To Supplement or Not? Confusing Reports about Vitamin D and Calcium — August 2014


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To Supplement or NotConsumers are left scratching their heads with recent news about the popular supplement combination — calcium and vitamin D. While it is known that they are essential for bone and teeth health, it’s not clear that taking these supplements do everything they’ve been purported to do, like protect against broken bones, cancer and heart disease.

In 2013, the U.S. Preventive Services Task Force reported that taking calcium and vitamin D supplements do not prevent fractures among healthy postmenopausal women. Then, earlier this year, a new study performed at the University of Edinburgh, Scotland found little benefit of taking vitamin D. In fact, the only benefit identified was a link between vitamin D levels in late pregnancy and healthy newborn birth weights.

However, a study done at Erasmus University Medical Center in the Netherlands linked vitamin D3 supplementation to an 11 percent reduction in the risk of death. But this study was small and focused on the elderly.

In an editorial accompanying the study, Naveed Sattar, a medical professor at the University of Glasgow, Scotland explained that “There is an assumption that low blood vitamin D levels are causing or contributing to risk for many diseases but recent research tells us that, in fact, the opposite is the case and that having the disease in the first place leads to people having low vitamin D levels.” He further explained that risk factors like obesity, smoking and poor diet can lower vitamin D levels so that it is more important to correct the risk factors than to try to adjust low vitamin D levels.

Vitamin D: How Much and is Testing Accurate?

There continues to be scientific debate about what constitutes an optimal level of vitamin D: <20 ng/ml or <30 ng/ml. In addition, there are numerous testing methods and no internationally-recognized reference standard for measuring vitamin D levels. Since a clear definition of vitamin D deficiency has not been determined, it is difficult to know if a person is really deficient and how much vitamin D is needed to correct deficiency given that testing may not be consistent.

Many Considerations…

Since calcium supplements don’t appear to prevent fractures in healthy older women and have been associated with an increased risk for heart attack and the development of kidney stones, does it make sense to take them? Experts suggest patients talk to their doctors and perform a risk/benefit analysis.

As Dr. Sattar suggests, addressing risk factors, such as smoking and obesity, could have the added benefit of improving vitamin D levels.

Consider how much calcium and vitamin D comes from your diet. Good food sources of calcium include dairy products (milk, cheese and yogurt), soybeans, dark leafy greens (spinach, kale, collard greens), fish with soft edible bones (sardines and salmon), and fortified juices and bread products. A calcium-rich diet and regular exercise can help keep bones strong and may eliminate the need for supplementation.

Calcium’s partner, vitamin D is important too because it helps the body absorb calcium and is essential to a healthy immune system. Very few foods naturally contain vitamin D. Fatty fish (salmon, tuna and mackerel) are the best bet. Mushrooms, beef liver, cheese and egg yolks offer small amounts. Other products like milk, juices and cereals are fortified with both calcium and vitamin D. The sun is the best natural, though controversial, source of vitamin D. Unless you have had or are specifically at risk for developing skin cancer, dermatologists will often recommend sun exposure of no more than 15 minutes a day.

Supplements will most likely be recommended for people who:

  • Follow a vegan diet.
  • Are lactose intolerant and limit dairy intake.
  • Consume large amounts of protein or sodium which can cause your body to excrete calcium.
  • Take corticosteroids like prednisone or cortisone.
  • Have bowel or digestive diseases like celiac or inflammatory bowel disease that decrease your ability to absorb calcium.
  • Spend little time outdoors.
  • Have osteoporosis.
  • Are inactive.

Can You Take Too Much?

Yes! Too much calcium in your blood is called hypercalcemia, which can weaken your bones, cause kidney stones, and interfere with heart and brain function. It is seen in people who have overactive parathyroid glands, cancer, and who take excessive doses of calcium and vitamin D.

Now What?

Like all health decisions, the decision to take calcium or vitamin D supplements depends upon your particular situation. Your age, gender, risk factors and health status are important considerations. Your KnovaSolutions nurse can help you decide!

Let Us Know How We Can Help…

Your KnovaSolutions® nurse or pharmacist can help you gather information and form an opinion about the best course of action for you!

 

The information contained in this newsletter is for general, educational purposes. It should not be considered a replacement for consultation with your healthcare provider. If you have concerns about your health, please contact your healthcare provider.

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We encourage you to leave a comment or question below and a KnovaSolutions nurse or pharmacist will reply.


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5 Responses to To Supplement or Not? Confusing Reports about Vitamin D and Calcium — August 2014

  1. I fear providing this information to my elderly patients will only confuse them more, as your article gives a lot of good information, it really doesn’t help with knowing whether taking Vitamin D (Which by the way I have alway been a strong proponent of in the elderly), or Calcium (which I have been suspicious of recommending,outside of a dietary source, due to the obvious concerns of hypercalcemia). How do we narrow this down for our patients? What is a safe level? Too many unknowns! If supplementing with Vitamin D how much is too much?

    • Thanks for your comment; your questions get to the heart of the debate. Many recent studies have shown inconclusive evidence about how much calcium and Vitamin D are needed daily. Most primary care providers will make recommendations based on individual considerations, such as the health and age of the patient, their skin color, their daily exposure to sunlight, and their medications and diet. They also encourage their patients to add up how much calcium and vitamin D is in the supplements that they take since there are often overlaps — multivitamins often contain calcium and vitamin D, calcium supplements often contain vitamin D, and products marketed to support joint health often contain vitamin D. If one’s diet is rich in dairy products, leafy greens, soy, salmon and fortified products like juice and cereals, then less supplementation would be encouraged. You may also know that calcium has been known to decrease the effectiveness of some antibiotics and drugs used for osteoporosis and thyroid conditions, and may need to be limited with people with cardiovascular conditions.

      You are right when you say there are too many unknowns. The recent research is saying that more study is needed. Deciding to supplement with calcium and/or vitamin D requires a person-by-person approach best done in concert with primary care providers.

      Thanks again for raising these questions. We hope this conversation will help others learn more about the many variables involved in deciding to take supplements.

  2. Miz Fincan hit the target with her question.

    Physician Asst at work told me many he has tested that work here are low in vitamin D. He did not test me when I was sick but was of the opinion that I was low on D. He said I should take at least 2000mg per day. I started taking 4 of the Citrical amounting to 2000mg and Centrum Silver I take every day has 600mg. Is that too much?
    I don’t think I get much from food and it is too cold to be outside.

    • Andrew, you raise a good question that emphasizes the importance of considering all the components when beginning a supplement. The daily adult recommendation is 600 IUs (international units) for vitamin D and 1,000 mg for calcium (for healthy adults). Citracal contains both vitamin D and calcium, as does Centrum Silver. It sounds as if you are taking a total of 2,600 IUs of vitamin D and 2,500 mg of calcium daily.

      You may want to consider discussing this with your provider to determine if checking your vitamin D level would be important, and whether or not it makes sense to supplement with vitamin D only, rather than the calcium/vitamin D combination. The decision about how much to take is based on many factors such as your age, health, risk factors for heart and kidney disease and other health concerns, diet, daily sun exposure, and medications. You and your provider are best suited to determine how much you need given your unique circumstances. Please let us know if we can help you with any of your healthcare concerns.

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