Are Calcium Supplements Effective?

Are Calcium Supplements Effective?

September 15, 2019 53 By Ewald Bahringer


“Are Calcium Supplements Effective?” There has been an assumption
for decades that as a natural element, calcium supplements must
intrinsically be safe, but calcium supplementation
is neither natural nor risk-free, but the same could be said for
every medication on the planet. Yet doctors continue to write billions
of prescriptions for drugs every year because the hope at least is that
the benefits outweigh the risks. So what about the benefits
of calcium supplements? Yes, heart attacks and strokes can be
devastating, but so can hip fractures. The risk of dying shoots up in the
months following a hip fracture. About one in five women don’t
last a year after a hip fracture, and it may be even worse for men,
on average apparently cutting one’s lifespan short by four or five years. And unfortunately these dismal statistics
don’t seem to be getting much better. So even if calcium supplements caused
a few heart attacks and strokes, if they prevented many
more hip fractures, then it might result in a
favorable risk-benefit ratio. So how effective are calcium supplements
in preventing hip fractures? We’ve known that milk intake
doesn’t appear to help, but maybe that’s because any potential
benefit of the calcium in milk may be overshadowed by the
increased risk of fracture and death associated with the
galactose sugar in milk. But what about just the calcium
in a calcium supplement alone? Calcium intake in general does not seem
to be related to hip fracture risk at all. And when people have been
given calcium supplements, not only was there no reduction in hip
fracture risk, an increased risk is possible. The randomized controlled trials
suggested a 64% greater risk of hip fractures with
calcium supplementation compared to just getting
like a placebo sugar pill. Where did they even get this idea
then that calcium supplements might help our bones? It was this influential study in 1992
that found that a combination of vitamin D and calcium supplements
could reduce hip fracture rates 43%, but this was done on institutionalized
women, like in a nursing home, who were vitamin D deficient. They weren’t getting
sufficient sun exposure, and so if you’re vitamin D deficient
and you take vitamin D and calcium, no surprise your bones get better. But for women living independently,
out in the community, the latest official recommendations for
calcium and vitamin D supplementation to prevent osteoporosis is
unambiguous: do not supplement. Why? Because in the absence of
compelling evidence for benefit, taking supplements is not worth
any risk, no matter how small. Now this is not to say these supplements
don’t play a role in treating osteoporosis, or that vitamin D supplements might
not be good for other things, but if you’re just trying
to prevent fractures, women living outside of institutions
should not take them, and perhaps even in institutions.
In this study, instead of giving nursing home residents vitamin D
and calcium supplements, they randomized them to sunlight
exposure and calcium supplements. And those that got the calcium pills
had significantly increased mortality, lived shorter lives than
the sunshine only group. Although calcium supplements
don’t appear to prevent hip fractures, they may reduce overall
fracture risk by like 10%, so here’s how the
risk-benefit shakes out. If a thousand people took calcium
supplements for five years, we would expect 14 excess heart
attacks, meaning 14 people would have a heart attack that they
would not have had if they had nor started
the calcium supplements. So they were effectively
going to the store and buying something that
gave them a heart attack, plus ten strokes that otherwise
would not have happened, and 13 deaths — people
who would have been alive had they not started
the supplements. But that’s all balanced against the
26 fractures that would be prevented. Now it’s no fun falling down and
breaking your wrist or something, but I think most people would
look at that risk-benefit analysis and conclude that calcium supplements
are doing more harm than good. Given these findings, the use of these
supplements should be discouraged, and individuals advised to obtain
calcium from their diet instead. Calcium supplements
have been associated with elevated risk of myocardial
infarction (heart attacks), whereas dietary calcium
intake has not. How much calcium
should we shoot for? Interestingly, unlike most other nutrients,
there’s no international consensus. For example in the UK, the recommendation
for adults is 700 mg a day, but across the pond in the US,
it’s up to 1,200 a day. Whenever I see that kind of huge
discrepancy between government panels I immediately think scientific uncertainty,
political maneuverings, or both. Newer data based on
calcium balance studies, in which researchers make detailed
measurements of the calcium going in and out of people,
suggest that the calcium requirements for men and women is lower
than previously estimated. They found calcium balance was
highly resistant to change across a broad range of intakes,
meaning our body is not stupid. If we eat less calcium, our body
absorbs more and excretes less, and if we eat more calcium, we absorb
less and excrete more to stay in balance. Therefore, current evidence suggests
that dietary calcium intake is not something most people
need to worry about. This may explain why in most studies
no relationship was found between calcium intake and bone
loss anywhere in the skeleton, because the body just
kind of takes care of it. Don’t push it too far, though. I mean, once you get down to just
a few hundred milligrams a day you may significantly
get more bone loss. Though there may not be great evidence
to support the US recommendations, the UK may have the right idea, shooting
for between 500 and 1,000 mg a day from dietary sources unless you’ve had
gastric bypass surgery or something and need to take supplements. For most people, though, calcium
supplements cannot be considered safe or effective for preventing bone fractures.