Increasing calcium intake does not prevent fractures, nor are supplements useful for bone remineralization .
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Tell me three truths about bone health:
- - It is necessary to take a lot of calcium to have strong bones.
- - Dairy products are essential and protect us from osteoporosis.
- - If, despite having a high consumption of dairy products (ergo, calcium), our bone density suffers, it will be fixed by taking calcium in supplements or calcium-fortified foods.
Many will think that these three statements are obvious, everyone knows them and you do not have to be a nutritionist ... These messages come to us continuously through advertising, food marketing and the advice of some experts. Nothing new. Dairy = calcium = strong bones.
Although the truth is that it may not be so true.
It is encouraged not to leave the dairy products even if they are not tolerated, without much pausible evidence and with economic interests behind
Maybe the dairy industry has an interest in these messages and strives to reach us, especially when the trend indicates that sales fall. Maybe calcium intake is not directly proportional to bone mineralization . Perhaps there are preventive strategies for osteoporosis that are not prioritized because they do not report any economic benefit to any industry. Perhaps professional advice is often outdated or biased by interests, or poorly updated.
Yes, we started strong. Let's reduce the tension by talking a little about the recommended calcium intakes:
How much calcium?
Calcium intake recommendations are very variable among countries with similar conditions; we went from 900mg per day for adults in Spain to 1,000mg in the US or 700mg in the United Kingdom for the same age range. 30% less for the British than for the Americans, yes. The EFSA (European Food Safety Authority) for its part indicates a reference intake of 1,000 mg / day from 18 to 24 years and 950 mg / day for people over 25 ( PDF ). No changes in pregnancy or breastfeeding (Spain rises to 1,200mg in breastfeeding and the United Kingdom to 1,250mg) Do I need less calcium in London than in Madrid? If I breastfeed, do I increase my calcium intake by more than 60% as advised by the UK or do I keep it the same as the EFSA states? Or are the recommendations very dependent on other variables such as the type of diet, the bioavailability of the mineral and the interests of the person who formulates them? It is difficult to answer. But it is worth sowing the doubt and highlight that things are far from clear.
Do we take enough calcium?
Yes, we have enough, according to the Spanish Nutrition Foundation ( PDF ) and according to a study by Eduard Baladia, Julio Basulto and María Manera ( PDF ). Is media bombing with the issue needed then? Even if the intake is low ( as suggested by other sources ), is consuming more calcium the best strategy for good bone health? No: neither increase the intake prevents fractures , nor supplements are useful for bone remineralization . To these conclusions came two reviews published in the British Medical Journal in 2015.
It seems that the affirmations that opened the article begin to not be so clear.
The population is pressured to achieve a high calcium intake, especially in childhood and in postmenopausal women. All kinds of products focused on these objectives are designed: yogurts with twice as much calcium, milk enriched with even more calcium, children's products that outline in the package its content in such a heavy mineral ... It is encouraged not to leave dairy products even though they are not tolerated , because the industry gives solutions, launching government campaigns ... All without much pausible evidence and economic interests behind.
Meanwhile, one in four postmenopausal women have osteoporosis (according to the Spanish Society of Rheumatology in 2015 ), and the trend is increasing. It does not seem that the strategy is working at the level of population health.
Leaving aside economic interests, it can be said that insisting on increasing calcium intake lacks justification, from a health point of view. On the other hand, they are remarkably more effective indications to prevent osteoporosis and take care of bone health: recommend physical activity (especially strength exercises), an adequate protein intake (especially in the elderly), maintain a good level of vitamin D, moderate consumption of salt, get enough magnesium and vitamin K consuming vegetables, do not drink and do not smoke. And in the prevention of non-communicable diseases in general, incidentally.
But the message that the population receives is only to increase the calcium intake. And based on dairy, even if you do not like them or do not tolerate them. Dairy products that are frequently accompanied by huge amounts of sugar, especially those intended for children. You could even say that these sugary dairy products are a product to avoid and not to recommend.
Can economic interests have more weight in public health guidelines than the evidence itself? Maybe it's not just happening with dairy and calcium?
Lucía Martínez Argüelles , is a dietitian-nutritionist, master in nutrigenomics and personalized nutrition, TSD.
NUTRIR CON SCIENCIA is a section on nutrition based on scientific evidence and knowledge contrasted by specialists. Eating is much more than a pleasure and a necessity: diet and eating habits are now the public health factor that can most help us prevent many diseases, from many types of cancer to diabetes. A team of dieticians-nutritionists will help us to better understand the importance of food and to tear down, thanks to science, the myths that lead us to eat badly.