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Calcium Supplements: Are you taking them?

Have you ever felt like making the right dietary choices was more like crossing a minefield?  One day you are strolling along, sure that you are on the path to righteous wellness.  Then BAM!  The landscape changes and you find that you are in mortal danger.  This week, an announcement that victimized calcium supplements was just such a land mine.  Millions of women take these supplements. They've been sacrosanct.  For doctors, recommending calcium pills seemed like a no-brainer, and most were happy to give such easy and seemingly important instruction.

But a few days ago, the British Medical Journal announced that healthy older women who take calcium supplements appear to have as much as a 30% greater chance of suffering a heart attack than those who do not.  This conclusion was based on a review of 12,000 women and was consistent regardless of the type of supplement used.  In the wake of this news, TV health pundits were already distancing themselves from calcium pills.  (CBS News Video )

Once again, real food proved the winner.  Women who got calcium by diet alone had no such risk. For almost any nutrient you can name, food sources provide the safest means of consumption.  As most of you regular readers know, I don't think much of supplements.  In fact, I stopped taking calcium long ago.  For years, that has been my guilty secret. All of a sudden I'm looking like a clairvoyant.

One would think that the big news here is the danger of calcium pills (it’s hypothesized that they may accelerate hardening of the arteries).  But in fact, there are two other elements that are well worth examining.  The first is the conclusion of this and other studies that taking calcium supplements doesn't prevent osteoporosis (why were we all taking the blasted things then?). The second is the fallout that will occur as a result of this, the latest nutritional bombshell.

The editorial that accompanies the British Medical Journal study said:

"Calcium supplements, given alone, improve bone mineral density, but they are ineffective in reducing the risk of fractures and might even increase risk, they might increase the risk of cardiovascular events, and they do not reduce mortality. They seem to be unnecessary in adults with an adequate diet. Given the uncertain benefits of calcium supplements, any level of risk is unwarranted."

Once again, the news that stuns here is that calcium pills never did reduce fracture risk.  Undoubtedly, we would have continued to pour endless dollars into these supplements (just as we do into taking all sorts of fancy, unproven vitamin supplements) had this particular study not gotten big media play.

But in fact, the biggest story in the calcium saga may yet be unwritten and may come from the whiplash that occurs as a result of our rush to get calcium from something other than a pill.  Because we change our diets based on the daily proclamations of science, our eating habits are as fickle as a passel of runaway brides. One change often ripples out to create a host of others.  Remember this one? In the 1990's various researchers declared that fat was the enemy.  The result?  An entire country loaded up on fat free products. In our headlong rush to avoid fat, we vastly increased consumption of carbohydrates and sugars. We soon became increasingly more obese and diabetic. Read some Frontline interviews on the Fat Free Years  

We are only a few days into the calcium story, but already we are being advised to get more calcium via foods.  That seems like great advice, but the type of food is not being examined much.  Nor is the fact that many of the countries with the world's highest rates of osteoporosis have the highest calcium intakes.  No doubt, cartons of milk, chunks of cheese and anything made with soy will soon sport attractive labels that remind us that these foods contain calcium.  Will we stop and think about rushing to increase our consumption of these foods?  I doubt it.  Most  people (and I include health professionals) believe that all we need to do is plug the latest hole, in this case calcium.  The fat free experiment should have taught us something, but I guarantee....it hasn't.

We will probably start running to soy (many soy products are fortified with calcium) and dairy for our calcium. 

Fortified soy milks and cheeses have been promoted as healthy alternatives for those who can't tolerate milk, or just because.  Very few people would consider the Harvard School of Public Health a fringe organization but their view of soy is cautious.  It appears that soy is not the miracle food it purports to be.  Studies do not support soy's ability to lower bad cholesterol meaningfully, nor to stop hot flashes or menopausal symptoms.  And the phytoestrogens in soy have unknown effect.  Several studies even suggest that soy may stimulate the growth of breast cancer cells.  Harvard Nutrition Source: Soy. 

Similarly, you may be surprised to read what Harvard has to say about dairy: "Look beyond the dairy aisle. Limit milk and dairy foods to no more than one to two servings per day. More won’t necessarily do your bones any good—and less is fine, as long as you get enough calcium from other sources. […] While calcium and dairy can lower the risk of osteoporosis and colon cancer, high intake can increase the risk of prostate cancer and possibly ovarian cancer." 

Let’s think a bit before we rush to make big changes.

An interesting dietary conundrum is the fact that many of the countries with the highest dairy consumption (the Scandanavian countries and the US for example) have some of the world’s highest rates of osteoporosis. 

Researchers who believe in ancient eating styles point out that diets which are high in dairy (not ancient), cereal grains (not ancient) and meat, tend to present high acid loads to the blood.  Fruits and vegetables are more alkaline when digested.  When things get too acidic, the body needs to release an alkaline substance to neutralize the problem.  If it is not readily available in the food we eat, calcium is the buffer that calms the acid load.  With chronic consumption of an acidic diet, the theory goes; there is chronic release of calcium from the bones leading to osteoporosis.

Once again, the Primarian, ancient or Paleo diet avoids the problem.  This seems to be the case with each new diet "discovery".   That’s no surprise if you believe, as I do, that the only thing we are "discovering" is how to eat as humans always did.  Somehow, though, that’s never the conclusion we reach. Instead, we run to make a big correction.  In doing so, we tilt our diets like sailboats whose masts are listing in the wind.  Not a good idea when diets and health are all about balance.

An ancient diet is primarily composed of fruits, vegetables, nuts, berries, lean meats, poultry, fish, seafood and eggs. Lean toward the plant matter and add high quality animal protein. When possible, the animals we eat should be fed a diet that is composed of their own natural foods (in other words, grass fed rather than grain fed).  Grains are not a part of ancient diet, nor are legumes like soy because there was no original genetic exposure to these foods. While I include low fat dairy in my Primarian diet (for the sake of making it more palatable to modern eaters), I suggest sparing use.  Animal milk is a new food for most humans and many have a problem with it, including lactose intolerance—a condition that effects the majority of the world’s population.

In our modern world, a good diet may be defined as a diet that manages to survive every challenge issued by scientific "discovery".   In the past 7 years or so since I became primarily Primarian, I haven’t had a moment of diet fickleness.  Nothing has made me rush to change my plan because each new diet finding has neatly aligned with exactly what I’m eating.  Low salt, high potassium, more omega three, less saturated fats, more fish, fewer pills...less visits to the doctor.

I've got it covered.  

 
Dr. Barbara Berkeley on Aug 31, 2010

ARE YOU STRESSED OUT - How Can Acupuncture Help?

Stress is a natural part of life.  As a mother of two small children, I know what it’s like to be constantly running from babysitter to school to work, making dinner, cleaning up and then to violin lessons, laundry, paying bills, checking e-mails, etc.  It seems that life moves faster and there’s no time to slow down.   The never-ending hectic lifestyles and inability to handle stress, has caused major illnesses in America.  Stress can come in many different forms such as anxiety, insomnia, depression, obesity, and fatigue.  There are various techniques you can use to relieve stress.  Maybe you have tried a few different techniques such as yoga, deep breathing, listening to relaxing music, massage and meditation.  If those techniques are not effective enough for you, then you should try Acupuncture.

Acupuncture is an ancient Chinese healing art that involves inserting fine needles at very precise acupoints throughout the body. The needles stimulate the body’s natural healing processes in its energy system. Traditional Chinese Medicine states that energy or Qi (pronounced “Chee”) flows through the body system through channels or pathways called meridians. There are 14 meridians that run vertically throughout the body.  Stress causes an imbalance in the body’s Qi and causes it to flow improperly. The Qi can become blocked and stagnant.   It must be unblocked and flow freely in order to restore harmonious balance to the body.  Too much stress can cause the Qi to be blocked!  By stimulating the proper acupuncture points, the Qi can flow freely, thereby alleviating stress induced mental and physical symptoms. In Modern Medicine, researchers have discovered that the lesions produced by inserting a needle into a specific acupuncture point on the body, stimulates parts of the brain that then activates the principal survival systems – nervous, endocrine, immune and cardiovascular systems.  Acupuncture normalizes physiological homeostatis and promotes self-healing.  When needling for stress and anxiety, specific points are needled to activate reflexes to the brain, which creates a balance between the sympathetic and parasympathetic nervous systems to promote self-healing.  When we stress too long, we overuse our sympathetic system, we become exhausted because of consuming stored energy.  Our immune system becomes suppressed and we are more likely to get sick, become sensitive to pain, and are not able to handle stress.  With Acupuncture, the sympathetic nervous system is able to calm down and the parasympathetic system becomes active.  The Parasympathetic system helps us to relax i.e. ensures proper food digestion, which helps us to absorb and supply energy to the body.  Acupuncture helps to balance these systems thereby decreasing our stress and improving our health.

 
Susan M. Kim DC, CCN, CSCS on Aug 30, 2010

August is Psoriasis Awareness Month

Psoriasis is a skin disease that causes itchy or sore patches of thick, red skin with silvery scales. You usually get them on your elbows, knees, scalp, back, face, palms, and feet, but they can show up on other parts of your body. A problem with your immune system causes psoriasis. In a process called cell turnover, skin cells that grow deep in your skin rise to the surface. Normally, this takes a month. In psoriasis, it happens in just days because your cells rise too fast.

Psoriasis can last a long time, even a lifetime. Symptoms come and go. Things that make them worse include

  • Infections
  • Stress
  • Dry skin
  • Certain medicines

Psoriasis usually occurs in adults. It sometimes runs in families. Treatments include creams, medications, and light therapy.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

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For more information, please contact a Lake Health Professional Librarian.

 
Library on Aug 24, 2010

August is National Immunization Awareness Month

 Immunizations (or vaccinations) aren’t just for babies and young kids. We all need shots to help  protect us from serious diseases and illness.  Everyone over age 6 months needs a seasonal flu shot every year. Here are some other shots people need at different ages:

Young children:

Children under age 6 get a series of shots to protect against measles, polio, chicken pox, and hepatitis.

Preteens:

All 11- and 12-year-olds need shots to help protect against tetanus, diphtheria, whooping cough, and meningitis.

Doctors recommend girls also get the HPV vaccine to protect against the most common cause of cervical cancer.

Adults:

All adults need a tetanus shot every 10 years.

People age 65 need a one-time pneumonia shot.

Talk to your doctor or nurse about which shots you and your family need.

This week’s blog post focuses on adult immunizations.  Check back next week for information and resources on children and adolescent immunizations.

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For more information, please contact a Lake Health Professional Librarian.

 
Library on Aug 06, 2010

No Fan of Pills, No Fan of Prejudice

Readers of this blog know very well that I (vastly) prefer healthy behaviors to pills for the prevention and treatment of most of our modern medical problems.  But the FDA's approach to potential weight loss medications is frustrating and, in my view, prejudicial.

First, there was the FDA's denial of Rimonabant, a weight loss med that has been in use in Europe for some time.  The FDA based its thumbs-down ruling on Rimonabant's potential to cause depression and suicidal thoughts.  Data from long term trials in North America and Europe, however, suggest that while these effects are real, they generally occur early in treatment and disappear after the first year (see  Rimonabant Data ). in the European market, this problem was dealt with by new labeling and by educating prescribers on proper drug usage.  American physicians are completely familiar with using medications that may have deleterious side effects.  In particular, most of our popular (and excessively prescribed) antidepressants carry warnings about increased suicidal ideation.  Beta blockers, routinely used for heart conditions and blood pressure, can intensify or cause depression; as well as anxiety drugs like valium or xanax, narcotic pain relievers, and a host of other medicines. 

For the past couple of years, there has been a buzz around a new weight loss med called Qnexa.  Like its highly effective but controversial cousin Phen-Fen, Qnexa is a combination medication.  For some time now, obesity specialists have believed that weight gain must be blocked via multiple channels.  This means mixing drugs in order to strengthen their individual effects. 

Qnexa is a combination of two medicines:  phentermine and topirimate.  The first component, phentermine, is the same drug that formed half of the Phen-Fen combo.  It is an appetite suppressant which has mild stimulatory effects.  When given alone, it has not caused any of the problems seen with Phen-Fen, and has been used safely for many years.  Most weight loss doctors use it (even me, although rarely), but its efficacy is limited by the fact that tolerance develops rather quickly.  Within a fairly short time, appetite suppression is lessened and the drug stops working.  Side effects include increased heart rate and blood pressure and the potential for extra or skipped heartbeats.  Some people report jitteriness or insomnia.  For most, these effects can be mitigated by carefully controlled dosing. 

The second component of Qnexa is a relatively small dose of Topirimate, more familiarly known by its brand name Topamax.  Topamax was originally developed as an anti-seizure drug, but soon gained popularity as a migraine preventative.  When patients taking the drug noticed associated weight loss and appetite suppression, it began to be used off-label for weight control.  Topamax can cause confusion, word-finding difficulties, kidney stones, and a serious problem called metabolic acidosis.  However, many people take Topamax without difficulty and at much higher doses than those included in Qnexa. 

Weight loss trials with Qnexa have shown it to be moderately effective, but yesterday, the FDA panel charged with reviewing the drug disapproved it citing side effects.  This dismissal is seen as a foreshadowing of the fate of two other drugs (contrave and lorcaserin) that are currently in clinical trials. 

At the moment, doctors basically have only two prescription drugs for treating overweight:  sibutramine (meridia) and phentermine (adipex).  Neither drug is particularly harmful nor is neither drug is particularly effective.  Despite this fact, these drugs are controlled as if they were the most destructive medications on the face of the earth.  In the state of Ohio, for example, use of the drug phentermine is limited to a three month period (unheard of for any other medication).  Doctors must document that their patient is, in fact, obese prior to prescribing the drug.  The patient must show a documented weight loss while taking the drug.  The prescription must be written for three consecutive months without a break.  If there is a disruption, the prescription will not be filled.  Pharmacists can question the honesty of the physician.  I have personally received calls from pharmacists who wanted to know whether a certain patient really had a BMI of 30. In their judgment, the patient didn't look heavy enough!   Patients who are given prescriptions for weight loss drugs are often treated as if they were asking for heroin.  Many of my patients have been told, very dismissively, "we don't carry that!" They are made to feel embarrassed and demeaned.  Contrast this attitude toward weight loss drugs with the attitude toward narcotic pain meds.  Any dentist can prescribe truly dangerous medications like vicodin or percocet in large amounts.  I can send a patient out of my office with a prescription for fistfuls of oxycontin and I can renew that prescription monthly ad infinitum.  No patient will ever be questioned or looked at askance at the pick-up counter.  And I can guarantee that I will never get a call saying that the patient in question looks like someone who doesn't "deserve" their medication.

Weight loss medicines don't work very well, but for some people, they are at least a small raft to cling to.  Both my patients and I have experienced prejudice around the prescription and consumption of such medicines, despite the fact that in the big picture of drugs and their side effects, weight loss medications are minor players. I believe that the refusal of the FDA to forward new weight loss meds smacks of the same prejudice and hypocrisy.

Are we saying that it is ok for medications to have multiple side effects so long as they treat "important" and life threatening conditions?  What could be more life threatening and important than a condition that is killing 300,000 people yearly in America and is consuming 147 BILLION dollars of our annual health care budget (CDC estimate)? 

I suppose I should be happy that the FDA is protecting our overweight citizens from medicines that they might take indiscrimately and which might cause them harm, but I can't get past the fact that they seem to be trivializing the obesity epidemic with their decisions.  Personally, I am looking for a medication to help stabilize people in the first year or two of maintenance.  That medication might be one of these denied drugs, used judiciously and for a short period.  Now I am left without any ammunition, forced to make a choice whether to use drugs in an off-label situation, which shifts all the liability to me.

All the blame for our lack of weight loss meds does not fall on the FDA.  One of the major reasons for caution with these medications is the history of the weight loss industry.  If it were not so full of charlatans and pill pushers, if people had better and more thoughtful treatment, and if more physicians understood more about the problem, we would not have such a skittish FDA.  As things stand, I can't blame them for wanting to limit access to drugs that have such potential for over-prescription and abuse.

Still.  These FDA rulings make me feel that, once again, the powers that be are making the statement that obesity is simply a matter of self-control, and unlike those "important" conditions, it can live without adequate medical options.  I wonder if we’ll feel the same when 90% of our population is overweight? 

 

 
Dr. Barbara Berkeley on Aug 03, 2010

Coping with Juvenile Arthritis

Also called: Childhood arthritis, JRA, Juvenile idiopathic arthritis, Still's disease 

Juvenile rheumatoid arthritis (JRA) is a type of arthritis that happens in children age 16 or younger. It causes joint swelling, stiffness, and sometimes reduces motion. It can affect any joint, and in some cases it can affect internal organs as well.

One early sign of JRA may be limping in the morning. Symptoms can come and go. Some children have just one or two flare-ups. Others have symptoms that never go away. JRA can also cause growth problems in some children.

No one knows exactly what causes JRA. Scientists do know it is an autoimmune disorder, which means your immune system, which normally helps your body fight infection, attacks your body's own tissues. Medicines and physical therapy can help maintain movement, and help reduce swelling and pain.

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Library on Aug 02, 2010

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