Making too much of a weak case against calcium supplementation
In response to Bolland et al’s recently published meta-analysis about calcium’s role in increased myocardial risk (British Medical Journal July 2010), the majority of respondents from around the world believe the research is seriously flawed and the conclusion poorly justified.
You can read for yourself the array of comments from health and research professionals on the BMJ (British Medical Journal) website.
Whilst there are some who applaud the research conducted by Mark J Bolland (senior research fellow) and friends at the Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, their logic in doing so is as equally flawed as the research itself.
The first thing about this "research" that you must understand is that it is not in itself a well conducted, controlled clinical trial; it is a critique of a carefully selected
group of studies that had looked at the use of prescribed calcium supplementation for osteoporosis. Bolland's analysis of these studies looked at the rate of myocardial events amongst the groups and came up with the conclusion that calcium supplementation increases the risk of myocardial events by 30%.
Unfortunately, the mainstream media being the “bad news” and “anti natural health” hounds that they are picked up the story and ran wild with it, putting fear into the hearts and minds of calcium supplementers and osteoporosis sufferers across the globe.
The majority of respondents to the publication of the article in the BMJ believe that the meta-analysis was poorly conducted, fundamentally flawed and the conclusions confusing and largely unjustified. I tend to agree. It is my opinion that this research is little more than an exercise in propaganda designed to confuse and scare the lay-public into a fear of taking dietary supplements.
This study uses “drug model” analysis (poorly conducted even by pharmaceutical reasearch analysis standards) on a “drug style”, high dose, single nutrient supplement to support earlier statements by Prof. Reid that dietary supplements should be considered dangerous.
The analysis is flawed in so many ways, not least is the nutritional understanding that calcium does not act alone in the body whether it be from dietary or supplemental sources. It has always been our contention that calcium supplementation should be undertaken only in conjunction with important cofactors such as magnesium, manganese, boron, zinc and of course vitamin D.
If you don’t have time to read through the published meta-analysis or the comments from health professionals around the globe, here are a few comments that I found particularly pertinent:
The alleged danger this time: supplemental calcium was associated with a 30% increased risk of myocardial infarction, so the risks now outweigh the benefits. But was this proven? NO! Absolutely not. Nada. Zilch. Even the authors of this analysis know better than to claim that their report was definitive proof of these alleged dangers. Neil E. Levin, CCN, DANLA is a nationally board-certified clinical nutritionist with a Diplomate in Advanced Nutritional Laboratory Assessment
This study had no mention of magnesium levels or intake which is a major variable. Magnesium is also necessary for vitamin D metabolism, which was another problem with the study no 25 (OH) levels were done. Vitamin D has been shown to be cardioprotective. Most of the patients in the world are vitamin D deficient. Paul Battle PA-C, Physician Assistant, B.S Physiology, Denver, Colorado
30% in a meta-analysis of heterogenous studies is not very much and raises the question of significance. The diminutive risk is discounted by the lack of baseline data for a number of the included studies for hypertension, weight, and smoking, which could easily account for a 30% difference, each. Retiree from the National Library of Medicine, USA
The concern here is that Bolland et al's paper is going to dissuade our local patient population from taking their calcium supplements - when it doesn't apply to 96.5% of them, as they would have been excluded from the meta-analysis. Matthew L Grove, Consultant Rheumatologist, North Tyneside, UK
The paper by Bolland et al. is seriously flawed in many respects, the first of which is its misleading title. It is not a meta-analysis in the usually accepted sense i.e a review of published trials and a bringing together of their final collective meaning and statistical significance. Most of the data are unpublished, obtained by direct request from the relevant authors and impossible to verify. It provides some data from 15 trials but only 5 have patient level data. B.E. Christopher Nordin, Osteoporosis & calcium supplementation specialist, Visiting Professor, University of Adelaide
At present, it is simply a hypothesis without a biologically rational explanation and unsupported by a recent genuine meta-analysis which they do not quote. Unfortunately their paper is causing widespread concern among the public – even among some doctors – and threatens to set back the cause of osteoporosis prevention by a decade or more. It can only bring satisfaction to the manufacturers of more expensive pharmaceuticals. B.E. Christopher Nordin, Osteoporosis & calcium supplementation specialist, Visiting Professor, University of Adelaide
I conclude from this finding, as well as comments submitted by others re: the nature of the meta-analysis done, that the authors' purported link between calcium supplementation and risk of MI is theorized, but is far from clearly demonstrated. WIlliam H. Stigelman, Jr., Pharm.D. Ohia, USA
This poorly conducted piece of so-called “scientific research” presents more questions regarding the value and validity of meta-analytical research than it does about the safety (or non-safety as presented in this case) of calcium supplementation.
Whilst there is growing evidence to suggest that the orthodox thinking on calcium supplementation needs to be seriously looked at, this data analysis excluded supplementation that gave a better, broader base of mineral and vitamin supplementation and erronously fingered all calcium supplementation as "dangerous to health".
Whilst we also beleive the meta-analysis to be a very poor piece of "science" the findings strengthen the long held belief of natural health and nutritional experts that long term use of high dose, single nutrient supplementation is rarely a good thing. Nutritional supplementation should be utilised by those that need it to support and bolster an otherwise healthy diet (or more commonly long term unhealthy dietary practices that may or may not have been rectified).
Due to a variety of factors such as aggressive farming and land/crop mismanagement, unripe harvesting, chemical contamination, long storage, over processing and generally poor dietary habits, nutritional deficiencies are becoming more common than ever before. The food our grandparents and great grandparents had access to was very different to the food we have commercially available to us today.
So, dietary supplementation is more important now than ever before. But dietary supplements should reflect the complex nature of foods in that nowhere in nature is a nutrient found in isolation and never before has man eaten isolated nutrients in intense doses over a prolonged period of time.
Good quality dietary supplements, especially those that provide minerals such as calcium, should also provide the important co-factors for absorption, metabolism and utilisation of those nutrients. In the case of calcium these co-factors include magnesium, manganese, boron, zinc and vitamin D3.
Professor Chris Nordin from the Royal Adelaide Hospital in Australia has been working on calcium metabolism and osteoporosis for more than 50 years. He drafted the World Health Organisation dietary calcium recommendations which he stands by despite oposition from researchers such as Bollard and Reid. Prof. Nordin recommends 1000IU vitamin D3 and 600-1200mg elemental calcium (from all sources) daily for optimal bone health - the higher dose is especially important for post menopausal women.
Do not fear taking good quality, moderately dosed, multi-nutrient, calcium containing dietary supplements – there is no evidence to suggest these increase the risk of adverse events
Article author: Jacqui Simcock, Naturopath, Medical Herbalist, Technical Manager Health & Herbs International Ltd, New Zealand
Health & Herbs provide a variety of premium quality multi-nutrient dietary supplements including:
Radiance Calcium Complex
Radiance Mineral Power
Radiance Multi Power
Radiance Magnesium Complex
Nature’s Way Alive!