Tag Archives: calcium

A Growing Problem

One of my keen areas of interest is bone health or more specifically the thin bone disease known as osteoporosis.

It is an area of consistent research interest and the influence of diet, nutrition and vitamins is gaining a lot of press. We have come a long way from the idea that bone strength is all about calcium but the message is slow to leak through to the conventional medical community and general public alike. Personally, I feel that many people view bone as a hard, inert and brittle substance similar to the skeleton that use to hang in the corner of the school biology lab. In reality, living bone is a very different. Our skeleton is a highly active metabolic tissue and undergoes a regular process of renewal known as ‘bone turnover’. This process changes with age and is influences by many lifestyle factors.

I was lucky enough to be asked to contribute to an article written by Kate Miller on the subject of bone and joint health; thanks to Natural Product News, you can read the final article here A Growing Problem. By Kate Miller, Natural Product News July/August 2016.

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Don’t miss the window

Our skeleton starts off life as a delicate membrane-like template late in the second month of pregnancy but soon after the third month a primitive skeleton can be easily seen. Our bones form relatively early on because they are a key factor needed in the healthy growth and development of the growing baby. We tend to forget just how important a skeleton is but without it there would be nowhere for our muscles to attach and our vital internal organs would be extremely vulnerable to damage.

Throughout pregnancy, Mums-to-be are told to eat well and to get plenty of bone forming nutrients such as calcium. This advise extends to breast and bottle feeding and well into the weaning months and early years for good reason; the skeleton of a growing child is highly active and demands a plentiful supply or raw materials. However, there appear to be a gap somewhere between the early to mid teens and late 30’s where the focus of attention is taken away from skeletal health as other health priorities take the lime light and centre stage. For a growing number of people in this age bracket, weight management becomes an issue along with the trend for very restrictive diets in an attempt to drop the excessive weight. It’s not uncommon for levels of physical activity drop off especially in the school leaver population who either choose to avoid sports altogether or are forced into a more restrictive lifestyle that is so common in the digital workplace. Combine this with an increasing tendency to rely on processed and convenience foods and a lack of basic food, cooking and nutritional knowledge in many people and its quite easy to see how and why the early teen through to late 30’s are potentially hazardous to long term health. If we remain focused on the skeletal system, this phase of life is especially important considering that 90% of a girls skeletal mass is acquired by the age 18 and in boys by the age of 20. However, our bones keep developing reaching their lifetime peek mass by the age of 30 in both sexes. After this the skeleton remains quite stable until, in the case of women, the menopause starts when there can be a significant loss of bone mass. Men tend to loose bone mass slowly around the same phase of life but because of their greater skeletal size the effects are less noticeable in most cases. So, there appears to be window that can swing open for an opportunity to optimise skeletal health or slam shut, placing the maturing bone in jeopardy. Its rather like paying into a long term savers account or pension, you should have some reserves for later in life but it does mean you have to contribute early on and for many years to come with no real obvious outward signs of any benefit but in general you will be better off for the efforts.

The bare bones of skeletal nutrition We all know that calcium is important for bone health but it has been rather over played in the past. Our diets abound with calcium and the mature skeleton stores 99% of the bodies calcium reserves. In fact, our blood calcium levels are kept within such tight parameters that any fluctuation above or below the normal is considered a key sign of an underlying hormone disease rather than anything to do with dietary excess or deficiency. In saying that, calcium is still a vital bone mineral and one that is needed on a daily basis to maintain health. Despite many people having a problem in regards to sensitivity to allergy, milk and dairy products still provide a reliable and cost effective source of dietary calcium and protein. There have been some concerns raised about the intake of milk and an increased risk of thin bone disease but these claims have not been substantiated. In brief, the anti-milk theory suggests that the protein and phosphate naturally found in milk and dairy products make them ‘acid-producing’foods causing a shift in the bodies acid (pH) levels and triggering an accelerated loss of calcium from the bones and body; this process is not supported by any scientific evidence. Moreover, studies have confirmed that a higher phosphate intake was actually associated with decreased urine calcium and increased calcium retention. The theory then goes on to link this process with observations of thin bone related fractures in people from countries that consume a lot of milk and dairy foods; this is a case where correlation and causality can be misleading. Studies involving populations living and working in urban and rural environments yield quite different outcomes probably more related to their physical activity levels rather than to their milk and dairy food intake. While some people may find dairy foods a problem for those who do not a sensible level of intake would not appear to have any real detrimental effect on bone health and for some groups of people could be an important source of readily available protein and minerals. Check the tables below and see if you are getting enough calcium from your food (Table 1) compared to the recommended daily intake levels based on Western European, American and Canadian figures (Table 2).

Table 1: Calcium in common foods (apporoxamate)
Food Serving size Calcium (mg)
Milk, whole 236 ml 278
Milk, semi-skimmed 236 ml 283
Milk, skimmed 236 ml 288
Goats milk 236 ml 236
Yoghurt, low fat, plain 150 g 243
Yoghurt, low fat, fruit 150 g 210
Yoghurt, Greek style, fruit 150 g 189
Cheese, cheddar 40 g 296
Cheese, cottage 112 g 142
Tofu, soya bean, steamed 100 g 510
Soya drink 236 ml 31
Soya drink, calcium enriched 236 ml 210
Broccoli, cooked 112 g 45
Curley kale, cooked 112 g 168
Apricots, raw 160 g (1 fruit) 117
Orange 160 g (1 fruit) 75
Figs, ready to eat 220 g (4 fruits) 506
Almonds 26 g (12 whole) 62
Brazil nuts 20 g (6 whole) 34
Sardines, canned in oil 100 g (4 fish) 500
Pilchards, canned in tomato sauce 110 g (2 fish) 275
Whitebait, fried 80 g 688
Bread, white sliced 30 g (1 slice) 53
Bread, wholemeal, sliced 30 g (1 slice) 32
Pasta, plain, cooked 230 g 85
Rice, white, basmati, boiled 180 g 32
Table 2: Recommended daily intake of dietary calcium
Age Calcium (mg/day)
0-6 months 300-400
7-12 months 400
1-3 years 500
4-6 years 600
7-9 years 700
10-18 years 1300
Women
90 years to menopause 1000
Post menopause 1300
During pregnancy (1st trimester) 1200
Lactation 1000
Men
19-65 years 1000
65 + years 1300

As you can see from Table 1, getting adequate dietary calcium is not difficult but you need to know what too eat! A strict vegetarian who also avoids dairy foods will find it much harder to meet the minimum requirements for calcium without consuming specialist foods such as Tofu or taking a calcium supplement. Equally, someone following a strict weight loss may also fall short especially if they choose to follow the diet over a long term basis rather than modify their intake level across a balanced diet. Calcium is important but it is by no stretch of the imagination is it the key nutrient. What needs to be kept in mind is the fact that bone is a living tissue, its not simply a hard calcified mass. If it was it would be very prone to fracture because there would not be any flexibility or ‘give’in the skeleton when we jumped or ran. Proteins give bone its flexibility as well as a framework onto which the minerals (calcium, magnesium, phosphorous) can be deposited. A diet low in dietary protein is also detrimental to bone health. Fad diets that restrict proteins and poor general eating habits can that rely heavily on processed foods and carbohydrates starve the body of the essential protein building blocks of life known as amino acids. Key proteins from meat, fish, and eggs generally form the corner stone to human protein intake in Europe. In essence, there is nothing wrong with animal protein but there is no need to over consume from this food group since there are many great vegetable protein sources as well. Vegetarians and those seeking to rely less on animal proteins need to choose carefully but can increase their vegetable protein intake easily by eating more lentils, kidney beans and broad beans as well as soya, tofu, grain, nuts and seeds. By increasing the intake of vegetable proteins you will also be increasing the levels of other key bone nutrients including magnesium, zinc, B-vitamins (such as folic acid) and vitamin A generating beta carotene especially if you regularly eat the coloured vegetables such as orange, yellow and red peppers.   Absorb it or loose it In order to benefit from the calcium in your diet or from your supplement adequate levels of vitamin D are required. Over the past few years vitamin D has become a hot-topic in the press where it has been associated with many health problems ranging from MS through to certain types of cancers and even depression and psoriasis when levels are grossly deficient. The situation involving vitamin D and it’s involvement in such a variety of health problems is complex, poorly understood and undoubtedly linked to genetic susceptibility but when it comes to bone health the cause and effect relationship is very well understood and established. Vitamin D is not an easy vitamin to get in Northern European countries simply because of the lack of intense sunlight (more specifically the ultraviolet-B rays) needed to stimulate its production within the skin. Here we hit another controversy, by recommending sun exposure are we now putting people at risk of skin cancer? The simple answer is no! Just remember that sun exposure is healthy, sun burn is not. Getting 15-20 minutes of sun light per day, best between 10am and 2pm when the sun is at its peek, is all that is needed to boost natural vitamin D levels. For those of us at work stuck inside, shift workers or people confined to inside living some vitamin D can be obtained from a few foods (for example; salmon, mackerel, tuna, sardines, egg and liver) but to get enough you will need to eat quite a lot of it and on a very regular basis to meet the requirements for health let alone optimal health and there is no real vegetarian food option that delivers any vitamin D. In regards to vitamin D the only real option is a supplement especially over the winter periods. Intake recommendations for vitamin D vary greatly but supplements should be in the vitamin D3 form and need to be between 400iu (10mcg) to 1000iu (25mcg) in strength per day unless you have had a vitamin D blood test and need to significantly boost your levels under supervision. If you can’t get a blood test from your own GP we can always arrange this for you but the private lab will carry a lab fee of around £60 per test for a calcium and vitamin D test. You can take your own blood sample at home (a finger prick) and posted off to the lab for analysis. Another vital vitamin for bone health is vitamin K. This is required for the formation of specific bone proteins that actively help to build and strengthen the framework needed a healthy skeleton. Vitamin K is obtained from dark green leafy vegetables such as kale, cabbage and spinach as well as from lettuce. There are more specialist foods made from fermented soybeans that deliver high amounts of vitamin K. A good bone supplement should supply vitamin K but this needs to be avoided in anyone taking anticoagulant medication such as warfarin. Those on warfarin should not increase their vitamin K containing foods form the same reason.

Special situations The window for optimising bone health can be significantly helped by diet and lifestyle choices but there are a few occasions when other health issues can complicate things. People with certain digestive problems that adversely affect nutrient absorption, such a Coeliac disease and some inflammatory bowel problems, need special individualised attention and advise. This may also extend to the long term use of steroid based medications because of its adverse impact on bone health.

Dietary supplements While we have placed great emphasis on food, diet and what can be achieved through lifestyle adjustment, the use of a specific dietary supplement aimed at optimising bone specific nutrition may be appropriate in many cases. The bone specific supplement Calci-D-min delivers a highly absorbable plant calcium known as Aquamin (derived from red algae) that’s easy on the stomach and quickly absorbed and assimilated by the body. Aquamin also delivers magnesium and 74 other naturally occurring trace elements contained in the red algae. The Calci-D-min supplement has been formulated to supply effective levels of vitamin D3, K1 and K2 along with boron selenium and zinc. Depending on the diet, as food supplement two to four capsules are recommended taken with food. Because of the vitamin K ingredient, Calci-D-min is not recommended for anyone taking the anticoagulant drug warfarin. The product is 100% vegetarian and fully approved by the Vegetarian Society.

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Free talk 7th September on Bone Health in Regents Park, London

Join me Wednesday evening at the NutriCentre in Regents Park, London, for an evening free lecture in the book shop on Nutrients and Bone Health
The lecture will include many key aspects relating to supporting optimal bone health and diagnosing the early changes before the osteoporosis gets out of hand.
The evening lecture will discuss many factors relating to bone health including;
  • Normal bone and it’s healthy regulation
  • Diagnosing thin bones; osteopenia and osteoporosis
  • Types of osteoporosis and their causes
  • Making sense of your bone density (DXA) scan results
  • Using biochemical merkers for bone turnover
  • Key dietary aspects for healthy bones
  • Key nutrients and their controversies; The issue of calcium and heart disease
  • Specific supplements and their safe and effective use

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More is not always better…

More is not always better… I am not sure where the idea came from that calcium is the key nutrient for bone health; may be the dairy industry or something… However, medical specilists have been happily dishing out fruit flavoured chalky tablets of calcium carbonate with some vitamin D for years in the hope to stave off calcium deficiency and thin bone disease.

Whats come to light over recent times is the fact that its not calcium per say that keeps bones healthy and a high intake of calcium may actually be doing us more harm than good over the long term following publcations in the medical press suggesting that it may cause cardiovascular and kidney problems.

A recent study that was just published in the British Medical Journal looked at the relationship between calcium intake and risk for fractures and overall bone health. This was a very large study: more than 61,000 women, followed for 19 years overall, had a total of more than 14,000 incident fractures and more than 3800 incident hip fractures. This study suggests that it’s only the women who had the lowest intake of calcium, below about 750 mg a day, (this is a total intake value from diet and any food supplements) who had an increased risk for fracture, and then with increasing intake of calcium, evidence of further benefit for bone health and fracture reduction was very limited.

Just to throw the cat amoung the pigeons, the women who had the highest intake of calcium (above 1100 mg a day) actually had a hint of increased risk for hip fracture. The bottom line of this study was that more moderate levels of calcium intake were best for bone health and that more was not better!

Getting adequate calcium from the diet should not be that much of a problem with the use of low to moderate dose supplememts to make up any differences. Some of the best dietary sources are low-fat dairy products and leafy greens, fortified foods such as fortified fruit juices and cereals, and types of fish that have bones in them, such as sardines and canned salmon. As more work is performed on bone health it will become apparent I am sure that bone needs a wide variety of nutrients including a good supply of vitamin D3. Calcium from a supplement should supply 500-600mg a day and probably no more.

Further Reading

1. Updates Guidance on Vitamin D, Calcium. Institute of Medicine (USA) report

2. Dietary calcium intake and risk of fracture and osteoporosis: prospective longitudinal cohort study. BMJ 2011; 342:d1473

HHC Blog post on Vitamin D and osteoporosis drugs

HHC Blog post on Vitamin D and bone health

HHC Blog post on Liquid Calcium & Vitamin D product review

HHC Blog post on bone loss and ageing

Product links

Liquid calcium and vitamin D3 supplement

OsteoPrime, the original Dr Alan Gaby formula

Preventing and Reversing Osteoporosis by Dr Alan Gaby

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At last – a great new liquid calcium, phosphorous and vitamin D supplement that actually tastes good!

Getting enough calcium can be a challenge especially if you don’t like taking tablets or capsules. This new Blueberry Flavour Liquid Calcium plus Vitamin D, 1000 mg/400 IU makes it easy – and it tastes good for a change! The liquid mineral formula is specially designed to support bone health and being in liquid form it facilitates optimum absorption.

Supporting bone health with dietary minerals is essential for growing bodies, and is just as important to maintain skeletal strength through our latter years and may contribute to a reduced risk of bone fractures due to osteoporosis. Osteoporosis is an all too common bone disease characterized by low bone mass and deterioration of the bone structure. The National Osteoporosis Society (NOS) note that “one in two women and one in five men over the age of 50 in the UK will fracture a bone, mainly as a result of osteoporosis.” When it comes to taking supplements for bone health the NOS comment that “If we eat a healthy, varied diet then we should be able to get all the vitamins and minerals we need from food.” However, they also go on to say that “as we get older, we absorb nutrients less efficiently. Many older people also have smaller appetites so may benefit from supplements if they are getting insufficient nourishment from food.”

While many studies focus on calcium’s benefits for bone health, studies have also shown the importance of balancing calcium and phosphorus as well as vitamin D for osteoporosis prevention. Liquid Calcium plus Vitamin D, 1000 mg/400 IU from webber naturals® contains optimum amounts of Phosphorus and Vitamin D to improve the body’s absorption and use of calcium.

Why blend Vitamin D with Liquid Calcium?

While Calcium is the most prevalent mineral in bone, bone diseases such as osteoporosis are not only caused by a lack of calcium. Other nutrients and minerals are critical to maintaining healthy bones. Phosphorus is fundamental to growth, maintenance, and repair of all body tissues, including bones; phosphate actually makes up roughly half the weight of our bones. Optimum phosphorus intake throughout life helps ensure the proper balance to promote remineralization of bones and teeth and keeps them healthy.

Vitamin D facilitates calcium absorption from the intestines, decreases urinary calcium loss, and facilitates incorporation of calcium into the bones. Many osteoporosis sufferers could have prevented the disease’s advance by ensuring adequate Vitamin D intake along with their calcium. Despite solar exposure, there is a natural age-related decline in our ability to make adequate amounts of Vitamin D. Many experts recommend 400 to 600 IUs of supplemental Vitamin D per day, and 800 IUs if you already have thinned or osteoporotic bones.

Note: Dietary supplements are not intended to replace medical treatment or advise and should not be taken along side prescribed medication without consulting your doctor first.

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Vitamin D: the most used vitamin in a recent survey

A revealing new survey of 6,010 serious supplement users analyzes their usage of specific types of supplements and confirmed that vitamin D has taken the supplement world by storm. With all the positive effects related to this vitamin its no wounder that its jumped to the top of the list! Vitamin D came out the winner in 2010 as the “most used single vitamin” at 56.2% usage amongst those surveyed, and also won the “most improved” category with a 52% increase in usage since 2008. Fish oil wins in the “most used dietary oil” group and is used by 75.7% of persons surveyed. This is an increase of 1.7% since 2009. Calcium was the fourth most popular supplement, used by 55.3% of respondents, up from 51.2% last year.

Vitamin D promotes calcium absorption in the gut and maintains adequate serum calcium and phosphate concentrations to enable normal mineralization of bone and to prevent hypocalcemic tetany. It is also needed for bone growth and bone remodeling. Without sufficient vitamin D, bones can become thin, brittle, or misshapen. Vitamin D sufficiency prevents rickets in children and osteomalacia in adults. Together with calcium, vitamin D also helps protect older adults from osteoporosis. It has other roles in the body, including modulation of cell growth, neuromuscular and immune function, and reduction of inflammation. Many genes encoding proteins that regulate cell proliferation, differentiation, and apoptosis are modulated in part by vitamin D.

Fish oil has been studied for treating clinical depression, anxiety, and enhancing the benefits from depression medications. Countries with the highest intake of fish in their diets are correlated with the lowest rates of depression among their citizens.

Finally, women were much more likely than men to have taken vitamin D, calcium, or probiotics. Men were more likely than women to have taken herbs and extracts, glucosamine/chondroitin, vitamin E, resveratrol, amino acids, nutrition drinks and powders, and several other supplements.

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Isn’t bone loss just a normal consequence of ageing?

Dr Alan Gaby MD

Although bone mass normally declines progressively after the age of 35, bone loss severe enough to cause fractures after minimal trauma seems to be a relatively new phenomenon. Osteoporosis was rare in the late 19th century, and it was not until around 1920 that the condition began to attract attention among pathologists. Since that time, osteoporosis prevalence has increased progressively, even after adjusting for age. For example, the age-adjusted prevalence of osteoporosis in England and Sweden doubled between 1950 and 1980.[i] [ii] [iii] In addition, the prevalence of osteoporosis among elderly people in some developing countries is lower than that of elderly Americans, despite lower calcium intakes in those countries, further suggesting that osteoporosis is a disease of modern civilization.[iv]


[i] Boyce WJ, Vessey MP. Rising incidence of fracture of the proximal femur. Lancet 1985;1:150-151.

[ii] Johnell O, Nilsson B, Obrant K, Sernbo I. Age and sex patterns of hip fracture – changes in 30 years. Acta Orthop Scand 1984;55:290-292.

[iii] Bengner U, Johnell O. Increasing incidence of forearm fractures. A comparison of epidemiologic patterns 25 years apart. Acta Orthop Scand 1985;56:158-160.

[iv] Zeegelaar FJ, Sanchez H, Luyken R, Luyken-Koning FWM, van Staveren WA. Studies on physiology of nutrition in Surinam. XI. The skeleton of aged people in Surinam. Am J Clin Nutr 1967;20:43-45.

 

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