Bottom Line/HEALTH: Are you taking your calcium supplements wrong? You may be. Here’s what you need to know.

I’m Sarah Hiner, president of Bottom Line Publications, and this is our Conversation With the Experts, where we get the answers to your tough questions from our leading experts.

Today I’m speaking to Dr. Andrew Rubman, a leading naturopathic physician and the medical director of the Southbury Clinic in Southbury, Connecticut. Dr. Rubman is also a long-term contributing medical editor to Bottom Line. So welcome, Andy. It’s great to see you.

Dr. Rubman: Hi, Sarah.

Bottom Line: All right, so calcium. Probably one of the basic supplements that people have been taking forever, and yet a recent study showed that women who were supplementing with calcium had a 30% increased risk for heart attack. So, what? Is calcium suddenly wrong? Is calcium suddenly bad? Or are they doing something wrong?

Dr. Rubman: The latter. They’re doing something wrong. Number one, it’s important to understand that calcium is one of the macronutrients, which means we can’t take it by a pinch—we have to take it by the spoonful. It should be present in diet. Number two, it always needs to be paired with magnesium. Just as magnesium should never be taken by itself, calcium should never be taken by itself.

Bottom Line: And why is that, for calcium?

Dr. Rubman: Because magnesium determines the rate of uptake of most forms of calcium from the GI tract. So if you’re just taking calcium without the magnesium, chances are it’ll be in one end and out the other.

Bottom Line: Or is it going in one end and then just being absorbed into the system?

Dr. Rubman: Not usually. As we age, it becomes more and more difficult to absorb calcium. One of the problems is stress or acid suppressants. Most forms of calcium require a robust amount of hydrochloric acid in the stomach to be “chelated.” And unless it’s chelated, it won’t be properly absorbed.

Bottom Line: All right, but what happened in that research that showed that taking calcium increased heart attack?

Dr. Rubman: I believe that the research study was improperly designed. If the calcium that was used in the research was supplied in a way that it would’ve been dietarily matched with magnesium in an environment where there was sufficient amounts of vitamin D with people who were otherwise fundamentally healthy, then the research results would’ve turned out differently.

Bottom Line: How were they doing it in the study, and where did it go wrong?

Dr. Rubman: I believe that they were doing it in the study as a simple calcium supplement rather than a calcium-magnesium supplement. They weren’t checking the status of vitamin D in the people. They also weren’t making sure that the people had an adequate protein intake and adequate stomach hydrochloric acid for it to be processed properly.

So then you would say, “So why did it cause issues with the heart?” My guess is that because it was improperly processed before it was uptaken, that it contributed to inflammation within the heart and caused a certain amount of restriction in blood flow around the heart.

Bottom Line: All right, when you talk about people needing to have adequate levels of vitamin D, talk about them needing to have adequate levels of stomach acid to be able to process the calcium—most people don’t, either of those cases. So what does somebody need to do if they’re supplementing calcium in order to be sure that it is absorbed?

Dr. Rubman: They need to supplement it in conjunction with magnesium, usually a 2:1 ratio.

Bottom Line: Calcium to magnesium, twice as much calcium?

Dr. Rubman: Correct. They need to take additional vitamin D. Most of us do. We were wrong 10 years ago to say that just sunlight exposure would do it for most. That’s an important issue. And in terms of the stomach acid, I believe that most people 40 years of age or older need to be taking digestive enzymes, and that will cure issues with stomach acid. Remember, there’s no such thing as excess stomach acid in medicine.

Bottom Line: So for all those people who are taking acid-suppressing medications, is it adequate if they take calcium with magnesium and supplement vitamin D? Will that be adequate to get the absorption of the calcium?

Dr. Rubman: Probably not. They need to take it in a different form. If they really have their heart set on staying on that medication, they need to take a calcium and magnesium supplement which is the salt of butterfat. That’s absorbed in a special pathway, the same way as it’s absorbed from mother’s milk in the very, very young infant.

Bottom Line: What’s the salt of butterfat?

Dr. Rubman: Butterfat is an organic acid, butyric acid. When you make a salt of it, it goes from butyric to butyrate. So you want to take a calcium-magnesium butyrate.

Bottom Line: Different form of supplement.

Dr. Rubman: Right. And that is absorbed even if you have no stomach acid present.

Bottom Line: Is there any reason other than bones that people should be supplementing calcium?

Dr. Rubman: Absolutely. It’s very useful in many different areas. It helps in the conversion of tryptophan into serotonin; it helps to promote normal reflex activity in the smooth muscles, so everything from blood pressure to digestion; and it also helps with mood and temperament, as we would expect from serotonin’s effect. It’s used in many, many different areas in the body, and it’s one of those things that we oftentimes overlook.

Bottom Line: Should everybody be supplementing calcium?

Dr. Rubman: Or paying better attention to the calcium in their food. Many people are sensitive to dairy, which is usually looked at as being the best source of calcium, so a lot of supplementation of calcium is well-justified.

Bottom Line: So if you don’t eat dairy or you can’t tolerate dairy, what other food sources are there for calcium?

Dr. Rubman: There are sources in the grain community, in the legume community that will contain certain amounts of calcium. But your best bet is to try to find some kind of dairy source that you can reasonably tolerate.

There are some people who are actually lactose-intolerant, and so the lactase dairy protein products are good. But there are other people that can do better on goat and on sheep dairy products. Where they would have a problem with cow’s milk, they wouldn’t have a problem with those.

Bottom Line: Gotcha. All right, thank you, Dr. Andy. The bottom line on calcium? It’s still good for you, no matter what the recent headlines say. It does far more than strengthen your bones, and virtually everybody should be taking it.

But you have to take it right. You need to take calcium with magnesium to be sure that it’s absorbed properly into your body, and the form of calcium that you should take is actually calcium butyrate because in that way, it’ll be absorbed even if you don’t have enough stomach acid. So many people that are on acid suppressants will not be able to absorb calcium without taking it in that form. This is Sarah Hiner with Bottom Line.