CalciumAlways the good guy in the world of micronutrients, calcium has long shimmered under a halo of golden publicity—until now.

In a series of out-of-left-field twists,researchers have begun to raise questions about the safety of calcium supplements, going so far as to suggest that some women who take supplements are at elevated risk of a cardiovascular event. Other studies suggest a link between supplemental calcium and painful kidney stones. Instead of clarifying matters, the ensuing flurry of media attention has spread confusion, especially as the medical world’s “take your calcium” chorus continues.

What’s a health-conscious person to do?

First, the controversy. In the April 2011 issue of BMJ, researchers reversed the seemingly conclusive findings of the massive, seemingly authoritative Women’s Health Initiative, which found no cardiovascular downside to calcium supplements.

Reexamining the initiative’s data, the contrarian researchers alleged the following:

  • Women not taking calcium supplements prior to the clinical trial were at increased risk of cardiovascular events (mainly heart attack) once they began taking them.

  • In contrast, women who were already taking calcium supplements prior to the clinical trial did not have an elevated risk once the study began.

Searching for explanations, the researchers speculated that the alleged elevation in cardiovascular risk may have stemmed from sudden,unhealthful spikes in blood calcium levels when women first began taking supplements. Equally important, they concluded that the risk seemed to decrease over time.

Predictably, critics howled, calling the contrarians’ methodology flawed and proclaiming the debate “ongoing”—much like the seesawing debate over hormone replacement therapy continues today.

For most Americans, the real risk isn’t too much calcium in our diet; it’s too little calcium, says Academy of Nutrition and Dietetics spokesperson Dee Sandquist, MS, RD, CD. Repeated studies bear out this position.

Glance at many family trees and you’ll see evidence of inadequate calcium at nearly every branch: from odd, unexpected bone fractures to once-strong frames wizened by osteoporosis.

The Academy cautions that if your diet is chronically low in calcium—or if your lifestyle is high in stress,nicotine, cannabis, alcohol,caffeine, protein, inactivity,or certain meds—your body will satisfy its needs by pulling calcium straight from your bones. This process is entirely normal, but longterm shortfalls can lead to thinning bones and other cascading negative health effects elsewhere.

Getting enough calcium is important in other ways, as it is believed to be key in protecting colon cells from carcinogenic chemicals, reducing the pain from migraines, and lessening the severity of PMS symptoms.

People with on-the-go lifestyles need to be especially attentive, as their diets tend to be based on speed, convenience, and comfort eating. Ditto for women on low-fat or fad diets, which is ironic as scientists now see a possible link between low calcium intake and obesity.

The good news? Many of the dietary superstars score major points on calcium and taste, and they take zero prep time. If you think you’re too busy to meet your long-term calcium needs naturally think again. Consume just 6 ounces of low-fat yogurt, 6 ounces of calcium-fortified orange juice, and 1.5 ounces of low-fat mozzarella cheese and you will have met about 75% of your recommended intake for the entire day. Other good sources of calcium include green leafy vegetables, dried fruits, nuts, and soy-based drinks and foods.

Excessive calcium intake usually arises from going gonzo with supplements, not from eating calcium rich foods, for the simple reason that some supplements pack a  heavyweight punch. In October 2011, a major study led by the National Institutes of Health found that a sizeable minority of older women get too much supplemental calcium.

Some people may benefit from calcium-fortified foods. Again, don’t go overboard. Combine calcium-fortified cereal with calcium-rich milk and calcium-fortified yogurt—washed down with calcium-fortified orange juice and a calcium pill—and you’re likely getting too much of a good thing,Sandquist notes.

The National Osteoporosis Foundation recommends satisfying your calcium needs first through food and taking supplements only if you fall short of the daily recommended allowance. “Many people do not need supplemental calcium,” says Susan Randall, the foundation’s senior director of science and education.

These are the foundation’s recommendations:
  • Women younger than 50 need 1,000 milligrams of calcium and 400 to 800 IUs of vitamin D daily. Women ages 50 and older need 1,200 milligrams of calcium and 800 to 1,000 IUs of vitamin D daily.

  • Men younger than 50 need 1,000 milligrams of calcium and 400 to 800 IUs of vitamin D daily. Men ages 50 to 70 need 1,000 milligrams and 800 to 1,000 IUs, while men ages 71 and older need 1,200 milligrams and 800 to 1,000 IUs.

Sandquist cautions against believing in a one-size-fits-all solution. The 20-something woman with a family history of coronary disease may not need calcium supplementation as much as one whose family tree is riddled with osteoporosis.

“Find a qualified, licensed professional who can personalize a plan for your particular needs,” Sandquist advises. Make sure to look at your total diet, total 
intake of naturally derived nutrients, and lifestyle and family history, and then determine if a supplement is needed. “If someone gets 600 milligrams of calcium a day from her diet,” she notes, “she is not going to need 1,200 milligrams of supplemental calcium.”

Quite simply, more is not better.

Researchers agree that bone health is more than a matter of calcium intake. The Academy recommends taking calcium together with vitamin D (in the form of either vitamin D3 or D2) to enhance assimilation. Some studies highlight the need to take calcium with the mineral magnesium, asserting that it keeps calcium dissolved in blood rather than being deposited in coronary arteries and kidneys, possibly leading to kidney stones. The adult Recommended Daily Allowance for magnesium is 270 to 400 milligrams.

Looking at the big picture, Randall notes, “Getting too much calcium from supplements may increase the chance of developing kidney stones and other health problems in some people.”

While researchers continue to study this important mineral, the Academy encourages consumers to eat well, focus on natural sources of calcium, get regular exercise and plenty of sleep, and seek a comprehensive dietary review by a licensed professional.