The Calcium Supplement Controversy

The Calcium Supplement
Controversy
By James O’Keefe, MD
Chief Medical Officer and Founder
CardioTabs
Presents
2
• Calcium is best obtained from dietary
sources
• Standard calcium supplements may
increase risk of CV disease
• MicroCrystalline HydroxyApatite, along
with vitamins and minerals, may help to
improve bone health without increasing CV
risk
Key Messages
3
• Calcium is the most ubiquitous mineral in
the human body
• Only 30% of the US population consumes
the Recommended Dietary Allowance of
calcium
• We absorb only about 30% of calcium from
foods depending on the specific source
• The body will demineralize its own skeletal
system to maintain serum calcium levels
Calcium 101
4
According to the
US Surgeon
General’s Report,
one in two
Americans over
age 50 is
expected to have
or to be at risk of
developing
osteoporosis
Osteoporosis
5
• 1,000 mg for adults age 19-50
• 1,000 mg for males age 51-70
• 1,200 mg for females age 51-
70
• 1,200 mg for all adults age 71
and older
Daily Recommended Intake
6
Ancestors
Ethnographic and
anthropological
studies indicate that
adult human hunter-
gatherers consumed
most of their calcium
in the form of bones
from animals,
including small and
large mammals, birds,
fish, reptiles etc.
Hunter-Gatherer’s Diet
7
• Dairy foods and beverages account for about 70% of all
dietary calcium intake among Americans
• On an evolutionary time scale, dairy is a relative “new-
comer” to the hominin diet
• Cow’s milk has up to four times more
calcium than human milk, and this might
contribute to problems with iron and zinc
absorption
• Consequently, chronic dairy consumption
may have potential benefits as well potential
hazards, which will require much more research
to fully understand
Obtain Calcium from Dairy?
8
• Approximately 60% of middle-aged US women
regularly use calcium supplements
• The likely mechanism whereby calcium
supplements increase CV risk is recurrent acute
spiking in serum calcium levels
• Elevated serum calcium concentrations
are associated with carotid artery
plaque thicknessarterial and aortic
calcification, and incidence of MI
Mono-Nutrient Calcium Supplements
9
Strong epidemiologic associations exist between
decreased bone mineral density and increased risk
of both cardiovascular (CV) disease and CV death
Mono-Nutrient Calcium Supplements and Heart Disease
10
Other possible mechanisms that have
linked calcium supplements with CV
disease include:
– Acceleration of coronary artery
calcification
– Induction of a hypercoagulable state
– Effects on arterial stiffness
– Parathyroid hormone
Mono-Nutrient Calcium Supplements II
11
In contrast, calcium from dietary sources or bone
ingestion results in much smaller changes in
circulating calcium levels
Consuming Bone
12
The homeostatic balance between various
minerals appears to play a significant role in
bone, vascular and overall health
The Right Ratio of Minerals and Nutrients
Magnesium
Sodium/Potassium
Vitamin K
Vitamin D
13
• Vitamin D plays a major role in both
intestinal calcium absorption and bone
health
• In large meta-analyses calcium
supplementation was most effective for
preventing hip fractures when it was
combined with vitamin D
• Intake of protein plus calcium and/or
vitamin D may reduce fracture rates
through a mechanism independent of bone
density
Vitamin D
14
• The benefit of vitamin K on bone may not be due
to its ability to increase BMD, but rather to its
effects at increasing bone strength
• The oxidation of vitamin K results in:
– Activation/carboxylation of bone metabolism of matrix
Gla protein (MGP)
– Gamma-carboxylation of osteocalcin
• A recent meta-analysis concluded:
– While vitamin K1 improved bone health, vitamin K2 was
even more
– High vitamin K2 levels were associated with reduced:
• Vertebral fractures by ~60%
• Hip fractures by 77%
• All non-vertebral fractures by ~81%
Vitamin K
15
• Deposits calcium in appropriate locations like
bones and teeth
• Prevents calcium from depositing in locations
where it does not belong, such as the soft tissues
• K2 as MK-7:
– Fermented dairy foods contain vitamin K2 as MK-7
– Research has shown to be a highly effective form
– MK-7 increases the percentage of osteocalcin
Vitamin K2
16
• Dietary intakes of both potassium and
sodium are important factors in CV health
• Reducing excessive sodium intake is
associated with resultant decreased urinary
calcium excretion, which may help to
prevent against bone demineralization
• Moderate sodium diet (2 to 3 g/day) in
conjunction with a high potassium intake (>
3g/day) might derive the optimal CV
benefits for the general population
Sodium/Potassium
17
• Magnesium acts as a protective agent
against soft tissue calcification and may
reduce risk of MI
• Circumstantial and experimental evidence
have implicated magnesium deficiency in
osteoporosis
• Optimal dietary magnesium intake is about
7 to 10mg/kg/day, approximately a 2:1
calcium-to-magnesium ratio
Magnesium
18
We are genetically adapted to consume a large
proportion of our dietary calcium from bones,
where calcium is absorbed along with a matrix of
nutrients including:
– Magnesium
– Phosphorus
– Manganese
– Zinc
– Iron
– Copper
– Collagen protein
– Osteocalcin
Consuming Bone Supplements
19
MCHA
– Is the actual form of calcium found in bone
– Produces less of an acute spike in blood
calcium levels
– Stimulates bone osteoblast cells
– Contains virtually all of the
essential building blocks
of bone
– Highly absorbed
– Not just slows bone loss, but
builds bone
MicroCrystalline HydroxyApatite (MCHA)
20
MCHA Thickness Study
In a placebo controlled randomized trial
women who took 1,000 mg of calcium in
the form of hydroxyapatite in conjunction
with oral vitamin D showed a significant
increase in bone thickness whereas those
who took 1,000 mg of a standard calcium
supplement did not
21
MCHA Bone Loss Prevention Study
• HydroxyApatite (HA) was more effective than
calcium carbonate at preventing bone loss
– 40 randomly assigned osteoporotic patients
– 1400 mg calcium /daily
– After 20 months of treatment the loss of trabecular
bone was 0.8 +/- 0.5% in the (HA) group versus 1.8
+/- 0.7% in the calcium carbonate group.
22
BONE Essentials features MCHA combined with
vitamin D, K2 as MK-7, potassium, magnesium
and other essential vitamins and minerals to:
– Support bone health
– Promote bone density
– Be well absorbed
– Support heart health
BONE Supplement
1 sur 22

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The Calcium Supplement Controversy

  • 1. The Calcium Supplement Controversy By James O’Keefe, MD Chief Medical Officer and Founder CardioTabs Presents
  • 2. 2 • Calcium is best obtained from dietary sources • Standard calcium supplements may increase risk of CV disease • MicroCrystalline HydroxyApatite, along with vitamins and minerals, may help to improve bone health without increasing CV risk Key Messages
  • 3. 3 • Calcium is the most ubiquitous mineral in the human body • Only 30% of the US population consumes the Recommended Dietary Allowance of calcium • We absorb only about 30% of calcium from foods depending on the specific source • The body will demineralize its own skeletal system to maintain serum calcium levels Calcium 101
  • 4. 4 According to the US Surgeon General’s Report, one in two Americans over age 50 is expected to have or to be at risk of developing osteoporosis Osteoporosis
  • 5. 5 • 1,000 mg for adults age 19-50 • 1,000 mg for males age 51-70 • 1,200 mg for females age 51- 70 • 1,200 mg for all adults age 71 and older Daily Recommended Intake
  • 6. 6 Ancestors Ethnographic and anthropological studies indicate that adult human hunter- gatherers consumed most of their calcium in the form of bones from animals, including small and large mammals, birds, fish, reptiles etc. Hunter-Gatherer’s Diet
  • 7. 7 • Dairy foods and beverages account for about 70% of all dietary calcium intake among Americans • On an evolutionary time scale, dairy is a relative “new- comer” to the hominin diet • Cow’s milk has up to four times more calcium than human milk, and this might contribute to problems with iron and zinc absorption • Consequently, chronic dairy consumption may have potential benefits as well potential hazards, which will require much more research to fully understand Obtain Calcium from Dairy?
  • 8. 8 • Approximately 60% of middle-aged US women regularly use calcium supplements • The likely mechanism whereby calcium supplements increase CV risk is recurrent acute spiking in serum calcium levels • Elevated serum calcium concentrations are associated with carotid artery plaque thicknessarterial and aortic calcification, and incidence of MI Mono-Nutrient Calcium Supplements
  • 9. 9 Strong epidemiologic associations exist between decreased bone mineral density and increased risk of both cardiovascular (CV) disease and CV death Mono-Nutrient Calcium Supplements and Heart Disease
  • 10. 10 Other possible mechanisms that have linked calcium supplements with CV disease include: – Acceleration of coronary artery calcification – Induction of a hypercoagulable state – Effects on arterial stiffness – Parathyroid hormone Mono-Nutrient Calcium Supplements II
  • 11. 11 In contrast, calcium from dietary sources or bone ingestion results in much smaller changes in circulating calcium levels Consuming Bone
  • 12. 12 The homeostatic balance between various minerals appears to play a significant role in bone, vascular and overall health The Right Ratio of Minerals and Nutrients Magnesium Sodium/Potassium Vitamin K Vitamin D
  • 13. 13 • Vitamin D plays a major role in both intestinal calcium absorption and bone health • In large meta-analyses calcium supplementation was most effective for preventing hip fractures when it was combined with vitamin D • Intake of protein plus calcium and/or vitamin D may reduce fracture rates through a mechanism independent of bone density Vitamin D
  • 14. 14 • The benefit of vitamin K on bone may not be due to its ability to increase BMD, but rather to its effects at increasing bone strength • The oxidation of vitamin K results in: – Activation/carboxylation of bone metabolism of matrix Gla protein (MGP) – Gamma-carboxylation of osteocalcin • A recent meta-analysis concluded: – While vitamin K1 improved bone health, vitamin K2 was even more – High vitamin K2 levels were associated with reduced: • Vertebral fractures by ~60% • Hip fractures by 77% • All non-vertebral fractures by ~81% Vitamin K
  • 15. 15 • Deposits calcium in appropriate locations like bones and teeth • Prevents calcium from depositing in locations where it does not belong, such as the soft tissues • K2 as MK-7: – Fermented dairy foods contain vitamin K2 as MK-7 – Research has shown to be a highly effective form – MK-7 increases the percentage of osteocalcin Vitamin K2
  • 16. 16 • Dietary intakes of both potassium and sodium are important factors in CV health • Reducing excessive sodium intake is associated with resultant decreased urinary calcium excretion, which may help to prevent against bone demineralization • Moderate sodium diet (2 to 3 g/day) in conjunction with a high potassium intake (> 3g/day) might derive the optimal CV benefits for the general population Sodium/Potassium
  • 17. 17 • Magnesium acts as a protective agent against soft tissue calcification and may reduce risk of MI • Circumstantial and experimental evidence have implicated magnesium deficiency in osteoporosis • Optimal dietary magnesium intake is about 7 to 10mg/kg/day, approximately a 2:1 calcium-to-magnesium ratio Magnesium
  • 18. 18 We are genetically adapted to consume a large proportion of our dietary calcium from bones, where calcium is absorbed along with a matrix of nutrients including: – Magnesium – Phosphorus – Manganese – Zinc – Iron – Copper – Collagen protein – Osteocalcin Consuming Bone Supplements
  • 19. 19 MCHA – Is the actual form of calcium found in bone – Produces less of an acute spike in blood calcium levels – Stimulates bone osteoblast cells – Contains virtually all of the essential building blocks of bone – Highly absorbed – Not just slows bone loss, but builds bone MicroCrystalline HydroxyApatite (MCHA)
  • 20. 20 MCHA Thickness Study In a placebo controlled randomized trial women who took 1,000 mg of calcium in the form of hydroxyapatite in conjunction with oral vitamin D showed a significant increase in bone thickness whereas those who took 1,000 mg of a standard calcium supplement did not
  • 21. 21 MCHA Bone Loss Prevention Study • HydroxyApatite (HA) was more effective than calcium carbonate at preventing bone loss – 40 randomly assigned osteoporotic patients – 1400 mg calcium /daily – After 20 months of treatment the loss of trabecular bone was 0.8 +/- 0.5% in the (HA) group versus 1.8 +/- 0.7% in the calcium carbonate group.
  • 22. 22 BONE Essentials features MCHA combined with vitamin D, K2 as MK-7, potassium, magnesium and other essential vitamins and minerals to: – Support bone health – Promote bone density – Be well absorbed – Support heart health BONE Supplement