuals.”

The observational study enrolled 227 older adults (60 years above) and assessed food and supplemental calcium intakes. Participants with supplemental calcium use above zero were categorized as supplement users. Lesion volumes were assessed with MRI scans.

Key findings were:

  • Greater lesion volumes were found among calcium supplement users than non-users

  • The influence of calcium supplements was of a magnitude similar to that of the influence of high blood pressure (hypertension), “a well-established risk factor for lesions.”

  • The study found that the amount of calcium used was not associated with lesion volume and that “even low-dose supplements, by older adults may be associated with greater lesion volumes.”

  • Even after controlling for food calcium intake, age, sex, race, years of education, energy intake, depression and hypertension, the association between calcium supplement and lesion volumes held strong.

The study details were summarized as follows:

“In the present cross-sectional clinical observational study, the association between Ca-containing dietary supplement use and lesion volumes was investigated in a sample of 227 older adults (60 years and above). Food and supplemental Ca intakes were assessed with the Block 1998 FFQ; participants with supplemental Ca intake above zero were categorised as supplement users. Lesion volumes were determined from cranial MRI (1.5 tesla) scans using a semi-automated technique; volumes were log-transformed because they were non-normal. ANCOVA models revealed that supplement users had greater lesion volumes than non-users, even after controlling for food Ca intake, age, sex, race, years of education, energy intake, depression and hypertension (Ca supplement use: β = 0.34, SE 0.10, F(1,217)= 10.98, P= 0.0011). The influence of supplemental Ca use on lesion volume was of a magnitude similar to that of the influence of hypertension, a well-established risk factor for lesions. Among the supplement users, the amount of supplemental Ca was not associated with lesion volume (β = – 0.000035, SE 0.00 015, F(1,139)= 0.06, P= 0.81). The present study demonstrates that the use of Ca-containing dietary supplements, even low-dose supplements, by older adults may be associated with greater lesion volumes. Evaluation of randomised controlled trials is warranted to determine whether this relationship is a causal one.”

What is the mechanism beneath this association?

The researchers discussed the already established link between calcium supplementation and increased ischemic stroke risk, indicating that calcium supplementation may contribute to calcium deposits in the vasculature (i.e. arterial calcification), mainly in the fatty deposits (atheromas) that contribute to blocking the opening (lumen) of the blood vessels. They state that this process can lead to lack of blood flow and subsequent oxygen deprivation (ischemia), ultimately leading to the development of brain lesions. Another mechanism by which excess calcium may have a direct neurotoxic effect on the brain is the influx of excess calcium into brain cells, which lead to cell death. This possibility is greatly increased if the blood-brain barrier is compromised.

The researchers also highlighted the importance of the finding that calcium supplementation may have as significant a deleterious effect on brain lesions as high blood pressure (hypertension):

“If this finding is confirmed in longitudinal studies, it could have important health implications – because it is obviously much easier to cease Ca supplement use than to medically manage hypertension.”

In other words, hypertension is often caused by toxic antihypertensive drugs that may actually increase the risk of cardiac mortality. Why not remove one of the modifiable causes: calcium supplementation, which would strike to one of the root causes of the problem and resolve it.

The researchers concluded their study as follows:

“The use of Ca [calcium] -containing dietary supplements by older adults was found to be associated with greater brain lesion volumes, even after controlling for the usual amount of dietary Ca intake. Interestingly, neither the amount of supplemental Ca nor the duration of supplemental Ca use was associated with lesion volume. These findings indicate that adverse biochemical effects of supplemental Ca use may exist in older adults, regardless of the dose.”

So, what do we do instead of taking calcium supplements?

First, consider why you think you need calcium supplements. Is it because of the dairy industry promoting for decades the concept that we need calcium (from milk)? Or, is it because your doctor is throwing around terms like osteopenia and osteoporosis carelessly, without explaining to you that the present day bone mineral density (BMD) reference ranges assume that aging is a disease and even if you are 60 or 100 for that matter you are still supposed to have the BMD of a 25-year old young woman; an absurd and dangerous idea. Please read the expose, “Osteoporosis Myth: The Dangers of High Bone Mineral Density,” in order to understand how millions of healthy women were made to believe that aging is a disease, with worse health outcomes as a result of overdiagnosis and overtreatment.

Now, when it comes to calcium, focus on food sources. The site NutritionData.com lists about 1,000 of the highest calcium-containing foods, categorized by food group: ​Foods highest in Calcium. Also, remember that the accelerated bone loss that occurs later in life in women, is triggered by hormonal changes associated with the exhaustion of the ovarian reserve. Nature, however, provides ‘back up’ support for the ovaries in the form of pomegranate. Other hormone-modulating foods include the fermented soy food miso, prunes, and even vitamin C, which has recently been found to regenerate steroid hormones.

FDA Okays Hypoparathyroid Drug

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After an extended review, the FDA okayed Natpara, a parathyroid replacement therapy.

The FDA has OK’d a new drug to treat low blood calcium levels in patients with hypoparathyroidism.

The agency approved Natpara, a once-daily parathyroid hormone replacement injection, for patients whose calcium levels can’t be controlled on calcium supplementation or with active forms of vitamin D.

Since the condition affects only about 60,000 patients in the U.S., the drug had received orphan drug status. Last September, an FDA advisory committee voted 8-5 in favor of approval, but the FDA extended its review of the drug in October, asking for more information.

Natpara will come with a boxed warning about osteosarcoma, which occurred in animal studies. For that reason, the FDA in its press release emphasized that the treatment is only intended for those whose hypocalcemia can’t be controlled with calcium or vitamin D supplements.

It also comes with a risk evaluation and mitigation strategy (REMS), but the FDA did not mention any specific postmarketing studies.

Approval followed a clinical trial of 124 patients who were randomized to drug or placebo. A total of 42% of drug-treated patients achieved normal blood calcium levels on reduced doses of vitamin D or calcium supplements, compared with only 3% of placebo patients.

The most common side effects were sensations of tingling, tickling, pricking or burning of the skin, low blood calcium, headache, high blood calcium, and nausea, the FDA said.

Hypoparathyroidism occurs most commonly as a result of surgical removal of the parathyroid glands, and more rarely as a result of autoimmune or congenital diseases, the agency said.

Are Calcium Supplements Bad for the Heart?

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Supplements, but not dietary calcium intake, were associated with elevated risk for myocardial infarction.

Calcium supplements are widely used to minimize risk for osteopenia and osteoporosis, especially by older women. But do supplements promote vascular calcification and therefore cardiovascular (CV) events? Using data for 24,000 participants in a German study of cancer and nutrition, investigators analyzed the effect of calcium intake, both dietary and supplemental, on CV events and CV mortality.

During an average follow-up of 11 years, there were 354 myocardial infarctions (MIs), 260 strokes, and 267 CV deaths. There was no evidence of increased risk for MI, stroke, or CV mortality with increasing dietary calcium intake. However, use of calcium supplements was associated with significantly elevated risk for MI (hazard ratio, 1.86), but not stroke (HR, 1.05) or CV death (HR, 1.02), although the number of events in supplement users was small.

Comment: This analysis is one of several to suggest that calcium supplementation is associated with elevated cardiovascular risk and that intake of dietary calcium is not. How to explain the discrepancy? Editorialists postulate that dietary calcium, taken in gradually with other foods, may not raise serum calcium levels to the same degree as supplements, so that supplements may lead to vascular calcium deposition over time. Although this analysis does not prove a causal link, it seems prudent to rely predominantly on dietary calcium whenever possible, reserving calcium supplements for situations where their benefits clearly outweigh their risks.

Source: Journal Watch General Medicine

Calcium Supplements Might Increase MI Risk .

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Use of calcium supplements is associated with a near doubling of risk for myocardial infarction, but calcium intake through diet does not confer increased risk, according to a study in Heart.

German researchers analyzed data from nearly 24,000 residents aged 35 to 64 who completed questionnaires about diet and supplement use. After 11 years’ follow-up, some 350 people had experienced an MI. People who were in the third quartile of dietary calcium consumption had a lower MI risk, relative to those in the lowest quartile (hazard ratio, 0.69). However, those who took calcium supplements had increased MI risk, compared with nonusers (HR, 1.86).

The authors conclude that calcium supplementation “should be taken with caution.” Editorialists note: “The evidence is … becoming steadily stronger that it is not safe, nor is it particularly effective. … 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.”

Source: Heart