Millions of Americans take calcium supplements in an effort
to prevent thinning of the bones, but recent research is showing that extra
calcium is not all that helpful in preventing fractures and may increase the
risk of heart disease. It seems that the
extra calcium is not ending up in bone but rather settling in the arteries.
Calcium and Fractures
Despite being advised to take calcium for strong bones,
there is scant evidence that it does any good unless one is markedly deficient
in the first place. In February 2013 the
US Preventative Task Force stated “the current evidence is insufficient to
assess the balance of the benefits and harms of combined vitamin D and calcium
supplementation for the primary prevention of fractures in premenopausal women
or in men”.
A 1997 study in women over the age of 65 showed no
relationship between dietary calcium intake and fracture rate, while taking
extra calcium actually led to more fractures!
(Cumming 1997) On the other hand,
some studies that examine elderly patients, such as those in nursing homes,
have found that calcium supplements with vitamin D help increase bone density.
Calcium and the Heart
Three recent studies have caused alarm over the issue of
calcium and heart disease. First, from
2013 Journal of the American Medical Association (Xiao 2013) comes the
conclusion that “suggests that high
intake of supplemental calcium is associated with an excess risk of
cardiovascular disease death in men but not in women.”
Second, from the European Prospective Investigation into
Cancer and Nutrition study (Li 2012), “increasing calcium intake from diet
might not confer significant cardiovascular benefits, while calcium
supplements, which might raise heart attack risk, should be taken with caution.”
And from the British Medical Journal (Bolland 2010) results
show “Calcium supplements are associated with an increased risk of myocardial
infarction. As calcium supplements are
widely used these modest increases in risk of cardiovascular disease might
translate into a large burden of disease in the population. A reassessment of the role of calcium
supplements in the management of osteoporosis is warranted.”
A reanalysis of data from the 2002 Women’s Health Initiative
showed “the increased risk of cardiovascular events appeared largely due to
calcium supplements” (Bolland 2011).
How to Build Strong
Bones
Thought of only as the rigid framework that supports the
body, bones actually do much more and are a big player in many metabolic and
hormonal systems. Bone is a complex, and
constantly remodeling organ, that requires far more than just calcium for good
health. Strong bones are a combination
of both building strong bones, especially in our youth, and preserving bone
while aging.
Think of bone as being similar to a concrete wall – with concrete
and the internal metal scaffolding called rebar. Concrete is very hard, but brittle. The rebar gives a concrete wall its tensile
strength to prevent cracking under pressure.
Similarly, calcium is like the concrete while a delicate internal
structure similar to rebar is what gives bone its real strength to prevent
breaking. This internal bone scaffolding
is called the “matrix”.
Mature bone is made up from proteins and minerals. About 60% of bone, by weight, is mineral,
namely calcium and phosphorus. The
remaining 40% is the bone matrix and water.
The matrix is made up of proteins called collagen, which forms strong
tissues throughout the body, including bone, tendons, cartilage and even
skin. In the bone matrix, collagen
serves as the “rebar” scaffolding upon which minerals are laid down in an
orderly fashion. The precise patterns of
bone matrix are oriented to reflect the external forces placed upon it, thus
creating bones with elegant and logical patterns of matrix that provide the
strength and flexibility to resist breakage.
Hormones play the largest role in turning on the machinery
to either build or break down bone. Estrogen,
progesterone, testosterone, and growth hormone play the major role in
stimulating the growth of new bone and/or slowing bone breakdown. Other hormones such as parathyroid, thyroid,
or the stress hormone cortisol, can cause bone to breakdown when present in
excess.
Many nutrients play a role in the creation of a strong bone
matrix and the proper deposition of calcium onto the matrix. The process of bone formation requires an
adequate and constant supply of minerals, such as calcium, magnesium,
phosphorus, and potassium.
Vitamin D is necessary for the body to absorb dietary
calcium from the intestine. Vitamin C, also known as ascorbic acid, is
essential for the formation of the collagen matrix. Studies show that vitamin C contributes to
increased bone mineral density by improving markers of bone turnover. A bone specific protein called “osteocalcin”
is responsible for binding calcium into a strong matrix that helps give strength
and Vitamin K is necessary for the osteocalcin to function properly.
Vitamin K also
protects against the build up of calcium in arteries by activating a protein in
the artery wall that helps prevent calcium build up. The Rotterdam Heart Study showed that
adequate vitamin K, particularly the K2 subtype, lowered the risk of heart
disease and calcification in the major arteries.
Other vitamins and minerals needed for metabolic processes
related to bone include manganese, copper, boron, iron, zinc, Vitamin A and
Vitamin B.
A Bone Health Plan
For strong bones, first start with good gut health and
nutrition. Get plenty of high quality
protein, and fruits and vegetables that are rich in nutrients and
anti-oxidants. If you don’t get at least
800 mg/day of calcium in your diet, then taking a low dose calcium supplement
makes sense, but don’t take more than necessary. Of note, healthy bacteria that inhabit the
gut make most of the beneficial Vitamin K2.
Taking a probiotic is an easy way to replenish beneficial gut bacteria.
Studies show that most Americans are deficient in Vitamin D
and K2, and that supplementing helps build stronger bones and prevent
fractures. The only way to insure you
have adequate Vitamin D is to get a blood test – then take enough to get ideal
blood levels. Recent reports consider a
healthy Vitamin D level to be >50 nmol/L but many experts consider 70-100 nmol/L
to be ideal. Vitamin D3 is the type
normally made in the skin and is recognized as the best form to
supplement. Vitamin K2 intake of at
least 45 mcg/day appears adequate for bone and artery health. A good quality multi-vitamin will insure
adequate amounts of the other vitamin and mineral co-factors.
One of the most powerful tools to help keep strong bone is
hormone replacement therapy or HRT, for both men and women. This is a contentious area of practice but
the evidence just keeps growing that shows HRT prevents disease, including
osteoporosis, and that bioidentical HRT is the most safe and effective
treatment. Similarly, treating hormone
imbalances, such as high cortisol or low thyroid is critical for bone health.
Last, remember exercise builds strong bones. Not so much the aerobic type such as walking,
but more so the strength building exercises that build strong muscles. Core exercises and activities such as yoga are
particularly helpful.
FREE SEMINARS
“Supplements: Why You Need Them and How to Choose Them”
Monday, April 1st at
6pm, at the IMC
“Cleanse and Detox for Great Health”
Monday, April 15th, at
6pm, at the IMC
RSVP at 245-6911
Bio
Scott Rollins, MD, is Board Certified with the American
Board of Family Practice and the American Board of Anti-Aging and Regenerative
Medicine. He specializes in Bioidentical Hormone Replacement for men and
women, thyroid and adrenal disorders, fibromyalgia, weight loss and other
complex medical conditions. He is
founder and medical director of the Integrative Medicine Center of Western
Colorado (www.imcwc.com)
and Bellezza Laser Aesthetics (www.bellezzalaser.com). Call 245-6911 for an appointment or more
information.
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