Understanding Calcium: Supplements, Calcium Carbonate, Calcium Citrate, and More

Experts share their advice about what to consider when choosing a calcium supplement.

Are you getting enough calcium in your diet? Maybe not, especially if you're a woman or a teenage girl. Although Americans have improved at this in recent years, we're still not getting enough calcium to maintain our bone health.

How much is that? It depends on your age. According to the Institute of Medicine, the recommended daily amount of calcium to get is:

1-3 years: 700 milligrams daily4-8 years: 1,000 milligrams daily9-18 years: 1,300 milligrams daily19-50 years: 1,000 milligrams daily51-70 years: 1,200 milligrams daily for women; 1,000 milligrams daily for men71 and older: 1,200 milligrams daily

The Institute of Medicine says that most in the U.S. get enough calcium, except for girls 9 to 18 years old. Although women’s recommended calcium needs to increase with menopause, postmenopausal woman taking supplements may also be at greater risk of getting too much calcium.

"We know that peak bone mass occurs around age 30, so it's very important in childhood and adolescence to have a healthy intake of calcium early on," says Marcy B. Bolster, MD. She is a professor of medicine in the division of rheumatology and immunology at the Medical University of South Carolina and director of the MUSC Center for Osteoporosis and Bone Health.

"After age 30, we start to gradually lose bone, and that loss accelerates for women at the time of menopause. So it's very important to stave off bone loss with adequate calcium intake."

Your health care provider may recommend calcium supplements. But with so many choices of calcium supplements, where should you start? Here's what you need to know.

"I tell my patients to take the kind that they tolerate best and is least expensive," Bolster says. She says she recommends calcium carbonate because "it's inexpensive, won't cause discomfort, and is a good source of calcium."

Some people's bodies may have problems making enough stomach acid, or may be taking medications that suppress acid production. For them, says J. Edward Puzas, MD, a calcium citrate supplement might be better because it "dissolves a little better than calcium carbonate for these people." Puzas is a professor of orthopedics and director of orthopedic research at the University of Rochester Medical Center in New York.

What about other types of supplements, like calcium plus magnesium, coral calcium, and so on? Not necessary, the experts tell WebMD. But they note that supplements that combine calcium with vitamin D -- which is essential for the body to appropriately absorb calcium -- provide an added benefit.

The body can absorb only about 500 milligrams of a calcium supplement at any one time, says Puzas, so you can't just down a 1000-mg supplement first thing in the morning and call it a day.

Instead, split your dose into two or three servings a day. "The best way to take it is with a meal; calcium is absorbed better that way," Puzas says. If your daily diet includes calcium-containing foods and drinks, you may not need multiple doses.

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Iron Supplements May Prevent Anemia During Pregnancy

The benefits also include improved birth weights, analysis shows

By Robert Preidt

HealthDay Reporter

FRIDAY, June 21 (HealthDay News) -- Taking iron supplements during pregnancy reduces women's risk of anemia and is linked with an increase in birth weight and a reduced risk of low birth weight, a new analysis finds.

Researchers examined more than 90 studies that included a total of nearly 2 million pregnant women and found that daily iron supplements significantly reduced women's risk of anemia during pregnancy.

Anemia during the first or second trimester was associated with a significantly higher risk of low birth weight and preterm birth, according to the study, which was published online June 20 in the journal BMJ.

In addition, the investigators found that for every 10 milligram increase in iron dose per day (up to 66 mg), mothers had a 12 percent lower risk of anemia, birth weight increased by 15 grams and the risk of low birth weight fell by 3 percent.

The World Health Organization recommends that pregnant women take 60 mg of iron per day, the study authors noted in a journal news release.

They also said iron deficiency is the most common nutritional deficiency in the world, and the most common cause of anemia during pregnancy, particularly in low- and middle-income countries. It is estimated that iron deficiency affected 32 million pregnant women worldwide in 2011.

"Our findings suggest that use of iron in women during pregnancy may be used as a preventive strategy to improve maternal [blood] status and birth weight," Batool Haider, of the departments of epidemiology and nutrition at Harvard School of Public Health in Boston, and colleagues wrote.

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Rheumatoid Arthritis (RA): Best and Worst Supplements and Herbs

WebMD explains which supplements and herbs may help relieve rheumatoid arthritis symptoms and which ones you should not take.By Karen Springen
WebMD Feature

At 35, Chicago flight attendant Michele Mason says her bones felt like “pins and needles” were in them, and her hands were so swollen that she found it difficult to put on her infant son’s socks. Her knees ached, too. “I couldn’t even get out of the bathtub by myself,” she says.

When her doctor suspected rheumatoid arthritis, Mason worried that traditional medicines might not be good for her breastfeeding baby. So with her doctor’s blessing, she took a very low-dose steroid and turned to herbs and supplements, including boswellia (Indian frankincense) and fish oil, to help relieve the pain and inflammation.

A year later, her diagnosis of rheumatoid arthritis was confirmed. “I was happier to go with what I felt was a safer route with herbs,” she says. “While they didn’t make it go away, they did give me some relief."   

Like Mason, about 30% of patients surveyed from North Carolina with rheumatoid arthritis have tried supplements, according to a study in Preventing Chronic Disease . “And use is increasing,” says study co-author Leigh Callahan, PhD, associate professor of medicine, orthopaedics and social medicine at the Thurston Arthritis Research Center at the University of North Carolina at Chapel Hill.

So what are the best herbs and supplements for RA? And, are they safe? Here's what you need to know. 

First, know that herbs and supplements haven't been studied in the same way that prescription medicines for RA have. “There’s a tremendous disconnect between their widespread usage and people’s belief in their efficacy compared to what we’ve actually proven scientifically,” says Chaim Putterman, MD, chief of rheumatology at Montefiore Medical Center and Albert Einstein College of Medicine.

That is changing as the National Institutes of Health has a well-established center dedicated to studying complementary and alternative medicine . In the meantime, experts say that although some herbs and supplements may help relieve inflammation, they're best used in combination with RA medicines. “It’s not a good reason to throw out their disease-modifying anti-rheumatic drugs," says William St. Clair, interim chief of the division of rheumatology at Duke University Medical Center.”

Always talk to your doctor first, because herbs and supplements may interfere with other medicines you are taking. Remember, too, that since they are not regulated in the same way that drugs are, you cannot always be sure what you are buying, says St. Clair.

The National Center for Complementary and Alternative Medicine (NCCAM) recommends that women who are pregnant or nursing, or those considering CAM use in children use extra caution and consult their health care provider.

With that in mind, here are the herbs and supplements some experts suggest for RA.

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Understanding Calcium: Supplements, Calcium Carbonate, Calcium Citrate, and More

Experts share their advice about what to consider when choosing a calcium supplement.

Are you getting enough calcium in your diet? Maybe not, especially if you're a woman or a teenage girl. Although Americans have improved at this in recent years, we're still not getting enough calcium to maintain our bone health.

How much is that? It depends on your age. According to the Institute of Medicine, the recommended daily amount of calcium to get is:

1-3 years: 700 milligrams daily4-8 years: 1,000 milligrams daily9-18 years: 1,300 milligrams daily19-50 years: 1,000 milligrams daily51-70 years: 1,200 milligrams daily for women; 1,000 milligrams daily for men71 and older: 1,200 milligrams daily

The Institute of Medicine says that most in the U.S. get enough calcium, except for girls 9 to 18 years old. Although women’s recommended calcium needs to increase with menopause, postmenopausal woman taking supplements may also be at greater risk of getting too much calcium.

"We know that peak bone mass occurs around age 30, so it's very important in childhood and adolescence to have a healthy intake of calcium early on," says Marcy B. Bolster, MD. She is a professor of medicine in the division of rheumatology and immunology at the Medical University of South Carolina and director of the MUSC Center for Osteoporosis and Bone Health.

"After age 30, we start to gradually lose bone, and that loss accelerates for women at the time of menopause. So it's very important to stave off bone loss with adequate calcium intake."

Your health care provider may recommend calcium supplements. But with so many choices of calcium supplements, where should you start? Here's what you need to know.

"I tell my patients to take the kind that they tolerate best and is least expensive," Bolster says. She says she recommends calcium carbonate because "it's inexpensive, won't cause discomfort, and is a good source of calcium."

Some people's bodies may have problems making enough stomach acid, or may be taking medications that suppress acid production. For them, says J. Edward Puzas, MD, a calcium citrate supplement might be better because it "dissolves a little better than calcium carbonate for these people." Puzas is a professor of orthopedics and director of orthopedic research at the University of Rochester Medical Center in New York.

What about other types of supplements, like calcium plus magnesium, coral calcium, and so on? Not necessary, the experts tell WebMD. But they note that supplements that combine calcium with vitamin D -- which is essential for the body to appropriately absorb calcium -- provide an added benefit.

The body can absorb only about 500 milligrams of a calcium supplement at any one time, says Puzas, so you can't just down a 1000-mg supplement first thing in the morning and call it a day.

Instead, split your dose into two or three servings a day. "The best way to take it is with a meal; calcium is absorbed better that way," Puzas says. If your daily diet includes calcium-containing foods and drinks, you may not need multiple doses.

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Testosterone Supplements May Hurt Male Fertility, Study Finds

Infertility clinics find that many men seeking help were taking 'T'

By Randy Dotinga

HealthDay Reporter

FRIDAY, May 10 (HealthDay News) -- Testosterone supplements are touted as a cure for low libido, but men who take them may reduce their odds of fathering a child, new research suggests.

Many men who sought infertility treatment at two U.S. clinics reported taking prescription testosterone supplements, according to a new study. And in most cases their sperm counts skyrocketed after they stopped taking the male hormone.

The study, limited to a pair of clinics in Alabama and Kansas, looked at the years 2005 to 2011. The researchers don't know if testosterone supplements, which continue to gain popularity, are contributing to even more cases of infertility now. Nor is it clear whether the hormone is harming fertility across the nation.

Still, the research suggests that testosterone spells trouble for many American men who want to have children, said study co-author Dr. Peter Kolettis, a professor of urology at the University of Alabama at Birmingham. "This has become a preventable cause of infertility."

Use of testosterone supplements -- or "T" -- is rapidly rising in the United States, and some observers think usage will remain inflated as more men see it as a possible cure for fatigue and flagging sex drive. Critics, however, question whether testosterone treatment is being prescribed to men who don't need it.

"More men are coming into [doctors'] offices asking for testosterone because they've seen the advertisements, and it looks like the fountain of youth: It will reduce fat, make them look sexier," said Dr. Bradley Anawalt, an endocrinologist and chief of medicine service at the University of Washington Medical Center in Seattle, who was not involved in the study.

But testosterone can cause side effects such as male breast growth and blood clots. And "very few physicians are warning that it will turn off their sperm production," Anawalt said.

Adding testosterone to the body through supplementation spurs a process that impedes sperm production, Anawalt said. "Men struggling with fertility should not be on testosterone," he said. "[But] this is not something that most physicians or patients are thinking about."

The study, presented Wednesday at the annual meeting of the American Urological Association in San Diego, aimed to find out how many infertile men take the supplements despite the risks.

The researchers examined medical records of more than 1,500 men with an average age of 35 who sought fertility treatment at the two clinics.

Seven percent of the men were taking supplemental testosterone prescribed by a physician. The study focused on 34 men who agreed to stop using the hormone supplements.

Overall, the sperm counts of most patients bounced back. Average sperm concentration in semen jumped from 1.8 million per milliliter to 34 million per milliliter after supplemental testosterone was discontinued.

But the sperm counts of six of the 34 patients didn't recover. Testosterone treatments normally don't hurt fertility permanently, and it's not clear if they played a role in the men's continued infertility. The study also did not prove a direct cause-and-effect relationship between testosterone supplements and lowered sperm count.

Anawalt said it typically takes between one and six months for a man's sperm count to recover after he stops using a testosterone supplement.

Kolettis, the study co-author, said certain men should avoid testosterone supplements. "I tell men not to take it until they're done having their own biological children," he said.

The supplemental testosterone in question is prescription-only, and unrelated to over-the-counter supplements marketed to increase testosterone production.

Data and conclusions presented at meetings should be considered preliminary until published in a peer-reviewed medical journal.

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Glucosamine Supplements Tied to Risk of Eye Condition

Seniors taking them had side effect that has been linked to glaucoma, small study finds

By Denise Mann

HealthDay Reporter

THURSDAY, May 23 (HealthDay News) -- Glucosamine supplements that millions of Americans take to help treat hip and knee osteoarthritis may have an unexpected side effect: They may increase risk for developing glaucoma, a small new study of older adults suggests.

Glaucoma occurs when there is an increase of intraocular pressure (IOP) or pressure inside the eye. Left untreated, glaucoma is one of the leading causes of blindness.

In the new study of 17 people, whose average age was 76 years, 11 participants had their eye pressure measured before, during and after taking glucosamine supplements. The other six had their eye pressure measured while and after they took the supplements.

Overall, pressure inside the eye was higher when participants were taking glucosamine, but did return to normal after they stopped taking these supplements, the study showed.

"This study shows a reversible effect of these changes, which is reassuring," wrote researchers led by Dr. Ryan Murphy at the University of New England College of Osteopathic Medicine in Biddeford, Maine. "However, the possibility that permanent damage can result from prolonged use of glucosamine supplementation is not eliminated. Monitoring IOP in patients choosing to supplement with glucosamine may be indicated."

Exactly how glucosamine supplements could affect pressure inside the eye is not fully understood, but several theories exist. For example, glucosamine is a precursor for molecules called glycosaminoglycans, which may elevate eye pressure.

The findings are published online May 23 as a research letter in JAMA Ophthalmology.

The study had some shortcomings. Researchers did not have information on the dose or brand of glucosamine used, and they did not know how long some participants were taking the supplements.

Duffy MacKay, vice president for scientific and regulatory affairs at the Council for Responsible Nutrition, a Washington, D.C.-based trade group representing supplement manufacturers, said the findings don't mean that people should stop taking the supplements.

"This research letter raises questions and introduces a hypothesis that should be explored further, but the small number of cases investigated and the [fact that] researchers did not count capsules or control for dose or intake or duration of use of glucosamine provide extremely limited evidence of harm," MacKay said.

"This study should not change consumer habits; however, individuals with glaucoma or ocular hypertension who are taking glucosamine should let their doctor know so that the appropriate monitoring of intraocular pressure measurements can be done to identify any changes," he said.

MacKay concluded: "The good news is that increased IOP was reversible. So if you take the product, and your IOP goes up, then you can stop taking the product to see if it returns to normal."

However, previous studies have raised questions about whether glucosamine supplements provide any health benefit to consumers. A large recent study concluded it had no healing effect on arthritic pain.

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Vitamin D Supplements Tied to Lower Blood Pressure in Blacks

Study found modest, but significant, drops depending on dosage

By Steven Reinberg

HealthDay Reporter

FRIDAY, March 15 (HealthDay News) -- Black Americans who take vitamin D supplements may significantly lower their blood pressure, a new study suggests.

"Compared with other races, blacks in the United States are more likely to have vitamin D deficiency and more likely to have high blood pressure," said lead researcher Dr. John Forman, an assistant professor of medicine at the renal division of Brigham and Women's Hospital in Boston.

But among the black study participants, three months of supplemental vitamin D was associated with a drop in systolic blood pressure (the top number in a blood pressure reading) of up to 4 mm Hg, the researchers found.

"If our findings are confirmed by other studies, then vitamin D supplementation may be a useful means of helping black individuals lower their blood pressure," Forman said.

Dr. Michael Holick, a professor of medicine, physiology and biophysics at Boston University School of Medicine, said that vitamin D may lower blood pressure by causing blood vessels to relax, allowing for more and easier blood flow.

In addition, because many black Americans are deficient in vitamin D, taking a supplement may benefit their health even more, said Holick, who was not involved with the study.

"We are now beginning to believe that a lot of the health disparities between blacks and whites are due to vitamin D deficiency, including the risk for type 2 diabetes, heart disease, cancers and even infectious disease," he said.

Diet and sunlight are two natural sources of vitamin D in humans. However, having dark-colored skin cuts down on the amount of vitamin D the skin makes, according to the U.S. National Institutes of Health.

For the study, published online March 13 and in the April print issue of the journal Hypertension, Forman's team randomly assigned 250 black participants to one of three doses of vitamin D supplements or an inactive placebo.

After three months, the researchers found that those taking 1,000 international units (IU) of vitamin D a day saw their systolic blood pressure drop by 0.7 mm Hg. For those taking 2,000 IU, the drop was 3.4 mm Hg, and for those taking 4,000 IU, systolic pressure dropped by 4 mm Hg.

In contrast, those receiving the placebo saw their systolic blood pressure rise by 1.7 mm Hg, the researchers noted.

Forman said the gains from supplemental vitamin D were significant, but modest. In addition, there were no changes in diastolic blood pressure among those in any group.

Systolic blood pressure is pressure in the arteries when the heart beats. Diastolic blood pressure, the bottom number, is pressure in the arteries between heart beats, the study authors pointed out.

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Are calcium supplements unhealthy for men?

Posted May 16, 2013, 2:00 am

I’m a man in my 60s. I’ve been taking a calcium supplement to protect my bones, but I recently read that men shouldn’t take calcium supplements. Why not?

I wish I could give you a clear answer. Several recent studies have raised a question about whether regular use of calcium supplements might be bad for the heart. The bottom line: It’s too early to know if this risk is real.

There’s no doubt that we need calcium. It helps muscles to contract, blood to clot and nerves to communicate. And it plays an important role in building strong teeth and bones. As a result, many people take calcium supplements for bone health.

One new study followed the health of nearly 400,000 men and women. The study was published in the medical journal JAMA Internal Medicine. At the study’s start, the participants reported how much supplemental calcium they took. From diet surveys, the researchers estimated how much calcium the study participants were getting from food.

During 12 years of follow-up, men who took more than 1,000 milligrams (mg) of supplemental calcium per day were 20 percent more likely to succumb to heart disease than those who didn’t take calcium supplements. But there was no connection between calcium supplements and heart disease in women, and there was no connection with calcium from food.

Another recent study that followed more than 61,000 women in Sweden was published in the medical journal BMJ. Among women who took more than 1,400 milligrams per day of calcium supplements, the risk of premature death was more than doubled — particularly death from heart disease.

Both of these studies, and others that have pointed in a similar direction, involve large numbers of people and were carefully conducted. Yet they are observational studies, and you can’t make judgments about cause and effect from such studies. They clearly showed that men and women who took relatively high doses of calcium supplements had higher risks. But that doesn’t prove that the calcium supplements were the cause of higher rates of heart problems and death.

Surely, these studies don’t mean that you should forsake all calcium. Everyone needs calcium to keep bones strong, taken in conjunction with the bone-building vitamin, vitamin D. Losing calcium weakens bones and leaves them more prone to breaking. (I’ve put a table listing the daily recommended intakes of calcium and vitamin D below.)

With the safety of calcium supplements in question, try to get as much calcium as possible from food. Good calcium sources include:

Low-fat milk and cheese;Calcium-fortified orange juice or soy milk;Breakfast cereals (which are also fortified);Leafy greens, particularly, kale, turnip greens and Swiss chard. (Go easy on spinach. It is high in iron, which tends to block calcium absorption.)Sardines and other canned fish with bones included.

I’m sure there will be more research studies on this important question. I’ll keep you posted.

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Do Vitamin Supplements Make Sense?

Feb. 27, 2013 -- For years, women have been told to take extra calcium to guard against osteoporosis.

But doctors just reversed that advice. After looking at scores of studies, the U.S. Preventive Services Task Force (USPSTF) says that common doses of calcium and vitamin D don’t prevent fractures in women past menopause who have healthy bones, and they may raise the risk of kidney stones.

That recommendation comes on the heels of two new studies showing that men and women with high calcium levels from supplements were more likely to die of heart disease than those who got less calcium or who got their calcium from diet alone.

Calcium is just the latest supplement to falter under scientific scrutiny. Other studies have questioned the value of fish oil, and antioxidants like vitamins C, E, and beta-carotene.

Does that mean you should ditch your daily calcium pill? What about other kinds of supplements?

Experts on both sides of the debate say that despite discouraging headlines, it’s still smart for some people to take supplements, depending on their individual nutritional needs.

“I think scientists are still trying to make sense of it all, particularly the latest calcium studies. In many cases the risks don’t appear to apply to all people,” says Carol Haggans, a registered dietitian who keeps up with the latest research for the Office of Dietary Supplements at the National Institutes of Health.

Duffy MacKay, ND, cautions that nutrition research is complex and still “in its infancy.” He is vice president of scientific and regulatory affairs at the Council for Responsible Nutrition, a group that promotes supplements. 

Haggans says people should get two messages loud and clear:

Whole foods nearly always top pills. “We need certain amounts of these vitamins and minerals, and it’s preferable to get them from eating a variety of healthy foods. That really should be the basis of what people are trying to do,” she says.More is not better. “When you’re starting to take individual supplements or higher doses, that’s when you can potentially get into trouble,” she says.

Here’s what science says about several other popular supplements:

Women planning a pregnancy need at least 400 micrograms of folic acid from fortified foods or supplements each day, according to the National Institute of Medicine. Folic acid has been shown to prevent serious birth defects of the spine and brain. It may also cut a child’s chances of developing autism.

A recent study in the Journal of the American Medical Association found that women who started taking folic acid at least a month before their pregnancy and for eight weeks after conception had a 40% lower risk of having a child with autism than women who didn’t take folic acid.

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Vitamin D Supplements: Is What You See What You Get?

Title: Vitamin D Supplements: Is What You See What You Get?
Category: Health News
Created: 2/11/2013 4:36:00 PM
Last Editorial Review: 2/12/2013 12:00:00 AM

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Calcium Supplements May Raise Odds of Heart Death in Women

By Steven Reinberg

HealthDay Reporter

TUESDAY, Feb. 12 (HealthDay News) -- Women eating a high-calcium diet and taking calcium supplements adding up to more than 1,400 milligrams a day may be running nearly twice the risk of dying from heart disease, a large Swedish study suggests.

Both men and women take calcium supplements to prevent bone loss. The new findings come on the heels of another recent study that found a similar increased risk of death related to calcium intake among men.

"Many older adults increase dietary intake of calcium or take calcium supplements to prevent bone loss and there had been speculation that increased calcium intake with or without vitamin D could improve cardiovascular health," said Dr. Gregg Fonarow, an American Heart Association spokesman who wasn't involved in the study.

However, a number of recent studies have suggested that higher dietary intake or calcium supplementation may not only not improve cardiovascular health -- they may be associated with increased risk for cardiovascular events and mortality, said Fonarow, a professor of cardiology at University of California, Los Angeles.

The new report was published in the Feb. 12 online edition of the BMJ.

To see if calcium supplements raised the risk of dying from heart disease, a team led by Dr. Karl Michaelsson, a clinical professor in the department of orthopedic surgical sciences at Uppsala University in Sweden, analyzed data collected on more than 61,000 women enrolled in a study on mammograms.

Over 19 years of follow-up, nearly 12,000 women died -- almost 4,000 dying from cardiovascular disease, about 1,900 from heart disease and 1,100 from stroke, the researchers found.

The highest rates of death were seen among women whose calcium intake was higher than 1,400 milligrams a day, the researchers noted. On the other hand, women who took less than 600 milligrams of calcium a day were also at an increased risk of death.

Moreover, women taking 1,400 milligrams of calcium a day and also using a supplement had even a higher risk of dying than women not using supplements, Michaelsson's group found.

All in all, women getting more than 1,400 milligrams of calcium a day were more than twice as likely to die than women getting 600 to 999 milligrams a day, the researchers said.

The U.S. Office of Dietary Supplements recommends 1,000 to 1,200 milligrams of calcium a day for most adults.

According to the study authors, diets very low or very high in calcium can override normal control by the body, causing changes in blood levels of calcium.

Rather than worry about increasing calcium intake of those getting enough through their diet, emphasis should be placed on people with a low intake of calcium, the authors suggest.

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Vitamin D Supplements: Is What You See What You Get?

By Denise Mann

HealthDay Reporter

MONDAY, Feb. 11 (HealthDay News) -- Many vitamin D supplements may not contain what their label says they do, a new study warns.

Some pills may pack a lot more vitamin D than the label states, and others may provide markedly less, according to the findings, published in a research letter Feb. 11 in JAMA Internal Medicine.

The researchers are more concerned by pills delivering too little of the vitamin than pills providing too much.

"It can be hard to overdose on vitamin D," said study author Dr. Erin LeBlanc, an endocrinologist and researcher with the Kaiser Permanente Center for Health Research in Portland, Ore. However, the findings "may be a concern for those who have been told by their doctor to take vitamin D if their chosen supplement does not have the amount listed."

Vitamin D is known as the sunshine vitamin because it is produced in response to exposure to natural sunlight. This nutrient is also added to milk and other foods, and is available in small amounts in fatty fish, beef liver, cheese, and egg yolks. Still, it can be challenging to get as much D as needed through diet, so supplements are often recommended. Some researchers have linked vitamin D deficiency to the bone disease osteoporosis, heart disease and some types of cancer.

Exactly how much vitamin D people need has been somewhat controversial in recent years. The independent, not-for-profit Institute of Medicine recommends 600 international units (IU) a day for teens and adults, or 800 IU for those older than 70. Some groups feel that this bar was set too low.

In the new study, researchers analyzed 55 over-the-counter bottles of vitamin D supplements from 12 manufacturers. They also tested vitamin D pills made at a compounding pharmacy, which creates individualized drugs. The manufacturers were unidentified.

Overall, the amount of vitamin D found in the supplements ranged from 9 percent to 146 percent of what was listed on the label.

When LeBlanc and colleagues tested five pills from the same bottle, the supplements had anywhere from 52 percent to 135 percent of the stated amounts. When five pills were averaged, however, two-thirds were within the stated range.

Although the vitamin supplement industry remains largely unregulated, some manufacturers volunteer to have the quality of their supplements tested by the independent, not-for-profit U.S. Pharmacopeial Convention (USP), which sets standards for supplements.

One of the study samples had USP verification. "Generally, the pills that were from this manufacturer were more accurate," LeBlanc said.

Supplements from compounding pharmacies were the least accurate, LeBlanc said.

Duffy MacKay, vice president of scientific and regulatory affairs at the Council for Responsible Nutrition in Washington D.C., a trade group representing supplement manufacturers and ingredient suppliers, said that there is no excuse for supplements to deviate from their labels. Still, he said, "I am comforted that there are no safety concerns."

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Calcium Supplements May Raise Men's Death Risk From Heart Disease

By Steven Reinberg

HealthDay Reporter

MONDAY, Feb. 4 (HealthDay News) -- Men taking calcium supplements may be running a nearly 20 percent increased risk of dying from cardiovascular disease, a new study suggests.

Both men and women take calcium supplements to prevent bone loss. In this study of calcium intake, the risk of dying from heart disease was higher for men but not for women.

"Increasing evidence indicates that too much supplemental calcium might increase the risk of cardiovascular disease," said Susanna Larsson, an associate professor at the Institute of Environmental Medicine at the Karolinska Institute, in Stockholm.

Larsson, who was not part of the study but wrote an accompanying journal editorial, added that "the paradigm 'the more the better' seems invalid for calcium supplementation."

The report was published in the Feb. 4 online edition of the journal JAMA Internal Medicine.

To find out if calcium supplements were associated with an increased risk of dying from cardiovascular disease, a team of scientists led by Qian Xiao, of the U.S. National Cancer Institute, collected data on more than 388,000 men and women, aged 50 to 71 years old. They took part in a study on diet and health conducted by the U.S. National Institutes of Health and the AARP from 1995 to 1996.

Over an average 12 years of follow-up, about 7,900 men died from cardiovascular disease, as did nearly 4,000 women. Among those who died, 51 percent of men and 70 percent of women were taking calcium supplements, the researchers found.

Xiao's group calculated that men taking 1,000 milligrams a day of a calcium supplement had a 20 percent increased risk of dying from heart disease. Men also had a 14 percent increased risk of dying from a stroke, but this was not statistically significant, the researchers said.

Among women, however, calcium supplements were not linked to an increased risk of dying from cardiovascular disease. And, calcium from diet didn't increase the risk of dying from cardiovascular disease for either sex, the researchers found.

The study authors said more research is needed to determine whether there is difference between men and women in the cardiovascular effects of calcium supplements.

"Given the extensive use of calcium supplements in the population[often for osteoporosis], it is of great importance to assess the effect of supplemental calcium use beyond bone health," the investigators concluded in the study.

Taylor Wallace, a representative of the supplement industry, faulted this and other studies because, he said, they were not specifically meant to address calcium supplements and heart disease.

Wallace, who is senior director for Scientific & Regulatory Affairs at the Council for Responsible Nutrition, said most studies of calcium supplements show no effects on the heart.

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