Calcium supplement - best form to take?

MaryNY

Which is better? - calcium carbonate or calcium citrate. I know that calcium carbonate should be taken with food but calcium citrate can be taken on its own. Otherwise what are the differences?

thenewme

Hi Mary,

According to the National Institutes of Health:   Source Here

"The two main forms of calcium in supplements are carbonate and citrate. Calcium carbonate is more commonly available and is both inexpensive and convenient. Both the carbonate and citrate forms are similarly well absorbed, but individuals with reduced levels of stomach acid can absorb calcium citrate more easily."

mathteacher

Mary, what gives you the impression you're deficient in calcium?

MaryNY

Mathteacher: I thought it went with the territory. Chemotherapy pushed me into menopause which I understand puts me at risk of osteoporosis. I had a bone density scan last month which showed ostopenia.

Thenewme, thanks for the info above. 

bcincolorado

I was told to take calcium with vit d and a multi-vitamin when I was first dx and they made me see a nutritionist.  I HATE pills so take Viactiv chews which are more like eating carmels

mathteacher

Mary, yes, you may be pushed into menopause. But reduced estrogen means your bones lose their ability to retain calcium so supplementing only sends calcium to your coronary arteries, kidneys, etc for calcification. The myth that calcium benefits bones in menopausal women is widely marketed misconception. We have discussed it before here. I'd direct you to that discussion if I had time this morning.

Just remember that the countries consuming the most calcium have the most osteo.

Best of luck on your journey.

thenewme

Hi Mathteacher,  When you have time I'd love to see your source for your statement that "The myth that calcium benefits bones in menopausal women is widely marketed misconception."  I searched for the discussion, but didn't find much in the way of research to support calcium supplementation benefits being a myth. 

Hi Mary,  I haven't had a bone density scan yet, but I'm in chemopause too.  I see you're a little farther out from treatment than I am.  My onc says I may or may not be in permanent menopause, and I go back and forth about hoping I am or not, LOL!   Chemo itself can contribute to osteopenia, and the menopause from chemo does too, so it's an important issue for us to know about. Lots of people have advice about supplementation, and some recommend hormone replacement  therapy/BHRT, but I prefer to rely on facts and primary research.  

********************************** 

Dietary Supplement Fact Sheet: Calcium  SOURCE HERE

Groups at Risk of Calcium Inadequacy
Although frank calcium deficiency is uncommon, dietary intakes of the nutrient below recommended levels might have health consequences over the long term. The following groups are among those most likely to need extra calcium.

Postmenopausal women

Menopause leads to bone loss [26] because decreases in estrogen production both increase bone resorption and decrease calcium absorption [13,27,28]. Annual decreases in bone mass of 3%-5% per year frequently occur in the first years of menopause, but the decreases are typically less than 1% per year after age 65 [29]. Increased calcium intakes during menopause do not completely offset this bone loss [30,31].

Hormone replacement therapy (HRT) with estrogen and progesterone helps increase calcium levels and prevent osteoporosis and fractures. Estrogen therapy restores postmenopausal bone remodeling to the same levels as at premenopause, leading to lower rates of bone loss [27], perhaps in part by increasing calcium absorption in the gut. However, because of the potential health risks associated with HRT use, several medical groups and professional societies recommend that postmenopausal women consider using medications, such as bisphosphonates, instead of HRT to prevent or treat osteoporosis [32-34]. In addition, consuming adequate amounts of calcium in the diet might help slow the rate of bone loss in all women.

crazy4carrots

mathteacher:  Yes, I too would appreciate seeing your references for suggesting that calcium intake is useless for bones.  It is contrary to everything I have read, or been told by medical professionals and nutritionists.  Like thenewme, I've been doing quite a bit of research on this, largely because I always assumed I had strong, healthy bones until my first dexascan prior to chemo which showed mild osteopenia.  Fortunately, 2 years later, despite chemo and Femara, and perhaps because of calcium supplements, the osteopenia has not advanced.

I'm also interested in seeing your statistics regarding countries consuming the most calcium having the most osteoporosis.

Thanks!

mollyann

Oh, gosh, yes, this subject has come up big time at the CAM conferences I go to with my sister's business. This anti-calcium info goes back about 3 years. I remember one case a doctor presented where a breast cancer survivor took her multivitamin and calcium citrate in the morning, went to the gym and began feeling odd on the treadmill like a palpitation. So they called the ambulance even tho she didn't feel that bad.

When she got to the emergency room her blood calcium was high and there was a tiny, tiny amount of some heart attack enzyme in her blood (which could have been brought on by exercise) so they told her they thought she was having a heart attack and scheduled an immediate angiogram where they thread some catheter up to your coronary arteries. Meanwhile her twelve year-old twin daughters who had just seen their mother survive breast cancer are crying, thinking mom is going to die from a heart attack.

The angiogram (which is a high risk procedure) showed her heart/ arteries were that of a 30 year-old and she didn't have any heart attack. That would be great news, right? But the radioactive dye from the unnecessary angiogram did something nasty to her kidneys and she was in the hospital a week until her kidneys recovered.

The doctor reporting this, wrote it up somewhere. He is advocating magnesium and Vitamin D to get dietary calcium absorbed into the bones. You may want to look this up. I think the Townsend letter had a debate. Anyway, that's all I remember of the story. I still have my bottle of calcium citrate on the shelf, unused. I'm told some plants like it but I don't know which.

thenewme

Hi Mollyann,

That's terrible about that one woman, but does one patient testimonial negate the scientific evidence referenced above?

If you happen to have any sources for your information, it would be really helpful to this discussion.  Telling us we might want to look it up isn't all that helpful, especially since I, for one, have already looked it up and posted my findings above. 

Citations, links, and even quotes are so helpful in trying to sort out this complicated information.  

Thanks!

konakat

This probably explains why my oncs said to take Vit D with my calcium supplements -- to make sure the calcium is absorbed by my bones.  Interesting.  It would be nice it this was more widely known.

mollyann

Actually, thenewme, you didn't reference any studies at all. You referenced a government "interpretation" of information. That was an essay. Multiple independent studies are the gold standard for evidence.

Please show me some actual studies demonstrating calcium supplements alone improve bone density of estrogen deficient women. You can search pubmed.com

Thanks!

Kate0574

I work in the insurance industry and I have to tell you that the main reason women have the bone density scans is because of the osteopenia due to mentapause..... so I do not agree what there is a misconseption... I beleive it to be true from what I have read and the guidlines we use to cover these tests....

 Are any of you women on Tamoxifen? I ask because when I started three years ago at age 33, my Oncologist said no suppliments unless approved by me.. they lessen the effect of the Tamoxifen.  I have not done any research on this but I beleive his knowledge of 30 as an oncologist.. I do however have pain in my joint and muscles so I will talk to him about the bone density scan even though I am only 36 now.. I am feeling it... lol.

 HUGS to all of you!!

thenewme

LOL Mollyann,

The link I posted has 122 study references, most of them from PubMed.  I guess you can lead a horse to water, but you can't make 'em drink.  

Here's what Sloan Kettering has to say about calcium, including a good literature summary and discussion, complete with lots of reference links: 

http://www.mskcc.org/mskcc/html/69157.cfmI

I guess it boils down to a difference of opinion as to what sources of information are credible and which aren't.   For me, primary scientific sources, recommendations of widely respected cancer treatment institutions, and interpretations of research by experts far more qualified than I, are adequate.

I'm always looking for new and updated fact-based information, so if you happen to have any sources, it would be great!

cookiegal

Hi Mary, my onc says take tums...seriously that's what he thinks is the best.

mollyann

thenewme,

I don't think you're understanding --and this will be my last email to you on the subject --because you don't seem to understand that evidence is primary sources, i.e., peer reviewed studies, not interpretations of studies, which are secondary sources (essays) open to interpretation. AKA, B.S.

I already asked you to cite sources from pubmed and you couldn't. "literature summaries" is a phrase meaning "somebody's opinion. Please cite the sources if you can find any to support your thesis. It comes down to put up or shut up and I mean this only in the sweetest way.

Thanks!

MaryNY

Hi cookie! your avatar always makes me smile and long for a cookie. Thanks for the hint about tums.

Mollyann and mathteacher: you have both suggested that taking calcium supplements is not alone useless but can be harmful. Since this is the opposite of what most of us are being told by the medical profession, can you cite any scientific studies to support the claim that calcium supplements are harmful? I know Molly you included an anecdote about one person that you have heard of but that's just one patient. I have seen that there are studies that contradict one another re calcium and fractures and calcium and heart function, but none that show that calcium has a negative effect.

mathteacher

Mary--actually the burden of proof lies in those claiming that calcium supplementation will improve the bone health of post menopausal women. I know it is "common Knowledge" but is it accurate? That's what this board is for--checking out whether what we were told on commercials, from dieticians, etc is fact-based

Can you show studies?

MaryNY

Mathteacher: I would argue that the burden of proof lies with those of you who are arguing that the majority of the medical profession is wrong.

If you follow the link provided in thenewme's last post - http://www.mskcc.org/mskcc/html/69157.cfmI - that references four studies relating to calcium supplementation.

(1) Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. This study showed that for individuals over the age of 50, calcium supplementation alone or with vitamin D reduced bone loss and fracture risk.

(2) Calcium plus Vitamin D Supplementation and the Risk of Fractures. This study involved 36,282 postmenopausal women who were randomized to receive 1000mg of calcium as calcium carbonate with 400 IU vitamin D3 daily or placebo for seven years. There was no significant reduction in hip fractures. But there was a small but significant improvement in hip bone density and an increased risk of kidney stones.

(3)  Calcium plus Vitamin D Supplementation and the Risk of Colorectal Cancer. The data obtained from the previous study were analyzed to determine the association of calcium and vitamin D supplementation with reduced risk of colorectal cancer. Results showed no effect of supplementation on the incidence of colorectal cancer.

(4) Oral vitamin D3 and calcium for secondary prevention of low-trauma fractures in elderly people (Randomised Evaluation of Calcium Or vitamin D, RECORD): a randomised placebo-controlled trial. Study that suggest that oral supplementation with calcium used alone or in combination with vitamin D3 is not effective in preventing risk of secondary fractures in elderly people.

So study 1 and 2 showed calcium supplementation to have a positive effect on bone density. Study 1 also showed calcium supplementation reduced risk of fracture but Study 4 showed no reduction in risk fracture. So some of the evidence is contradictory, but none of those studies show that calcium supplementation has a harmful effect. Do such studies exist?  

mathteacher

Mary, consensus has been wrong many times because it was based on opinion, not on evidence. That is why we check the original research and look at it carefully. I have nothing against authorities in the medical profession so long as they have their facts straight.

That is why the burden of proof lies on the original consensus claim about calcium. The earth was flat was the consensus at one time. Then someone checked.

The studies you sent seem to be talking about including Vitamin D. And why was a colorectal cancer study padding the bibliography? You need to actually read the full studies, one by one, to see if they apply to the subject at hand, post menopausal bone loss.

I'm getting the impression you want to win an argument, not get at the facts. If that is true, I'll just wish you good luck and sign off.

Susie123

Hi Ladies,

I started Arimidex a few months ago and my oncologist said it was important to take calcium with vitamin D (1200mg per day) because the Arimidex causes bone loss. I also work at a pharmacy and the rph's always recommend calcium carbonate with D. It's better absorbed by your body. For us post menopausal women, and estrogen suppressed women, it's very important to take a calcium supplement. Just ask any of your Drs or Pharmacists. Also, on a personal note I've seen what bone loss does to a person, my mother in law is in awful shape. I would be crazy not to take calcium to prevent what she has been through.

Susie

MaryNY

Susie: I only recently started taking calcium at the urging of my primary care physican and two oncologists. LIke you, I intend to continue taking it ... unless someone can show me studies that prove it can be harmful.

thenewme

I find it so odd that Mollyann and Mathteacher insist that the links I've provided are "B.S" and keep pressing for more primary studies to "prove" that calcium is beneficial, but neither of them has been able to provide a single reference to back up their apparent position that not only is calcium supplementation not beneficial, but that it is actually harmful. 

I'm the one told to "put up or shut up?"  They claim to be interested in discussion and fact finding, but ignore repeated requests for them to provide useful information information to discuss. Questioning, challenging, and discussing information is a great way to learn, but when one side childishly drops in just to say, "nuh-uh" with no meaningful input, the discussion deteriorates.

It's probably just as well that they've opted out of this discussion, but I'm sincerely interested in hearing from anyone else who has any updated or different information regarding calcium supplementation. 

I've done a lot of research on calcium via Pubmed and lots of other sources, and I'm just not finding anything credible about harmful effects of calcium supplementation. Anyone?

crazy4carrots

thenewme -  Like you, I've been doing quite a bit of research and have found nothing to indicate taking calcium supplements w/VitD is harmful.  In fact, I just got my Harvard Health newsletter which said that the one supplement all post-meno women should be taking is calcium w/VitD.  I think I'll take the advice of those who have studied the benefits for many years.

thenewme

Bone Mineral Density in Postmenopausal Breast Cancer Survivors 

And this:  CTIBL (Cancer-Treatment-Induced Bone Loss)

"Calcium and Vitamin D Intake. Because calcium deposition is an important step in bone formation, maintaining adequate serum calcium levels by optimizing calcium intake is important for patients with or at risk of bone loss.[10] Administration of vitamin D maximizes intestinal calcium absorption; therefore, daily supplementation of both calcium and vitamin D is recommended for all adult women and men with or at risk of osteoporosis.[10] Results of clinical trials evaluating calcium supplementation (750-1000 mg daily) in postmenopausal women and elderly men have consistently shown a moderate reduction in bone loss over two to four years.[124,125] Furthermore, the results of one study suggest that fractures may be prevented in postmenopausal women receiving calcium supplementation.[124] While the effect of vitamin D supplementation alone on fracture rate in elderly patients is unclear, combining calcium and vitamin D supplementation in men and women 65 years or older has been shown to be effective in preventing bone loss and fractures.[126-128] In one large, randomized, double-blind, placebo-controlled study, patients received 500 mg of calcium citrate and 700 IU of vitamin D or a placebo daily for three years.[128] Those who received calcium and vitamin D supplementation had significant increases in BMD of the femoral neck (0.5% versus -0.7%, p = 0.02) and spine (2.1% versus 1.2%, p = 0.04) compared with patients who received placebo. In addition, fewer patients who received calcium and vitamin D supplementation suffered a fracture during the study compared with the placebo group (5.9% and 12.9%, respectively) (p = 0.02)." 

weety

Out of curiosity, how much calcium do you all take?  Are you pre or post-menopausal?  Do you think 750-1000mg is needed if one consumes lots of milk and cheese?  Or does the amount recommended mean in addition to normal dietary consumption?

Anonymous

Calcium Citrate with Vitamin D

weety

Thanks, Rose.  How much of each do you take?  Are you pre or post-menopausal?