Saturday, March 2, 2013

Calcium Supplement: A “do” that’s now a “don’t.” So What’s Next?

I received an e-mail early this week from my brother, a doctor, with the subject heading of “Don’t take calcium supplements” Attached was the latest journal article BMJ 2/13/13  that showed that calcium supplements were doing more harm then good for older women. After years of being told to take calcium and vitamin D to protect their bones from osteoporosis, along comes a study that shows that women who get too much calcium via supplements (1,400 mg a day or more) are twice as likely to die from cardiovascular disease. But those who take 600 mg or less are also at an increased risk of death.. “If you have a normal diet, you don’t need to take calcium supplements,” said the lead author, Dr. Karl Michaelsson, at Uppsala University in Sweden.

Also out this week, and also e-mailed to me by my brother, is a recommendation from the US Preventive Services Task Force that healthy older women shouldn’t bother with relatively low-dose dietary supplements of calcium and vitamin D, as taking 400 international units of D and 1,000 milligrams of calcium doesn’t prevent broken bones but can increase the risk of kidney stones. Annals of Internal Medicine 

So first things first, let’s discuss the calcium supplement piece. According to the NIH’s Office of Dietary Supplements, the recommended daily allowance (RDA) of calcium for women 50 and up is 1,200 mg. Yet, this study indicates that somewhere between 600 and 1,000 milligrams might be a better target range.  Next consider that most Americans believe that the primary source of calcium is milk, when in fact, calcium appears in many different foods, including fortified cereals, nuts, beans etc. Water is also a source, if you live in an area with hard water, If you want to get some idea of how much calcium you are actually getting, try the Calcium Food Calculator. 

Now for the bigger issue. Things come in and out of vogue in healthcare. A quick look at the Choosing Wisely list of tests and treatments you may either not need or should use sparingly points to how things that were once common practice are being thought of in different ways. Mammography and prostate cancer screening, once the gold standard for cancer prevention are undergoing radical shifts in how they are administered.  Hormone replacement therapy (HRT) was once widely prescribed not only because it reduced or eliminated menopausal symptoms,  but it was believed to have other health benefits. However, this practice came to a halt when the Women’s Health Initiative found an increase in breast cancer in women taking HRT, particular those who had taken it for a long time.

When you see studies, such as the ones my brother e-mailed, it gives one pause. What am I doing now, believing it to be healthy, that will be found to be problematic in a few years?

“Whoopsies” in health care practices have always occurred. They just may be a bit more loudly announced then in previous generations thanks to the internet and social media. Consequently, we need to continually adjust our thinking based on new knowledge and information. 

So in the face of all of this, how does one pick and choose what to do?

Consider the following:

• Understand that no matter what you eat, drink or do, we all come with an expirations date. …. health rules can mislead you into halfway believing that if you eat only the right things, or exercise in the proper way, you can escape not just run--of--the--mill illnesses but death itself. This way of thinking leads to a distorted set of priorities: Instead of trying to be healthy so that you can enjoy life, you squander your happiness in the pursuit of more health.. Live a Little! Breaking the Rules Won’t Break Your Health by Susan Love and Alice Domar 

• Listen to your body and notice how it responds to changes in diet, exercise, new medications, supplements etc. and act accordingly.

• Know your family’s medical history. If there are certain diseases that are prevalent in your family, understand what can be done to help prevent them or reduce their impact by using food, exercise and other non invasive strategies first before you try medications, supplements or other measures.

• Use common sense and caution. There are a lot of charlatans out there, so be a smart medical consumer.  Scam, Frauds and Quacks 

• Look at the sources of information and research. Talk show hosts, celebrity doctors-even though they have an MD after their name, and advertisements aren’t the best sources of information.

•  Think of food as your primary source of healing and eat accordingly. Try not to rely on supplements for getting the necessary nutrients your body needs.

• Exercise wisely, working to incorporate movement through out your day.

• When you have questions and concerns, talk it over with your medical provider.

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