text: Too Much Calcium - How Much Calcium Is Too Much
  Save your heart—or protect your bones? Just as it seemed we were being asked to make an impossible choice, along came a startling announcement in February from the U.S. government group that develops health recommendations for all Americans. Calcium supplements—or at least the commonly prescribed combo of 1,000 mg of calcium plus 400 IU of vitamin D—didn't prevent fractures in healthy women with adequate D levels, a new research review showed. Would a different dose—maybe one with higher D—work? "We can't say," says panel member and public health expert Jessica Herzstein, M.D. "All we know is, this amount of calcium and D isn't helping reduce fractures."
  Which leaves us…confused. While the experts duke it out in their scientific journals—not everyone's convinced the heart risk is real or that supplements don't help—what are women supposed to do to make sure their bones stay strong? We asked top experts for their best advice. Surprisingly, the answer is really rather simple.
  Don't pop pills—eat. "Calcium is a nutrient, not a pharmaceutical. The right way to get it is through food, where it's packaged with protein and other nutrients," says Robert Heaney, M.D., an osteoporosis expert at Creighton University in Omaha. When the government recommends 1,000 mg of calcium a day (1,200 if you're 51 or older), that means total calcium—not a level of supplementation on top of the calcium you're getting from food. So if your doctor automatically advises a hefty dose of supplements, speak up. Tell her how calcium-rich your diet is—or will be, now that you know the score.
  Can you overdo it with what you eat? One of the heart studies did find that women whose calcium intake from food and supplements was really high—2,100 mg a day—were more likely to die of heart disease. But the lead author is reassuring. "I think the [trouble] comes when you combine high calcium intake with supplements," says Karl Michaëlsson, M.D., of Uppsala University in Sweden. "If you consider just diet, the increased risk of heart attacks is quite modest."
  Take D seriously: It's essential to bone health and, by boosting muscle strength, it helps prevent bone-breaking falls in older people. So eat plenty of vitamin D–containing foods: fatty fish, egg yolks, and fortified foods like milk and cereal. Supplement if you need to. The official recommendation is 600 IU of D per day, though many health experts advise 1,000.
  Know your risks: Even if you do everything right, you could still develop osteoporosis—your chances also depend on your build, medical history, and genetics. Whatever your age, talk to your doctor about your calcium needs and the best ways to meet them. "Some women are afraid to take any supplements, which can be bad," says osteoporosis expert Susan Ott, M.D., of the University of Washington. And all women need to start bone-density screening at age 65—or even earlier if risk factors make their fracture odds as high as those for someone that age.
  You need these, too: Strong bones require other nutrients besides calcium. The trouble is, many of us get too little of them in our diets, so eat up. And don't just pop a megadose supplement: Overloading on some nutrients—zinc, manganese, copper, and the retinol form of vitamin A, for example—can be risky.
  - Take calcium carbonate at meals or within a few hours of eating—it needs stomach acid to be absorbed. (Calcium citrate can be taken at any time.)
  - Space your doses: You can absorb only about 500 mg at a time—plus, questions about heart risks make it sensible to avoid taking too much at once. If you need more than that on top of your dietary calcium, take it in separate doses.