Category Archives: diet and health

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Beware of the dangers of too much calcium….

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Calcium rich foods are an important part of a healthy diet.  BUT, as always, balance is important.  Too much of a good thing is not always a good thing.  And when it comes to calcium, research is showing that too much (especially when it comes from supplements) may actually be harmful.

When I was in medical school and residency I was always told to encourage women to drink milk and eat yogurt and if they didn’t do that daily to advise a calcium supplement. The recommended doses at that time were 1000mg for pre-menapausal women and 1500mg for post-menopausal women.   In many conferences and lectures we were encouraged to just given women 1000- 1500mg of calcium in supplements to be sure they were getting enough.

I went along with that for a long time. Interestingly, in noticed that my patients often took less than I prescribed. Perhaps these women had an intuitive sense that too much calcium from supplements might be unnecessary or even potentially harmful.  I will outline some of the potential risks in this blog today.

But what about the “potential benefits?  Every pill or supplement you take into your body will offer you both potential risk and potential benefit.  It is wise to keep this in mind and to be sure you are fully aware of both sides of the equation before deciding if something will be part of your regular routine.

Let’s start with the benefits…..

1) BONE HEALTH:
Calcium is an important mineral to the body.  It is largely stored in the bones and does contribute to bone strength.  In fact 98% of the calcium in your body is located in your bones.  The rest is divided between your teeth (1%) and your blood (1%).

In women who have a low intake of dietary calcium, research has shown the taking 500mg a day of calcium citrate does improve the strength of bones in the femur, spine, and wrist.   Other research has made it clear that adding vitamin D to the calcium supplement is needed to show definite benefit in decreasing the risk of osteoporosis in post menopausal women.  The reason you need to take the vitamin D is because you need adequate vitamin D in your body or else the calcium will not be properly absorbed.

A 2010 report from the Institute of Medicine (IOM) found that most Americans get more then enough calcium from diet to maintain healthy bones.  The only group who did not seem to be taking enough in through diet was girls aged 9 through 18.  This may be why research published in 2011 in Osteoporsis Int showed improved bone strength in a group of girls aged 9 through 13 who took calcium 800mg  PLUS vitamin D  (400mg) for 6months.

In contrast, many post-menopausal women may be taking too much calcium if they take high dose supplements.

2) OTHER  POTENTIAL BENEFITS:

Other potential benefits of calcium supplementation include: reducing PMS,  slightly lowering blood pressure, slightly improving cholesterol levels, and possibly preventing polyps in the colon.  Some favorable research does exist for each of these conditions.

There was a time when calcium was reported to aid in weight loss but follow up research proved that was not true.

3) DEATH AND HEART DISEASE:
There was a study with white, postmenopausal women published in the Archives of Internal Medicine in 2011 that showed a 3.8% reduction in risk of death over a 22 year period in the women who took up to (but not over) 900mg per day in supplements.

Another recent study published in the Journal of the American Medical Assn this year followed a large group of men and women for 12 years and showed a decreased risk of death from heart disease with increased calcium intake (from all sources combined), up to a total of  about 1200mg per day.

Remember that is 1200mg from BOTH food and supplements.  Taking 1000mg a day in supplements is very likely to put you well over this and into a much higher range of calcium intake.  This is important to realize because excessive calcium intake appears to carry with it some pretty concerning risks.  Read on to learn more….

The Risks of calcium supplementation: 

1) HEART DISEASE:
In addition to the findings that some calcium intake may be protective to the heart research is showing that too much calcium (especially from supplements) may be doing just the opposite.

In recent years medical research has certainly shown that we have good reason to be cautious.  In 2010 a study in the British Medical Journal showed an increase in heart attacks in women taking high doses of calcium.  Interestingly this risk was NOT seen when the women took both calcium and vitamin D.  So there are still a lot of questions about what is really going on here.

Still that same study mentioned above, the one published this year in JAMA, showed that in men taking more than 1000mg a day of calcium in supplement form, there was a significantly increased risk for death from heart attack over the 12 year period studied.    This finding was not seen in the women in that study but other studies have shown some association between heart disease in calcium supplementation for both men and  women if  they  were already taking in more than 805 mg of calcium from foods.  Fortunately there was NO association between dietary calcium and an increased risk for heart attack.  The problem seemed to come from combining a moderate to high amount of dietary calcium along with the supplements.

More recently the British Medical Journal published a 19-year study conducted in Sweden that showed a significantly higher risk of Death in women with high calcium intake (especially if it came from supplements).  Women in the group taking >1400mg of calcium per day (from diet and supplements) were 40% more likely to die during the trial period compared to women in the group taking in 600mg to 1000mg per day(Michaelsson, BMJ 2013).

Some experts have theorized that there is a high spike of calcium in the blood following ingestion of a supplement and speculate that this “burst” of calcium may increase the risk for the calcium to deposit in the arteries leading to increased risk of developing plaques/ blockages in those arteries.  We still don’t know.  But there are enough questions re: safety to make it clear that more is not better when it comes to your calcium pills.

2) PROSTATE CANCER:  Here’s a quote from the Harvard School of Public Health on this issue:

“A diet high in calcium has been implicated as a probable risk factor for prostate cancer. (17) In a Harvard study of male health professionals, men who drank two or more glasses of milk a day were almost twice as likely to develop advanced prostate cancer as those who didn’t drink milk at all. (18) The association appears to be with calcium itself, rather than with dairy products in general: A more recent analysis of the Harvard study participants found that men with the highest calcium intake—at least 2,000 milligrams a day—had nearly double the risk of developing fatal prostate cancer as those who had the lowest intake (less than 500 milligrams per day). (19)”

More research is needed.  But until that time it seems wise for men to limit their calcium intake.  Most experts agree it is best for men to get their calcium from food and to keep their total intake to <2000mg per day.  If a man does take a supplement most experts advise to keep it to 500mg or less.

3) KIDNEY STONES:   Research has shown that there can be an increased risk of kidney stones from calcium supplementation, especially with doses 1000mg or over.  Fortunately there has not been any problem found from dietary calcium so if you have a history of  kidney stones you can still feel safe to get your calcium from food.

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OTHER FACTORS TO CONSIDER IN CALCIUM BALANCE:

So the question remains, is there benefit to taking calcium supplements?  The answer depends on you.  Do you follow a very acid diet?  Is your dietary intake of calcium low?

The calcium in your bones does play a role in keeping your bones strong but it also has another function.  It is critical to maintaining a healthy acid-base balance in the blood.  Your blood must keep within a very narrow pH range.  Going just a little bit too high or too low will lead to dire health consequences.   If your pH begins to drift out too much into an “acid” range then the bones release calcium into the blood to buffer the excess acids.

This is key to understand because the standard American diet is one that drives the body toward an acid state.  In fact the amount of calcium you take in may not be the only thing we need to focus on when it comes to bone health.  Equally important is reducing the amount of high acid foods and getting enough alkaline foods.  Acid forming foods include: Soda (regular AND diet),  meat,  dairy (yes, dairy!), white sugar, processed foods, trans-fats.  Alkaline foods include: fruits and vegetables, beans, herbs).  High salt intake can also trigger the kidneys to excrete calcium and lead to weakening of bones (http://www.jacn.org/content/25/suppl_3/271S.full)

Loss of calcium through the urine goes UP when diets are high in protein and sodium.  In fact it has been shown that vegans (people who eat no animal protein) have low excretion of calcium in their urine and vegetarians lose less than omnivores. (Breslau, J. of Clincal Endocrinology and Metabolism. 1988)

Furthermore, calcium absorption will be increased and excess loss decreased by:

–Keeping your vitamin D level in the normal range

–Avoiding excess animal protein (have some vegetarian meals if you can)

–Limit your intake of sodium to less than 2400mg per day (read labels!)

–Eat more fruits and vegetables, they help keep the blood more alkaline.  (aim for 7-9 servings/day)

–Avoid excessive caffeine and alcohol (both have been linked to accelerated bone loss)

–Avoid white sugar and simple carbohydrates (they push the blood in the acid direction)

Also there may be foods that are particularly protective.  One researcher looking into this and according to the textbook on Integrative Medicine:

“Muhlbauer described 25 plant foods as bone resorption inhibitory food items (BRIFI). These include garlic, rosemary, Italian parsley, sage, thyme, parsley, dill, onion, arugula, prune, fennel, orange, leek, yellow boletus, wild garlic, field agaric, red cabbage, celeriac, red wine, and lettuce.[51] In addition to effects on acid-base balance, the benefits of plant foods also appear to be related to the pharmacologically active compounds they contain. Certain specific monoterpenes,[52] flavonoids, and phenols[53] may be responsible for the observed beneficial effects on bone.”

Keeping these foods in your diet will likely slow your loss of calcium and therefore decrease your need for supplementation.

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GETTING CALCIUM FROM FOOD:

And of course including plenty of dietary sources of calcium helps, too.  I’m going to include a link to a table here to guide you but bear in mind adding up the “millgrams” of each of these is only part of what will keep your bones healthy.

Some foods may be more “bioavailable” meaning that the body is better able to absorb the calcium they contain (this is likely true for dark greens).  Also some people may be better able to absorb calcium.  Pregnant women have been shown to be better able to absorb and maintain calcium in their systems during this time.  They still need to take in calcium but they don’t need to take in more than their non-pregnant peers.

For those who like hard numbers the following recommendations currently exist:

For those ages 1-3: 700mg/day, ages 4-8: 1000mg/day,  ages 9-18:  1300mg /day,  ages 19-50:  1000mg/day,  ages 51- 70: 1000mg/ day for men and 1200mg/day for women, ages >71: 1200mg.

Here’s that link that lists the specific calcium content in foods:

http://www.ucsfhealth.org/education/calcium_content_of_selected_foods/index.html

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CALCIUM FROM SUPPLEMENTS:

If you do take supplements then bear the following in mind:

–Do not take more than 900mg/day in supplements.  Looking at the research suggests that a max of 500mg is  enough.

–Be sure to take vitamin D with your calcium so it can be absorbed

–Calcium citrate is better absorbed and can be taken with or without food.  This type of calcium may be a better choice for people with low stomach acid.  Calcium carbonate is less expensive but less easily absorbed so it is better to take with meals.

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Additional References:

Naturadatabase.com Calcium monograph

Rakel, David MD.  Integartive Medicine, 3rd ed

Harvard school of public health web site:  http://www.hsph.harvard.edu/nutritionsource/calcium-full-story/#calcium-from-milk

consumerlab.com : product review of calcium supplements

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Taking control of your DNA

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After 5 years of having a regular email newsletter I have decided to branch out to blogging.  As with my newsletter  the purpose of this blog will be to empower you to be healthier and happier by providing you with information about how you can alter your environment to optimize your health and happiness.  Today I’m writing an article about health, but other blogs will focus on specific foods and recipes that will help you to follow a healthier path.

Today’s Article:

Taking control of your DNA:  How diet and lifestyle change your cells.

Medical research has shown that our health has much more to do with the environment we place the cells of our body in than it does with the DNA blueprints handed down to us from our families.  What do I mean by “environment”?  Read on to learn more.

The Environment of your Body and Cells:

The environment that influences the way your cells express or manifest the information encoded in your DNA consists of many things.  In this article I break them down into 4 major categories:  1)Food,  2) Exercise 3) Stress 4) Social support.

For today I am going to mainly focus on #1.  Future posts will offer more details on the other factors listed above.

1) The food you eat:   Just like your mom may have told you when you were young,  “You are what you eat.”  It’s not just a matter of getting enough protein, carbs, and fats to run the motor of your body each day.  The quality of those proteins, carbs, and fats makes a huge difference.

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Quality proteins come from:  beans, tofu, nuts, fish, eggs, lean poultry.

The much studied “Mediterranean diet” places these proteins front and center.  Research has confirmed that those who follow this diet have reduced risk of heart attack.  According to the Harvard School of public health,  “Hundreds of scientific studies have linked the diet, which emphasizes fish, vegetables, whole grains, legumes, olive oil, and less red meat and dairy, to reduced heart disease, Alzheimer’s, cancer, type 2 diabetes, and other conditions.”

Poor quality proteins come from : deep fried fish,  meat raised on a factory farm with antibiotics and hormones, full fat dairy like ice cream.  Eating more high quality proteins and less or no unhealthy ones will start you on the track for improved health and well being.

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Quality carbohydrates  include whole grains and vegetables.

These healthy carbs are what has been called low glycemic index carbohydrates.   You may recall from past newsletters what I  mean by low glycemic carbohydrates.  These carbs are more slowly digested and so lead to a slower rise in blood sugar and more sustained energy after eating them.  To offer a brief summary these are complex carbohydrates, minimally processed like whole grains,  non-starchy vegetables, some fruits.  You can click on the link on the sidebar titled “glycemic index” to learn more.

Poor quality carbohydrates are either highly refined or so simple to digest that they almost immediately turn into sugar in your body once you eat them.  These include white bread, baked goods, pastries, cookies, white rice, candy, sugar sweetened drinks, and fruit juices.

Eating diets high in poor quality carbohydrates increases your risk for high cholesterol, obesity, and of course diabetes.  In the United States we are experiencing epidemic levels of obesity and diabetes.  The health consequences for both can be quite dire.  To quote the Harvard school of public health “In a study of more than 160,000 women whose health and dietary habits were followed for up to 18 years, those who averaged 2 to 3 servings of whole grains a day were 30 percent less likely to have developed type 2 diabetes than those who rarely ate whole grains.” (  de Munter JS, Hu FB, Spiegelman D, Franz M, van Dam RM. Whole grain, bran, and germ intake and risk of type 2 diabetes: a prospective cohort study and systematic review. PLoS MedOpens in New Window. 2007; 4:e261).  So you can see that choices you make in your diet now can influence your future health.

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Quality fats are unsaturated fats.  These include the fats found in olive oil, avocados, raw nuts, fatty fish.

Unhealthy fats are transfats and saturated fats.

Trans fats are the worst kind of fat.   Although there are some naturally occurring transfats in red meat, the majority of trans fats available for the standard American diet come from man made trans fats.   Trans fat is a vegetable oil that has been processed so that it will take longer to spoil. It gives packaged snacks a longer shelf-life. It is also commonly found in oils used for deep frying in restaurants and fast food chains. This type of fat is not natural. It has been altered and the change in it’s chemical structure creates a lot of problems with the human body.

Foods that may contain trans fats: stick margarines, vegetable shortenings, french fries, doughnuts, packaged pastries and cookies, and non-dairy creamers.  Intake of trans fats has been linked to increased inflammation in the body and may play a role in the development of diabetes, arthritis, and heart attack.  Eating more trans fats causes higher levels of “bad” cholesterol and lower levels of “good” cholesterol.  BUT if you change the environment of those cholesterol producing cells and surround them with more healthy fats and less unhealthy one the opposite is true.  Levels of good cholesterol go up and the levels of bad cholesterol go down.  A good goal is to remove all trans fats from your diet.  The good news is that due to public health efforts a lot of trans fat has already been removed from foods.  But don’t be fooled. Read labels and beware of fried foods when eating out.  Ask the restaurant what kind of oil they use.

Since 2006 the US Food and Drug administration has required manufacturers to list trans fats on the nutrition label. BUT if a product contains less than a gram, it can be listed as zero. But this is still dangerous for you as the quantities can add up with multiple servings.

You can avoid this pitfall by reading the ingredient list as well. Trans fats are listed as “partially hydrogenated oil”, “vegetable shortening”

Saturated fats are those that come from animal sources (meat and dairy).  And high intake of these has also been associated with increased risk for heart disease and high cholesterol.  Some research (see the book “The China Study”) has also linked the intake of animal proteins with increased risk for cancer.  Research has shown that removing saturated fats from your diet can improve your health IF you replace them with unsaturated, healthy fats.  (Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Saturated fatty acids and risk of coronary heart disease: modulation by replacement nutrients. Curr Atheroscler RepOpens in New Window. 2010;12:384-90.)

However, replacing saturated fats with “low fat” processed foods does NOT improve health.  In fact research shows it actually worsens it.  First of all our bodies need healthy fats, they are essential to proper cell function.  Secondly the “low fat” cookies, etc at the store have almost universally replaced the fat that was there with unhealthy carbohydrates (ie: sugar).   Again to quote the Harvard school of public health, “Eating refined carbs in place of saturated fat does lower “bad” LDL cholesterol—but it also lowers the “good” HDL cholesterol and increases triglycerides. The net effect is as bad for the heart as eating too much saturated fat—and perhaps even worse for people who have insulin resistance because they are overweight or inactive. (17,25)”

Do not be fooled by health claims on low fat products.  It is best to eat real foods, whole foods and to make foods that are high in unhealthy proteins, fats, and carbs an occasional  thing, not a regular practice.  If you can eat healthy 80% of the time that is most likely good enough.  You don’t have to be perfect, if you eat healthier more than half the time your body will see the improvement.

As you place your cells in the environment of healthy foods they will be different.  They will express DNA differently.  Dean Ornish MD showed this in his research on prostate cancer.  When a man is diagnosed with low stage prostate cancer he is often advised to wait to start treatment because the treatments may be more harmful than watchful waiting.  Dr Ornish  took a group of men with a history of low stage prostate cancer and some of them continued with their regular diet and lifestyle (they were the control group) while the other group followed a diet high in vegetables and fruits with protein from vegetarian sources and almost no saturated fats (called the study group or experimental group).   Here’s a quote from his website summarizing that research:  “We examined the effects of intensive lifestyle changes on men with early stage Prostate Cancer after 1 year. After 1 year, none of the men in the experimental group underwent conventional treatments compared to 6 in the control group. Prostate Specific Antigen (PSA) decreased 4% in the experimental group compared to a 6% increase in the control group, and prostate cancer cell growth was inhibited almost eight times as much in the experimental group compared to the control group. These results indicate that intensive lifestyle changes may effect the progression of early low grade prostate cancer.” (Ornish D, Weidner G, Fair WR, et al. Intensive lifestyle changes may affect the progression of prostate cancer. Journal of Urology. 2005; 174(3): 1065-70).

Other aspects of his research showed that those in the experimental group had cells were cancer fighting genes were turned ON and cancer promoting genes were turned OFF.  The opposite was true in the control group.  Perhaps the expression of the genes in each group was different because the environment they put their genes in was different.

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Which brings me to some of the other aspects of “environment”.  Once again when I talk about the environment you put your body and cells in I am referring to the food you eat, but also much more.  This environment is also made up of several other factors including:

2) Healthy movement:  This means having a regular exercise practice that you enjoy.  You don’t have to kill yourself to get the health benefits.  Any movement helps to reduce stress and improve health.  Walking is great.  Walking outside is ever better (because of enhanced reduction of stress).  The key factor is to choose something you enjoy doing and then to find a way to fit it into your life as a regular practice.  Even 30 min 3x a week can have a profound impact.

3) Reduced effects of Stress:   I could write several newsletters on this topic alone!  I have written on the topic of stress in the past and I will write about it again in the future.  To summarize here though, chronic stress leads to hormonal changes in your body that can advsersely affect your mood, your concentration, your sleep, your digestion, your fertility, your blood pressure, and more.  There will always be stressful times in life and often you will not have control over them.  What you can control however is how you respond to the stress and how the stress impacts your body and spirit.  Techniques known to help in this include: yoga, tai chi, exercise, meditation, guided imagery, hypnosis, massage, acupuncture, having a creative outlet, sleeping well, spending time in nature….just to name a few.

4) Social support:  No one can make it through this life on his/her own.  We all need love and support.  Having healthy supportive relationships is an essential part of whole health.  Of course being on good terms with family, friends, and coworkers help quite a bit.  In addition many people find comfort from the support of a spiritual practice.  This can be through organized religion or through your own individual path.  However we are more than our bodies.  I know there is much debate around this area but it is clear that there is something more to a living person than just their body.  Connecting with your spirit in a healthy way reduces stress and enhances health.

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In the prostate cancer research mentioned above from Dr Ornish the study/ experimental group followed a special diet but they also did much more than that.  They also engaged in regular exercise such as walking and participated in a program to help reduce stress either through yoga or meditation.   Finally they were also offered enhanced social support.  It is likely all of these things together that brought about the healthy cellular changes.

This brings me back to health counseling.  When I studied at the Institute for Integrative nutrition the founder of the school taught us about his concept of “primary foods.”  Primary foods are what feed our souls.  These include : a regular type of exercise that you enjoy,  healthy relationships,  satisfying career, and a spiritual connection.  If something is out of balance with your primary foods then you will most likely find yourself  drawn to unhealthy foods as a way to comfort yourself.  It is in times of stress that we crave simple sugars and unhealthy fats.  Becoming aware of this allows you to begin to change it.

Working with my clients using both health counseling and hypnosis, I help them to uncover where there may be blocks or imbalances adversely affecting their health and happiness.  And then we work together to help them find their way to make a healthy change.

I write this article today to help all my readers to know they have much more control over their own health than they may have been previously led to believe.  And also to encourage you to make one or two changes  now to improve the environment of your cells.  It is a new year after all and a great time for setting healthy intentions.  You don’t have to do it all, just start moving in the right direction and keep adding on you go.  Here are some examples of simple changes to get you started:

–Eat one vegetarian dinner a week or if you feel more inspired

–Eat one vegetarian meal a day

–Start walking

–Take up yoga

–Sit down to eat meals.  Sit at a table, turn off the TV and be with each other (this reduces stress, improved portion control, and enhances social support)

–Bring your own lunch to work once a week (or more).

–Remove all trans fats from your kitchen

–Start cooking with olive oil

There are so many options, I could go on and on.  I just want to finish up by reminding you that even one small change can set you on a path to being healthier and happier and may just prevent illness in the future.   Whatever you decide for your new years resolution I hope it is something that supports you and nourishes you.

Please feel free to let me now how you like the new format.  And please feel free to share the link with friends and family.  Happy 2013 Everyone!!