Living Well Blog: Saratoga's Holistic Health Forum

Calcium Supplementation for Women- Does it really stand the test for bone health or heart health?

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2012 TOP READS ARE POSTED!

Here are some of the most not to miss highlights for this month:
1. A continued discussion from last week's blog on breast health including an abstract about the sensitivity of mammograms in breast cancer detection and a discussion on calcium supplements and heart disease links!
2. The safety of Naturopathic and Chiropractic Modalities (discussed by Dr. Mercola).
3. Potent Nutrigenomic effects of Milk Thistle on Cancer, Vitamin C on Asthma, and Zinc for Bone health
4. Various Drug updates such as Dr. Northrup's blog on HRT and safety studies on MS medications.

Calcium- More Insight on Why It May Not Be a Woman's Best Bone Friend!

By Dr. Sarah LoBisco, ND

In a society obsessed with youth and perfection, mid-life women are led to believe that as they age, they are doomed to hormonal mishap resulting in weak, estrogen deficient, brittle, bones. Conventional guidance teaches the belief that bisphosphonate drugs and a calcium supplement will keep bones healthy and strong. However, the one pill panacea is not how the body works. Below, Dr. Mercola discusses how this one sided approach have led women astray, and he warns us to not be a blind lemming in popping so-called panaceas, consider these facts:

Taking elemental calcium supplements (with or without vitamin D) in amounts of 500 mg or more may actually increase your relative risk of heart attack by up to 27 percent, and may even increase your risk of stroke
Taking the wrong type of calcium and in isolation, without complementary nutrients like magnesium, vitamin D and vitamin K, which help keep your body in balance, can have adverse effects, such as calcium building up in coronary arteries and causing heart attacks
Osteoporosis, as defined by DXA bone screenings using the T-score, are highly misleading, because they compare your bone density to a 25-year old (and not your age group) as the standard of normality. Bone density and bone strength are two different things, and having highly dense bones may increase your risk of breast cancer as a woman by 300% or more.
Evidence that supplementing with calcium safely prevents fractures is lacking, but plentiful research suggests calcium deposits are major contributors and even causative factors in many health conditions
In order for calcium to do your body good, it must be in a biologically appropriate form and balanced out with vitamins D and K and other important trace minerals, as part of a total nutritional plan
There are actually a number of studies indicating that mass market calcium supplements increase your risk for cardiovascular incidents and other problems, while offering little benefit to your bones. Only because something can increase your bone density: eating what amounts to chalk or pulverized bone meal, or worse, chemicals like the drugs Fosamax and Evista, does not mean this will translate into improved health for your bones, or any of your other organ systems.

Indeed, before jumping off the lemming-like cliff of conventional medical wisdom, consider there is a solid body of research indicating that higher bone density may actually increase the risk of malignant breast cancer by 300% or more! Considering that close to 1 in 4 women will be diagnosed with cancer in their lives, with breast cancer top on the list, isn't the neurotic fixation on increasing bone density with calcium supplements misplaced, especially when it may increase the overall risk of dying from cancer and, as we will see, cardiovascular disease (the #1 killer), as well?

My words of caution in scientific research:

1. Causation is not proved with association. The study referenced in the British Medical Journal linking the risk of cardiovascular events to calcium usage only used a small dose of vitamin D (400IU) to a large dose of 1 g of calcium in the comparison groups of placebo and calcium alone. No other balancing nutrients were assessed or accounted for! What did this study prove? That the issue is balance and bio individuality. Studies that don't account for individual needs and blindly give supplements to participants without assessing their dietary needs or other risk factors are not a good means to assess risk and disease associated with their usage.

Evidence based studies on the intake of calcium supplementation is neither positive nor negative, but there is an association with increased calcification and breast cancer risk with excess supplementation.

2. Bone density scans are only one risk assessment for fracture risk. Furthermore, denser bones or the risk of fractures modulated with calcium supplementation is lacking. The abstract below from the Clinical Journal of the American Society of Nephrology sums up some major take home points:

Abstract

Credible evidence that calcium supplements reduce the risk of vertebral, nonvertebral, or hip fractures is lacking. Flaws in study design and execution such as inclusion of calcium-replete individuals, high dropout rates, and poor compliance preclude testing the hypothesis that calcium deficiency increases fracture rates or that calcium supplements reduce them. Intent-to-treat analyses of individual trials have failed to detect antifracture efficacy. Post hoc analyses of subgroups with a low calcium intake and per-protocol analyses of compliers have reported fewer fractures in the supplemented groups. However, this may be the result of confounding by violation of randomization; compliers to placebo have a lower morbidity and mortality than noncompliers. Higher hip fracture rates and cardiac mortality in patients receiving calcium supplements, as reported in some studies, may also be due to factors other than supplementation. Hypothesis testing requires that a cohort be stratified into calcium-deficient and calcium-replete groups, with each person randomized to a supplement or placebo. This design quantifies the risk of fracture attributable to calcium deficiency and any benefit that supplementation confers in the calcium-deficient and calcium-replete groups. To regard a calcium-deficient arm as unethical begs the question. Consensus statements that support the widespread use of calcium are opinion-based; they accept claims of beneficial effects despite flaws in study design, execution, and analysis; and they reject reported adverse effects because of them. Until well designed, well executed, and well analyzed studies demonstrate a net benefit in morbidity, mortality, and cost, recommendations supporting the widespread use of calcium supplementation remain belief-based and not evidence-based. PMID: 20089500

What's a woman to do?

Dr. Brown offers a fracture risk assessment on her website that takes into account a holistic assessment besides bone density. Furthermore, she discusses all the important nutrients needed for bone health, beyond Calcium, and Vitamins D and K. My past blog on this subject provides a summary of additional tools.

The bottom line is that everyone is different, with different needs, and that's why blindly taking supplements, like drugs, can cause an imbalance in the system. I suggest speaking with a well versed practitioner or nutritionist who can assess your individualized needs and perhaps provide a functional analysis of your own bone turnover and nutrient assimilation. Also, let's keep in mind that the safety profile of supplements and nutrients doesn't even scrap the effects of properly prescribed medicines.

References:

Dr. Mercola . Breast Cancer and Heart Attacks: A Deadly Side Effect of Calcium Supplements? January 30 2012. http://articles.mercola.com/sites/articles/archive/2012/01/30/calcium-supplement-on-heart-attack.aspx?e_cid=20120130_DNL_art_1

Seeman E. Evidence that calcium supplements reduce fracture risk is lacking (abstract). Clin J Am Soc Nephrol. 2010 Jan;5 Suppl 1:S3-11.

J M Zmuda, J A Cauley, B M Ljung, D C Bauer, S R Cummings, L H Kuller. Bone mass and breast cancer risk in older women: differences by stage at diagnosis (abstract). J Natl Cancer Inst. 2001 Jun 20;93(12):930-6. PMID: 11416114

Bolland MJ, Grey A, Avenell A, Gamble GD, Reid IR. Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women's Health Initiative limited access dataset and meta-analysis (abstract). BMJ. 2011 Apr 19;342:d2040. doi: 10.1136/bmj.d2040.

Brown, S. Are Your Bones Healthy & 20 Key Bone Building Nutrients. Accessed January 31, 2012. http://www.betterbones.com/bonenutrition/20keybonenutrients.aspx


Happenings:

Upcoming Essential Oils Workshops with Terry Quigley at the Healing Garden. Contact Terry at 518-831-9469

Next Health Forum is February 9th at 6:15pm. Learn more.

Radio For Your Body-Mind-Soul: Dealing with Addiction

Do you or your loved one suffer from an addiction?

Addiction is one of the top health care concerns for the U.S. and Europe. In the U.S. alone, over 7 billion is spent on alcohol and substance abuse treatment. Join Gabrielle and her guest, addiction specialist Elisa Hallerman, for a powerful discussion on how to deal with addiction issues.

Book of the week: The Calcium Lie by Robert Thomson, MD

This book discusses that bone is comprised of at least a dozen minerals, not just calcium. Supplementing with excessive calcium off balances other minerals and important electrolytes in various tissues, including bone tissue. In fact calcium supplementation can worsen bone density and actually increase your risk for osteoporosis. Dr. Thompson discusses overconsumption of calcium can also increase your risk of heart disease, kidney stones, gallstones, osteoarthritis, hypothyroidism, obesity and type 2 diabetes.

Read more on my blog.

· Listen to my colleagues and other experts as they discuss solutions to menopausal issues on a show dedicated just for women in mid-life! Here is a link from my interview on 360menopause Radio Show on Panic Attacks and Menopause and a list of archived shows.

· Check out my latest answer on Dr. Oz's Sharecare:

· View the Updated Link Resources on my homepage

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An updated research study reports on the use and frequency of DEXA scans along with treating bones with bisphosphonates:

Dr. Margaret Gourlay, the study’s lead author and a family practice specialist and osteoporosis researcher at the University of North Carolina, said she and her colleagues were surprised by how slowly osteoporosis progressed in women.

Medicare pays for a bone density test every two years and many doctors have assumed that is the ideal interval, although national guidelines recommend them only at “regular intervals.” “I think this will change the way doctors think about screening,” Dr. Gourlay said.

The results, said Joan A. McGowan, director of the division of musculoskeletal diseases at the National Institute of Arthritis and Musculoskeletal and Skin Diseases, “provide telling evidence that you are not going to fall off a cliff if you have normal bone density in your 60s or early 70s, that you are not going to have osteoporosis in the next five years unless something else happens.”

For example, said Dr. McGowan, who was not involved in the study, a woman who had to take high doses of corticosteroids for another medical condition would lose bone rapidly. But the findings “cover most normal women,” she said.

Bone density screening took off after Fosamax, the first bisphosphonate, was approved at the end of 1995. For the first time, doctors had a specific treatment that had been shown to prevent fractures in people with osteoporosis.

For years doctors were overly enthusiastic, prescribing it for women whose bone density was lower than normal but not in a danger zone, keeping women on the drug indefinitely. They even gave a name, osteopenia, to lower than normal bone density, although it was not clear it had real clinical significance.

Now, osteoporosis experts consider osteopenia to be a risk factor, not a disease, and its importance varies depending on a patient’s age, said Dr. Ethel S. Siris, an osteoporosis researcher at Columbia University who was not involved in the study.

Doctors are more likely to prescribe bisphosphonates for older patients and recommend against them for most younger postmenopausal women with osteopenia.

The experts also generally recommend that most people on bisphosphonates take them for just five years at a time, followed by a drug holiday of undetermined length. The idea is to reduce the risk of rare but serious side effects, including unusual thighbone fractures and necrosis of bone in the jaw.

Source: Source: New York Times, Online Edition Jan 18, 2012. http://www.nytimes.com/2012/01/19/health/bone-density-tests-for-osteoporosis-can-wait-study-says.html?_r=1

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Reisa Mehlman

As a New York State Licensed Aesthetician, New York State Licensed Nail Specialist, and the Director of Living Well Healing Arts Center & Spa, Reisa combines her love of spa services and healing arts to achieve optimum skin and nail health, create greater overall wellness and bring forth our optimal, individual beauty.

"I believe that the day spa should be an instant getaway; a place that is quiet without being stuffy, relaxed, elegant and yet entirely comfy. You should feel warm and welcome, surrounded by people who care about you and what they are doing. This is the environment we strive to create at Living Well Healing Arts Center & Spa. Here, you are never just the "next" number; we allow ample time for your services, offer a flexible schedule and can be reached after hours. After all, to me, spa craft is not really a business, it's a lifestyle." Read more...


Dr. Sarah Lobisco

Whether the goal is to lessen pain, find an alternative to pharmaceuticals, or improve your quality of life, Dr. LoBisco's Naturopathic Medicine lets you get the best of both worlds conventional medicine, combined with safe and proven complementary therapies.

Dr. Sarah LoBisco has been involved in wellness for over 8 years. Her experience includes mentoring with holistic practices throughout New York, Vermont, and Connecticut. Read more...