“You can get past the dead end. You can break through the ceiling. I did and so have countless others.”

Clinical Pearl Wednesday #159

The golden child of supplements used to be calcium, but in recent years, calcium has been linked to the hardening of the arteries and cardiovascular disease. Because of this newer information, many experts are much more hesitant to recommend calcium nowadays.  

The Coronary Artery Calcium scan has become a very useful tool for determining actual plaque accumulation in arteries of the heart.  Although insurance does not typically cover this test, it isn’t terribly expensive and can often be requested by patients without an order from a prescriber.  The cost runs about $150 – 200 in most places.  Even for us as prescribers, this test may offer great benefit to our patients because the CAC provides a score that indicates the amount of calcification identified during the 5-minute CT scan.  

Scores less than 100 indicate very little calcification or arterial plaque buildup, whereas a score up to about 400 indicates a moderate amount of plaque.  A score greater than 400 indicates a lot of calcification and should be addressed because these elevated scores are associated with the highest risks of CV disease, including CVA and MI events. 

So, what does that have to do with calcium? Because the CAC test evaluates the actual amount of calcification of arteries, it poses risks to patients if we continue to advocate or recommend high doses of calcium supplementation.  Food sources of calcium have NOT been shown to be correlated with coronary calcification.  

Also, note that there may be a few patients who DO need calcium supplementation, but as prescribers, we should evaluate the risks vs. benefits AND consider HOW we make those recommendations.  Low-dose calcium supplements taken WITH food may pose less risk than a 1200 mg dose taken mid-afternoon by itself; we have no specific data regarding timing, but it’s a logical thought process, don’t you think?  We can also encourage Vitamin D3 and Vitamin K2 alongside the calcium to help ensure more effective and efficient absorption of all three supplements.  So, the next time you think about recommending high-dose calcium, think about where that excess calcium may end up. 

2 Responses

  1. Thank you for this article! I’ve long been a proponent of Vitamin D3 and understand the importance of taking K2 with it. My understanding is that K2 in the form of MK-7 is more bioavailable than MK-4, but that MK-4 has more support for bone health and reducing fractures.
    1) Do you have any insight or recommended resources on determining the best form of K2 to be taken in conjunction with Vitamin D3 and calcium and/or how to differentiate between which is best on a case-by-case basis?
    2) Do you know or have resources on determining the best ratio of Vitamin D3 to K2? (Oftentimes if purchased together as a single supplement, this ratio is already done for you, but if you want to double someone up on their Vitamin D3 dose, is it safe to also double up on the K2? Or would it be best to take them separately and double the D3 dose while maintaining the single K2 dose?) I’m probably overthinking this, but it’s a question for which I haven’t been able to figure out a solid answer yet. Thanks!

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