Calcium and the true risk to you heart: Dr MARTIN SCURR answers your health questions
QUESTION: I am worried about taking calcium supplements because of the increased risk of having a heart attack or stroke. Is it time to stop taking them?
Amy Collins, Hackney, London.
ANSWER: There have been studies, including a review published last year in the journal Annals of Internal Medicine, suggesting calcium supplements may increase the risk of heart attack and stroke.
The theory is that calcium in excess may contribute to calcification, or furring, of the arteries.
But, while I understand your concern, the evidence is not as clear cut as you might think. In fact, it is highly conflicting.
Most people who take calcium supplements (usually with vitamin D) do so because they have osteoporosis.(Stock image)
Until research settles the dispute, the usual advice is that doses of more than 500mg at one time should be avoided.
Most people who take calcium supplements (usually with vitamin D) do so because they have osteoporosis, which weakens bones, making them more fragile and more likely to break.
There are several options for preventing or treating loss of bone mass, but the first step is eating foods rich in calcium, which helps to build bones, and vitamin D, which helps the body absorb calcium.
The recommendation for those with osteoporosis is a total daily intake of 1,200 mg of calcium along with 800 international units (IUs) of vitamin D. That has been the advice for many years.
Dr Martin Scurr (pictured) examines whether calcium supplements increase your risk of having a heart attack or stroke
It has long been known that there is a possible relationship between calcium consumption and cardiovascular events such as stroke.
In 2007, a seven-year study was published involving 30,000 postmenopausal women; half were taking 500mg of calcium a day, plus vitamin D twice daily, and half had a placebo.
The conclusion was that those with the higher calcium intake were not at higher risk of heart attack or stroke.
Then, in 2010, a review of data from several trials involving 8,000 people concluded there was an increased risk of heart attack in those taking calcium supplements.
This was followed by more research (published in 2011) which concurred.
However, the same year another major study suggested calcium supplementation may actually reduce the risk of hospitalisation and mortality in patients with pre-existing furring of the arteries — atherosclerotic cardiovascular disease.
Postmenopausal women who face higher risk of osteoporosis and weakened bones generally are advised to consume calcium-rich foods, such as green and leafy vegetables. (Stock image)
This is compelling evidence that calcium supplementation is safe.
You can see why there is controversy and confusion.
So what can we make of all this?
Although the ideal intake has not been established, postmenopausal women — who face higher risk of osteoporosis and weakened bones generally — are advised to consume calcium-rich foods, such as green, leafy vegetables, tinned fish and dairy products, along with taking up to 500mg of calcium twice daily.
Strict vegans or vegetarians may find it difficult to get enough calcium and vitamin D from food, so should obtain expert recommendations tailored to their preferences from a qualified dietitian.
In my view…patients need the human touch
There has been much discussion about a ‘new normal’ once lockdown ends, but I really fear what this will mean for general practice.
Since the pandemic struck, around 80 per cent of GP consultations have been conducted on the telephone or via a digital screen.
Where patients are seen in person, the examination is more thorough than usual.
Personal, face-to- face communication and skilled physical examination is the bedrock of healthcare. I have lost count of the number of times where the absence of a face-to-face consultation would have resulted in the death of a patient.
Take, for example, the woman who called several times about her persistent cough. She was reluctant to be seen and even more reluctant to undress so her chest could be examined.
I found that she had fungating breast cancer (where the tumour is so advanced it grows out of the skin). The cancer had spread into her lungs, hence her cough.
Or the teenager whose parents called for advice about ‘flu’. When I visited, I found a few flecks of a purple rash on her wrist, signs of meningococcal meningitis, which would have killed her later that day had she not been raced to intensive care.
And it is not just about diagnosis; explanation and support is needed when treating patients with severe illness.
Cancer, heart disease, chronic neurological conditions such as multiple sclerosis — all benefit from the human touch.
If we retain or expand the commitment to distanced medical care, the outcome will be dehumanising. Let’s hope it doesn’t become the new normal simply out of convenience.
As my boss would say when I was a trainee: ‘Telephones are for making appointments, not diagnoses.’
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