Sticks and stones
Should you toss out your calcium and vitamin D supplements?
I think you know the answer to that one. And by now, I’m sure you know the drill…
When the government offers advice about supplements, ALWAYS assume they’re wrong. That way, you’ll do the right thing about 99% of the time.
Recently, you probably heard that older women should forget about calcium and vitamin D supplements to prevent fracture risk. Actually, that recommendation isn’t ALL wrong. But it’s only about half right. At best.
But anyone who knows me knows I like to be all right. So I’ve asked Dr. Spreen to set this simplistic advice back on the right track for us.
No quick fix
The U.S. Preventive Services Task Force (USPSTF) says Recommended Daily Allowance levels of calcium and vitamin D do not prevent bone fractures in older women.
But we know all about RDA levels. They’re set ridiculously low. So no one should be surprised when paltry doses produce no benefits.
Also, according to USPSTF, a paltry dose of calcium might ever so slightly increase risk of kidney stones. So (their logic goes) the “risk” is reason enough to stop taking the supplement altogether. (Too bad they can’t seem to apply that logic to prescription drugs.)
Now… Let’s get real.
Dr. Spreen isn’t surprised that this advice from government experts is highly simplistic. “Especially when it’s about supplements, since they know nothing about them, anyway.”
They’re probably right about the calcium being useless at the RDA dose. But Dr. Spreen notes that dose is just part of the problem. There’s also the FORM of the calcium to consider.
Dr. Spreen: “Calcium carbonate (specifically mentioned), is about as poorly absorbed as any form of calcium on the market. So it probably is a waste of time. Calcium citrate is better.
“Also, humans don’t find calcium in nature without magnesium. I give calcium 2:1 with magnesium.
“Next, 400 IU of vitamin D is pretty much useless. So they’re right again. I start at 5,000 IU of D-3. That’s pretty much a different ballpark altogether. And for the elderly, that probably isn’t enough. (They need blood level testing to determine dose.)”
But here’s the catch. Dr. Spreen notes that even at higher doses, calcium, magnesium, and vitamin D can’t do the job alone. Here’s his list of additional supplements needed to help aging bones stay healthy…
- Vitamin K
- Vitamin C
- Hydrochloric acid
Note that this list is for everyone. For post-menopausal women, he might also include natural progesterone.
And… “Then, you add some exercise, so the bones have a reason to re-mineralize.”
Obviously, this isn’t a simple fix. Dr. Spreen recognizes that. And he knows that’s why most doctors and patients are inclined to keep it simple and take an osteoporosis drug. Clearly, that’s not the route he would ever recommend. But he would “at least” hope that seniors take a good multi-vitamin, a good multi-mineral, and high-dose vitamin D.
And finally… What about that kidney stone risk?
Dr. Spreen simply dismisses it. “Yes, some (not all) kidney stones contain calcium. But that doesn’t explain why it’s laid down improperly in one person, and not in another who’s taking even more calcium. Besides, if you add magnesium, the risk goes down.”
And that is my RDA…recommended dose of Allan (Dr. Allan Spreen, that is.)
“USPSTF Says No to Vitamin D, Calcium for Older Women” John Gever, ABC News, 6/13/12, abcnews.go.com
“Healthy Women Advised Not to Take Calcium and Vitamin D to Prevent Fractures” Gina Kolata, New York Times, 6/12/12, nytimes.com