Calcium is commonly used to prevent osteoporosis and fractures, but experts are now debating how much calcium is really needed, especially by women. Continue reading
Readers of this blog over the last year, have seen many of my posts on the plethora of studies and recommendations about vitamin D. Now there’s some new data I think you’ll be interested in. Continue reading
Treating premenstrual syndrome (PMS) is never easy. And, the reason is that few substances have been shown to be effective. Nevertheless, there are some natural medications that may help women suffering with PMS.
WebMD reported, “A supplement containing vitamin E and essential fatty acids may help reduce symptoms of premenstrual syndrome (PMS),” according to a study published in the journal Reproductive Health.
“Of 120 women with PMS or the more severe premenstrual dysphoric disorder (PMDD), those who took one- or two-gram capsules of vitamin E and a combination of gamma linolenic acid, oleic acid, linoleic acid, and other polyunsaturated acids daily showed marked improvements in their PMS symptoms at six months, compared to women who received dummy pills.”
Notably, “women who received the higher two-gram dose of the new supplement showed greater improvements in PMS symptoms than those who received the lower one-gram dose,” WebMD added.
Other natural medications (herbs, vitamins, or supplements) showing evidence of effectiveness in PMS, as rated by the Natural Medicines Comprehensive Database include:
- BREWER’S YEAST
- PYRIDOXINE (VITAMIN B6)
- VITEX AGNUS-CASTUS
- EVENING PRIMROSE OIL
You’re likely hearing a fair bit of controversy over the Institute of Medicine’s (IOM’s) new recommendations (RDA) for vitamin D and calcium. I first reported on this in my blog, “Institute of Medicine says megadoses of vitamin D, calcium unnecessary.”
The IOM calls for MORE vitamin D and LESS calcium … but many experts say the vitamin D doses are still not high enough.
The new RDA is:
- 400 IU for infants,
- 600 IU for ages 1 to 70, and
- 800 IU for over 70.
But these RDAs are based ONLY on the amount needed to prevent bone problems, such as rickets, osteomalacia, osteopenia, osteoporosis, and fractures.
Higher amounts of vitamin D are associated with a lower risk of falls, cancer, heart disease, autoimmune disorders, etc. But the RDA is not set higher because the IOM feels there’s not sufficient proof of these benefits.
The experts at Prescriber’s Letter (PL)are telling healthcare professionals, “Recommend 400 IU for infants, 600 IU for kids, and 800 to 2000 IU for adults. The higher adult dose is safe and may provide extra benefits.” I’m with Prescriber’s Letter on this one. I concur with the new guidelines from Osteoporosis Canada recommending 1000 IU/day for adults under age of 50 and 2000 IU/day for adults over 50.
PL goes on to say, “Discourage adults from taking over 4000 IU/day without monitoring. Consider vitamin D testing for people likely to be deficient due to advanced age … dark skin … limited sun … malabsorption … etc.”
As I’ve told you before (Vitamin D Supplementation and Cancer Prevention): I check a vitamin D level as part of my annual exam. I do this on all adolescents and adults. If the vitamin D level is below 30, I suggest supplementing with vitamin D and rechecking.”
I give my patients two options:
- OTC vitamin D, 2000 IU per day, and recheck the level in 4-6 months, or
- Prescription vitamin D, 50,000 IU per week for 12 weeks and then recheck the level.
PL recommends, “Aim for a serum 25-hydroxyvitamin D level above 20 ng/mL for bone health … but below 60 ng/mL until more is known about the long-term safety of higher levels.” In my practice, we’re aiming for levels of 30 to 50 ng/mL.
The new RDA for elemental calcium is:
- 1300 mg for adolescents,
- 1000 mg for women up to 50 and men up to 70, and
- 1200 mg for older adults.
PL says, “Advise people not to get carried away with calcium supplements. Recommend not going over 2000 mg/day from food AND supplements for adults over 50. Too much calcium FROM SUPPLEMENTS might increase the risk of kidney stones and POSSIBLY heart attacks.
You can read more in my blog, “Can Calcium Supplements Cause Heart Attacks?“
In a front-page article, the New York Times says, “The very high levels of vitamin D and calcium that are often recommended by doctors and testing laboratories – and can be achieved only by taking supplements – are unnecessary and could be harmful, an expert committee says” in a low-awaited report.
The “group said most people have adequate amounts of vitamin D in their blood supplied by their diets and natural sources like sunshine.” Dr. Clifford J. Rosen, “a member of the panel and an osteoporosis expert at the Maine Medical Center Research Institute,” said, “For most people, taking extra calcium and vitamin D supplements is not indicated.”
The AP reports, “Long-awaited new dietary guidelines say there’s no proof that megadoses prevent cancer or other ailments – sure to frustrate backers of the so-called sunshine vitamin.”
This “decision by the prestigious Institute of Medicine, the health arm of the National Academy of Sciences, could put some brakes on the nation’s vitamin D craze, warning that super-high levels could be risky.”
Notably, “a National Cancer Institute study last summer was the latest to report no cancer protection from vitamin D and the possibility of an increased risk of pancreatic cancer in people with the very highest D levels. Super-high doses – above 10,000 IUs a day – are known to cause kidney damage, and the report sets 4,000 IUs as an upper daily limit – but not the amount people should strive for.”
According to a report in the Wall Street Journal, the committee members disagreed with previous findings that Americans and Canadians do not consume sufficient vitamin D, and instead suggested that a blood level of 20 nanograms/ml was adequate.
This suggestion contradicts groups such as the Endocrine Society and the International Osteoporsis Foundation, which have recommended 30 ng/ml for good bone health — and is what I recommend for my patients.
Meanwhile, the NIH has begun to recruit participants for a large study that will compare the impact on health of vitamin D and omega-3 fatty acids derived from fish oil.
USA Today reports, “According to the report, children and adults younger than 71 need no more than 600 international units (IUs) of vitamin D a day and should consume 700 to 1,300 milligrams of calcium a day, depending on their age.”
Indeed, the “committee was surprised to see that most Americans are meeting their needs for both of the nutrients, except for adolescent girls who may not be getting enough calcium and some elderly people who don’t get enough of either, says Catharine Ross, professor of nutrition at Pennsylvania State University and chairwoman of the panel that prepared the report.”
Still, Time points out, “Those 71 years or older … may need more vitamin D, up to 800 IU a day, to combat deteriorating bone,” the group said.
Due to “the lack of sufficient data to date, advice on vitamin D up to this point was not considered as a recommended dietary allowance, which is based on stronger scientific evidence, but rather an adequate intake suggestion, and stood at anywhere from 200 IU to 400 IU for adults.”
Notably, the “new recommendations are based on data from more than 1,000 studies, most of which included trials in which volunteers were randomly assigned to receive either vitamin or calcium supplements or a placebo, after which their health outcomes were compared to one another.”
The Washington Post “The Checkup” blog says, “The United States and Canada asked the Institute of Medicine, which is part of the National Academy of Sciences, to update the official vitamin D recommendations for the first time since 1997.”
You read more about my application of this report in my blog, “My Take on the new Vitamin D and Calcium Recommendations.”
Good news! Aging does not have to equal weight gain. Women do tend to put on a pound a year in their 40s and 50s, but it’s more likely due to a drop in activity rather than hormones. However, hormonal changes can shift your body composition, so any pounds you do gain tend to land in your middle. Here are some tips from Rachel Meltzer Warren, MS, RD, that were first published on Health.com:
Here are some ways to stay slim, reduce menopausal symptoms, and cut the health risks that can rise after menopause.
1) Go fish
Heart disease risk is likely to rise after menopause, so you should try to eat at least two servings of fish per week (preferably those with healthy fats like salmon or trout).
“Women may want to give [fish oil] supplements a try if having two servings of fish a week is problematic,” says JoAnn Manson, MD, chief of preventive medicine at Brigham and Women’s Hospital, in Boston.
Preliminary research suggests that fish oil may also help prevent breast cancer.
Aim for two servings of fish a week—and talk to your doctor about whether or not you should try a supplement.
2) Slim down
If you’re overweight you can minimize menopausal symptoms and reduce the long-term risks of declining hormones by losing weight, says Mary Jane Minkin, MD, clinical professor of obstetrics, gynecology, and reproductive sciences at Yale University School of Medicine, in New Haven, Conn.
Slimming down not only reduces the risks of heart disease and breast cancer, both of which go up after menopause, says Dr. Minkin, but new research shows that it may also help obese or overweight women cut down on hot flashes.
3) Bone up on calcium
Your calcium needs go up after age 50, from 1,000 milligrams per day to 1,200 mg. “With less estrogen on board, your bones don’t absorb calcium as well,” says Dr. Minkin.
If you have a cup of low-fat milk, one latte, and one 8-ounce yogurt, you’re getting around 1,100 mg calcium. This means you need to take only an additional 100 mg of supplements a day—less than one caplet’s worth—to make up the difference.
If you’re eating dairy, choose low-fat products. These have roughly the same amount of calcium as their full-fat counterparts, but with fewer calories.
4) Ease bloating
“About 100% of my patients going through menopause complain of bloating,” says Dr. Minkin. Although the reasons aren’t clear, fluctuating hormones during perimenopause may play a role.
Dr. Minkin recommends cutting the amount of salt and processed carbohydrates in your diet, as they can make you retain water. But don’t skimp on whole grains, which are rich in heart-healthy fiber, as well as fruits and vegetables.
If healthy food, such as apples and broccoli, make you feel bloated, Dr. Minkin suggests taking Mylanta or Gas-X to combat gas buildup.
5) Rethink that drink
Red wine gets a lot of press for its impact on heart health, but for menopausal women the drawbacks of alcohol might outweigh the benefits.
“One drink a day has been linked to an increased risk of breast cancer,” says Dr. Manson. “So while it has been linked to a reduced risk of heart disease, it really is a trade-off for women.”
If you enjoy a glass of Pinot, try watering it down with seltzer to make a spritzer (you’ll cut calories too). Also keep in mind that red wine and other drinks may bring on hot flashes as a result of the increase in blood-vessel dilation caused by alcohol.
6) Say yes to soy
Soy contains plant estrogens, so many women think it can increase their breast cancer risk, says Dr. Minkin. However, there is little data to support this. The misconception likely comes from studies of high-dose soy supplements, which may stimulate the growth of estrogen-sensitive tumors.
Soy foods like tofu, soy nuts, and soy milk may offer relief from mild hot flashes and are not thought to increase breast cancer risk. “Women in Japan have the highest soy intake and the lowest risk of breast cancer, but Japanese women who move to the U.S. and eat less soy have a higher risk,” adds Dr. Minkin.
7) Try iced herbal tea
A warm cup of joe might be as much a part of your a.m. routine as brushing your teeth. Still, starting your day with a piping-hot drink may not be the best idea during menopause.
“In general, warm beverages seem to trigger hot flashes,” says Dr. Manson. “And the caffeine in coffee and tea could also be having an effect.”
Cover your bases by swapping your morning cup with something cool and decaffeinated—like a Tazo Shaken Iced Passion Tea at Starbucks or a decaf iced coffee.
8) Find a diet that fits
If you need to shed pounds, weight loss is no different during menopause than before it. “If you take in less calories than you burn for a long period of time, you’re going to lose weight,” says Dr. Minkin.
Any balanced diet that cuts calories—and that you can stick with in the long run—will do the job.
However, one study found that postmenopausal women who were on a diet that was low in fat and high in carbohydrates from vegetables, fruits, and grain were less likely to gain weight than women who ate more fat. Consider the new CarbLovers Diet which is rich in whole grains and other figure-friendly foods.
Calcium supplements are coming under scrutiny due to concerns that they might increase heart attacks. A new study shows that patients over 40 who take 500 mg/day or more of calcium have an increased risk of heart attack.
And, the theory is plausible as too much calcium might lead to vascular calcification and atherosclerosis.
But it is WAY, WAY, WAY too soon to jump to any conclusions for at least a couple of reasons:
- The analysis only looked at people taking calcium supplements alone.
- It doesn’t address the role of dietary calcium or taking vitamin D along with calcium. Especially since some research suggests that taking calcium plus vitamin D does not significantly affect coronary artery calcification.
The Doctors of Pharmacology at the Natural Medicines Comprehensive Database tell prescribers this:
Continue to advise people to use calcium supplements if needed, but not to exceed recommended amounts.
Advise patients to consider their TOTAL calcium intake from supplements PLUS foods. Recommend aiming for calcium 1000 mg/day for adults under 50 and 1200 mg/day for adults over 50. Many people get about half this amount in their diet.
To this I add, if you’re going to take a calcium supplement (and, I do), then be sure to take it with vitamin D (and consider having your doctor test your vitamin D level).
To figure out dietary calcium intake, I have my patients count 300 mg/day from NON-dairy foods plus 300 mg/cup of milk, fortified orange juice, etc.
I also recommend vitamin D (based upon the new guidelines from Osteoporosis Canada) 1000 IU/day for adults under age of 50 and up to 2000 IU/day for adults over 50, to maintain adequate levels and help prevent fractures. I recommend using vitamin D3 (cholecalciferol) because it’s more active, but vitamin D2 (ergocalciferol) is also fine for increasing vitamin D levels. And, I do not recommend sunlight exposure for increasing vitamin D levels. You can read my reasons here.
Keep in mind, as I’ve told you before, the Institute of Medicine will come out with new calcium and vitamin D recommendations later this fall.
Daily Calcium Plus Vitamin D Supplements May Reduce Fracture RiskBloomberg News reports that “calcium doesn’t just build strong bones, it may fight cancer too,” according to a study presented at the meeting of the American Association for Cancer Research.
Investigators found “that women who took calcium had a 40% lower risk of getting breast cancer, while those getting multivitamins showed a 30% reduction in risk.”
These “data contradict results of a December 2008 trial that showed no reduction in cancer risk from vitamin supplements.”
HealthDay pointed out that “the authors of the study … did not separate out which specific vitamins might be beneficial, but suggested that the interactions of different vitamins together might account for the beneficial effect.”
You can read a couple of my other posts about the benefits of calcium:
- Daily Calcium Plus Vitamin D Supplements May Reduce Fracture Risk
- Specific vitamins and a supplement (B vitamins, vitamin D, and calcium) may lower risk of stroke, blindness, and cancer
A couple of other tips about calcium. I recommend synthetic calcium carbonate. No reason to take a natural calcium (coral, oyster shell, dolamite earth, or bone) as they may be contaminated with heavy metals.
Also, the body absorbs calcium best when it’s taken with food. But, remember, taking more than 600 mg of elemental calcium in a single dose is not recommended. If you’re going to take more than 600 mg, take it in two or more doses.
Last, but not least, if you are on any prescription medications, check with your pharmacist or physician about whether the can or should not be taken with vitamins or supplements.
MedScape reports that daily supplements of calcium plus vitamin D, but not of vitamin D alone, are associated with significantly reduced fracture risk, according to the results of a patient level-pooled analysis reported in the January 12 issue of the BMJ.
“A large randomised controlled trial in women in French nursing homes or apartments for older people showed that calcium and vitamin D supplementation increased serum 25-hydroxyvitamin D, decreased parathyroid hormone, improved bone density, and decreased hip fractures and other non-vertebral fractures,” write B. Abrahamsen, from Copenhagen University Hospital Gentofte, in Copenhagen, Denmark, and colleagues from the DIPART (vitamin D Individual Patient Analysis of Randomized Trials) Group.
“Subsequent randomised trials examining the effect of vitamin D supplementation — with or without calcium — on the incidence of fractures have produced conflicting results. … We used individual patient data methods to do a meta-analysis of randomised controlled trials of vitamin D — with or without calcium — in preventing fractures and investigated if treatment effects are influenced by patients’ characteristics.”
The goals of the study were to identify characteristics affecting the antifracture efficacy of vitamin D or vitamin D plus calcium regarding any fracture, hip fracture, and clinical vertebral fracture and to evaluate the effects of dosing regimens and coadministration of calcium.
Selection criteria were randomized trials with at least 1 intervention group in which vitamin D was given, in which there were at least 1000 participants, and in which fracture was an outcome. The investigators identified 7 major randomized trials of supplementation with vitamin D plus calcium or with vitamin D alone, enrolling a total of 68,517 participants.
Mean age was 69.9 years (range, 47 – 107 years), and 14.7% of participants were men. Significant interaction terms were identified with logistic regression analysis, followed by Cox’s proportional hazards models incorporating age, sex, fracture history, and use of hormone therapy and bisphosphonates.
Overall risk for fracture was decreased in trials using vitamin D with calcium (hazard ratio [HR], 0.92; 95% confidence interval [CI], 0.86 – 0.99; P = .025), and risk for hip fracture was also decreased (HR for all studies, 0.84; 95% CI, 0.70 – 1.01; P = .07; HR for studies using 10 μg of vitamin D given with calcium, 0.74; 95% CI, 0.60 – 0.91; P = .005).
There were no significant effects for vitamin D alone in daily doses of 10 μg or 20 μg, nor was there any apparent interaction between fracture history and treatment response. No interaction was noted for age, sex, or use of hormone replacement therapy.
“This individual patient data analysis indicates that vitamin D given alone in doses of 10-20 μg is not effective in preventing fractures,” the study authors write. “By contrast, calcium and vitamin D given together reduce hip fractures and total fractures, and probably vertebral fractures, irrespective of age, sex, or previous fractures.”
Limitations of this study include lack of data for 4 of the 11 identified studies meeting inclusion criteria, and insufficient information about compliance to do a per protocol analysis. In addition, only a single study provided data for vitamin D given alone at the lower dose.
“We must emphasise that this analysis does not allow for a direct comparison of vitamin D against vitamin D given with calcium, but only comparisons between each intervention and no treatment,” the study authors conclude.
“Whether intermittent doses of vitamin D given without calcium supplements can reduce the risk of fractures remains unresolved from the studies in this analysis. Additional studies of vitamin D are also needed, especially trials of vitamin D given daily at higher doses without calcium.”
In an accompanying editorial, Dr. Opinder Sahota, from Queen’s Medical Centre in Nottingham, United Kingdom, notes that these findings are important because they show that vitamin D alone, irrespective of dose, does not reduce the risk for fracture.
“Although the evidence is still confusing, there is growing consensus that combined calcium and vitamin D is more effective than vitamin D alone in reducing non-vertebral fractures,” Dr. Sahota writes.
“Higher doses are probably necessary in people who are more deficient in vitamin D, and treatment is probably more effective in those who maintain long term compliance. Further studies are needed to define the optimal dose, duration, route of administration, and dose of the calcium combination.”
Here are some of my other blogs on vitamin D:
- Heart patients lacking vitamin D more likely to be depressed
- Vitamin D deficiency in kids is getting more attention
- Study suggests 70 percent of children, young adults do not get enough vitamin D
- More reasons to consider having your vitamin D level checked – you may think better and have less arthritis
- Specific vitamins and a supplement (B vitamins, vitamin D, and calcium) may lower risk of stroke, blindness, and cancer
- Vitamin D tests soar as deficiency, diseases linked
- Lack of vitamin D raises death risk
- Vitamin D Recommendations for Teens May Be Too Low
- Vitamin D may protect against heart attack
- Low Vitamin D Levels Associated with Artery Disease
If you’re a vegan, you likely know the necessity of taking B12 supplements. Now, you may need to add a calcium supplement to your regimen.
More Information: Continue reading
In recent blogs I have discussed studies showing that multivitamins may not to be helpful for preventing chronic diseases: Are multivitamins helpful or harmful when it comes to preventing chronic diseases? and Report Casts Doubt On Routine Vitamin Supplements. Also, in past blogs I’ve discussed why you should consider vitamin D supplementation: Vitamin D deficiency and diseases linked; Lack of vitamin D raises death risk; and Vitamin D may protect against heart attack, just to name a few.
However, there is evidence that specific vitamins may be helpful in some people. Today I want to tell you about two studies this week backing up my contention that a specific combination of B vitamins and calcium may be worthy of your consideration.
More Information: Continue reading
According to the LA Times, “a spate of high-profile studies published in the last few years shows that a variety of popular supplements — including calcium, selenium, and vitamins A, C and E — don’t do anything to reduce the risk of developing heart disease, stroke, or a variety of cancers.” And, the New York Times is reporting, “In the past few years, several high-quality studies have failed to show that extra vitamins, at least in pill form, help prevent chronic disease or prolong life.” But what about multivitamins? Are they helpful or harmful
More Information: Continue reading
Here are my takes on some of today’s health headlines.