Calcium Supplements Archives - Health Tips From The Professor

Are Calcium Supplements Heart Healthy?

February 6, 2024 by Dr. Steve Chaney

Should You Follow Your Doctor’s Advice About Calcium Supplementation?

Author: Dr. Stephen Chaney

Are calcium supplements good for your heart or bad for your heart? If you don’t know the answer to that question, don’t feel badly. You have every right to be confused. Some studies say that calcium supplements increase heart disease risk while others say they decrease heart disease risk. The headlines have veered between “killer calcium” and “beneficial calcium”.

The trend appears to be moving in a positive direction. In recent years most of the studies have suggested that calcium supplements either decrease heart disease risk or have no effect on heart disease risk.

However, the medical profession has been slow to take note of this trend. Most medical societies and health professionals have focused on earlier studies and are still recommending that their patients get calcium from food rather than from supplements. I will talk more about that recommendation below.

With this context in mind, this week I will review and discuss the results from the latest study (MG Sim et al, Heart, Lung and Circulation, 32: 1230-1239, 2023) on the effect of calcium supplementation on heart disease risk.

How Was This Study Done?

The authors of this study performed a meta-analysis of 12 double-blinded randomized clinical trials with 87,899 participants comparing the effect of a calcium supplement versus a placebo on heart disease outcomes (heart attack, stroke, heart failure, cardiovascular mortality, and all-cause mortality).

The studies included in this analysis:

Used calcium doses from 500 mg/day to 2,000 mg/day.

Used supplements with calcium coming from a variety of sources (calcium carbonate, calcium citrate, calcium gluconolactate, and tricalcium phosphate).

Ranged from 18 months to almost 12 years in length.

Were performed with population groups from a wide range of countries (United States, England, France, Australia, New Zealand, European Union, Denmark, and Thailand).

Included calcium supplements with and without vitamin D.

Were primarily (86% of participants) conducted with post-menopausal women. One small study (0.3% of participants) was conducted with non-osteoporotic men. The rest were conducted with mixed populations (men and women) diagnosed with colorectal adenoma.

Are Calcium Supplements Heart Healthy?

This is the largest meta-analysis performed to date of double-blind, placebo-controlled randomized clinical trials on the effect of calcium supplementation versus a placebo on heart disease outcomes. This study found no effect of calcium supplementation on:

Heart attack.
Stroke
Heart failure.
Cardiovascular mortality.
All-cause mortality.

This study also evaluated potential confounding variables and found no effect of calcium supplementation on heart disease risk for:

Calcium supplements with and without vitamin D.

Dosage of calcium in the supplements (The dosage ranged from 500 mg/day to 2,000 mg/day).

Females (I suspect the number of males in this study was too small to come to a statistically significant conclusion).

Duration of calcium supplementation ≤ 5 years (The shortest duration of calcium supplementation in these studies was 18 months).

Different geographical regions.

However, this meta-analysis reported considerable variation between studies included in the analysis. Simply put,

Some studies showed an increase in heart disease risk.
Some studies showed a decrease in heart disease risk.
Some studies showed no effect on heart disease risk.

What this analysis showed was that when you combine all the studies, the aggregated data is consistent with calcium supplementation having no effect on heart disease risk.

The authors concluded, “Calcium supplementation was not associated with myocardial infraction [heart attack], stroke, heart failure, and cardiovascular/all-cause mortality. Further studies are required to examine and understand these associations.

Should You Follow Your Doctor’s Advice About Calcium Supplementation?

As I said above, most medical societies and health professionals have focused on earlier studies and are still recommending that their patients get calcium from food rather than from supplements. That may be the advice you are getting from your doctor.

Before you assume your doctor isn’t keeping up with the latest science and ignore his or her advice, we should ask why they are giving that advice. The top three reasons most medical societies give for recommending dietary sources of calcium are:

1) Some studies do show an increased risk of heart disease associated with calcium supplementation. The prime directive for health professionals is to do no harm. Yes, the average of all studies shows no effect of calcium supplementation on heart disease risk. But what if the studies showing increased risk are true for some of their patients? Those patients could be harmed.

Are you someone who might be at increased risk for heart disease if you take calcium supplements. The short answer is we don’t know because previous studies have not asked the right questions.

In my opinion, it is time to pause additional studies and meta-analyses on calcium supplementation and heart health until we have gone over existing studies with a fine-tooth comb to figure out why the results differ so wildly. For example, we need to ask whether the effect of calcium supplements on heart disease risk is influenced by things like:

- Age or ethnicity of participants.

- Other preexisting health conditions.

- Other lifestyle factors (exercise is probably the most important, but others may be involved as well).

- Diet context. For example, we already know that the effect of eggs and dairy on heart health is influenced by diet context. [I have covered this for eggs in a previous issue of “Health Tips From the Professor”.]

- Other unanticipated variables.

Only when we have identified variables that might influence the effect of calcium supplements on heart disease risk, will the scientific community be able to design studies to identify the population groups who might be adversely affected by calcium supplementation.

This would allow health professionals to make informed decisions about which of their patients should avoid calcium supplementation and which of their patients would benefit from calcium supplementation.

2) We really don’t need the recommended RDAs for calcium to build strong bones. The recommended RDAs for calcium are 1,000 mg/day for adults 19-50, 1,000 mg/day for men and 1,200 mg/day for women 51-70, and 1,200 mg/day for both men and women over 70. But do we really need that amount of calcium to build healthy bones?

I have discussed this topic in detail in a previous issue of “Health Tips From the Professor”. Here are the key points:

- The current RDAs are based on calcium needs for people consuming the typical American diet and following the typical American lifestyle. If that is you, the current RDAs probably apply.

- However, strong bones are absolutely dependent on three things, adequate calcium, adequate vitamin D, and adequate weight-bearing exercise. Most recent studies of calcium supplementation and bone density include adequate vitamin D, but almost none of them include exercise. Previous studies have been inadequate.

- The best calcium supplements contain certain nutrients besides vitamin D that optimize bone formation. I have listed those nutrients in the article cited above.

- Our ability to use calcium to build strong bones is dependent on diet (something I call a bone-healthy diet) and lifestyle (something I call a bone-healthy lifestyle).

- For more information on each of these points, read the article I referenced above.

In short, I agree that the current calcium RDAs may be too high for individuals consuming a bone-healthy diet and following a bone-healthy lifestyle. But the current calcium RDAs are likely accurate for people consuming the typical American diet and following the typical American lifestyle.

- While we do not have a calcium RDA for populations following a bone healthy diet lifestyle, some studies suggest that 700-800 mg of calcium/day may be sufficient for this group.

3) Calcium from supplements is absorbed faster and gives higher blood level spikes than calcium from foods. That could be a problem because high blood levels of calcium are associated with calcification of our arteries, which is associated with increased heart disease risk.

This is a theoretical concern, because high blood calcium levels from supplementation are transitory, while it is continuous high blood calcium levels that are associated with calcification of our arteries.

However, it is a plausible concern because most supplement companies design their calcium supplements based on how quickly they get calcium into the bloodstream rather than how effectively the calcium is utilized for bone formation. Here are my recommendations:

- Choose a calcium supplement that provides RDA levels of vitamin D plus other nutrients shown to support strong bone formation.

- Choose a calcium supplement supported by clinical studies showing it is effectively utilized for bone formation.

4) We should be getting our calcium from foods rather than supplements.

While it is always easy for doctors to recommend that we get our nutrients from food rather than supplements, they need to ask whether we are getting those nutrients from our diet. For calcium the data are particularly sobering.

- The average American gets around 740 mg of calcium/day from their diet. That is probably enough for the small percentage of Americans following a bone healthy diet and lifestyle. But it is 260-460 mg short of the 1,000-1,200 mg/day recommended for older adults with the typical American diet and lifestyle.

- - And for the average American, around 70% of their calcium intake comes from dairy foods.
  - So, Americans who are following a typical American diet and lifestyle and are restricting dairy may require 800-1,000 mg/day of supplemental calcium unless they carefully plan their diets to optimize calcium intake.
  - Finally, vegans average about 550 mg/day from their diet. That might be borderline even if they were following a bone healthy lifestyle.

- In short, we cannot assume our diet will provide enough calcium for strong bones unless we include dairy foods and/or plan our diet very carefully. Some degree of supplementation may be necessary.

How Much Calcium Do You Need?

I have covered a lot of territory in this article, so let me summarize the four concerns of the medical community and answer your most important question, “Should you take calcium supplements?”

1) Calcium supplements may increase the risk of heart disease for some people.

That is true, but we have no idea at present who is at increased risk and who isn’t. So, we should minimize our risk by taking the precautions I describe below.

2) We don’t need RDA levels of calcium to build strong bones. That is probably true if you are one of the few people who follows a bone healthy diet and lifestyle, but it isn’t true if you follow the typical American diet and lifestyle.

The current RDAs of 1,000 – 1,200 mg/day are a good guideline for how much calcium you need if you follow the typical American diet and lifestyle.

If you a one of the few people who follow a bone healthy diet and lifestyle (For what that involves, read this article) you may only need 700-800 mg/day. But we don’t have clinical studies that can tell us what the actual RDA for calcium should be under those circumstances.

3) Calcium from supplements is absorbed faster and gives higher blood calcium spikes than calcium from foods. You may remember that the theoretical concern is that even short-term spikes of high blood calcium may lead to calcification of your arteries, which increases your risk of heart disease. So, the important question becomes, “What can we do to minimize these spikes in blood calcium levels?”

We should avoid calcium supplements that brag about how quickly and efficiently the calcium is absorbed. That could lead to calcium spikes. Instead, we should look for calcium supplements that are backed by clinical studies showing they are efficiently utilized for bone formation.

We should look for calcium supplements that include RDA levels of vitamin D and other nutrients that optimize bone formation. You will find more information on that in the same article I referenced above.

Some experts recommend that calcium supplements be taken between meals. But it is probably better to take them with meals because foods will likely slow the rate at which calcium is absorbed and reduce calcium spikes in the blood.

We are told to limit calcium supplements to less than 500 mg at any one time because calcium absorption becomes inefficient at higher doses. It might be even better to limit calcium to 250 mg or less at a time to reduce calcium spikes in the blood.

4) We should get calcium from foods rather than supplements.

Many Americans do not get enough calcium from diet alone, especially if they avoid dairy foods. So, some degree of calcium supplementation may be necessary. I have given some guidelines depending on your diet and lifestyle above.

The amount of supplemental calcium needed is relatively small. I do not recommend exceeding the RDA unless directed to by your health professional.

The Bottom Line

Some studies say that calcium supplements increase heart disease risk while others say they decrease heart disease risk. The headlines veer between “killer calcium” and “beneficial calcium”.

A recent meta-analysis of 12 double-blinded randomized clinical trials with 87,899 participants comparing the effect of a calcium supplement versus a placebo on heart disease outcomes has just been published. This study found no effect of calcium supplementation on:

Heart attack.
Stroke.
Heart failure.
Cardiovascular mortality.
All-cause mortality.

The authors of the study concluded, “Calcium supplementation was not associated with myocardial infraction [heart attack], stroke, heart failure, and cardiovascular/all-cause mortality.

For more details and advice on whether you should follow your doctor’s recommendations for calcium supplementation read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

_____________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

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About The Author

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years. Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”. Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Do Calcium Supplements Increase Deaths From Heart Valve Disease?

June 14, 2022 by Dr. Steve Chaney

What Did This Study Get Wrong?

Author: Dr. Stephen Chaney

“Killer calcium” is back. Once again, we are seeing headlines saying that calcium supplementation increases our risk of dying from heart disease. If you have seen these headlines, you are probably confused.

After all, there have been three major clinical studies looking at the effect of calcium supplementation on heart disease risk. These studies followed close to 100,000 Americans for 10-20 years. And none of the studies found any increase in the risk of developing or dying from heart disease for people taking calcium supplements. For more information on this topic, see an article from “Health Tips From the Professor”.

You are probably wondering, “What is going on? I thought this issue was settled”.

In the first place, this study did not look at heart disease in general, but on a very specific form of heart valve disease called aortic stenosis. Aortic stenosis is a narrowing of the heart valve leading to the aorta. And it is often associated with calcification of the heart valve.

The cause of aortic stenosis is complex, but it is associated with:

Chronic inflammation.
High cholesterol levels.
Tobacco use.
Dysregulation of calcium metabolism caused by things like elevated parathyroid levels and end-stage kidney disease.
Elevated blood levels of calcium and/or vitamin D.

Because of the role of calcium and vitamin D in aortic stenosis, the current study (N Kassis et al, Heart, Epub ahead of print, 1-9, 2022) was designed to ask whether calcium and vitamin D supplementation influenced the risk of dying from aortic stenosis.

How Was This Study Done?

The Cleveland Clinic scanned their Echocardiography Database for patients aged 60 years or more who had been diagnosed with mild to moderate aortic stenosis. 2,657 patients met these criteria (average age = 74, 58% men) and were followed for an average of 59 months in their database.

In terms of calcium and vitamin D supplementation:

49% did not supplement.

12.5% supplemented with vitamin D (dose not defined).

38.5% supplemented with calcium (500 – 2,000 mg/day) ± vitamin D.

The study looked at the correlation between vitamin D supplementation and calcium supplementation with:

Aortic valve replacement surgery.

All-cause mortality* with and without aortic valve replacement surgery.

Cardiovascular mortality* with and without aortic valve replacement surgery.

*Note: Since all the patients had aortic stenosis at the beginning of the study, both all-cause and cardiovascular mortality were primarily due to aortic stenosis.

Do Calcium Supplements Increase Deaths From Heart Valve Disease?

Before I describe the results of the study, there are two things you need to know:

Vitamin D supplementation did not have a significant effect on any outcome studied, so I will not mention vitamin D in the rest of this article.

In the calcium supplementing group, there were only a few people taking calcium supplements without vitamin D. However, their outcomes were the same as for people taking calcium + vitamin D supplements. Therefore, the authors discussed their results in terms of calcium supplementation, not calcium + vitamin D supplementation. I will do the same.

With those two things in mind, here is what the study found.

With respect to the need for aortic valve replacement surgery:

Calcium supplementation increased the need for surgery by 50%.

With respect to all-cause mortality:

Calcium supplementation increased the risk of death by 31%. When you divided the results into patients who did and did not have aortic valve replacement surgery within the 59-month follow-up of this study:

- Those who received aortic valve replacement surgery did not have a statistically significant increase in risk of death.

- Those who did not receive aortic valve replacement surgery had a 38% increased risk of death.

With respect to cardiovascular mortality:

Calcium supplementation doubled the risk of death. When you divided the results into patients who did and did not have aortic valve replacement surgery within the 59-month follow-up of this study:

- Those who received aortic valve replacement surgery did not have a statistically significant increase in risk of death.

- Those who did not receive aortic valve replacement surgery had a 205% increased risk of death.

The authors concluded, “Supplemental calcium … is associated with lower survival and greater AVR [aortic valve replacement surgery] in elderly patients with mild to moderate AV [aortic stenosis].”

What Did This Study Get Wrong?

Let me start by looking at the limitations of this study.

#1: This is a single study. It is a well-designed study, but it is only one study. And, as the authors acknowledge, previous studies have come down on both sides of this issue. Until we have more well-designed studies that come to the same conclusion, we cannot be confident this study is correct.

#2: The results of this study could have been significantly influenced by confounding variables.

For example:

End-stage kidney disease is associated with a dysregulation of calcium metabolism that can lead to aortic valve calcification. Patients in the calcium supplementation group had a 2-fold higher incidence of chronic kidney disease and a 10-fold higher incidence of kidney dialysis.

There were also significant differences in several diseases and drugs that influence the risk of developing aortic stenosis between the groups.

In the words of the authors, “Given the degree of clinical differences between the groups, there was a risk of residual confounding that may have impacted our findings; we attempted to mitigate this with our statistical model.”

However, as Mark Twain is quoted as saying, “There are lies. There are damn lies. And then there are statistics.”

That is a humorous way of saying we should not put too much faith in statistical manipulations of the data.

#3: They did not measure parathyroid levels. That is a serious omission because elevated parathyroid levels are a major driver of the type of dysfunctional calcium metabolism that could lead to calcification of the aortic valve.

#4: Serum calcium and vitamin D levels were slightly lower in the calcium supplementation group. This is unexpected because aortic stenosis is usually associated with higher serum calcium and vitamin D levels.

The authors speculated this might be due to transient increases in serum calcium levels following supplementation. This is possible for some calcium supplements, but not others.

Specifically, some calcium supplements are marketed on how quickly they get into the bloodstream. But those same supplements often do not provide all the nutrients needed for bone formation. There is always the possibility that excess calcium not used for bone formation might be deposited where we do not want it (such as in the aortic valve).

What Did This Study Get Right?

#1: It was a larger, longer lasting study than previous studies on the effect of calcium supplementation on aortic stenosis. Even though it has limitations, we shouldn’t discount it. It might just be correct.

#2: It doesn’t necessarily conflict with the earlier studies showing that calcium supplementation doesn’t increase cardiovascular disease risk. That’s because the design of these studies is very different.

The health of the people studied was very different.

- The earlier studies started with healthy adults and asked whether calcium supplementation increased their risk of developing cardiovascular disease.

- This study started with people who already had a form of cardiovascular disease associated with abnormal calcium metabolism and asked whether calcium supplementation increased their risk of dying from the disease.

The age of the people studied was very different.

- The earlier studies started with middle-aged adults and followed them for 10-20 years

- This study started with people in their mid-70’s and followed them for almost 6 years.

The type of cardiovascular disease studied was different.

- The earlier studies included all types of cardiovascular disease.

- This study focused on a very minor type of cardiovascular disease, aortic stenosis. Aortic stenosis accounts for about 10% of all cardiovascular disease 17% of cardiovascular deaths. There may not have been enough deaths from aortic stenosis in the previous studies to have had a statistically significant effect on the results.

Given all these differences, the results of this study may not be incompatible with the results of previous studies

What Does This Study Mean For You?

There are three important takeaways from this and previous studies:

1) For most Americans calcium supplementation does not increase the risk of cardiovascular disease. That has been shown in three major clinical studies.

2) However, if you have been diagnosed with aortic stenosis, calcium supplementation may increase your risk of needing heart valve replacement or of dying from the disease. This study is not definitive, but I would advise caution.

You may wish to discuss with your doctor how to best balance:

- The need for calcium supplementation to prevent osteoporosis…

- With the need to limit calcium supplementation to prevent adverse outcomes from your aortic stenosis.

3) Finally, the authors did not discuss a very significant observation from this study, namely that heart valve replacement reduced the risk of dying from aortic stenosis in people taking calcium supplements.

Aortic valve replacement is the only proven treatment for aortic stenosis. If your doctor recommends aortic valve replacement, you should consider it.

The Bottom Line

A recent study looked at the effect of calcium supplementation for people with aortic stenosis, a rare form of heart disease.

The study found:

Calcium supplementation increased the need for aortic valve replacement surgery by 50%.

Calcium supplementation increased the risk of all-cause mortality* by 31%. When you divided the results into patients who did and did not have aortic valve replacement surgery during the study:

- Those who received aortic valve replacement surgery did not have a statistically significant increase in risk of death.

Calcium supplementation doubled the risk of cardiovascular mortality*. When you divided the results into patients who did and did not have aortic valve replacement surgery within the 59-month follow-up of this study:

- Those who received aortic valve replacement surgery did not have a statistically significant increase in risk of death.

*Note: Since all the patients enrolled in this study had aortic stenosis at the beginning of the study, these deaths were primarily due to aortic stenosis.

There are three important takeaways from this and previous studies:

1) For most Americans calcium supplementation does not increase the risk of cardiovascular disease. That has been shown in three major clinical studies.

You may wish to discuss with your doctor how to best balance:

- The need for calcium supplementation to prevent osteoporosis…

- With the need to limit calcium supplementation to prevent adverse outcomes from your aortic stenosis.

Aortic valve replacement is the only proven treatment for aortic stenosis. If your doctor recommends aortic valve replacement, you should consider it.

For more details, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Do Calcium And Magnesium Reduce Migraines?

May 11, 2021 by Dr. Steve Chaney

Avoiding Migraines

Author: Dr. Stephen Chaney

Migraines can be agonizing. They can upend your life. Drugs provide some relief, but they have side effects. I am often asked about natural approaches for preventing migraines.

My simple answer is that there is no single thing that can eliminate migraines. As the saying goes, “It takes a village”. There is no “magic” supplement or herb you can take. It requires a holistic approach to defeat migraines.

I will discuss the holistic approach for migraines in more detail below. But first I would like to describe a recent study (SH Meng et al, Frontiers in Nutrition, doi.org/10.3389/fnut.2021.653765) that suggests calcium and magnesium should be part of that holistic approach.

How Was This Study Done?

This study used data from the CDC’s most recent National Health and Nutrition Examination Survey (NHANES). The CDC has been doing these surveys since 1960, but the most recent NHANES study began in 1999.

Briefly, data collection for the current NHANES began in early 1999 and remains a continuous annual survey. Each year approximately 7,000 randomly selected residents across the United States are given the opportunity to participate in the NHANES survey.

The NHANES survey provides information on demographics, physical examinations, laboratory tests, diet surveys, and other health-related questions.

This study used data from 10,798 NHANES participants between 1999 and 2004 who completed a questionnaire asking if they suffered from severe headaches or migraines.

[Based on previous studies they considered self-reported severe headaches as likely migraines and grouped the two together. Accordingly, I will simply refer to them as migraines in this review.]

Here are a few important characteristics of the participants:

Gender was 51% male and 49% female.

Average age was 51.

Average intake was low for both calcium (70% of the RDA) and magnesium (62% of the RDA).

Only 20% suffered from migraines. However, the gender discrepancy was significant.

- Women (64%) were much more likely to suffer from migraines than men (36%). This is consistent with previous studies.

Do Calcium And Magnesium Reduce Migraines?

The investigators divided intake of both calcium and magnesium into quintiles and compared the frequency of migraines of those in the highest quintile with those in the lowest quintile.

For calcium, the highest quintile was ≥1,149 mg/day, and the lowest quintile was ≤378 mg/day.

- For comparison, the RDA for calcium is 1,200 mg/day for women between 50 and 70 and 1,000 mg/day for men between 50 and 70.

For magnesium, the highest quintile was ≥371 mg/day, and the lowest quintile was ≤161 mg/day.

- For comparison, the RDA for magnesium is 320 mg/day for women over 30 and 420 mg/day for men over 30.

For women:

Those with the highest intake of calcium were 28% less likely to suffer from migraines than those with the lowest intake of calcium.

Those with the highest intake of magnesium were 38% less likely to suffer from migraines than those with the lowest intake of magnesium.

For men:

Those with the highest intake of calcium were 29% less likely to suffer from migraines than those with the lowest intake of calcium.

Those with the highest intake of magnesium were 20% less likely to suffer from migraines than those with the lowest intake of magnesium, but this result was not statistically significant.

The authors concluded, “Our study found that high dietary intake of calcium and magnesium…were inversely associated with migraines in women. For men, high dietary calcium intake was inversely associated with migraines. People should pay more attention to dietary calcium and magnesium, which may be an effective way to prevent migraines.”

Avoiding Migraines

This study showed that RDA levels of both calcium and magnesium are effective at reducing the risk of developing migraines. However, if you suffer from migraines, you are probably looking for more than a 28-38% reduction in migraines. You want them to be gone. That is why a holistic approach is best.

What does a holistic approach for migraines look like? In fact, it is very individualistic. Different things work for different people. Here are a few suggestions.

In addition to calcium and magnesium, make sure you are getting enough omega-3 fatty acids, vitamin D, coenzyme Q10, riboflavin, and vitamin B12 in your diet.

Avoid “trigger foods”. Different foods trigger migraines in different people, but here are a few of the most common.

- Nitrate-containing processed meats.

- Cheeses containing tyramine such as blue, feta, cheddar, Parmesan, and Swiss.

- Alcohol, especially red wine.

- Chocolate and foods containing caffeine.

- Processed foods.

Some evidence suggests that a plant-based diet may reduce migraines, but only if it includes adequate amounts of the nutrients listed above.

Stay hydrated. Drink pure water rather than other beverages.

If overweight, shed some pounds. Obesity is linked to migraines.

Get adequate rest.

Try stress reduction techniques like yoga or meditation.

This is not a comprehensive list. If you have migraines, I probably left some of your favorite approaches off my list. The bottom line is that there are many natural approaches for reducing migraines. None is a “magic bullet” by itself but keep searching for the ones that help you the most.

What Does This Study Mean For You?

Getting back to magnesium and calcium, this study shows that RDA levels of both calcium and magnesium are sufficient to significantly reduce your risk of migraines. The problem is that many Americans are not getting RDA levels of calcium and magnesium from their diets. Why is that?

Dairy foods are the biggest source of calcium in the American diet. However, many Americans don’t get enough dairy foods in their diet because:

- Restrictive diets like Vegan and Paleo exclude dairy foods.

- They are trying to avoid saturated fats.

- They are lactose intolerant or have milk allergies.

- They have a malabsorption disease or have undergone gastric bypass surgery.

Magnesium is found in lots of whole foods. The problem is that most Americans are eating highly processed foods instead of whole foods.

If you are not getting enough calcium and magnesium in your diet, supplementation is a viable option. However, you don’t want megadoses of either one. You just want to reach RDA levels. Here are some tips:

Calcium:

Start by estimating how much calcium you are getting from your diet. My rule of thumb is to estimate 250 mg of calcium from each serving of dairy and an additional 200 mg of calcium from a typical diet. Subtract that from 1,200 mg, and you have the amount of supplemental calcium you need to match the highest quintile of calcium intake in this study.

The calcium supplement should also contain vitamin D because vitamin D is needed for calcium absorption.

Take no more than 500 mg of supplemental calcium at a time. Higher amounts are absorbed less efficiently.

It is generally better to take calcium supplements between meals than with meals. That is because many components of the typical diet interfere with calcium absorption. For example,

- Phytates in some high fiber foods.

- Oxalic acid in spinach and some other leafy greens.

- Saturated fats.

Magnesium:

The amount of magnesium in your diet is more difficult to calculate. However, 200 mg of magnesium will take you from the lowest quintile to the highest quintile in this study. And if you are already at the highest quintile, an extra 200 mg will not be excessive.

Magnesium can cause diarrhea, so I suggest a slow-release magnesium supplement.

The Bottom Line

Migraines can be agonizing. They can upend your life. Drugs provide some relief, but they have side effects. I am often asked about natural approaches for preventing migraines.

A recent study reported that calcium and magnesium should be part of a holistic approach to reduce migraines.

The study found that:

For women:

Those with the highest intake of calcium were 28% less likely to suffer from migraines than those with the lowest intake of calcium.

Those with the highest intake of magnesium were 38% less likely to suffer from migraines than those with the lowest intake of magnesium.

For men:

Those with the highest intake of calcium were 29% less likely to suffer from migraines than those with the lowest intake of calcium.

Those with the highest intake of magnesium were 20% less likely to suffer from migraines than those with the lowest intake of magnesium, but this result was not statistically significant.

For more details about other components of a holistic approach and my recommendations for calcium and magnesium supplementation read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Does Poverty Affect Nutritional Status?

September 22, 2020 by Dr. Steve Chaney

How Can We Improve Nutrition In Disadvantaged Communities?

Recently there has been increased focus on health disparities in disadvantaged communities. In our discussions of the cause of these health disparities, two questions seem to be ignored.

1. Does poverty play a role in poor nutrition?

2. Does poor nutrition play a role in the health disparities we see in disadvantaged communities?

The study (K Marshall et al, PLoS One 15(7):e0235042) I discuss in this week’s “Health Tips From The Professor” attempts to address both of these questions.

Before, I start, let me put this study into context.

Osteoporosis is a major health problem in this country. Over 2 million osteoporosis-related fractures occur each year, and they cost our health care system over 19 billion dollars a year. Even worse, for many Americans these osteoporosis-related fractures often cause:

- A permanent reduction in quality of life.

- Immobility, which can lead to premature death.

Inadequate calcium and vitamin D intakes increase the risk of osteoporosis.

While most studies simply report calcium and vitamin D intakes for the general population, this study breaks them down according to ethnicity and income levels. The results were revealing.

How Was The Study Done?

This study drew on data from the 2007-2010 and 2013-2014 National Health and Nutrition Examination Surveys (NHANES). These surveys are conducted by the National Center for Health Statistics, which is part of the CDC. They are designed to assess the health and nutritional status of adults and children in the United States and are used to produce health statistics for the nation.

The NHANES interview includes demographic, socioeconomic, dietary, and health-related questions. The examination component consists of medical, dental, and physiological measurements, as well as laboratory tests administered by highly trained medical personnel. All participants visit a physician. Dietary interviews and body measurements are included for everyone.

This study measured calcium intake, vitamin D intake, and osteoporosis for adults 50 and older. The data were separated by gender, ethnic group and income level. Four different measures of poverty were used. For purposes of simplicity, I will only use one of them, income beneath $20,000, for this article.

Does Poverty Affect Nutritional Status?

The Effect of Ethnicity And Gender On Calcium And Vitamin D Intake:

When the authors looked at the effect of ethnicity and gender on calcium and vitamin D intake, in people aged 50 and older the results were (Note: I am using the same ethnic nomenclature used in the article):

Hispanics:

- 66% (75% for women and 56% for men) were getting inadequate calcium intake.

- 47% (47% for women and 47% for men) were getting inadequate vitamin D intake.

Non-Hispanic Blacks:

- 75% (83% for women and 64% for men) were getting inadequate calcium intake.

- 53% (51% for women and 54% for men) were getting inadequate vitamin D intake.

Non-Hispanic Whites:

- 60% (64% for women and 49% for men) were getting inadequate calcium intake.

- 33% (30% for women and 37% for men) were getting inadequate vitamin D intake.

For simplicity, we can generalize these data by saying:

Gender:

- Women are more likely to be calcium-deficient than men.

- Men are more likely to be vitamin D-deficient than women.

Ethnicity: For both genders and for both calcium and vitamin D:

- The rank order for deficiency is Non-Hispanic Blacks > Hispanics > Non-Hispanic Whites.

The Effect Of Poverty On Calcium Intake, Vitamin D Intake, And Osteoporosis:

When looking at the effect of poverty, the authors asked to what extent poverty (defined as income below $20,000/year) increased the risk of calcium and vitamin D deficiency in adults over 50. Here is a summary of the data

Hispanics:

- For both Hispanic women and Hispanic men, poverty had little effect on the risk of calcium and vitamin D deficiency.

Non-Hispanic Blacks:

- For Non-Hispanic Black women, poverty had little effect on the risk of calcium deficiency, and vitamin D deficiency.

- For Non-Hispanic Black men, poverty increased the risk of both calcium and vitamin D deficiency by 32%.

Non-Hispanic Whites:

- For Non-Hispanic White women, poverty had little effect on the risk of calcium deficiency but increased the risk of vitamin D deficiency by 30%.

- For Non-Hispanic White men, poverty increased the risk of both calcium deficiency and vitamin D deficiency by 18%.

For simplicity, we can generalize these data by saying:

- Poverty increased the risk of both calcium and vitamin D deficiency for Non-Hispanic Black men, Non-Hispanic White women, and Non-Hispanic White men.

Other statistics of interest:

The SNAP program (formerly known as Food Stamps) had little effect on calcium and vitamin D intake. There are probably two reasons for this:

- In the words of the authors, “While the SNAP program has been shown to decrease levels of food insecurity, the quality of the food consumed by SNAP participants does not meet the standards for a healthy diet.” In other words, the SNAP program ensures that participants have enough to eat, but SNAP participants are just as likely to prefer junk and convenience foods as the rest of the American population. The SNAP program provides no incentive to eat healthy foods.

- We also need to remember that dairy foods are a major source of calcium and vitamin D in the American diet and that Hispanics and Non-Hispanic Blacks are more likely to be lactose-intolerant than the rest of the American population. There are other sources of calcium and vitamin D in the American diet. But without some nutrition education, most Americans are unaware of what they are.

An increased risk of osteoporosis was found in Non-Hispanic Black men, and Non-Hispanic Whites with incomes below $20,000/year.

- This increased risk of osteoporosis was seen primarily for the individuals in each group who were deficient in calcium and vitamin D. There were other factors involved, but I will focus primarily on the effect of poverty on calcium and vitamin D intake in the discussion below.

How Can We Improve Nutrition In Disadvantaged Communities?

Let’s start with the two questions I posed at the beginning of this article:

1. Does poverty play a role in poor nutrition?

2. Does poor nutrition play a role in the health disparities we see in disadvantaged communities?

In terms of calcium intake, vitamin D intake, and the risk of osteoporosis, the answer to both questions appears to be, “Yes”. So, the question becomes, “What can we do?”

It is when we start to ask what we can do to increase calcium and vitamin D intake and decreased the risk of osteoporosis in disadvantaged communities that we realize the complexity of the problem. There are no easy answers. Let’s look at some of the possibilities.

[Note: I am focusing on what we can do to prevent osteoporosis, not to detect or treat osteoporosis. The solutions for those issues would be slightly different.]

1. We could increase funding for SNAP. That would increase the quantity of food available for low income families, but, as noted above, would do little to improve the quality of the food eaten.

2. We could improve access to health care in disadvantaged communities. But unless physicians started asking their patients what they eat and start recommending a calcium and vitamin D supplement when appropriate, this would also have little impact on diet quality.

3. We could improve nutrition education. A colleague of mine in the UNC School of Public Health ran a successful program of nutrition education through churches and community centers in disadvantaged communities for many years. The program taught people how to eat healthy on a limited budget. Her program improved the health of many people in disadvantaged communities.

However, the program was funded through grants. When she retired, federal and state money to support the program eventually dried up. The program she started is a model for what we should be doing.

4. The authors suggested food fortification as a solution. In essence, they were suggesting that junk and convenience foods be fortified with calcium and vitamin D. That might help, but I don’t think it is a good idea.

If we want to improve the overall health of disadvantaged communities, we need to find ways to replace junk and convenience foods with healthier foods. Adding a few extra nutrients to unhealthy foods does not make them healthy.

5. The authors also said that a calcium and vitamin D supplement would be a cheap and convenient way to eliminate calcium and vitamin D deficiencies. Unfortunately, supplements are currently not included in the SNAP program. Unless that is changed, even inexpensive supplements are a difficult choice for families below the poverty line.

As I said at the beginning of this section, there are no easy answers. It is easy to identify the problem. It would be easy to throw money at the problem. But finding workable solutions that could make a real difference are hard to identify.

Yes, we should make sure every American has enough to eat. Yes, we should make sure every American has access to health care. But, if we really want to improve the health of our disadvantaged communities, we also need to:

Change the focus of our health care system from treatment of disease to prevention of disease.

Train doctors to ask their patients what they eat and to instruct their patients how simple changes in diet could dramatically improve their health.

Provide basic nutrition education to disadvantaged communities at places where they gather, like churches and community centers. This would cover topics like eating healthy, shopping healthy on a limited budget, and cooking healthy.

We don’t necessarily need another massive federal program. But those of us with the knowledge could each volunteer to share that knowledge in disadvantaged communities.

Cover basic supplements, like multivitamins, calcium and vitamin D supplements, and omega-3 supplements in food assistance programs like SNAP.

The Bottom Line

Osteoporosis is a major health problem in this country. Over 2 million osteoporosis-related fractures occur each year, and they cost our health care system over 19 billion dollars a year. Even worse, for many Americans these osteoporosis-related fractures often cause:

A permanent reduction in quality of life.

Immobility, which can lead to premature death.

We know that inadequate calcium and vitamin D intakes increase the risk of osteoporosis. But most studies simply report calcium and vitamin D intakes for the general population. At the beginning of this article, I posed two questions.

Does poverty play a role in poor nutrition?

2. Does poor nutrition play a role in the health disparities we see in disadvantaged communities?

A recent study looked at the effect of gender, ethnicity and income levels on calcium intake, vitamin D intake, and the risk of developing osteoporosis. The results of this study shed some light on those two questions.

When looking at the effect of gender and ethnicity on the risk of inadequate calcium and vitamin D intake, the study found:

Women are more likely to be calcium-deficient than men.

Men are more likely to be vitamin D-deficient than women.

For both genders and for both calcium and vitamin D, the rank order for deficiency is Non-Hispanic Blacks > Hispanics > Non-Hispanic Whites. [Note: Note: I am using the same ethnic nomenclature used in the study.]

Poverty (defined as incomes below $25,000/year) significantly increased the risk of both calcium and vitamin D deficiency for Non-Hispanic Black men, Non-Hispanic White women, and Non-Hispanic White men.

An increased risk of osteoporosis was also found in Non-Hispanic Black men, and Non-Hispanic White men and women with incomes below $20,000/year.

This increased risk of osteoporosis was seen primarily for the individuals in each group who were deficient in calcium and vitamin D.

In short, this study suggests that the answer to both questions I posed at the beginning of the article is, “Yes”.

For more information and a discussion of what we could do to correct this health disparity in disadvantaged communities, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Preventing And Reversing Osteoporosis

November 19, 2019 by Dr. Steve Chaney

A Bone Health Lifestyle

Author: Julie Donnelly, LMT – The Pain Relief Expert

Editor: Dr. Steve Chaney

Fall is glorious in my book. I was up in New York a few weeks ago, and the trees were just changing – I was about a week too early for the best colors, but it was still beautiful. Then I flew out to Lake Tahoe, and it was really beautiful there. The air was crisp and clean, and I loved all the fall decorations.

In Florida we are entering our most wonderful time of year. It’s starting to get cooler, the humidity is going down, and hurricane season is over. Hooray! It’s great to be outdoors again!

Please remember all the people who are still going through very difficult times in the Bahamas. Many people have lost their homes, their workplaces and the income that supports them, and some have lost loved ones. A devastating loss.

We here in the USA were blessed that Dorian didn’t come any further west and do the same thing to Florida, Georgia, and the Carolinas. I wanted to share what I have with the people who now have nothing. That made me search for places I trust that will send all the money I donate. In case you want to help, and you don’t have a favorite charity, I want to share those places with you:

https://disaster.salvationarmyusa.org

http://secure.americares.org/help/now‎

https://www.mercycorps.org/articles/hurricane-dorian-bahamas#mercy-corps-helping

Preventing And Reversing Osteoporosis

Weight-bearing exercise builds strong bones. That statement is so common that just about everyone knows they need to exercise for strong muscles and bones, and for all the good it does for just about every system in the body. And, we are what we eat, so nutrition is vital.

Do you like to exercise? Some people are almost addicted to exercise, but I’m not one of them. I go to the gym and I have a fitness trainer to help me stay on track, but it fits right in with my eagerness of going to the dentist. I must say, I’d like that to change, and maybe if I can find a workout partner, it will.

Meanwhile I need to do something because I’ve been told I have osteoporosis. Yikes! One thing for sure, I’m not taking any type of medication. I truly believe there is another solution.

While I’m not an exercise nut, I do love nutrition and I know that the body is so adaptable that if it’s given the proper nutrition, it can do miracles. I believe nutrition and exercise can reverse this osteoporosis diagnosis.

A Bone Healthy Lifestyle

The first thing I did was contact my friend, Steve Chaney, PhD, author of the weekly blog “Health Tips From The Professor. He pointed me to an article he had written on a “Bone Healthy Lifestyle”. Here is a brief summary:

Exercise, calcium, and vitamin D are all essential for bone formation. If any of them are missing, you can’t form healthy bone. The reason so many clinical studies on calcium supplementation and bone density have come up empty is that exercise, or vitamin D, or both were not included in the study.

Get plenty of weight bearing exercise. This is an essential part of a bone healthy lifestyle. Your local Y can probably give you guidance if you can’t afford a personal trainer. Of course, if you have physical limitations or have a disease, you should consult with your health professional before beginning any exercise program.

Get your blood 25-hydroxy vitamin D level tested. If it is low, take enough supplemental vitamin D to get your 25-hydroxy vitamin D level into the adequate range – optimal is even better. Adequate blood levels of 25-hydroxy vitamin D are also essential for you to be able to utilize calcium efficiently.
Consume a “bone healthy” diet that emphasizes fresh fruits and vegetables, minimizes meats, and eliminates sodas and other acidic beverages. For more details on whether your favorite foods are acid-forming or alkaline-forming, you can find plenty of charts on the internet.
Minimize the use of medications that adversely affect bone density. You’ll need to work with your doctor on this one.
Consider a calcium supplement. Even when you are doing everything else correctly, you still need adequate calcium in your diet to form strong bones. Dr. Chaney wasn’t advocating a “one-size fits all” 1,000 to 1,200 mg/day for everyone. Supplementation is always most effective when you actually need it. For example:

o If you are not including dairy products in your diet (either because they are acid-forming or for other health reasons), it will be difficult for you to get adequate amounts of calcium in your diet. You can get calcium from other food sources such as green leafy vegetables. However, unless you plan your diet very carefully you will probably not get enough.

o If you are taking medications that decrease bone density, that may increase your need for supplemental calcium. Ask your pharmacist about the effect of any medications you are taking on your calcium requirements.

If you do use a calcium supplement, make sure it is complete. Don’t just settle for calcium and vitamin D. At the very least you will want your supplement to contain magnesium and vitamin K. Dr. Chaney recommends that it also contain zinc, copper, and manganese.

Between increasing my exercise and ramping up all the nutrients that build bone, I just know that by this time next year I’m going to be surprising the doctor with my great health

Should We Take Calcium Supplements?

September 27, 2016 by Dr. Steve Chaney

Clearing Up The Calcium Confusion

Author: Dr. Stephen Chaney

Should we take calcium supplements? You have every right to be confused about calcium supplementation. There have been a lot of conflicting headlines in recent months.

It has seemed like a no-brainer for years that calcium supplementation could help post-menopausal women and men over 50 avoid the debilitating effects of osteoporosis.

After all:

>99% of adults fail to get the USDA recommended 2.5-3 servings/day of dairy products.

67% of women ages 19-50 and 90% of women over 50 fail to meet the RDA recommendations for calcium intake from diet alone.

Men do a little better (but only because we consume more food). 40% of men ages 19-50 and 80% of men over 50 fail to meet the RDA recommendations for calcium intake from diet alone.

Inadequate calcium intake over a lifetime is considered a major risk factor for osteoporosis.

Osteoporosis is serious business. It doesn’t just cause bone fractures. It can result in chronic pain, disability, long term nursing home care, and even death.

It’s no wonder that some experts have predicted that supplementation with calcium and vitamin D could save over $1 billion per year in health care cost savings. It is also why health professionals have recommended calcium supplementation for years, especially for postmenopausal women and men over 50.

However, recent headlines have claimed that calcium supplementation doesn’t really increase bone density or prevent osteoporosis (more about that later). Other headlines have suggested that calcium supplementation is actually bad for you. It may increase your risk of heart disease.

That’s why the general public, and even many doctors, are confused. Should we take calcium supplements? Everyone wants to know the answer to two questions:

Do calcium supplements work?

Are calcium supplements safe?

I will start with the second question first.

Are Calcium Supplements Safe?

I have discussed the issue of calcium supplements and heart disease risk in a previous issue of Health Tips From the Professor. Briefly, the initial studies suggesting that calcium supplementation might increase the risk of heart attacks and cardiovascular disease were good studies, but they were small, short-term studies.

The initial studies raised an important question, so the scientific community stepped up to the plate and conducted larger, longer term studies to test the hypothesis. Both of those studies concluded that calcium supplementation posed no heart health risks.

Now a third major study on the subject has just been published (Raffield et al, Nutrition, Metabolism & Cardiovascular Disease, doi: 10.1016/j.numecd.2016.07.007). The study followed 6236 men and women ages 45-84 for an average of 10.3 years. The subjects were from four different race/ethnicity groups and came from 6 different locations in the United States. More importantly, there were 208 heart attacks and 641 diagnoses of cardiovascular disease during the study, so the sample size was large enough to accurately determine the relationship between calcium supplementation and heart disease.

The results were pretty straight forward:

The authors concluded: “[This study] does not support a substantial association of calcium supplement use with negative cardiovascular outcomes.” If you would like the plain-speak version of their conclusion, they were saying that they saw no increase in either heart attacks or overall cardiovascular disease in people taking calcium supplements.

If anything, they saw a slight decrease in heart attack risk in those taking calcium supplements, but this was not statistically significant.

In summary, the weight of evidence is pretty clear. Three major studies have now come to the same conclusion: Calcium supplementation does not increase the risk of either heart attacks or cardiovascular disease.

Of course, once information has been placed on the internet, it tends to stay there for a very long time – even if subsequent studies have proven it to be wrong. So the myth that calcium supplementation increases heart attack risk will probably be with us for a while.

So, should we take calcium supplements? Let’s first investigate a little further.

Do Calcium Supplements Work?

As I mention above, recent headlines have also suggested that calcium supplementation does not increase bone density, so it is unlikely to protect against osteoporosis. I analyzed the study behind those headlines in great detail in two previous issues of Health Tips From the Professor.

In Part 1 Calcium Supplements Prevent Bone Fractures I pointed out the multiple weaknesses in the study that make it impossible to draw a meaningful conclusion from the data.

In Part 2 Preventing Osteoporosis I discussed the conclusion that the study should have come to, namely: Adequate calcium intake is absolutely essential for strong bones, but calcium intake is only one component of a bone healthy lifestyle.

The bottom line is that calcium supplementation will be of little use if:

You aren’t getting adequate amounts of vitamin D and all of the other nutrients needed for bone formation from diet and supplementation.

You aren’t getting enough exercise to stimulate bone formation.

You are consuming bone dissolving foods or taking bone dissolving drugs.

Conversely, none of the other aspects of a bone healthy lifestyle matter if you aren’t getting enough calcium from diet and supplementation.

The bottom line is that you need to get adequate calcium and have a bone healthy lifestyle to build strong bones and prevent osteoporosis, and calcium supplementation is often essential to make sure you are getting adequate calcium.

Should We Take Calcium Supplements?

Should we take calcium supplements? If you are one of the millions of Americans who aren’t meeting the RDA guidelines for calcium from diet alone, the answer is an unqualified yes. Calcium supplementation is safe, and it is cheap. Osteoporosis is preventable, and it is not a disease to be trifled with.

However, you also need to be aware that calcium supplementation alone is unlikely to be effective unless you follow a bone healthy lifestyle of diet, exercise and appropriate supplementation to make sure you are getting all of the nutrients needed for bone formation.

Of course, it is always possible to get too much of a good thing. The RDA for calcium is 1,000 – 1,200 mg/day. The suggested upper limit (UL) for calcium is 2,000 – 3,000 mg/day. I would aim closer to the RDA than the UL unless higher intakes are recommended by your health care professional.

The Bottom Line

80% of men and 90% percent of women over 50 do not get enough calcium from their diet.

Consequently, doctors have consistently recommended calcium supplementation to prevent osteoporosis, and 50% of men and 60% of women over 60 currently consume calcium supplements on a regular basis.

Some small, short term studies suggested that calcium supplementation might increase the risk of heart disease, and warnings about calcium supplementation have been widely circulated on the internet. This hypothesis has been evaluated by three larger, longer term studies that have all concluded that calcium supplementation does not increase heart disease risk.

A recent study claimed that calcium supplementation was ineffective at increasing bone density, and that report has also been widely circulated. However, there are multiple weaknesses in the study that make it impossible to draw a meaningful conclusion from the data.

If you are one of the millions of Americans who aren’t meeting the RDA guidelines for calcium from diet alone, you should consider calcium supplementation. It is safe. It is effective when combined with a bone healthy lifestyle of diet, exercise, and appropriate supplementation. Finally, it is cheap. Osteoporosis is preventable, and it is not a disease to be trifled with.

Of course, it is always possible to get too much of a good thing. The RDA for calcium is 1,000 – 1,200 mg/day. The suggested upper limit (UL) for calcium is 2,000 – 3,000 mg/day. I would aim closer to the RDA than the UL unless higher intakes are recommended by your health care professional.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.