DEAR DOCTOR K:
Many years ago, my doctor told me that men, like women, should take calcium supplements. So I have been. Now I hear that it’s a bad idea. What do you think?
All of us — patients and doctors — wish we had all the answers, and that the answers never changed. Unfortunately, the way the human body works, and malfunctions, is very complicated. To understand it, we conduct research. But no study is perfect, and the answers sometimes change as larger and better studies are conducted.
There’s no doubt that we all need calcium. It helps muscles to contract, blood to clot and nerves to communicate, and it plays an important role in building strong teeth and bones. As a result, many people take calcium supplements for bone health.
One fairly recent study followed the health of nearly 400,000 men and women. Over the course of 12 years of follow-up, men who took more than 1,000 milligrams (mg) of supplemental calcium per day were 20 percent more likely to succumb to heart disease than those who didn’t take calcium supplements. But there was no connection between calcium supplements and heart disease in women, and there was no connection with calcium from food.
Another recent study followed more than 61,000 women in Sweden. Among women who took more than 1,400 mg per day of calcium supplements, the risk of premature death was more than doubled — particularly death from heart disease.
Both of these studies involved large numbers of people and were carefully conducted. Yet they were observational studies, and you can’t make judgments about cause and effect from such studies. They clearly showed that men and women who took relatively high doses of calcium supplements had higher risks. But that doesn’t prove that the calcium supplements were the cause of higher rates of heart problems and death.
Moreover, other studies like these have not found an increased risk of heart disease from calcium supplements, in either men or women.
So the question of whether men should take calcium supplements is controversial. My advice to patients, advice that I follow myself, is to emphasize calcium-rich foods rather than to take calcium pills. Men do not need as much calcium as women because we are less likely to develop osteoporosis (thinning of the bones).
Surely, you should not forsake all calcium. Everyone needs calcium to keep bones strong, taken in conjunction with bone-building vitamin D. Losing calcium weakens bones and leaves them more prone to breaking.
With the safety of calcium supplements in question, try to get as much calcium as possible from food. Good calcium sources include:
- Low-fat milk and cheese.
- Calcium-fortified orange juice or soy milk.
- Breakfast cereals (which are also fortified).
- Leafy greens, particularly kale, turnip greens and Swiss chard. (Go easy on spinach. It is high in iron, which tends to block calcium absorption.)
- Sardines and other canned fish with bones included.
I’m sure there will be more research studies on this important question, and I’ll keep you posted.
(This column is an update of one that ran originally in May 2013.)