How much calcium do we need and does excess cause harm? This Vitamin D
newsletter is always reviewing the latest information. It is worth reading the
research on Calcium.
We all get about 800 mg from our average diet and we get about 1400 mg of
phosphorus so I give enough calcium (500 mg) in Beyond Any Multiple and in
Beyond Chelation-Improved to avoid SECONDARY HYPERPARATHYROIDISM. Also I
insist on giving 500 mg of Magnesium (with B-6) to help tame the calcium
(i.e. a calcium channel blocker effect) whenever I give any calcium, which is
almost never more than the 500 mg in BAM.
Of course, with the research on vitamin D we almost all need more than we
get and with the fact that we are all living longer, who wants calcified
vascular tissues and resulting hypertension, so we also need K-2.
Garry F. Gordon MD,DO,MD(H)
President, Gordon Research Institute
www.gordonresearch.com
The Vitamin D Newsletter
March 20, 2010
Quest Diagnostics and Cardiovascular Disease
This is a periodic newsletter from the Vitamin D Council, a non-profit
trying to end the epidemic of vitamin D deficiency. If you want to
unsubscribe, go to the end of this newsletter. If you are not subscribed, you can do
so on the Vitamin D Council's website.
The Annals of Internal Medicine published two important reviews this
month. In the first review, Dr. Anastassios Pittas and colleagues from Tufts
University reviewed 106 articles and combined the 32 quality studies, a
meta-analysis, looking at "cardiometabolic" outcomes such as diabetes,
hypertension and cardiovascular disease. Their conclusion: "Lower vitamin D status
seems to be associated with increased risk for hypertension and
cardiovascular disease, but we do not yet know whether vitamin D supplements will
affect clinical outcomes." Read on.
Pittas AG, et al. Systematic review: Vitamin D and cardiometabolic
outcomes. Ann Intern Med. 2010 Mar 2;152(5):307-14.
The second Annals of Internal Medicine review, by Dr. Lu Wang and
colleagues at Harvard, looked at studies of vitamin D supplementation and found two
randomized placebo controlled trials to combine. Dozens of different types
of studies have looked at vitamin D and cardiovascular outcomes. The
latitude studies are clear, the closer you live to the equator, the less
cardiovascular disease. The dietary studies are mixed, because vitamin D is not
contained in the diet, at least in significant amounts. The epidemiological
studies are clear.
Wang L, et al. Systematic review: Vitamin D and calcium supplementation in
prevention of cardiovascular events. Ann Intern Med. 2010 Mar
2;152(5):315-23.
Dr. Wang concluded, "To date, evidence from prospective observational
studies and randomized controlled trials suggests that vitamin D
supplementation at moderate to high doses may have beneficial effects on reducing the
risk for cardiovascular disease."
About the same time that the two above meta-analyses were published, Dr.
Brent Muhlestein, director of cardiovascular research at the Intermountain
Medical Center Heart Institute in Murray, Utah, presented a paper at this
year's American College of Cardiology's annual scientific session in
Atlanta.
The Utah group studied 31,000 patients over one year and found those with
the lowest vitamin D levels had a 170-per-cent greater risk of heart
attacks than those with the highest levels. Those with the lowest vitamin D
levels also had an 80-per-cent greater risk of death, a 54-per-cent higher risk
of diabetes, a 40-per-cent higher risk of coronary artery disease, a
72-per-cent higher risk of kidney failure and a 26-per-cent higher risk of
depression.
Mittelstaedt, M., Vitamin D may slash risk of heart-disease risk. Globe
and Mail, 3/15/2010
In order to prove that it was the vitamin D, and not a confounder
(confusing fact), Dr. Muhlestein took 9,400 patients and gave them vitamin D,
finding a 30% reduced risk of death. He did not think it was ethical to withhold
vitamin D in a placebo control group, in order to do a randomized
controlled trial.
This Utah study is unique in that these remarkable results were obtained
in only one year – not the usual ten years - so the initial 25(OH)D blood
test probably represented an accurate picture of vitamin D health. Dr.
Muhlestein is not waiting for further studies, saying, "My recommendation to all
my patients, and certainly I did it for myself, is to get your vitamin D
checked and if you're very low or even a little bit low, start taking
supplementation and then get it rechecked."
My recommendation is if you have cardiovascular disease – and even if you
don't – take at least 5,000 IU of vitamin D3 (cholecalciferol) per day and
be sure to have your blood tested periodically for 25-hydroxy-vitamin D.
(You may not need any vitamin D in the summer.) Since you already have a
fatal disease, and cardiovascular disease is a fatal disease, maintain your
25(OH)D levels in the high normal range, 70-100 ng/ml, not the mid-normal
range, 50-70 ng/ml, you want if you are healthy.
Remember to obtain a copy of your 25-hydroxy-vitamin D [25(OH)D] blood
test report to guarantee your doctor ordered the correct test. Too many
doctors are still ordering the wrong test, a1,25-dihydroxy-vitamin D, thinking
they are checking for vitamin D deficiency, when they are doing nothing but
falsely reassuring you and wasting your money. Get an actual copy of your
lab report and be sure it says 25-hydroxy-vitamin D or 25(OH)D.
Also, remember that vitamin D needs numerous co-factors to work in the
body. The ones you have to worry about are magnesium, zinc, boron and vitamin
K because many people are deficient in these four nutrients. You can get
these by simply eating a handful of seeds and nuts every day, while being
careful to eat green leafy vegetables once a day.
At least one professor is having none of this. Dr. Lenore Buckley of
Virginia Commonwealth University thinks vitamin D may do cardiovascular harm,
even at low doses. She also thinks vitamin D supplementation should be
racial, with Whites getting more than Blacks, Whites enough to obtain blood
levels of 20-30 ng/ml, and Blacks enough to only obtain levels of only 15 ng/ml.
Jancin B. Skepticism Mounts on Need for Vitamin D Supplementation. Family
Practice News Volume 40, Issue 3, Pages 1-2 (15 February 2010)
Dr. Buckley quotes two papers only. One – on calcium supplementation alone
– was a randomized controlled trial while the second paper on vitamin D
levels was cross-sectional, meaning it was a picture in time. In the first
paper, Dr. Mark Bolland and colleagues of the University of Auckland gave
1,000 mg of calcium citrate over five years to 700 women in the treatment
group who were already getting 800 mg/day of calcium in their diet and compared
the treatment group to placebo controls who were getting 800 mg/day of
calcium from their diet alone. So the study compared 1800 mg/day to 800 mg/day.
Bolland MJ, et al. Vascular events in healthy older women receiving
calcium supplementation: randomised controlled trial. BMJ. 2008 Feb
2;336(7638):262-6.
They found 1800 mg/day of calcium may well do harm, with apparent
increased rates of cardiovascular disease. However, they excluded anyone with frank
vitamin D deficiency, exactly the patients who may benefit the most from
extra calcium. (The extra calcium may decrease renal metabolic clearance of
the little vitamin D such patients have.) The real problem came when they
tried to verify the reported cardiovascular events with the national
database in New Zealand; their findings were then of marginal significance
(P=.05).
The authors noted that previous studies of total calcium intake (both diet
and supplements), such as the Boston Nurses Study or the Iowa Women's
Health Study have both found that women with the highest total calcium intake
had either the lowest death rates or the lowest cardiovascular disease. That
said, it seems it is better to get your calcium from your diet and not
from a pill, always a good rule.
This is a good time to say that vitamin D sufficient adults need about
1,000 mg of calcium a day from all sources, including diet and supplements and
even that recommendation is based largely on studying vitamin D deficient
people. In my opinion, no vitamin D sufficient person should be taking
1,000 mg of calcium/day in supplements, unless they get zero from their diet,
pretty difficult to do.
NIH: Dietary Supplement Fact Sheet: Calcium
No one knows how much calcium supplements vitamin D sufficient older
people need to take, but it is undoubtedly less than 1200 mg/day the NIH
recommends, as someone with a 25(OH)D level of 32 ng/ml absorbs a lot more calcium
than does someone with a level of 10 ng/ml. If you want an answer to the
question of vitamin D/calcium interactions, the person to ask is Professor
Robert Heaney and I know where you can ask him. Dr. Heaney is speaking to an
all-day Grassroots Health seminar on vitamin D in San Diego on Friday,
April 9, 2010. His talk is "Interactions: vitamin D, calcium and safety."
Please tell me what he says.
John Cannell, MD
Executive Director
Vitamin D Council
[Non-text portions of this message have been removed]
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