AMA report below : Prepared exclusively for Dr. Paul Goldfinger, AMA Member. July 13, 2012
On the front of its Personal Journal section, the Wall Street Journal (7/3, D1, Beck, Subscription Publication) reports in “Health Journal” that although some individuals are not taking in an adequate amount of calcium, studies indicate that other people are taking in an excessive amount. Some research suggests that calcium supplements may be linked to increased risks of heart attack and kidney stones. Recently, the US Preventive Services Task Force, in a draft recommendation, said that the benefits of taking calcium and vitamin D may not outweigh the risks. The article points out that Institute of Medicine guidelines recommend that most adults should get 1,000 milligrams of calcium each day.Some people may be taking in an excessive amount of calcium.
Tropicana Forum Medical Commentary: By Paul Goldfinger, MD, FACC
I was recently prowling the aisles at a health food store. My attention was focused on the many choices of Vit D. Reading labels in the food supplement section of this store or others is quite a challenge, even with my medical degree. Hmmmm….should I choose the 400 IU capsules or should I be daring and get the 800 IU size?
A store employee approached and offered help. He didn’t say what his credentials are, but he sure had a lot to say about the dose issue. His professional recommendation: 5,000 IU per day. OK..thank you very much. After he walked away, I looked around and grabbed a bottle of the 800 IU size.
As many of you know, the Vit D issue is tied in with the calcium issue. Many women, for example, take calcium in tablets, often 600 mg per tab, which also contain Vit D–usually 400 IU per tab. But this subject isn’t just about females. Both sexes need to worry about the risk of weak bones—ie osteoporosis; especially as we get older than 50. But the choices and opinions regarding the calcium and Vit D controversies are enough to make your head spin and even make your bones nervous.
In this excellent Wall Street Journal article by health writer Medlinda Beck, we get a balanced dose of information regarding the concern that calcium supplements might be harmful. In the process, she also covers the subject of supplement dosing. I learned a lot from her piece which includes a superb audio recording of an interview with her.
The advice that experts offer on nutritional issues such as these is often contradictory, because the science of medical nutrition tends to produce weak and contradictory research. A scientist commenting on this problem says, “There are a lot of mixed messages out there.”
However, we can generalize and say that the average amount of calcium required for most people is 1,000 mg per day, and it’s best to get as much as possible from food sources. After that, calcium supplements can fill in the rest. The dose requirements vary according to sex and age. The WSJ article provides a chart. It is estimated that most adults do not get enough calcium , including foods and supplements.
As for the question of heart risk, there is no good evidence that confirms such a possibility. In cardiology we often help heart patients by using drugs called “calcium blockers,” but those drugs act at the cellular level, and their use has nothing to do with the amount of calcium in your blood. We don’t even obtain calcium blood levels as part of a heart workup.
The bottom line is that if you have to worry about your calcium intake, worry more about not getting enough, but don’t forget to add up your total daily calcium once in a while to be sure that the amount you are ingesting is just right . And please don’t drink milk as a calcium source unless it is fat free. 8 ounces (one cup) of whole milk has about 300 mg of calcium, 2% milk has the same, but “Skim Plus” milk has no fat, and the added milk solids bring the calcium content up to 405 mg. per cup—a win-win product (you could count the carbs—-but take it easy; should we just eat grass? We can’t even do that—it’s brown)