Dear Dr. Roach: I read your recent column on calcium. I was recently informed by my physician that there is a link between excess calcium and heart disease. She recommended that I stop taking calcium supplements. I feel like I’m between a rock and a hard place: osteoporosis versus heart disease.
Does the type of calcium matter — i.e., calcium carbonate or calcium citrate? From my research, I learned that calcium citrate is better for my bones. But now I don’t know what to do.
The effect of supplemental calcium on coronary artery disease remains controversial, with some studies showing no effect and others suggesting an increased risk in supplement users. In contrast, the effect of dietary calcium on heart disease has been protective in several studies. I recommend that whenever possible, calcium intake should be through diet, as it is possible to get all the calcium your bones need from diet. So my previous advice on calcium for kidney stones (diet reduces risk, supplements increase it) may be true with heart disease as well. Avoiding calcium supplements is most important for people at higher risk for coronary disease or those who already have it.
However, for people with osteoporosis who cannot take in enough dietary calcium (good sources include dairy, green leafy vegetables such as kale and broccoli, and fish with bones, such as sardines), I think there is an overall benefit to taking calcium. Calcium citrate is better absorbed than calcium carbonate, but there is no known difference in heart risk between the two, if indeed there is any increase in risk.
Dear Dr. Roach: I am a 63-year-old female whose only medical issue is Graves’ disease. I had a thyroidectomy and am now on thyroid replacement. My question has to do with cholesterol levels. My HDL is 100, my LDL is 88, and my total cholesterol is 204. My doctor says to try to lower my levels. My HDL (good cholesterol) is quite high, so should I try to lower that number in order to bring down my total number? My levels have been like this since I had my thyroid removed. Should I try to lower both numbers? My triglyceride level is 59, and all other blood work looks good. I am confused as to what to do.
I am confused why your doctor wants you to lower your cholesterol. Your HDL is higher than your LDL, which is not a common occurrence, and it puts you at substantially lower-than-average risk for blockages in the arteries of your heart. I wouldn’t treat your cholesterol with medications at all.
The first treatment for cholesterol is normally a good diet, low in simple sugars and starches, high in vegetables and fruits, good protein sources, and liberal amounts of healthy fats, such as those in nuts and olive oil. Along with a healthy diet, regular exercise, such as a brisk 30-minute walk daily, can also help with cholesterol.
More importantly, these healthy lifestyle changes not only reduce heart-disease risk, they help reduce cancer risk, probably reduce risk of Alzheimer’s disease and help make people feel well and live longer.
Perhaps your doctor is recommending healthy lifestyle changes for the myriad benefits, not just your cholesterol. I would certainly not recommend medication treatment in a healthy person with your cholesterol numbers except under very unusual circumstances, such as if you had a twin with heart disease (a situation I have seen once).
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.