Conference Coverage

Calcium supplement use linked to cancer death

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You can’t take just one nutrient 


These are observational data. This is not saying we put someone on calcium, and they ended up with cancer, and when you look at this whole thing it’s amazing to me that nobody is discussing the benefits that were found in patients taking magnesium, vitamin K2, and other vitamins. The other thing I would like to point out is that, for at least a decade, it has been really well established that we shouldn’t be using more than 1,000 milligrams of calcium a day, especially from a supplements source. In this study, supplemental calcium intake of 1,000 mg/d or higher was associated with increased risk of cancer death, so what’s the big deal?

The big thing with calcium is calcium comes in 7 different forms. When you eat a variety of fruits and vegetables the source of calcium you get is mixed. The problem with supplements is you are using one or maybe two forms of calcium, but if your body doesn’t recognize that form of calcium then you aren’t getting calcium and it may not be beneficial to you.

What we need to do here, in my opinion, is we need to look at the whole picture. We know that dieting alone or exercising alone does not improve outcomes. It’s the combination of diet, exercise, hormone balance, nutrients from supplements, and emotional balance that makes you healthy. Similarly, you can’t say if you just take this one nutrient you are going to improve your quality of life.

With calcium and vitamin D, you have to take vitamin K2, because vitamin K2 activates osteocalcin, a protein that rebuilds the matrix of the bone. Without vitamin K2, you can’t deposit calcium in the bones. K2 also prevents the deposition of calcium in the blood vessels.
Magnesium is another tremendously important mineral, and magnesium deficiency is the most common mineral deficiency in the United States.

Probably one of the most common causes of magnesium deficiency is the use of acid blockers. I would be very curious to know how many people were taking proton pump inhibitors or acid blockers in general. I bet you most of them were.

Derrick DeSilva Jr., MD, is an internist, practicing in Edison, N.J. He made these comments in an interview. He reported serving as a consultant for Common Sense Supplements, a company that produces dietary supplements.


 

REPORTING FROM INTERNAL MEDICINE 2019

The latest published report links calcium intake from supplements to increased risk of cancer death, a nutrition specialist noted at the annual meeting of the American College of Physicians.

Marijane Hynes, MD, Director of Weight Management at the George Washington University School of Medicine and Health Sciences, Washington, Andrew D. Bowser/MDedge News

Dr. Marijane Hynes

The report, published (Ann Intern Med. 2019 Apr 9. doi: 10.7326/M18-2478) just 2 days before the start of the Internal Medicine meeting, found no mortality benefits associated with any reported dietary supplement use among nearly 31,000 adults in the National Health and Nutrition Examination Survey.

On the contrary, they found that excess calcium consumption was associated with increased risk for cancer-related deaths. Calcium supplements were specifically implicated in the excess of mortality, according to the investigators, with a rate ratio of 1.53 (95% confidence interval, 1.04-2.25) for intakes of 1,000 mg/day versus no intake.

“It’s better to get all of your vitamins from your food, over supplements,” said Marijane Hynes, MD, director of weight management at George Washington University, Washington, in a meet-the-professor session at the conference.

The amount of calcium patients are getting from food can be estimated with one rule of thumb: Multiply the number of dairy servings per day by 300 mg, Dr. Hynes said, who added that a serving is 8 ounces of milk or 1 ounce of hard cheese. Dark green vegetables, breads, cereals, and some nuts can provide 100-200 mg of calcium per day.

Calcium carbonate can be taken with food to enhance calcium absorption, according to Dr. Hynes, while calcium citrate can be taken without food, and is preferred for patients taking acid reflux medications.

Because calcium absorption is reduced at higher doses, patients who need more than 600 mg/day should be taking divided doses, she said.

Bone health goes beyond the dairy aisle, Dr. Hynes added. High vitamin K intake was linked to reduced hip fracture risk among the Framingham Heart Study participants. To get the recommended amount of vitamin K in the diet, patients can consume one or more servings of broccoli, kale, collard greens, or dark green lettuce.

Dr. Hynes reported she that had no relationships with entities producing, marketing, reselling, or distributing health care goods or services consumed by, or used on, patients.

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