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Should Women Take Calcium and Vitamin D or Not?

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One of my patients recently brought in a magazine article whereby a popular mainstream magazine article was citing an article from the British Medical Journal (BMJ) from April 2011 regarding calcium increasing risk for heart attacks.

She was concerned that taking her usual low dosage -- 400-800mg of calcium supplement per day -- would put her at higher risk of heart attacks. This incident spurred me to write this article to clarify this issue for all women who were concerned about their bones, but are now concerned about their heart as well as their bones.

The article, published in BMJ in 2011, was one in which the authors re-evaluated the data from the Women's Health Initiative (WHI) study on calcium supplementation where 36,282 women were looked at in a seven-year, randomized, placebo-controlled study as to how calcium and vitamin D supplementation affected them.[1]

In the initial study meta-analysis, there was no increased risk of heart disease seen in the study for women on calcium and vitamin D. But in the re-evaluation of a sub-group of the study (about 16,718 women), which then was published as the 2011 article in BMJ, the women who were not taking any personal calcium supplements were lower in risk of heart attacks then those women who were taking the treatment dosages of calcium and vitamin D.[2]

The authors in the 2011 study felt that the original interpretation did not account for the fact that some of the women in the placebo group were taking low dosages of calcium according to their own regimen aside from the study, and so the placebo group was not a true placebo group in the initial evaluation, which they felt was then not a true representation of what calcium and vitamin D would do to a women's body in respect to heart disease risks.

This reasoning seems initially plausible... However, when you look at other subgroups in the WHI study, you do not see the same finding of the heart attack risk. What is interesting about this study is that, depending on which subgroups you look at, you might get different findings in respect to impact of calcium and vitamin D on heart disease in women. So in another subgroup where if you just look at coronary artery calcium levels, there were no increased heart disease risk in these women who were taking calcium and vitamin D compared to the placebo group.

Basically, when you put aside all the nitty-gritty details and scientific jargon of all the published articles that came out of the Women's Health Initiative study on calcium and vitamin D, what you should take away from these studies are that you should take what your body needs and don't take more than what it needs.

What this means is that if your calcium level is low and your vitamin D level is low and you are at higher risk for osteoporosis than heart disease, you should focus on getting adequate levels of calcium and D in foods and supplements. I am a huge proponent of getting your nutrients from food first and foremost... then using supplements as a gap-filler if you are not absorbing what you need via your foods. So, aim for foods rich in vitamin D and calcium if you need these fundamental building blocks for your body. Then, if your levels are still low or that you have osteopenia or osteoporosis, you should have some additional supplementation of these two nutrients.

When it comes to supplementation, I always advise my patients to always be "the bear that gets it just right." Too much or too little is not good, so aim for getting what you need from a balanced diet rich in vegetables and nutritious foods like nuts, legumes and fruits, and less from processed foods. Then, if you are still lacking in nutrient levels, or your health concerns demand more of various fundamental building blocks of various nutrients, then ask your physician about appropriate dosing of these nutrients via supplementation. Just remember, more isn't always better.

For all the women who have a strong family history of heart disease, there is one last point I want to touch on from this study to bring you peace of mind: There is suggestion that it is the abrupt rise in calcium and vitamin D in the women who were treated with these supplements that may have some impact on heart disease.

So if you are someone who eats foods low in calcium and vitamin D, then suddenly taking high dosages of vitamin D and calcium might not be the best idea. Instead, make sure you are getting foods rich in these nutrients, in which case you may not need supplementation of vitamin D and calcium.

However, if you see that you still need more of these two ingredients in your body, then consider adding low dosages of the supplements slowly and incrementally to reach the level you need instead of going from no exposure of these nutrients in your body to sudden high dosages.

So, the main take-away points are to make sure you are getting enough of these nutrients in your diet, and if you have osteoporosis or osteopenia, ask your physician about slowly titrating you up on these nutrients for healthy bones.

If you have heart disease concerns but also need vitamin D and calcium, try to get them in your diet first, then fill any gaps with low-level supplements of vitamin D and calcium and slowly titrate up the dosages of these supplements with your physician's guidance until you reach the levels you need for these two important nutrients.

Just remember that calcium and vitamin D are not menacing compounds that our body rejects -- we actually need them for our organs and body to function correctly. So the key is not to avoid them -- because we need them -- but rather to get them in healthy amounts in foods and supplements at dosages and levels that are appropriate for your own individual health needs.

References:

[1]Abrahamsen B., Sahota O. "Do calcium plus vitamin D supplements increase cardiovascular risk?" BMJ. 2011 Apr 19; 342:d2080.

[2] Bolland, MJ, et al. "Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women's Health Initiative limited access dataset and meta-analysis." BMJ. 2011 Apr 19; 342:d2040.

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