Calcium supplements damaging?

Member_of_the_Club

I'm interested in hearing what you think about this article was in the Washington Post this morning.  The threat of calcium supplements in this article strikes me as overblown, but I'm new to all this:

washingtonpost.com/national/health-science/calcium-and-vitamin-d-findings-show-that-caring-for-your-bones-can-be-complicated/2013/03/04/37356768-7470-11e2-8f84-3e4b513b1a13_story.html

 

fredntan

I couldn't get link to work.

but I read something in my local paper this weekend.

it said calcium supplements can cause kidney stones. i will take that risk. Kidney stones are much easier to cure than thin bones. I don't take much stock in what I read in magazines or newspapers. that stuff is for general public. usually written by lord knows who. with lord knows what credentials

voraciousreader

Member...the link didn't work...However, all I had to do was a google search of "washington post calcium"  and the article popped up. 

The article is okay.  It discusses the heart risk as well as bone risk of taking calcium based on some small studies.  When the heart study was published last year, I immediately contacted the DH's cardiologist because he is taking calcium.  He was placed on calcium by the gastroenterologist because there was a small study that concluded that drugs in the PPI family, such as Prevacid deplete the body of calcium.  After numerous phone calls, it was decided that the DH continue taking the calcium.  However, VR was NOT a happy camper.  The article that you posted in the Washington Post contains a very small paragraph, but a powerful one...."It's confusing, even for doctors.  But there's a common thread:  None of the heart or kidney risks were associated with calcium from food.....and it has brought their focus back to what their patients eat."

The question that should be answered regarding supplements is whether or not eating a "balanced" diet will give you all of the nutrients that your body needs without causing an increased risk of other diseases. Now here's what needs to be answered, .....is taking supplements the equivalent to getting those nutrients in our diets?  We don't see clinical trials comparing diet WITH supplements.  The DH also has a rare genetic metabolic disorder that requires manipulations in his diet.  His endocrinologist is very concerned about taking supplements even though in some situations he MUST prescribe them.  Manipulating the DH's diet has been one of the most effective treatments for his orphan illness.

Unfortunately, creating clinical trials involving diet are extremely hard to do.  I am encouraged with last week's news focusing on a Mediterranean diet being heart healthy that in the future, we will begin to see more studies involving diet because it's beginning to appear that some supplements can actually be potentially harmful.

Member_of_the_Club

Could someone who is more competent than I am post the link?

Its is the cardiac issues that I am concerned about, though my immediate concern is bone loss.  While I agree that it is better to get calcium, and any nutrient really, from your diet, I know that won't be enough for me because of the arimidex and family history.  Sooooo, I would love to hear if anyone else has thoughts on this.

What is VR?

Anonymous

this one might work:

http://www.washingtonpost.com/national/health-science/calcium-and-vitamin-d-findings-show-that-caring-for-your-bones-can-be-complicated/2013/03/04/37356768-7470-11e2-8f84-3e4b513b1a13_story.html

LtotheK

One of the things I find really interesting about the BC community is, we tend to get access to health info before it trickles out into the general community.  This is all info I knew even going into my treatment:  the 1200 mg a day recommendation is potentially dangerous, and the jury is out on D as the miracle cure, at least insofar as what the sweet spot is for blood levels.

It all makes pretty clear common sense to me.  The body is too complicated to throw one thing at it and not get another reaction.  I can't think of any supplement or drug that doesn't have other potential risks.  We learn that one quick as patients and survivors.

Supplements in general are really questionable in my book.  I may have shared with some of you that one of my second opinions urged me not to take more than US RDA 100% of anything with my Tamox.  She said there will never be enough research to look at the contraindications of all these things together.

So, every time I pop my 250 mg calcium, 500 mg magnesium, 5000 IU D (the only thing that gets me in the range of 35+), fish oil, and probiotic, I stop and wonder.  I've started separating them:  supplements at night, Tamox during the day.

I'm also on Fosamax for my bones.  I had good improvement in one year (my spine was osteoporotic).  Was it the Fosamax?  The weight training and D in combination?  Estrogen kicking back from chemo?  Impossible to say.

voraciousreader

member....."VR" is short for my user name "voraciousreader."  I often refer to myself in the third person, hence, "VR."

Regarding the evidence...These are small studies, so it's difficult to parse what's valid clinically to do.  I, too, have a strong family background with heart disease, so I am especially concerned when I read studies like these.  I just think they should give us pause before we pop anything other than healthy food into our mouths....

SelenaWolf

We can't keep jumping on/off the bandwagon everytime one these new "studies" comes out.  There are risks in everything.  If calcium supplements are taken with enough magnesium to absorb there calcium properly, then the risk is decreased.  In addition, don't take calcium with your morning coffee; caffeine prohibits it's absorption.  Taking too much calcium will have almost the same effect on your bones as taking too little.

Vitamin D supplements do not have calcium in them, but if you "mega-dose" on Vitamin D i.e., take over 50,000iu per day over a course of several months - the risk of a Vitamin D toxicity (which causes a build up of calcium in your blood, just like calcium toxicity) is greatly increased. 

Taking a daily Vitamin D supplement according to the recommended dose of 600iu per day will, very likely, not put you at risk for this side effect.  Neither will staying within the recommended dosage for calcium.

Lee64

I also saw this article in our local newspaper and had some concerns. My Onc never told me to take any supplements. At my last check-up in Dec. I saw a NP instead of my Onc and she recommended that I start taking 1200 mg. of calcium and 1000 units of vitamin D daily.  My blood calcium level is within normal limits and my vitamin D level has never been checked as far as I can tell. I had a DEXA scan before I started Arimidex in Sept. of 2011 and was told I have "strong bones". If you ladies had a DEXA, how often should it be done? I sure don't want to end up with kidney stones or worse because I took something that I didn't need in the first place

Thanks for starting this discussion, Member. 

sas-schatzi

Lee64, I'm a retired nurse, I hate to say it that NP did you a diservice on multiple levels.

1. she told you to take supplements based on old information---very old---years old.

2. All patients should have a dexa scan when placed on any medication that has listed in it's untoward reaction list that it may cause ostopenia(low bone density) or osteoporosis (lower or very low bone density). There are more drugs than just chemotherapy/ AI's/Serms-tamox & Evista/ Prednisone that affect bone density. The age recommendations for the first Dexascan changes every few years and I don't know what it is now, but the most recent was far to old, close to 60. Most insurance will not approve less than 2 years between studies.

Lee64

sas-schazi, thank you for your response.  Now I am really confused. Are you saying that no one should take calcium or vitamin D unless it is needed? I have noticed while reading through posts on BCO that a lot of women are taking many different supplements (some in pretty high doses) but I don't know if it was recommended by their Dr. I am not a pill taker so I have never taken anything unless directed to do so.  I'm just trying to muddle through this BC as best I can.  Most of the studies I read make my head spin!

Sorry if I misunderstood what you meant.

Member_of_the_Club

I had a baseline dexa before starting arimidex and every year and a half (there's been two of those) after.  Now thatt I have osteopenia my onc wants me to have my next one in a year, not a year and a half.  So some of this is personal.  If you have bones of steel, like Jo-5, I can imagine waiting 3 years.

So the question for calcium is how much is too much. 

ruthbru

I wouldn't throw out the Calcium/Vitamin D suppliments yet. The study sounds pretty 'iffy' to me. I'm reading about it in the paper right now, and here are some of the points from the article:

* 'There is not enough evidence to tell if (higher doses) prevent fractures, in an otherwise healthy person....the panel urged more research."

* 'It is a confusing message....regrettably we don't have enough information....'

* 'The main caution: These recommendations aren't for people for people at high risk of weak bones.' (my italics)

* 'Vitamin D also is being studied for possibly preventing cancer and certain other diseases, something that Monday's guidelines don't address.'

Wren44

I'm keeping my Calcium and Vit D. My mother and grandmother had osteoporosis. I have osteopenia and am on anastrasole. It's no guarantee, but I think I'm safer taking it. After being in the bad arm of a Vit A study, I don't take anything but the calcium and D.

voraciousreader

I looked at the study published in the BMJ. Basically, what the researchers were looking for in the prospective analysis was whether or not the patients who took calcium reduced their mortality. Instead what they found was that those patients who took more than the daily recommended amount of calcium had an increased risk of dying from heart disease. The researchers thought that if the patients were ingesting the daily requirement via their diet, there was no need to take additional calcium. This study did not make a recommendation for people who had bone issues. The study emphasized diet manipulation for people who had low calcium concentrations. One of the strengths of the study was the size of the number of women studied for a long period of time and in addition to diet diaries, there was a lifestyle diary as well.

ruthbru

From what I've seen, many new studies make a big 'splash', but often don't live up to their hype in the long run.

Of course, it is best to get your vitamins from real food, but I also will keep taking calcium plus D...there is no way I could eat my way to as much as we need without eating thousands and thousands of extra calories!

voraciousreader

IMHO... There is a trend occurring with a number of these studies. It appears that unless you have a confirmed deficiency, less is more. Recall how years ago it seemed like everyone was taking Vitamin E. Before that it was Vitamin C and in the last year everyone was taking a multi-vitamin which now we are being told is unnecessary. With today's foods fortified with nutrients and excellent access to fresh foods, there is little reason to open a bottle. Think Geratol!

LtotheK

Member, I've heard 500 is the new general recommendation.  I didn't get that from my doc, rather, a trusted friend in the medical profession.  That said, I can't see how "megadosing" even on D is a great plan.  I do wonder what 5000 units a day will end up doing to me, because it just seems like way more than the body could know what to do with every morning at 8 am.

I ended up doing 500 or less anyway.  Even with supplemental magnesium, it is so hopelessly constipating for me the idea of 1200 mg makes me turn to stone.

Not sure I wholly agree with fortified foods, and the US does have serious issues with food nutrition due in part to depleted soils and industrial farming.  You just have to travel to take note of that.  I had arugula one day in EE brought in fresh that day.  I promise you've never tasted anything like it.  I also think part of the reason they tend to eat and weigh less is, their food tastes very powerful.  Enough happens faster!  But that's for another discussion. 

Member_of_the_Club

This is all helpful.  It does make sense to me that if you already have bone loss, these studies don't apply.  My blood levels are fine for everything, but I think I will take a realtively low level supplement.

ruthbru

Here is a post I did two years ago. As research changes, so do the recommendations, but I still think it offers 'food for thought':

I went to a very interesting speaker the other day. She is a doctor, nutrition specialist, and an eleven year breast cancer survivor. Here are some of her tips for staying healthy:

1. We all know we should eat more fruits & veggies, whole grains, less red meat, processed food etc. so I am not going to go into any of that.

2. EVERYONE should be taking a multi-vitamin. Make sure it says ‘Complete' on the label. Make sure it contains iodine, Vitamin K, selenium and folic acid along with all the other good stuff. Interesting facts about why multi-vitamins are important:

* older women with the lowest levels of vitamin B-12 were at the greatest risk for breast cancer

* taking acid-blocking medications make you less able to absorb B-12

* she recommends 400 mcg of folic acid a day. It works with the B-12 (studies have found that folates may help to make chemo more effective and decrease side effects)

* B 6 is important in lowering the risk of breast and colon cancer

* she recommends 90 mg of vitamin C

* 30 iu of E

3. Omega 3.....either eat oily fish twice a week or use fish-oil supplements (make sure it says EPA and DHA approved) 1000 mg a day. It's associated with decreased risk of cancer, heart disease, inflammatory disease, depression and more.

4. Vitamin D....a big deal.....she recommends getting it tested (should be between 40-50 ng/dL). She recommends 2000 iu a day to maintain a good level. Many, many conditions are associated with low vitamin D; heart attack, cancers, rheumatoid arthritis, muscle weakness, asthma, diabetics, multiple sclerosis etc. etc. etc. There are over 200 different body tissues that have been identified so far that have receptors for the vitamin D hormone and they need it to work properly.

* adequate Vitamin D levels has been shown to reduce the side effects of taxol based chemotherapy

* Adequate Vitamin D has shown to reduce the side effects of aromatase inhibitors

* start with a multi-vitamin, drink milk, eat yogurt (check and make sure it has vitamin D added), and most people will also need a supplement to keep that high of levels

5. Vitamin K, should get 100 mcg a day. Check your multi-vitamin, not all of them have it added. Inadequacy leads to an increased risk of various cancers, heart disease, osteoporosis and kidney problems.

SelenaWolf

As always, this study is referring to taking calcium supplements in much higher than recommended amounts.  In other words, people who abuse the supplement.    In addition to the heart disease risks, too much calcium can- and does weaken bone and contribute to osteoporosis.  In this case, more is not better.

Same goes for Vitamin D.  When taken in much higher than recommended amounts, especially when you don't have a documented Vitamin D deficiency, it can- and will be toxic.  Vitamin D toxicity is similar to calcium toxicity; it causes hypercalcemia, which can lead to heart disease, kidney stones, etc.  Again, more is not better.

The studies linking Vitamin D to a decreased risk of developing breast cancer have been, largely, misinterpreted by the general public.  What these retrospective studes discovered was, in the small group of data studied, many of the women who had been recently diagnosed with breast cancer had some sort of Vitamin D deficiency.  That's it.  Based on that observation - an observation based on old data from a small group of women - the study tossed around the idea that MAYBE there was a link.  And, as a result, thousands of women with breast cancer or at high risk to develop breast cancer rushed out and started taking large amounts of Vitamin D in the hopes that it would be their "magic bullet".  So far, further studies into this "link" have yet to come up with anything conclusive.

The link between Vitamin D deficiency and breast cancer is just another interesting, but possibly useless piece of information coming out of these retrospective studies.  It was observational only.  It's never been proven - without a doubt, based on a clinical trial - that taking a larger-than-recommended Vitamin D supplement will, actually, lower your risk of developing breast cancer or developing a recurrence.  The science is just not there.  Which is why some oncologists and doctors don't recommend taking any more than the daily recommended dosage of 400iu of Vitamin D per day.

wenweb

 It's hard to know which direction to turn while deciding how much calcium and/or Vitamin D to take.  I don't think any 2 doctors would give you the same answer.  I also don't know whether to continue taking 1200mg of calcium and 4-5000iu's of Vitamin D or not.  Talk about head spinning, (and) as if we don't already have enough choices to make.  What's a girl to do 

voraciousreader

Here's some more info to make your head spin:

Vitamin D Potency Varies Widely in Dietary Supplements, Analysis Finds:

http://www.sciencedaily.com/releases/2013/02/130211162231.htm

Nearly 80 Million Americans Won't Need Vitamin D Supplements Under New Guidelines:

http://www.sciencedaily.com/releases/2012/10/121024175229.htm

Wenweb....I disagree with regard to asking two doctors their opinions and getting two answers.  I would ask my physician what the current research is showing and here's a more important question to ask, "And in what direction is the research TRENDING?" 

I think many people are making themselves into patients unnecessarily.  In Eric Topol, MD's important book, The Creative Destruction of Medicine, he describes the importance of knowing your family history of illness (which BTW will be done more frequently in the future using genetics) and being proactive in reducing those risks of developing those family diseases.  For the majority of people, nothing more than a healthy diet and exercise is necessary.  I think the reason why many people have become so conscientious about doing more, requires us to look back a decade or two at the advent of statins.  When statins hit the market, people lined up to find out their cholesterol numbers.  Today, frequently, people will tout their cholesterol numbers as though they are in an Olympic heat, despite the fact that 50% of people who get heart attacks have low cholesterol numbers.  I think many people have come to the belief that if they pop a pill, they will see "results."  I just don't think it's that easy.  I also firmly believe that once a person is diagnosed with a disease, they might feel like they must do "everything" especially when it comes to cancer. Got to keep the beast at bay.  So, doing more makes people feel better even if there is NO evidence that whatever it is one is doing will, in fact, keep them well.  And now we have studies that are telling us that doing more might even be harmful.  Before you do more, read Otis Brawley, MD's book, How We Do Harm.

Member_of_the_Club

Ruthbru, I like your list I think we have to be careful about recommending supplements during chemo.  At least when i was going through it there was some concern that anti-oxidants, in particular, could counter the effects of chemo.  So I think its something women should ask their oncs.

My vitamin D levels have been fine.  My GP also thinks the whole vitamin D thing is a trend and it doesn't have nearly the power people attribute to it.

As for cholesterol, it isn't everything but for some people it really can be an important number.  Statins can actually do a great deal for people at high risk for heart disease.  I wish we knew as much about preventing cancer as we do for heart disease but we don't.

voraciousreader

Member...most people can tell you their cholesterol numbers but can't tell you their risk of a cardiac event in 10 years based on the NCEP guidelines. And heart disease is an enigma too. Friend's husband had a massive heart attack a few weeks ago and was attended at Mass General. Chief of cardiology said he had NO risk factors preceeding the attack and could not have been predicted 48 hours before.

ruthbru

Oh yeah with chemo, people should not mess around with vitamins/supplements etc. at all as you are trying to kill cells, not build them up.

I think it's important to look at your own family history, as well as individual health issues. For instance, high blood pressure, high cholesterol and heart disease runs rampant in my family. Even though people without high cholesterol can have heart attacks; with my family history, it makes a lot of sense to keep my numbers down (So far, I have been able to keep it in line with exercise, diet, and niacin (with doctor's monitoring)....didn't want to do a statin unless I had to). I have a friend with ongoing kidney problems, which run in her family, and she should never take extra calcium; in fact, she has to really limit it in her diet.

So, what to do is pretty individual; although I think it is safe to say that mega-doses of anything is a bad idea unless you have some very wierd and unusual syndrome, and it is prescribed by a doctor who actually knows what he/she is doing!

Member_of_the_Club

I agree that cholesterol doesn't tell the whole story but it is an important piece.  While you can have heart disease without bad numbers, if you have bad numbers you have an increased risk.  Its kind of like you can get breast cancer without a family history, but if you have a family history you have an increased risk.

Golden01

VR - Thanks for posting those links. The one on Vitamin D potency may have answered a question for me. I have osteopenia and am "working on my bones" to get ready for a switch from Tamoxifen to an AI down the road. My Vitamin D level was 32 so have been taking 2,000 IU of D3 for about a year. Just had my blood level tested and it had gone down to 22 which wasn't making any sense. I'd bought the Vitamin D on a buy-one-get-one-free sale so, although they are within expiration dates, I've had the current bottle awhile. Think I'll get a new bottle and try a different brand. Oh yes, the broken bone in my foot has healed so I am going to go for a walk in the sun every day too. 

voraciousreader

Member....If you have "bad" numbers, that is just ONE OF THE RISK FACTORS that needs to be considered ALONG WITH OTHER RISK FACTORS before one should be given a statin.  My point is that there are physicians who are recommending a statin simply based on the SINGLE RISK FACTOR of elevated lipids.  Many physicians are NOT looking at the NCEP guidelines when they are deciding if a patient should be on a statin.  They look at the patients cholesterol numbers closely, without doing the NCEP guidelines calculation.  Furthermore, if you have "bad" numbers and truly have an increased risk, what researchers are finding out is that controlling those "bad" numbers doesn't necessarily lead to lowering your risk of heart attack.  What researchers and physicians DO KNOW is that for MEN who have had a heart attack, or at high risk of having a heart attack, based on the NCEP risks and recommendations, then statins are very effective.  For the majority of people, including women, you would have to treat many patients with a statin to prevent a single heart attack in 10 years.  What researchers are also finding out, as they try to come up with better lipid drugs to reduce the chances of a heart attack, is that their initial thoughts such as raising the "good" cholesterol, HDL, hasn't panned out with creating a targeted medicine that would lead to a significant decrease in heart attacks.

My point is simple.  Many physicians and patients are led to believe that doing more is better.  Unfortunately, for most of us, that simply isn't true.  And I welcome studies like the one you posted.  Because, here we have a study that actually tried to pinpoint diet and it's effect on the body, just like the one published a few weeks ago regarding the Mediterranean diet and heart disease.  Rather than looking for medications and supplements, researchers are FINALLY beginning to study diet and it's profound effect on the body and THAT IS REFRESHING!  Along with studying genetics which will tell us who is at greater risk of diseases and targeted therapies to treat those diseases, I see that revolution that Dr. Topol describes in his visionary book, The Creative Destruction of Medicine finally occurring.  It's also very interesting to see that "targeted therapies" doesn't necessarily have to be in the form of a pill.

voraciousreader

Golden....Glad you're feeling better....I broke my foot last year and I missed my morning walks!  Enjoy your walk!

voraciousreader

And for anyone interested in looking at the NCEP guidelines, here they are:

http://www.nhlbi.nih.gov/guidelines/cholesterol/index.htm