The Calcium Paradox**

For a Lifetime of Strong Bones

UPDATE: To benefit immediately from new research, limit calcium supplementation to no more than 600 milligrams unless you know your dietary intake amount. The safest total amount with diet and supplement sources added together falls between 600 mg to 1000 mg per day. Dietary daily calcium load is usually between 300 to 800 milligrams. Many foods are fortified with extra calcium, like orange juice and cereals, so supplemental calcium at 600mg may actually be a little high for some. To be fair, here is another study around the same time that arrived at what appears to be an opposite heading, that higher calcium is protective. BUT, look at the dosages for the higher and the truth is revealed (lower <458 mg/d for men, <417 mg/d for women versus the higher quartile of dietary calcium intake (>762 mg/d for men, >688 mg/d for women). ref  Here is another study showing longer term benefits against osteoporosis but not for 3 year fracture prevention. ref  (Note that the long term benefits were assumed and not a verified fact using just the measurement of increased bone density at 3 years.)

FYI: Women tend to benfit more from increased calcium and vitamin D than men. Men should limit total calcium from diet and supplements to under 1000 mg per day. ref

...YOU HAVE TO KNOW HOW MUCH DIETARY CALCIUM YOU CONSUME DAILY BEFORE YOU ADD CALCIUM SUPPLEMENTS.

1000-1200 mg minus dietary or food calcium intake determines how much or if you should supplement. ref If daily calcium intake is low, supplements may be necessary. BUT, if consumption is already high, little if any extra calcium supplementation is needed. The concept of supplement calcium load spike is involved here. Therefore, it is wise to take any supplemental calcium in small divided dosages. And include adequate vitamin D and vitamin K2, with MK7 preferred over MK4 or K1, as well as the other synergistic minerals, such as phosphorous, magnesium, zinc, and potassium. Elimination of calcium in urine is appropriate to measure, but it varies with many different factors. It is a guide not a steady data point. Dietary calcium intake influences amounts and they vary from about 20-250 mg. with over 250 representing excess calcium elimination. Highest ever recorded was 741 mg. but that is rare. The urinary calcium level can be used to determine bone turnover rate. It is often elevated in osteoporosis and renal stone situations. ref ref

From the Harvard Medical School newsletter:

Calcium helps make strong bones, and vitamin D aids calcium absorption. Take a daily vitamin D3 supplement (D3 is the form most easily absorbed) between 600 to 1,000 IU, depending on your blood levels of vitamin D. For calcium, some evidence indicates that large doses of calcium pills may increase the risk of death from heart disease. (ref) So as much as possible, get calcium from food—dairy products*, leafy dark green vegetables, tofu, and sardines. The Recommended Dietary Allowance (RDA) of calcium for men ages 51 or older is 1,000 to 1,200 milligrams (mg) per day. For women ages 51 or older, it's 1,200 mg per day. ****If your diet doesn't provide enough calcium, take a low-dose calcium supplement to reach your RDA, but not exceed it.**** ref

*Dairy products do not contain enough magnesium to balance calcium in body. Be sure to supplement with some magnesium or add foods rich in magnesium. 

REMEMBER: Add up food calcium amount together with supplement amount to not go over the recommended amounts at 1,000 or 1,200 milligrams total per day. DO NOT SUPPLEMENT 1000 MG. ref The diet has between 300-700 mg. One serving of dairy has 300 mg. of calcium. Plus, it may not be appropriate for some people to consume these high levels of calcium without knowing amounts of other related nutrients.

Somehow, over a period of time, simple logic (and Science) lost out to marketing rhetoric in telling the bone health calcium story. At fault, science is not even following it's own scientific protocols in examining theories for credibility. The Calcium dance may be one of the most complex nutritional issues of our time. More is not always better. ref  cautions> ref  Excellent general Calcium info from Harvard Medical> ref  Bone info, ref       

Calcium is vital to health    

What you think are calcium facts are really marketing stories not entirely based on science, or at least not the whole picture but just small segments. Unless you have an understanding of the principles involved and correctly apply them, you are doomed to suffer mis-steps in the CALCIUM dance. Bones are just the tip of the iceberg for calcium actions, and while difficult to believe, calcium is not even among the top few recommendations from science for healthy strong bones. ref ref  

Here is a key bone basic from the US Surgeon General's report ref : "The bony skeleton is a remarkable organ that serves both a structural function, providing mobility, support, and protection for the body, and a reservoir function, as the storehouse for essential minerals."

Absent from this report is the fact that fats and bones interact and serve an endocrine function for energy metabolism and insulin resistance.  article  ref.      

Here are study results mentioned above for milk drinkers exhibiting more hip fractures when 3 or more glasses consumed per day. Three glasses of milk could supply over 900 mg of calcium. But not nearly enough magnesium. Questions about study are also mentioned. Direction but not absolutes.

Next reference below is a report from Italy, thus might not be completely USA similar, that shows supplemental calcium load has to be added to dietary amounts to get to 1000 - 1200 mg per day.

Click here>J Int Med Res. 1999 Jan-Feb;27(1):1-14.

The Calcium Paradox**

**VITAL ANALYSIS LINKS ABSENT FROM BONE HEALTH DISCUSSIONS** 

Calcium has many vital roles to perform in the body to maintain health, and not just for bone density. Calcium supplements and calcium fortified foods have become major players in dietary programs recommended by Doctors and Nutritionists. Many foods are now calcium fortified. The theory goes like this. Bones are made up of collagen protein structures that form a matrix of inner-connecting tubes, very similar to honeycomb in a beehive. Next, minerals fill in the spaces left in theses tubes to give more strength. Since calcium is the most abundant mineral found in bones, it was assumed that taking more calcium would increase bone mineral density and thus prevent future fractures.  

A logical look now at the facts reveals this assumption might not be entirely true. ref (controversial) Countries with the highest dietary intake of calcium often have much higher bone fracture rates than countries where the people consume less than half as much calcium. In studies of healthy young people, adding extra calcium does increase bone density, but when the studies end and the extra calcium is stopped, the density levels return to the pre-study level. Vital Fact # 1 is that bones act as a calcium storage area. Yes, it is not always a fair comparison since in lower calcium consuming Countries there is increased exercise, and possibly higher sun produced vitamin D. Muscle movement is a major factor in generating stronger bones.

MAJOR CALCIUM FUNCTION

Let's for the sake of discussion, assume that bones indeed act as storage for extra calcium. What purpose for the body would this calcium storage function serve? The body has a very elaborate mechanism to regulate calcium levels. This allows the body to adapt to a wide range of calcium intake levels and still maintain healthy calcium functions such as strong bones. But there are limits. The driver of this process is not the amount of calcium in bones, but the level of calcium in the blood. A one percent calcium amount is needed in blood to allow nerves to fire, muscles to contract, enzymes to work, and for cells to die a natural death at the end of their lifespan.

When calcium blood levels dip a little too low, the parathyroid gland secretes the hormone PTH which activates the production of the hormone form of vitamin D to regulate the following functions; It increases calcium intake from food during digestion, it prevents calcium elimination from the kidneys and colon, and if needed, it takes calcium (and thus also magnesium, a little zinc, and phosphorus) out of bone storage.

When blood calcium levels become a little too high, the thyroid gland secretes the hormone calcitonin which shuts down PTH production that turns off the activation of the vitamin D hormone form. ref* This reduces the intake of calcium from the digestive tract and increases elimination out of the kidneys and colon. Plus it stops pulling calcium out of bones and starts to increase bone densities. This action could also be a residual effect of PTH and the hormone form of vitamin D to stimulate the production of bone building as well. 

FAILURE OF HIGH CALCIUM INTAKE

 If you take high amounts of supplemental calcium everyday, while the body attempts to compensate, the results may not be advantageous for either the health of the body or long term fracture prevention. ref ref ref (risk and benefits)

Let's follow the logic:

• High calcium from food rarely reaches detrimental effects since dosages are low plus buffers also present in food to further limit absorption. Thus it is supplemental calcium that tends to become problematic, or from supplement and food sources added together. 
• First, high calcium intake will increase blood levels and stimulate calcitonin production which shuts down calcium absorption from the digestive system by turning off hormone vitamin D activation. 
• The Kidneys start to increase calcium elimination and decrease colon calcium percentage absorption. 
• Plus, the extra calcium that gets into the blood will be sent to the bones for storage.
• Bone building cells are activated to make this happen. They can pack more calcium into already built bone cells, plus also into the new bone cells constantly being built. (osteocytes, ref)
• Normally, these actions would sooner or later result in a balanced calcium blood level with future days swinging slightly back and forth when high or low calcium intake triggers opposite processes.
• But, taking large doses of calcium supplements (and calcium fortified foods) everyday changes this pattern to always be on the high side, even though the body is ramping up it's calcium anti-absorption and faster elimination processes. Calcium levels may still increase due to osmotic gradiant competitive absorption of minerals in the lower small intestines.
• ***Supplements release calcium rapidly into the system and this spikes blood levels. In contrast, food source calcium, usually at much smaller dosage amounts, releases gradually allowing for smaller spikes in blood calcium levels at one time. These lower amounts help the body properly deal with calcium and other minerals without over stimulating body control and regulation influences. Food sources also contain many nutrients with buffering effects to further control mineral balance.
• To understand the implications of this higher blood calcium level pattern, you need to know about mineral absorption channels as well.
• UPDATE: Higher calcium supplement intakes are associated with deceasing storage form of vitamin D levels in blood stream of subjects not deficient in vitamin D, without vitamin D supplements having any impact. ref
• There could be a negative vitamin D response to higher calcium supplement intake. This does not change with vitamin D taken at the same time.
• In subjects who are low in vitamin D, the result of calcium and vitamin D normalizes vitamin D levels in females. 

CAUTION SENIORS: It has to be mentioned that certain forms of calcium are more difficult to absorb than others. Check out this study. Calcium carbonate is difficult to absorb for older folks and can cause problems, especially since it lowers stomach acid. But, the differences are not as large as expected. Follow the recommendations in the previous linked study as Protein digestion could become a related problem. The new plant source calcium in red algae is present as calcium carbonate, even though this is not mentioned on the label. Of note is that the calcium carbonate in limestone is all in the form called calcite. The red algae plant adds two extra forms, aragonite and vaterite with calcite. Vaterite has greater biogenerating and reacting abilities, thus is relatively unstable and present in small amounts. Aragonite can break down to calciite. These different forms give red algae calcium carbonate only about a 10-15% absorption and activity advantage over limestone calcium carbonate, plus the benefit of a small amount of other minerals.

Caution Senior 2: It has been discovered that some Seniors have limits to the conversion of the storage from of vitamin D into the hormone in the Kidneys. Something blocks an enzyme needed for this conversion. ref  This lowers the action of hormone D to increase calcium absorption. Calcium balance goes negative leading to bone loss. This may be one reason some Nutritionists recommend much higher intake amounts for Seniors. ref Above a certain level, passive absorption can be forced. This unfortunately could also lead to calcium ending up in the wrong areas.

MINERAL ABSORPTION PRINCIPLES

• Calcium is one of just a few minerals to have an active absorption process in the first third of the small intestine. Elements (from hormone vitamin D) are secreted into the intestinal track, combine with free floating isolated calcium, and carry it back into the cells lining the intestinal tract for assimilation.
• The other minerals are mostly absorbed in the next two-thirds of the small intestines by simple osmotic gradients depending upon their concentration to each other. This point is critical.
• After the body actively pulls in the amount of calcium it wants directed by body needs (rarely more than about 200 mg. at each meal), any calcium left in the intestinal track participates more or less in a free for all to gain access through osmotic gradient channels competing against all the other minerals.
• Since calcium, phosphorous, magnesium, and zinc all compete, excess levels of one could reduce the amount of the others that get absorbed.  ref    ref
• ***Magnesium is needed to maintain and control calcium levels inside cells.*** ref  ref
• Mineral ratios to calcium impact body processes beyond the level of the body's ability to compensate for some imbalances. Calcium over a 2:1 ratio with magnesium is counter productive to health. Most foods average a 1:1 ratio when dairy is not considered.
• With just food levels of these minerals, this competition does not reach the degree it can with higher supplement amounts. Plus, the over consumption of just one food group, dairy, might also create changes to mineral absorption rates and balance since dairy has a calcium to magnesium ratio of 10 to 1.
• If this was not enough to have to consider, along comes some food types with mineral binders, such as the phytate content of beans, especially soy. Almost all the minerals in soy are bound up by phytates in the small intestines and eliminated out of the body. Fermenting soy de-actives much of this phytate action.
• STRONTIUM <everything you need to know and more. Here the important fact is that strontium competes against calcium for absorption. If you unwisely consume strontium, it is recommended to take calcium at a different time. CAUTION: Do not take high doses of strontium over 100 mg unless you are under a Doctor's care. After 10 years, research now shows there is a greater cardiovascular disease risk.

Here is the rub from continual high intakes of calcium; it turns off the production of the active hormone form of vitamin D. This lowers the amount of calcium absorbed by the active process. Which of course makes more calcium available to participate in the mineral free-for-all for osmotic absorption in the rest of the intestines against all the other minerals. High chronic calcium intake inhibits the absorption of many other minerals, such as magnesium, phosphorus, and zinc. Does this sound like a good idea?

Insight: THE BODY IS NOT DESIGNED TO HANDLE LARGE AMOUNTS OF CONCENTRATED SUPPLEMENTAL CALCIUM, or any other mineral. Nature limits mineral levels in food and often includes buffer elements to further slow down and regulate absorption. In foods such as dairy where one finds high levels of calcium, nature never intended this food to be consumed for a lifetime. The infant needs these larger amounts (a relative term) of calcium to turn soft cartilage like bones into hard solid bones able to support upright walking and increased weight gain.

When you read about the benefits of vitamin D, they are mostly from the active hormone form and not the passive storage form generated by sunshine and supplements. The passive form serves as the material for the Kidneys to make the active hormone vitamin D. Yes, there is another important function for the passive D form. At the proper levels, it goes directly into certain tissues such as breast, prostate, and colon where it produces the hormone D form locally to protect these tissues. This is why it needs to be kept at an optimal level, not too much or too little.

NOTE: Some Nutritionists say Vitamin D levels are too low and recommend larger doses. They point to studies that do not find a benefit as testing too low a vitamin D dose. Check out this study that measured vitamin D levels both as inert 25-OHD and the hormone form 1,25OH2D in children with Rickets. Vitamin D levels did NOT show profound differences, with even higher hormone form activity in rickets, but still no increase in calcium absorption. Many questions left unanswered. Here is another study that shows extra vitamin D in healthy younger women does not increase overall calcium absorption. Then this study comes out that higher intakes of supplemented vitamin D actually result in greater loss of bone mineral density. The levels of vitamin D tested were between 400 IU, 4,000IU, and 10,000 IU in 360 subjects for 3 years, The 400IU group lost the least density over this period. Some calcium was also included at 600 mg.

USE OF BONE HORMONES to PREVENT BONE LOSS

While research is not conclusive on this, it is interesting that the only hormone treatment showing promise to aid bone health, out of attempts using the three natural hormones involved in blood calcium balance, is the intermittent use of PTH. To accomplish this naturally requires the diet to vary between higher and lower calcium intake days or periods of time. Remember low blood calcium levels are the trigger for PTH production while high blood calcium levels turn it off. Science found that continual use at constant amounts of either PTH, calcitonin or calcitriol (hormone vitamin D3 form) all exhibited adverse effects. This might mean you should not take calcium supplements every day, or at least not always at the same amount, in an attempt to get PTH levels swinging up and down to mimic the only condition science found effective for long term bone health. This aspect makes sense, but have you ever heard nutritionists and dietitians mention this factor? Or researchers study and test this theory?

    BONE BUILDING CELLS - LIFESPAN FACTOR (**NEW**)

Long term studies are not showing the expected prevention of bone fractures from high intakes of calcium or dairy. It is time to acknowledge another potential concept recently discovered.  Bone cells have a controlled lifespan due to the replicative capacity theory for most cell types. Bone cells divide a set number of times before they die a normal death. A lifetime of high calcium intake which demands that the body pack extra calcium in bone cells or build new ones more frequently, may in fact wear out the bone building cells too soon. Or simply not enough of them are produced. ref Osteoporosis would develop and there would be less options to mitigate condition at this point, but at least it would indicate the appropriate treatment protocol. This process is known as cellular replicative capacity. Inside bone, osteoblasts turn into osteocyctes which continue to repair bone tissues. These cells do not divide and live 25 years, but are prone to damages and destruction if overworked. ref

An analysis of the age of bone building cells from people with osteoporosis reveals that more of these cells are indeed at a later stage of their natural lifespan compared to those in people without osteoporosis. Older bone building cells simply do not function at the level the body requires to balance with the still robust activity of bone tearing down cells. These two actions are usually nearly balanced in the natural bone repairing program. Unfortunately, the bone tearing down cells evidently do not age at the same rate. This topic will be expanded in future articles since research is still at such an early stage of discovery.

SIDEBAR: It of interest to note that the method of action of many bone saving Drugs is to target the bone tearing down cells by poisoning them so the tearing down activity will slow down to be closer to the limited bone building activity. But, this is a delicate balance to achieve and a few people taking bone drugs have developed major problems such as jaw bone disintegration, perhaps due to an unbalanced bone remodeling process that leaves too much old and weak bones to support integrity of jaw bones. They simply disintegrate from not enough bone building to refill all the holes and micro-cracks in bone. 

Where is the pure science and scientific protocols regarding calcium intake and functions? For more details see Boneworks article.  ref   Dr Mercola has good study resources listed  here.  Not all study references report the same findings.

VITAL UPDATE:  The body has a bone repair process that exhibits a major impact on healthy bones. There are two critical types of bone remodelling cells that are responsible for maintaining strong bones. Small sections of bone are continuously being torn down and new bone is re-built in the space. This is how the body re-news bone and keeps it strong and pliable. The process that controls the activation of these bone repair cells is the RANK, RANKL, and OPG system. article While estrogen helps control and balance this process for many years, it appears after menopause, the system is easily corrupted and generates too many tear down cells and not enough build back up cells. Over time, this generates big holes in bones resulting in weak bones and a condition called Osteoporosis. It may very well be that actions before this time are needed to maintain strong enough bone to last the rest of life. And no amount of bone nutrients or drugs will completely fix this situation, they will only modify to various degrees. Strong bones require a lifetime program.

SIDEBAR: You might have been told to take calcium between meals or at night. If you want to help prevent kidney stones, calcium should be taken with meals so the calcium will bind with the kidney stone generating oxalates found in certain foods and eliminate them out with feces. Many forms of calcium also need stomach acid present at mealtime to help absorption.

A New twist for Seniors on Bone Turnover Rate

For Seniors with osteoporosis, the bone turnover rate is too high. Plus, the remodeling balance of teardown is alot higher than build up so there is a net loss of bone tissue. The bone tissue that is lost is sending the calcium it contained, first into the blood stream, and then out with urine. STOP! What is the effect of this bone released calcium on the bone rebuilding process when it hits the blood stream?

Nutritionist want Seniors to take more calcium, a lot more, up to 1200 mg. When the body gets too much calcium in the blood, it shuts down PTH production which reduces calcium absorption and increases urine elimination. Something is not right with this picture. In the average size person, at a bone loss of 7% per year, this would dump about 230 mg. of calcium per day into the blood stream.

PTH is produced when calcium starts to lower in the blood. This activates vitamin D which helps absorb calcium from the digestive tract as well as stimulate bone building cells. None of this happens when calcium is constantly entering the blood stream in higher amounts. Active vitamin D is needed for other activities like building immune system protection against invading germs.

New Finding on Calcium absoption in Seniors: Scientists have discovered that some Seniors develop a resistance to both the actions of the hormone form of vitamin D to increase cacium absorption as well as the to the conversion of the storage form of vitamin D in the Kidneys into the hormone form. ref 

Scientists have found that the way the body functions best for bone building is to swing back and forth between PTH production and shut off. A diet of various calcium intake levels would assist this process. New bone research is forthcoming that will explain the processes involved to a greater degree. There are many factors to consider. One of the chief ones is determined by bone cells called osteocytes imbedded far into bone. These cells appear to regulate the remodeling process through the balance of RANKL activity and OPG production. When OPG decreases and RANKL activity increases, bone is lost. ref

This requires a completely new paradigm in thinking. Return soon for that information. And read this other article on this website. 

Calcium and Cardiovascular Health

There is a connection of calcium to cardiovascular artery health. ref  But it is not always easy to comprehend. Calcium can get deposited in plaque build up inside artery walls. And to complicate this situation, the amount of calcium in artery walls is not directly related to calcium consumption amounts. Both low or high calcium intake levels can be associated as well as any in-between level. Very high, over 1500mg, becomes more unstable for body to regulate. Thus, there must be another factor or two that determines this artery calcium plaque build up process. Vitamins K2 and D, plus the ratio of calcium to magnesium and phosphorous. Potassium is vital too.*

Consuming calcium by itself may not be wise without knowing magnesium and phosphorous intakes. Yes, of course the body has some remarkable abilities to compensate for higher calcium intakes but this becomes less efficient if chronic excess calcium is consumed over a long time.

The chart here may just represent an association of calcium magnesium ratios to heart disease, but there could very well be a physiological basis for it. Only Greece with the heart healthy Mediterranean diet escapes this almost linear progression. The evidence is building - ref

The FDA and the AMA have only recently acknowledged that measuring the calcification extent of arteries is a risk factor for potential heart disease. In fact, it may actually be more reliable than cholesterol levels.

Coffee has some interesting benefits. It appears the more you drink, the lower your risk of heart disease. It could be the 70 mg of magnesium per cup helps offset the high calcium in the American diet plus coffee also has many antioxidants to help lower inflammatory factors, all participants of importance for artery health. ref ref

In this article, a Science-Based Medicine Health Professional describes his two year evaulation and analysis of studies on calcium's influence of the cardiovascular disease rate.   

Here is the conclusion from a coffee study, "In conclusion, caffeinated (and decaf from other studies) coffee consumption was associated with lower risk of CHD mortality and heart valve disease development or progression in older Framingham subjects without moderate or severe hypertension."

Of INTEREST: Here is one result from a large review of many studies on the influence of calcium on heart disease. "Calcium supplement consumption was associated with more heart attacks, but not strokes or overall cardiovascular death. The observed rise in heart attack risk was substantial and statistically significant (hazard ratio of 1.86, confidence interval of 1.17-2.96). This elevated risk was even higher in calcium-only supplementers, where a 2.39x elevated risk was observed (confidence intervals 1.12-5.12). There also appears to be a relationship between bone loss and artery calcification. As bones reduce density, arteries exhibit increased calcification.  Check out this ref.

The calcium only group would increase the ratio of calcium to magnesium which according to the chart above, increases risk just like the report found.

VITAL: Dr Martha Payne analyzed brain lesions in Seniors to see if there were any associations with nutrient intakes. She found verified by MRIs that only two nutrients were associated positively with greater size and number of brain lesions, Calcium and Vitamin D. Brain lesions show up as abnormal dark or light spots on MRIs and CT scans. ref They might form as the result of head trauma, or from abnormal internal events like strokes. A certain amount might just be due to ageing of the vascular system. ref 

Just like in arteries, cholesterol and calcium may build up as a protective mechanism employed by the body to help support damaged and weakened blood vessel walls so they will not rupture. Vitamin D may be guilty because it helps absorption of calcium and impact of calcium placement in body by osteocalcin generation. Osteocalcin is a protein that needs vitamin K to become activated so it can participate in binding calcium into bone. Without enough vitamin K for activation, not only will calcium not be directed to bones, but another vitamin K activated protein, MatrixGLA, will not keep calcium out of arteries. ref It could be this mechanism that Dr Payne really found for the Calcium association with greater amount of brain lesions. Here is first 2008 research ref and here is 2nd recent 2014 study ref  These are very significant studies that need continued and immediate verification to validate safety of calcium supplements for Seniors, or at least the vitamin K2 connection to limit calcium going into soft tissues. ref Seniors may not convert enough vitamin K1 into K2 at adequate amounts to satisfy needs.

On Dementia: Reference that follows shows another recent study with an association between increased calcium supplements and dementia in women who have suffered strokes or show stroke brain damage on CT or MRI scans. ref

Here is result of study: When women had white matter lesions that can be a precursor to strokes, the dementia risk was three times greater when they took calcium supplements.  Dr Payne's work above adds strength to this recent study. 

*Potassium at adequate levels is protective of bone calcium remaining in bones. Plus it helps regulate nerve impulses and thus body communication signals, many of which involve calcium.

More interesting calcium charts found here.

Since vitamin D is involved with calcium and bones, this next chart showing the influence of bones and osteocalcin, a vitamin D and K associated protein hormone, from glands and organs.

Calcium and Prostate Health

A recent report from 2009 looked at the risk of dying from prostate cancer (PC) compared to the total blood levels of calcium, both ionized (most important) and protein bound. This information came out of the respectable NHANES research study. The analysis revealed increased risk of from 2 to 4 times greater in men at the highest levels, especially of ionized or free calcium ref, compared to those with the lowest levels. ref ref  The 4 times risk was found when these dying from prostate cancer in the first three years were not considered since other influences from before the study began could be involved. The study was a 5-6 year study. And yes, there is a genetic change to a vitamin D receptor that is involved. This information was used to set the calcium supplement level for men in this new criteria. And it is quite low compared to what Nutritionists recommend. Is there anything that can lower the blood level of ionized calcium?  

SIDEBAR: It is the potential for alkaline pH in the blood that can lower ionized calcium levels by increasing calcium protein binding. Eat more vegetables and less sugars, proteins, especially animal source, and simple carbohydrates. It is not that the blood pH will change. It must stay between a very narrow range. It is more about the pH elements that keep this range in check that increase calcium protein binding. To regulate Blood pH, the body can pull calcium compounds out of bone if not enough vegetables are consumed containing potassium, the preferred buffer the body uses to help maintain this vital pH.

Causes are harder to pinpoint as to why higher calcium levels have this increased risk. It could be that higher blood calcium levels turn off the activation of the hormone form of vitamin D plus lower PTH levels might be involved. Or that the non active storage form of vitamin D levels are too low to have a direct influence on protecting prostate tissue by going directly into the prostate and turning into the hormone form. Or that a critical enzyme or mineral, like magnesium, is limited that triggers this conversion. This conversion action was only recently discovered.  Of interest here, several studies show that while dairy foods increase this risk, calcium supplements apparently do not, or at least not at the same rate. Note: Not all studies show a detrimental effect from dietary calcium, dairy or calcium supplements. This fact brought forth another theory recently that since dairy calcium is combined with phosphate, it could be the phosphate levels and not just the calcium levels by themselves that are affecting prostate health. Most calcium supplements are not bound with phosphate, except bonemeal and related hydroxyapatite. But, calcium in bone is combined with phosphate. The damaging effect of colas is due to how much phosphate they add. Remember: Many fast food items contain added phosphate ingredients.

The above mentioned study found that individuals with PC that had lower total calcium blood levels were not at a higher mortality risk level and thus did not require prompt treatment procedures, an important consideration since many prostate cancer treatments have serious side effects.

3 possible SIDEBARS: 

1. There is also the possibility that calcium levels influence Parathyroid hormone (PTH) levels and this could have an effect on prostate cell growth. Again possibly by turning on or off hormone D activation.

2.  A new discovery points to the need for a balance point of vitamin D produced osteocalcin between vitamin K2 carboxylated and non-carboxylated osteocalcin forms. Carboxylated stimulates growth of prostate cells while non-carboxylated inhibits, or balances.

3.  Another new theory from Vanderbilt University School of Medicine; Calcium only gets involved when blood levels or and tissue cell levels of magnesium are also low. ref ref  Plus the ratio of calcium to magnesium might be involved according to new research. Another way to express instead of "ratio" would be to say the balance between the two minerals. They work in tandem with opposite reactions for cell mineral movement gradients. Magnesium inside cells and calcium outside cells until an action energy potential is generated where they are pumped in the other direction, calcium into cell such as muscles to generate contraction potential, and magnesium out of cells and then back in to elicit muscle relaxation.   

This author believes another potential influence is that dairy has a very high ratio of calcium to magnesium, as mentioned above under Calcium and Cardiovascular. Calcium supplements often have magnesium included at a two to one ratio while dairy has a 9 to 1 ratio of calcium to magnesium which could explain why supplemented calcium has a lower risk than dairy. Or it could be any number of other elements in dairy, i.e. saturated fats, IGF-1, etc.

This increased ratio could jeopardize the normal calcium movement in and out of cells. Magnesium is the cell door keeper to control how much calcium goes into cells. These calcium doors are called calcium channels. Remember that calcium channel blocking drugs are given to control blood pressure. Since dietary magnesium amounts are often lower than required, this could be a very real possibility. Some research looking at just adding magnesium to the diet has shown to be of value for proper calcium metabolism.

Another possibility is that the IGF-1 (Insulin-like growth factor) contained in dairy, especially from rBGH (Bovine Growth Hormone given to increase milk production) treated cows might play a role in initiating or stimulating cancer cell growth. This now also has research support. IGF-1 has many positive roles to play in the developing human body plus the maintenance of tissues as one ages, especially muscle mass. It is usually combined with an IGF protein binding 3 molecule. In this form and at normal levels it is protective, but at higher levels and without enough IGF protein binding 3, IGF-1 might participate in turning cells cancerous, stimulating existing cancer cell growth rates, and preventing the destruction of cancer cells through normal cell death mechanisms. ref  Calcium is needed for this process as well and scientist are looking for ways to get cancer cells to uptake more calcium to activate this natural cell death mechanism. 

These facts reveal important considerations for both prostate and cardiovascular disease risk reductions. Watch for follow up research. NOTE: An unexpected result for IGF-1 acting to prevent atherosclerosis... ref 

SIDEBAR: Of course vitamin D levels are associated with calcium levels. Here is study looking into vitamin D levels and prostate. ref

Here is impact from this reference: The optimal range of circulating vitamin D for prostate cancer prevention may be narrow. Supplementation of men (already) with adequate levels may be harmful. Cancer Epidemiol Biomarkers Prev; 23(8); 1494–504. ©2014 AACR.

Here is a study reporting that massive vitamin D just before prostate surgery exhibited positive effects on one cancer marker.

FYI: Now, along comes Vitamin D Binding Protein (DBP) to further complicate factors. DBP controls action levels of vitamin D and thus calcium. High blood DBP and low vitamin D are connected to a decreased risk of PC while low DBP and high vitamin D are related to an increased risk. This appears to say that nature wants to limit vitamin D actions of increasing calcium blood levels and that it is not wise for men to consume vitamin D unless testing low. 

     Below copied from 2009  Medscape cancer news blog

"IONIZED CALCIUM AND PROSTATE CANCER 

Ionized Serum Calcium a Potential Biomarker of Fatal Prostate Cancer

NEW YORK (Reuters Health) Feb 27 - New evidence indicates that elevated serum levels of ionized calcium may predict the risk of death from prostate cancer. If verified in future prospective studies, levels of ionized calcium in serum could assist physicians and patients in making decisions regarding treatment.

In a previous analysis of data from the National Health and Nutrition Examination Survey (NHANES I) study, Dr. Halcyon G. Skinner, at the University of Wisconsin-Madison, and Dr. Gary G. Schwartz at Wake Forest University in Winston-Salem, North Carolina, observed a link between elevated serum calcium and risk of fatal prostate cancer.

For their current report in the February issue of Cancer Epidemiology, Biomarkers & Prevention, the researchers examined associations between total and ionized serum calcium and prostate cancer fatalities among 6710 men examined between 1988 and 1994 for the NHANES III, which was linked to the National Death Index.

During a mean of 5.3 years of follow-up, there were 25 prostate cancer deaths. Average age at death was 78.1 years.

Compared with men in the lowest tertile, men in the highest tertile of total serum calcium had a relative risk for prostate cancer mortality of 2.02, after adjusting for sociodemographics, body mass index, and general health status (1 is neutral no effect, 2 is getting high)

The relative risk associated with ionized serum calcium corrected for serum pH was 3.12. After excluding three cases that died within the first 3 years of follow-up, the relative hazard in the highest tertile was 4.65.

In a Wake Forest press release, Dr. Schwartz comments that many men with prostate cancer are treated unnecessarily. "These new findings, if confirmed, suggest that men in the lower end of the normal distribution of ionized serum calcium are three times less likely than men in the upper distribution to develop fatal disease."

"These men may choose to delay treatment or perhaps defer it

 altogether," Dr. Schwartz added.--

The question researchers have to answer: How does supplemental versus dietary calcium sources influence both ionized free calcium levels and protein bound calcium? What increases this particular protein needed for calcium binding?

STRONTIUM on Bone Health

EDITORIAL (opinion please!)

Is Strontium a savior for stronger bones or a Pandora's Box with other diseases lurking in the future??????

While many Nutritionists are promoting the use of Strontium for bone health, the short and only truthful answer is the latter, with some qualifications. Over time, high dose Strontium will displace calcium not only out of bones, but also participate by depositing in organs such as Kidneys and in Artery walls. Plus, the bone formed from high dose Strontium is quite different in shape than regular normal calcium only bone. Yes it is harder BUT... This displacement probably is not a wise thing to continuously do because it might increase conditions that include kidney functions and disease, dementia, and artery breakdown leading to cardiovascular problems.

The one situation where Strontium might possibly be an appropriate treatment is when bone conditions have deteriorated to such a point that drug treatment is the only recourse. Then and only then should Strontium Renalate or a similar compound now available in vitamin stores be considered UNDER THE GUIDANCE OF A MEDICAL PROFESSIONAL. They will make a risk assessment and monitor for kidney, dementia, and mal-formation of bone. Fortunately, at this stage, length of life usually limits these potential side effects.

SIDEBAR: Dexa bone density scores are given in relation to those of a 25 year old person. The normal bone density of a 65 year is going to naturally be lower. What would happen if the 65 year density was compared to the average of all healthy 65 year olds? 

European Warning: A new warning has been issued to Doctors against using Strontium Renalate unless critical conditions for immediate fractures exist since heart events have increased now with longer term studies.

One possibility is that Strontium interferes with the Kidney's ability to convert vitamin D into it's active hormone form. 

CAUTION: Under no circumstances should a younger and otherwise healthy person consume high dose STRONTIUM just due to the result of a bone density health screening. Strontium is not a panacea for thinning bones. For further clarification, see article 1.  ref

Is there a need for Strontium in a healthy bone diet? Maybe just in trace amounts under 20 mg, but this is still waiting to be verified. What Strontium does in the body: most excellent ref, ref

COPY of Warning: (Updated April 26, 2013) The European Medicines Agency has confirmed the recommendation to restrict the use of strontium ranelate (Protelos/Osseor, Servier) because of concerns about the risk for adverse cardiac events with the product. The EMA's Pharmacovigilance Risk Assessment Committee (PRAC) recommended the restrictions earlier this month, and the Committee for Medicinal Products for Human Use (CHMP) has now endorsed this.

Strontium Ranelate has been approved in Europe since 2004 for the treatment of osteoporosis to reduce the risk for vertebral and hip fractures in postmenopausal women. In 2012 the indication was expanded to include men at increased risk for fracture. It is not currently approved in the United States.

In a routine benefit/risk assessment of trials involving about 7500 patients, the PRAC found an increased risk for adverse cardiac events, including myocardial infarction (MI), in women receiving strontium ranelate compared with those who received placebo. However, there was no increased risk for death. There was also an imbalance in the number of serious cardiac events seen with the medicine in 2 other studies, one in men with osteoporosis and the other in patients with osteoarthritis, the CHMP said.

This more in-depth risk evaluation was undertaken due to earlier concerns about other serious adverse events such as venous thromboembolism and rare but serious skin reactions with strontium ranelate.

The following restrictions apply, the CHMP said today:

• Strontium ranelate should only be used for the treatment of severe osteoporosis in postmenopausal women at high risk for fracture and severe osteoporosis in men at increased risk for fracture.

• Strontium ranelate should not be used in patients with current or past history of ischemic heart disease (such as angina or MI), peripheral arterial disease, or cerebrovascular disease or in patients with uncontrolled hypertension.

• Physicians should base their decision to prescribe Protelos/Osseor on an assessment of the individual patient's risks. The patient's risk of developing cardiovascular disease should be evaluated before and at regular intervals during treatment.

The CHMP opinion will be sent to the European Commission, the executive branch of the European Union, which will issue a legally binding decision

********(end warning alert)  

Some adverse effects from Strontium occur in the first 2 months while others take time to develop. They would occur in supplements for strontium too. It is the strontium, and not what it is combined with that generates these adverse conditions. Over short term, strontium appears to be very successful in preventing fractures, especially over the first 3 years. Lower amounts such as 300 mg offer slightly less benefits and may limit any adverse effects, or at least pospone them. 

Calcium to Hip Fractures

A 2007 review of studies to find if calcium intake prevents hip fractures over time:

Click >Am J Clin Nutr. 2007 Dec;86(6):1780-90.

This review found little or no hip fracture prevention over time from higher calcium intake. Remember, this did not consider vitamin D or any other bone building nutrients. Hip fractures represent one of the most severe problems for Elders since the one year survival rate is quite low. This review is not a fly weight analysis since it had so many Medical Professionals putting it together at the Department of Nutrition, Harvard School of Public Health, Boston, MA.

From conclusions: "Pooled results from randomized controlled trials show no reduction in hip fracture risk with calcium supplementation, and an increased risk is possible."

This "increased risk possibility" appears to need an explanation since Nutritionists and Doctors are recommending calcium for protection against bone loss and hip fractures.

DAIRY on Hip Fractures

Here is another long term study on dairy and hip fractures that says milk and dairy are protective. Also from the same study above, the Nurses Health Study, plus including the Health Professionals study on male Doctors. It shows a positive benefit for reduction of hip fractures with greater number of dairy servings. Looking at the charts included below, the results of this study appear to be opposite the Country overall statistics. No explanation is given why this might have occurred. Might it have been due to fact that this group of health workers were largely on their feet and moving each day?

Vitamin D helps Calcium Studies

Here is a study that looked at vitamin D as well which showed positive outcome for vitamin D only, but not for dairy or calcium supplements. Check out chart below for calcium consumption on hip fracture rates in different Countries. Why is the United States often on top? ref

Here is another chart showing hip fractures to milk consumption. Interesting comparisons.

While Finland appears to have a lower hip fracture rate per amount of calcium comsumed, the death rate from cardiovascular disease is one of the highest since very high calcium to magnesium intake ratio.

These charts do not paint a very rosy picture for increasing calcium or calcium with vitamin D intake to prevent hip fractures. Maybe hip bones are difficult for calcium to enter and protect. Or, maybe, there is more to good and strong bones than just calcium or even calcium and vitamin D. Check out how a team of related bone building nutrients and lifestyle factors work together to make stronger bones. article