05/31/2012 02:03 pm ET | Updated Jul 31, 2012

Calcium Supplementation Linked to Increased Risk of Heart Attacks

Calcium is a double-edged sword. Insufficient calcium leads to bone loss, muscle cramps and insomnia. Too much calcium may result in calcium being deposited in unwanted areas of the body, such as the arteries. So, where is the sweet spot for calcium intake? Doctors have recommended calcium supplements for osteoporosis or osteoporosis prevention for years. At one point the recommendation was 1,500 milligrams each day and in one pill! Nature never delivers such a whopping dose all at once.

Now comes a large observational study that showed a link between calcium supplementation and heart attacks. The European study reported May 21, 2012 in the journal Heart followed 25,000 people for 11 years, and in the study those who reported taking calcium supplements regularly experienced more heart attacks. This new study adds fuel to the fire that calcium supplements may be causing more harm than good. Observational studies point to possible problems but are not entirely reliable. The study does not identify the form of calcium that was consumed. Typically, most people follow their doctor's advice regarding calcium supplementation. The usual recommendation is calcium carbonate, and in the United States doctors recommend a form of calcium carbonate, the antacid Tums. Tums is not a good source of calcium, and it decreases the very stomach acid needed to aid calcium absorption and protein digestion.

Bone is very complex, so to dumb it down to only calcium is the first mistake. When calcium comes in food there are other nutrients that come along with it, especially in the plant world. Magnesium and vitamin K are two nutrients essential for bone and heart health. Vitamin D plays a key role in calcium absorption and bone and heart health. The study did not look at these other factors. Calcium should never be taken alone.

Another concern I have with high-calcium diets or with calcium supplementation is inflammation. Are people simply taking calcium and not reducing inflammatory foods? Calcium tends to wind up where inflammation is. The usual health culprits that cause inflammation include: cigarette smoking, processed carbohydrates, sodas, sugar and too much stress. Taking or consuming a lot of calcium with such a diet increases the risk of developing atherosclerosis (hardening of the arteries).

Should anyone consider supplements? Yes, those who have osteoporosis or a malabsorption condition might need supplementation. Unfortunately, the typical medical physician does not evaluate dietary needs. It is best to work with a nutritionist who can help you figure out if you are getting enough calcium from the food you are eating and if you need to make dietary changes to make sure you are eating a balanced diet. A nutritionist who understands bone can help you determine whether or not you can benefit from supplementation.

• Calcium absorption is increased by as much as 50 percent if you have enough vitamin D on board. Without testing for vitamin D deficiency, 2,000 IU is safe for healthy people. Unhealthy people may need more or less vitamin D depending on their condition and should be tested.

• Too much calcium can cause constipation.

• Magnesium loosens stools. The right amount balances calcium and too much can cause loose stools or diarrhea.

• Magnesium is needed to balance calcium. There are different opinions, ranging from a 2:1 ratio (calcium/magnesium) to 1:1. I favor somewhere in between depending on the patient.

• Dairy is high in calcium but should be limited to 1-2 servings each day, preferably organic. Don't buy fat-free. The fat is important for digestion and fat-free means a higher concentration of sugar.

• Calcium supplements -- calcium citrate or calcium malate is absorbed better than calcium carbonate because it has an acid component, and you need acid to digest calcium.

• If you do take a calcium supplement, only take as much as you would get from a serving of yogurt or a glass of milk -- 200-300 milligrams -- at one time. Spread it out throughout the day.

• Before bedtime is a good time to take calcium and magnesium. It will help you sleep and eliminate those muscle cramps.

• Vitamin K is very important to aid calcium's transit from the blood into the bone. The vitamin K found in natto (fermented soy beans) is the most abundant source, but it is an acquired taste. Natto also comes in supplement form. 100 mcg is a good amount and the best form is K2 (MK7). If you are on blood thinning medications talk with your doctor before taking vitamin K.

Food is your best source of calcium and vegetables the absolute best, so eat those green leafy vegetables. Author Michael Pollen says it best: Eat food, not too much, mostly plants.

For more by Lani Simpson, D.C., C.C.D., click here.

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