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Does Calcium Cause Heart Attack?

Medical doctors monitor your health with both bone density scans and coronary artery calcium (CAC) score scans. Have you wondered if the calcium supplements you take to prevent or treat osteoporosis might be depositing in the walls of your arteries? If you have a family history of both heart disease and osteoporosis and feel confused as to whether you should take calcium supplements, then congratulations you are not alone!

Fortunately, there are reasonable and effective ways to balance treatments for heart disease and osteoporosis.

Heart Disease:
Heart disease is the leading cause of death in the United States. One of the tests that doctors use to assess risk for heart attack is called the CAC score to measure calcium built up in the walls of the coronary arteries. According to the CDC, about 610,000 people die of heart disease every year in the US.

Osteoporosis:
Osteoporosis-associated fractures occur more than 1.3 million times every year in the United States. According to the National Osteoporosis Foundation, about half of women over age 50 will break a bone because of osteoporosis.

We are all familiar with the downward spiral that can happen after a hip fracture in the elderly. In fact, mortality rates double after hip fracture, and women ages 65-69 who break a hip are 5x more likely to die within a year than women of the same age who don’t break a hip according to a study funded by the National Institutes of Health.

Bone mineral density peaks at age 30 and decreases thereafter. The first step in the prevention or treatment of osteoporosis is adequate nutrition in regards to calcium and vitamin D. Vitamin D enhances intestinal absorption of calcium and phosphorus.

Research Suggests Dietary Calcium > Supplements:
Supplements – The research has been mixed as to the association of calcium supplements with heart disease. A 2013 study by the NIH suggests there is an increased risk of heart attack or stroke from taking calcium in men only. A 2016 Johns Hopkins study published in JAMA suggests taking calcium supplements may raise the risk of plaque build-up in arteries, although a diet high in calcium-rich foods appears to be protective. A Women’s Health Initiative (WHI) trial showed no effect of calcium and vitamin D supplementation on cardiovascular disease (CVD).

Dietary Calcium – In contrast to the concern raised with calcium supplements, prospective studies have shown either no relationship or a beneficial relationship between dietary calcium intake and risk of heart disease. Dietary calcium intake comes from dairy (milk, cheese, yogurt), dark leafy greens, broccoli, sardines, white beans, calcium-fortified foods like orange juice, tofu, and milk substitutes.

How can you tell if you are getting enough calcium in the foods you eat?

– There are several easy-to-use online calcium calculators such as on the International Osteoporosis Foundation website.

– The recommended daily calcium intake for postmenopausal women with osteoporosis is 1200mg (diet + supplement) and vitamin D is 1000IU. For pre-menopausal women, or men with osteoporosis, the recommended amounts are 1000mg Calcium and 800IU vitamin D. The National Osteoporosis Foundation considers supplementation in the dose range recommended above to be safe from a cardiovascular viewpoint.

If you calculate your dietary calcium intake and find that you fall short of the recommended daily values for calcium, what should you do?

– If you cannot increase your dietary calcium intake further, then you should use a calcium supplement to make up the difference. Your dietary calcium + your supplement should equal 1000mg per day for premenopausal women and 1200mg/day for postmenopausal women. Your total calcium intake (diet + supplement) should not exceed 2000mg/day because of possibility of adverse effects like kidney stones or cardiovascular disease. Other potential side effects of taking too much calcium include indigestion (dyspepsia) and constipation. In addition, calcium supplements interfere with the absorption of iron and thyroid hormone, and therefore these medications should be taken at different times.

– Calcium supplements can be most commonly found as either calcium carbonate or calcium citrate. Calcium carbonate is less expensive, but you have to take it with food to absorb it, and it is poorly absorbed if you are taking medication for heartburn. Calcium citrate is well absorbed in either the fasting state or with food, and is not affected by taking heartburn medications. Calcium supplements can only be absorbed 500mg at a time, so there is no reason to take more than 500mg in a single dose. Calcium-fortified foods are more like supplements than natural sources of calcium. They can vary in their bioavailability (how much you can absorb and use), but can be helpful for people who cannot tolerate dairy.

In summary, the best source of calcium for your health occurs in the foods you eat. You should use calcium supplements only if necessary to achieve the recommended daily amount of calcium and vitamin D. Supplementation in this dose range is considered safe from a cardiovascular standpoint.

I personally have measured my calcium intake using the online calculator and supplement with 500mg of food-based calcium 3-4 days per week.

Dr. Boston sees patients at the Akasha Center for Integrative Medicine at 520 Arizona Ave in Santa Monica, CA. (310)-451-8880.

Longevity Depends on Your Liver

Your health depends on your liver. The liver is your largest solid organ other than your skin. It is located in the upper right corner of your abdominal cavity tucked under your rib cage. Your liver helps you digest and absorb fats and vitamins. It stores iron so that you can make red blood cells to circulate oxygen. It stores glucose for when you need a burst of energy. It makes proteins involved in blood clotting. The liver is the site of immune activity to protect from invading organisms that might enter your body through your gut. It detoxifies chemicals and metabolizes drugs. The liver helps filter your blood, removing unwanted chemicals from the bloodstream.

The cells of the liver are called hepatocytes. Hepatocytes release enzymes when they are inflamed or damaged. Detecting elevated liver enzymes on a routine blood test may be the only way you find out your liver is stressed. Early stress to your liver can be caused by excessive alcohol intake, obesity, diabetes, or viruses. Early damage causes a small bump in liver enzymes, and if the damage continues then triglyceride fat deposits within the hepatocytes causing fatty liver. At this point, the liver damage is completely reversible, and the liver cells are able to regenerate to a healthy state as long as the offending source is remediated.

If the damage continues, then fatty liver progresses to cirrhosis when functional liver cells are replaced with hardened scar tissue. Once a liver is cirrhotic, it usually cannot regenerate and a liver transplant is required. Signs and symptoms of liver failure include abdominal pain and swelling, nausea, jaundice, fatigue and internal bleeding.

Liver cancer is the fastest increasing cause of cancer death in the U.S. Unhealthy livers are more at risk for liver cancer. At least 50% of liver cancer diagnoses in the U.S. have preventable factors, including excessive alcohol intake, hepatitis viruses, cigarette smoking, obesity, and exposure to toxins like fungal aflatoxins in crops or arsenic in drinking water.

What can you do to reverse fatty liver? There is no magic pill, but committing to lifestyle changes can allow your liver cells to regenerate to healthy detoxifying machines. Along with lifestyle changes, and an herbal supplement called milk thistle can help your liver heal.

Glutathione, the most important antioxidant synthesized in cells, plays a key role in liver detoxification. Glutathione helps recover oxidative-stress induced liver damage. You can boost your glutathione production by eating sulforaphane-rich cruciferous vegetables, like broccoli, cabbage, cauliflower, and kale. Oral glutathione supplements are controversial because they get broken down by gastric juices, however, supplements like Antiox Restore by Akasha Naturals can help support your body’s own glutathione production. Glutathione can also be given via the intravenous route to deliver antioxidants directly to your bloodstream.

Lifestyle Changes for a Healthy Liver
• Avoid excessive alcohol intake
• Avoid tobacco products
• Avoid excessive sugar intake
• Avoid environmental toxins
• Protect against hepatitis viruses
• Eat more cruciferous veggies
• Lower your triglycerides
• Lose weight
• Exercise

Bren Boston, MD is a Sports Medicine, Pain and Women’s Care specialist at the Akasha Center for Integrative Medicine in Santa Monica, California. Call (310)-451-8880 or email us at info@akashacenter.com

HIV: It Hasn’t Gone Away

I read an article in the January 2016 issue of the Journal of Family Practice titled, “HIV Prevention: A 3-Pronged Approach” by N. Yagoda, MD and R. Moore II, MD.

I have been thinking about HIV lately because I know many college students who are blossoming in their new-found freedom and sexual exploration, and they are not thinking about HIV at all. HIV is not in the headlines anymore, and therefore it seems to be less powerful in helping young adults to choose protected versus unprotected sex. This is despite the fact that total HIV incidence has failed to decrease in the last 25 years.

Per the article, there are more than 1.2 million people living with HIV in the USA, and 12.8% of them are unaware that they have it while only 30% of those diagnosed with HIV are receiving treatment to suppress the virus.  This means that the virus is out there, multiplying unchecked in almost million people in the US alone.

RISK FACTOR:  Unprotected sex.

RISK FACTOR:  IV DRUG USE.  In my realm of pain management, a scary truth is that a considerable number of people who become addicted to prescription pain medication eventually switch to injected heroin because it is a lot cheaper. In calm suburbs across the country, there are regular people who are secretly injecting drugs due to addiction and finances.  Intravenous drug use, or even sex with a person who uses IV drugs, is considered a major risk factor for contracting the HIV virus.

The 3-pronged approach to HIV prevention mentioned in the article includes  1) screening all individuals ages 15-65 for HIV, 2) pre-exposure prophylaxis for high-risk patients (taking anti-viral medications to reduce the risk of contracting HIV), 3) harm reduction.

Pre-exposure prophylaxis is for individuals who cannot or choose not to avoid risky behavior for a period of time in their life.  The downsides include possible drug resistance, high cost (although insurance covers part of it), stigma for those who seek to protect their sexual health, and possible affects to the kidney.

Harm reduction is a group of strategies that help IV drug users avoid HIV transmission.  Needle and syringe exchange programs and opioid substitution therapy (methadone or buprenorphine) are examples.

The bottom line is that young people need to be educated about safe sex, which means using a condom correctly every time, even if other forms of birth control are already being used.  I recommend all college-bound teens to read a book titled, “Seductive Delusions” by Dr. Jill Grimes which goes through all the sexually transmitted infections (STI), the ways you can catch them, and how to treat them, in a very readable format.  I also encourage all people to consider screening for STIs, given that infidelity is common, and treatment for STIs is available.