Tuesday, November 8, 2016

Calcium Supplementation IS Vital for Individuals with Osteoporosis

Over the years there have been numerous studies about the benefits and risks of calcium - much of it inconsistent - and this has led to a lot of confusion and frustration. It all began in 2008 when Mark Bolland and Ian Reid (1) from New Zealand studied 336 healthy, older women (mean age 74) and concluded there may be a slight increase in cardiovascular events when taking supplemental calcium. Although numerous researchers found fault in Bolland and Reid's research methodology, a new study by Norwegian researcher Gunhild Hagen (2016) concludes that although we don't know for sure if calcium has this negative
effect, “the modest effect of supplemental calcium and vitamin D on the risk of fracture is not large enough to outweigh the potential increased risk of cardiovascular disease."(2) Is your head spinning yet?

Since improving the strength and density of my own skeleton after a diagnosis of severe osteoporosis at age 45 (with 12 fractures in 5 years), I have been helping others with bone fragility for over 10 years now. Because I have a personal interest and bias, I review each published article on bone health and carefully evaluate it based on the type of study, the populations included in the study, the quality of the design and execution, analysis of the data, etc. I hope, because of this, I can continue to be your trusted source of effective, reliable information in your quest to combat osteoporosis.

Let's look at the facts: 

FACT: We need adequate calcium for good health. Calcium is important for skeletal health, as well as a host of other essential functions. Without calcium there would be no nerve transmission, muscle contraction, cell signaling, blood clotting, constriction and relaxation of blood vessels, or secretion of hormones like insulin.(3) Studies have consistently found that higher calcium intakes reduce the risk of hypertension, obesity, and type 2 diabetes.(4,5,6,7) In a 2015 study from the National Osteoporosis Foundation, Weaver, C.M., et al. found a "significant decrease in fractures with calcium and vitamin D supplements."(8)

FACT: People should strive to meet the calcium levels recommended by the Institute of Medicine (IOM), using food sources to the greatest extent possible. The Recommended Dietary Allowances (RDAs) for most adults (ages 19 to 70) is 1,000 mg of calcium daily, and women older than 50 and men older than 70 should aim for 1200 mg of calcium per day.(9) A healthful, well-balanced diet should include dairy (especially yogurt and kefir), dark leafy greens, and other calcium sources like sardines, almonds and beans.

Unfortunately, some people are sensitive or allergic to dairy. In addition, although many physicians recommend dairy as a calcium source, high dairy intake may come with other undesirable effects. Besides grave concerns over the dairy industries use of rBGH (growth hormones), milk is acidifying to the body (not good for bones) and casein, the major protein found in milk, has neoplastic (cancer) potential. Also, D-galactose (from the lactose sugar in milk) has been shown to increase inflammation, contribute to neuro-degeneration and reduced immune function. To this point, Michaelsson, et al. (British Medical Journal, 2014) observed a link between high milk intake (3 or more glasses per day) and higher rate of both mortality and fracture in women, and a higher rate of mortality in men. "There were positive associations between milk intake and concentrations of markers for oxidative stress and inflammation." The authors concluded "A higher consumption of milk in women and men is not accompanied by a lower risk of fracture and instead may be associated with a higher rate of death."(10)

FACT: Many Americans do not meet the RDA for calcium. The 2015 Dietary Guidelines Advisory Committee (DGAC) concluded that many Americans, due to a variety of socio-ecological factors and the concerns cited above, don't meet the IOM recommendations and declared calcium "a nutrient of public health concern for under-consumption."(11)

FACT: Inadequate intake from dietary calcium impacts individuals differently. Healthy, active individuals with strong bones may efficiently absorb enough calcium to maintain bone density. They are also more likely to have a balanced bone remodeling system without excessive osteoclastic (bone destroying) activity that would require a greater intake of calcium to keep up with demands. Individuals with bone fragility, on the other hand, are already at a deficit because their remodeling system is out of balance. The osteoclasts within their bones are destroying it faster than the osteoblasts can build new bone. "If there isn't enough calcium coming in from the diet, the body will pull calcium from the bones for all the things that need to be done,” notes Andrea J. Singer, MD, FACP, CCD, director of women's primary care and bone densitometry for the Department of Obstetrics and Gynecology at MedStar Georgetown University Hospital and clinical director of the National Osteoporosis Foundation.
FACT: Adequate calcium intake (1200 - 1400 mg), taken as directed, is vital for Individuals with bone fragility.  By now you may be thinking, "I know I need calcium for bone health yet it is difficult to get adequate calcium unless I drink a lot of milk. But high dairy intake doesn't sound wise either...so what am I supposed to do in light of the recent research concerning the safety of supplemental calcium?

First, always try to get as much calcium from your diet as possible. As they say, "you are what you eat." Eating foods high in calcium is good for you...and your bones. 

Second, take supplemental calcium (and magnesium and trace minerals) to ensure you are getting the minerals necessary for skeletal health. But, take your calcium in small doses through-out the day. It is not wise to take large doses of supplemental calcium such as those used in Bolland and Reid's studies. High amounts (400 mg or more) of calcium all at once can cause an excess spike of calcium in the blood - a problem that could potentially interfere with normal heart function. This may be the link between calcium and cardiovascular events, if indeed it exists.

Our OsteoNaturals’ OsteoSustain tablets contain only 175 mg because I believe in GENTLY providing the body with what it needs to build bone. Taking 3 tablets spread out over the day with meals provides 525 mg calcium in a safe, effective manner. For many patients with severe bone loss, I advocate taking an additional one or two tablets of OsteoMineralBoost for more calcium plus trace minerals in addition to the OsteoSustain. Taking one OsteoSustain and one OsteoMineralBoost at a sitting provides 315 mg calcium which is well below the 400 mg level.
As a general protocol for severe bone loss, 3 tablets of OsteoSustain and 2 tablets of OsteoMineralBoost provide 805 mg supplemental calcium daily. This, along with a diet rich in veggies, will put that person just right at 1200 to 1400 mg calcium per day - PERFECT for someone with bone loss. In addition, OsteoNaturals’ products provide the body with bioavailable magnesium, vitamins D and K, and trace minerals...all important for utilizing the calcium and helping your body put this vital mineral where it belongs...in your bones.
FACT:  In addition to ingesting an adequate (not excessive) amount of minerals for bone building, the key to fighting osteoporosis is to focus on balancing bone remodeling – reducing osteoclastic bone resorption and increasing osteoblastic bone formation. As explained in my book, The Whole Body Approach to Osteoporosis, regaining balance is best achieved by eating a healthful, well-balanced, alkaline diet; taking quality, nutritional supplements like OsteoNaturals' OsteoStim (our product designed to enhance balanced bone remodeling activity); exercising (both cardio and weight-bearing); and evaluating health-related lifestyle behaviors.
Calcium is important for skeletal and overall health. Most advocacy organizations and health policymakers stand by the IOM recommendations for daily calcium levels. It's best to get calcium through diet but this is often extremely difficult, if not impossible. Quality, trusted supplements – taken as directed – should be used to make up the shortfall. 

If you have bone loss, I urge you not to run from calcium because of some shaky research that used excessive amounts of an important mineral and came up with a possible link to an adverse effect. The same thing happened in 2001 with the Women's Health Initiative Study that concluded estrogen was bad for women. This study used excessive amounts of estradiol in a population of women they should not have used (advanced age and asymptomatic). The researcher's back then concluded that estrogen was BAD and did a huge dis-service to women. Because of this, instead of using estrogen PROPERLY (using smaller dosages and initiating it in women no more than 5 years after menopause) doctors ran the other way and stopped prescribing estrogen all-together. Let's NOT let this same reaction prevent us from obtaining the most abundant mineral in the body, calcium.

(1) Bolland, M.J., et al. 2008. Vascular events in healthy older women receiving calcium supplementation: randomized controlled trial. BMJ 336:262-6.
(2) Hagen, G., et al. 2016. The predicted lifetime costs and health consequences of calcium and vitamin D supplementation for fracture prevention - the impact of cardiovascular effects. Osteoporos Int 27(6)2089-2098.
(3) Linus Pauling Institute. Calcium dietary supplemental fact sheet. National Institutes of Health Office of Dietary Supplements website: http://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/. Updated November 21, 2013.
(4) Alender, P.S., et al. 1996. Dietary calcium and blood pressure: a meta-analysis of randomized clinical trials. Ann Intern Med 124:825-31.
(5) Bucher, H.C., et al. 1996. Effects of dietary calcium supplementation on blood pressure. A meta-analysis of randomized controlled trials. JAMA 275:1016-22.
(6) Villegas, R., et al. 2009. Dietary calcium and magnesium intakes and the risk of type 2 diabetes: the Shanghai Women's Health Study. Am J Clin Nutr 89:1059-67.
(7) Teegarden, D., et al. 2003. Calcium intake and reduction in weight or fat mass. J Nutr 133:249S-51S.  
(8) Weaver, C.M., et al. 2016. Calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation. Osteoporos Int 27:367-376.  
(9) Institute of Medicine. 2011. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press.
(10) Michaelsson, K., et al. 2014. Milk intake and risk of mortality and fractures in women and men: cohort studies. BMJ 349:g6015.  
(11) US Department of Agriculture, US Department of Health and Human Services. Scientific Report of the 2015 Dietary Guidelines Advisory Committee. Published February 2015.

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