Category Archives: calcium

New research links FOS and Bone Health

A recent study published in the Journal of Nutrition suggests a link between fructooligosaccharides (FOS) and bone health. It indicates that combining a calcium supplement with FOS is more effective than taking a calcium supplement alone (1).

The two-year study followed 300 post-menopausal women and measured markers of bone health. The women were randomly divided into three groups. One group of women were given a daily calcium supplement, while a second group were given a combination of calcium and FOS . The third group were given a placebo supplement. At the end of the study, measures of bone turnover and bone density were taken.

At the end of the study, there were no significant differences in bone density between any of the three groups. However, the results showed that the combination of FOS and calcium had the greatest effect on bone turnover.

Bone is constantly being broken down and rebuilt. The rate at which this happens is known as ‘bone turnover’ and is a known indicator of bone quality. The change in bone turnover markers in the women taking both FOS and calcium indicates ‘a more favourable bone health profile’ according to the researchers in this study.

FOS seems to enhance calcium absorption in the large intestine, and the researchers suggest that this is the reason for its effect on bone health. These findings certainly support the need for more research in this area, particularly for vulnerable groups such as postmenopausal women.

More about FOS

FOS or prebiotics are found in chicory root, jerusalem artichoke, asparagus, leeks, onion, beans, peas and lentils.
FOS or prebiotics are found in chicory root, jerusalem artichoke, asparagus, leeks, onion, beans, peas and lentils.

FOS is a prebiotic nutrient found in plant foods. Prebiotics are not digested, and simply pass through the body. In doing so, they act as ‘food’ for healthy bacteria in the bowel, boosting numbers of health-promoting acidophilus and bifidobacteria, and crowding out disease-causing bacteria. As well as improving calcium absorption, FOS also supports both digestive and immune health.

High concentrations of FOS or prebiotics are found in chicory root, jerusalem artichoke, asparagus, leeks, onion, beans, peas and lentils. FOS can also be taken in supplement form, and its sweet taste means that it works well mixed into oatmeal, yoghurt or smoothies, or simply used as a low-calorie sweetener to enhance flavour.

In the UK, most of us average an intake of around 12g of fibre each day – only half of the recommended amount. More research is still needed in the area of FOS and bone health. In the meantime, increasing fibre intake, and prebiotic foods in particular, seems a sensible measure to ensure the recommended intake for optimal health.

References

Slevin, M, Allsopp P, Magee M, Bonham V, Naughton J, Strain M, Duffy J, Wallace E, McSorley E. 2014. “Supplementation with Calcium and Short-Chain Fructo-Oligosaccharides Affects Markers of Bone Turnover But Not Bone Mineral Density in Postmenopausal Women”. Journal of Nutrition Jan 2014

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Choosing the Best Supplements: Part Two

In Part One I discussed some guidelines to help ensure that you are getting the best out of your supplements. Read on for more pointers.

Mineral Bioavailability
There isn’t much point in taking a supplement in a form that your body cannot use. Mineral bioavailability simply refers to the proportion of a mineral that is actually absorbed into the blood to be used by the body.

A ‘bioavailable’ mineral must be soluble in the intestine so that it can be absorbed. Minerals should be bound to different compounds to aid their absorption. This binding, or ‘chelation’, helps the mineral to survive the acid environment of the stomach and pass through into the small intestine for absorption.

If the mineral is bound too tightly, or not tightly enough, it can be released at the wrong time.  This is why the ‘form’ of the mineral is an important consideration.

Generally inorganic forms of minerals – carbonates, sulphates and oxides are not well absorbed. On the other hand, organic forms such as citrates, gluconates, aspartates and amino-acid chelates are more bioavailable.

Better quality minerals, i.e. those that are in a bioavailable, organic form do tend to be more expensive. However, cheaper supplements may be a false economy if they are poorly utilised by the body. Choosing a supplement becomes a case of weighing the cost of the supplement against its bioavailability. For example, in the New Optimum Nutrition Bible, Patrick Holford (1) explains that iron amino acid chelate is four times better absorbed than other forms, making it worth the additional cost.

Holford lists the most bioavailable forms of each mineral. All of the following forms are the most readily available to the body. In descending order (the very best first), he lists:

multi-nutrient
A multi-mineral supplement including Chronium, Calcium, Magnesium, Iron, Zinc, Manganese and Selenium.

Calcium – amino acid chelate, ascorbate, citrate, gluconate, carbonate

Magnesium – amino acid chelate, ascorbate, citrate, gluconate, carbonate

Iron – amino acid chelate, ascorbate, citrate, gluconate, sulphate, oxide

Zinc – picolinate, amino acid chelate, ascorbate, citrate, gluconate, sulphate

Manganese – amino acid chelate, ascorbate, citrate, gluconate

Selenium – Selenocysteine or selenomethionine, sodium selenite

Chromium – Picolinate, polynicotinate, ascorbate, gluconate

Tablets or Capsules?
Deciding between capsules or tablets is often a personal preference. Those who find tablets difficult to swallow often favour easy-to-swallow capsules. Sensitive individuals also tend to prefer capsules which are more likely to be free from fillers or binders. On the other hand, tablets can be compressed meaning that a higher dosage can be delivered in a single pill. They also allow for ‘sustained-release’ formulas. This can be useful for water-soluble vitamins such as Vitamin C, where absorption is better when given as a steady release formula rather than in a single dose.

For very sensitive individuals or for the delivery of light-sensitive nutrients such as coenzyme Q-10, capsules are the best choice. There are of course advantages to both types of supplements, which are listed below.

Capsules Tablets
Superior protection against oxygen and light Low cost
No need for fillers and binders Allows for sustained-release formulas
Odorless and tasteless Can fit more ingredients in through compression
Less gastrointestinal irritation Can be notched to divide the dose

Quality Assurance
The simplest way to be certain of the quality of a supplement is to check that it is GMP certified. Good Manufacturing Practice (GMP) is an assurance of quality of manufacture. While medical drugs are held to these strict standards, it is not currently a legal requirement for food supplements in the UK. However, most reputable supplement companies voluntarily submit their products to GMP certification. This compliance requires thorough record keeping, quality testing, and standards consistent with the manufacture of drugs.

Reference

1. Holford, P (2004) Patrick Holford’s New Optimum Nutrition Bible. London: Piatkus.

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Choosing the Best Supplements: Part One

Choosing the right kind of supplement is extremely important, and yet the choice available can create lots of confusion. I am frequently asked about how to select the most suitable type of supplement. Will the supplement be absorbed properly, and is a ‘natural’ form always better than a synthetic form? Are capsules better than tablets? Which brand is best? Some simple pointers can help you to choose the right supplement for you.

Is Natural better than Synthetic?

Many people prefer to take vitamins in their natural form as they believe that nutrients derived from plants and other natural materials are more effective. Although this is not always the case, there are certainly instances where this belief holds up. Vitamin E, for example, is almost 40% more potent in its natural form that in its synthetic form. The natural form of Vitamin E is called d-alpha-tocopherol and this natural form, usually derived from wheat germ or soya oil, is undoubtedly superior.

Likewise, the natural form of Vitamin D, cholecalciferol or D3, has a more sustained effect on Vitamin D levels in the body than its synthetic counterpart Vitamin D2.

Generally, however, the natural and synthetic forms of most vitamins and minerals tend to behave in similar ways. Synthetic forms of some nutrients, such as Vitamin C, can in fact work out cheaper and can be more concentrated.

Perhaps the most important consideration is that vitamin supplements derived from natural sources may well contain as yet unknown nutrients that help increase their effectiveness. Vitamin C, for example, is more effective when taken alongside bioflavonoids, and these nutrients are almost always found together in nature. Supplement manufacturers can utilise this natural Vitamin C ‘boost’ by combining a potent synthetic Vitamin C supplement with additional bioflavonoids. By replicating this natural combination manufacturers can improve the supplement’s potency.

Improving supplement absorption

Getting the best out of your supplements also means making sure that you are taking them correctly. There are a number of lifestyle and dietary factors that can affect supplement absorption. Supplements should always be taken separately from alcohol, especially if the supplements contain magnesium or B vitamins. Alcohol lowers levels of digestive enzymes from the pancreas, meaning that supplements may not be broken down and digested (1). Alcohol also damages the cells lining the stomach and intestines, impairing absorption (2).

Cal-mag
Calcium and magnesium are better absorbed alongside proteins

As smoking influences the absorption of minerals such as calcium, it is not recommended to smoke during meal times, especially if you are taking your supplements with a meal.

Stress is another lifestyle factor that can hinder supplement absorption. As stress can effectively shut down digestion, it would be wise to try to take your supplements after a leisurely meal rather than on the run during a busy day.

To ensure maximum absorption, most vitamin and mineral supplements are best taken immediately after a meal. Calcium and magnesium are better absorbed alongside proteins. Vitamins A, E and D are all fat-soluble, and so are best taken alongside a meal containing fats or oils.

Other important factors when choosing a nutritional supplement include bioavailability, the form of delivery (tablet or capsule) and the manufacturing standards of the supplement company.

References

(1) Korsten, M.A. Alcoholism and pancreatitis: Does nutrition play a role? Alcohol Health & Research World 13(3):232-237, 1989. 

(2) Feinman, L. Absorption and utilization of nutrients in alcoholism. Alcohol Health & Research World 13(3):207-210, 1989. 

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Optimising supplements for managing joint pain and inflammation

Osteoarthritis is the most common cause of musculo-skeletal disability in the elderly and, within the secondary care system, its management is primarily focused on palliative relief using pharmaceutical drugs such as non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics. As with many pharmaceutical drugs, there are potential side effects, with treatment regimens also failing to address the progressive and complex nature of the condition.

The potential role of pharmaconutrients
Not surprisingly, given the safety profile of the majority of nutritional interventions, practitioners are continually striving to identify disease-modifying pharmaconutrients that are capable of both improving symptoms and preventing, slowing, or even reversing the degenerative process. Clinically, osteoarthritis is characterised by joint pain, crepitus (grating or cracking sounds on movement), stiffness after immobility and general limited movement. Identifying nutrients that can aid and support these symptoms are crucial to providing both relief from pain and treating the condition itself [1, 2].

Fatty acids as immunomodulators
Marine omega-3 fatty acids such as eicosapentaenoic acid (EPA) and the omega-6 fatty acid gamma-linolenic acid (GLA) exhibit anti-inflammatory effects through the production of eicosanoids – substances with both anti-inflammatory and immunoregulatory properties. As such, both are well documented as useful natural agents to help treat inflammatory diseases, alone and in combination.

Gamma-linolenic acid
GLA is found in certain plant-seed oils, including evening primrose seed oil, and is metabolised to dihomo-gamma-linolenic acid (DGLA) the direct precursor to anti-inflammatory and immunoregulatory products. Supplemental GLA has been shown to suppress acute and chronic inflammation in several conditions, including arthritis [3].

Omegaflex Duo
Omegaflex Duo is one supplement that combines glucosamine, calcium and EPA which is beneficial for bone health.

Eicosapentaenoic acid
The specific ratio of the principal omega-3 and omega-6 fatty acids AA (arachidonic acid) and EPA provides valuable information on the measure of the body’s eicosanoid balance and the AA:EPA ratio provides a direct indication of the inflammatory state of the body. Developing an anti-inflammatory treatment regime means preventing or reducing the accumulation of AA from the diet. By reducing AA through EPA supplementation, we reduce the substrate for the formation of inflammatory eicosanoids and increase the production of anti-inflammatory eicosanoids directly from EPA. Interestingly, whilst the benefits of EPA as a potent anti-inflammatory and immune-regulating fatty acid are well established, [4] these benefits are significantly superior for osteoarthritis sufferers when combined with glucosamine [5].

Glucosamine
As well as pain and joint degeneration, osteoarthritis also involves progressive loss of cartilage. Glucosamine is an amino monosaccharide believed to stimulate production of compounds called glycosaminoglycans and proteoglycans, the ‘building blocks’ of cartilage. Whilst glucosamine is important as a structural component, it is also known to exert specific pharmacologic effects by decreasing the production of inflammatory products. Glucosamine does this by regulating their production at the genetic level, by switching off genes that are directly involved in their production, thereby interfering with the inflammatory signalling cascade. When administered exogenously, it is used for the treatment of osteoarthritis as a prescription drug or a dietary supplement [6].

Calcium
The synovial fluid within joints contains calcium, as does the cartilage lining the joints. When that calcium crystallises, the resulting tiny shards wear away the joint surface and spur the release of enzymes that further break down cartilage. Not surprisingly, it is sometimes thought that because osteoarthritis is aggravated by calcium deposition in joints, osteoarthritis patients should avoid taking calcium. Formation of calcium crystals can, however, result in calcium deficiency and, whilst calcium serves to maintain healthy bones and teeth, it is also essential for the normal functioning of muscles, blood vessels and nerves. If proper management of calcium is not carried out, this could be harmful for osteoarthritis patients, who may be at a higher risk of also developing osteoporosis, especially if they are long-term users of NSAIDs [7].

 

Written by Dr Nina Bailey

References
1. Lopez HL: Nutritional interventions to prevent and treat osteoarthritis. Part I: focus on fatty acids and macronutrients. PM & R : the journal of injury, function, and rehabilitation 2012, 4:S145-154.
2. Lopez HL: Nutritional interventions to prevent and treat osteoarthritis. Part II: focus on micronutrients and supportive nutraceuticals. PM & R : the journal of injury, function, and rehabilitation 2012, 4:S155-168.
3. Dawczynski C, Hackermeier U, Viehweger M, Stange R, Springer M, Jahreis G: Incorporation of n-3 PUFA and gamma-linolenic acid in blood lipids and red blood cell lipids together with their influence on disease activity in patients with chronic inflammatory arthritis–a randomized controlled human intervention trial. Lipids in health and disease 2011, 10:130.
4. Calder PC: Omega-3 polyunsaturated fatty acids and inflammatory processes: Nutrition or pharmacology? British journal of clinical pharmacology 2012.
5. Gruenwald J, Petzold E, Busch R, Petzold HP, Graubaum HJ: Effect of glucosamine sulfate with or without omega-3 fatty acids in patients with osteoarthritis. Advances in therapy 2009, 26:858-871.
6. Rovati LC, Girolami F, Persiani S: Crystalline glucosamine sulfate in the management of knee osteoarthritis: efficacy, safety, and pharmacokinetic properties. Therapeutic advances in musculoskeletal disease 2012, 4:167-180.
7. Vestergaard P, Rejnmark L, Mosekilde L: Fracture risk associated with use of nonsteroidal anti-inflammatory drugs, acetylsalicylic acid, and acetaminophen and the effects of rheumatoid arthritis and osteoarthritis. Calcified tissue international 2006, 79:84-94.

 

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The importance of bone health

Bone health is an issue which is becoming increasingly more prominent in today’s society. According to the National Osteoporosis Society (1), one in two women and one in five men over the age of 50 in the UK will suffer with a bone fracture. This is mainly due to poor bone health which means that we all need to know how important it is to build and maintain strong bones.

In addition to weight baring exercise, nutrition is absolutely vital for establishing strong bones in childhood and adolescence as this is when the body passes through the bone growth stages to create individual peak bone mass. Within the 4 years surrounding an adolescent’s peak height, around 39% of their total body bone mineral is gained. This highlights how crucial this time is for building strong bones for the future as we go in to adulthood, as low bone mineral growth during youth is linked to the risk of developing brittle bones and osteoporosis in older age.

Fresh Orange Juice
Many Fresh Orange Juice's can be bought fortified with Calcium, Magnesium or Vitamin D.

Nutrients such as calcium, vitamins D and K and magnesium have all been specifically identified for bone health and having an influence on bone mineral density. A recent review (2) published in the journal Clinical Biochemistry focuses in particular on calcium’s effect on bone health. They reviewed numerous research papers looking into the effects of certain calcium rich foods on bone density.

For example, one study reported that women who had a lower intake of milk in childhood and adolescence had low bone density in adulthood and as a result they had a much greater risk of fractures later in life. Additionally, the authors reported on findings that with low intake of cow’s milk, even pre-pubertal children can have a higher risk of fractures which shows how important calcium intake is in early life.

As well as dietary calcium intake, calcium supplementation has also been found to be a fantastic contributor to bone mineral accretion. So be sure you add calcium to your family’s supplement regime to ensure all your bones are as strong as they can be to help prevent breakages.

Once peak bone mass is achieved around the age of 20 it needs to be maintained in the bone maintenance stage which lasts around 10-20 years. Then as we reach middle age our bone density starts to reduce by approximately 0.5–1.0% per year. However, it is important to note that female bone losses can be considerably more around the time of the menopause, at around 2–3% per year due to decreases in oestrogen levels. This represents a crucial time for maintaining bone density through our food and nutrition choices. Not surprisingly, calcium intake has been linked to the prevention of bone loss around this time.

Within the review paper, the research indicates that baseline calcium intakes of 500–1000 mg/day (meeting the recommended intake of 700mg a day) which were increased by 500–1200 mg/day prevented bone loss.

In order to be within this calcium intake, try to include the following foods into your typical day’s food intake, which combined equates to around 1578mg of calcium:

Typical servings: plain low fat yoghurt, 225g (415 mg of calcium), cheddar cheese, 40g (307mg), milk (around 300mg), pink salmon, 85g (181mg), Orange juice, calcium-fortified, 170ml (375mg). Dietary calcium is also available from sources such as other dairy products, bony fish, legumes, certain nuts (such as almonds and Brazil nuts), fortified soya milk and some fortified breakfast cereals also contain smaller amounts of calcium.

However, the report noted that most people’s calcium intake from dietary sources is often not sufficient especially for those that do not drink milk e.g. Chinese cultures. They therefore recommended calcium supplementation to meet the requirement. Vitamin D is also a great contributor to healthy bones on its own however when combined with calcium it has a much greater effect and the review noted that supplemental vitamin D combined with supplemental calcium can help to slow bone loss. This study included 1200 mg/day calcium and 1000 IU/day vitamin D supplementation and found that the two nutrients used together had a greater effect on maintaining bone density than when used individually.

It was also noted that calcium and vitamin D supplementation, at an intake of around 1000–1200mg calcium (depending on dietary calcium intake) and 800 IU vitamin D daily, is particularly important for those with osteoporosis or those at risk of its development. However, make sure that you are not exceeding the recommended upper limit of calcium which is 3,000 mg/day for children and adolescents aged 9–18 years, 2,500 mg/day for 19–50 year olds and 2,000mg/day for those aged> 50 years.

What all of this means it that it is really important to get enough calcium and vitamin D in both food and supplement forms to help keep bones healthy and strong, and also that your kids are getting enough to help build their bones for the future.

Written by Lauren Foster

(1) National Osteoporosis Society

(2) Zhu, K. & Prince, R.L. (2012) Calcium and bone. Clinical Biochemistry, p7.

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10 Tips for Hay Fever Sufferers

10 Tips for Hay Fever Sufferers

If you missed last week’s bodykind newsletter about Hay Fever and some effective and natural ways to manage the symptoms, you may be interested in the “10 Top Tips” that bodykind’s Nutritional Therapist Nadia Mason came up with below:

Blueberries, Blackberries and Elderberries are good for Hay Fever symptoms
Fruits such as Blueberries, Blackberries and Elderberries are good for managing Hay Fever symptoms
  1. Reduce histamine levels by eating plenty of magnesium and methionine-rich foods. Good sources are sunflower seeds, nuts, oats and leafy greens.
  2. Try to eat cabbage, onions and apples regularly. These foods are good sources of quercetin, a natural antihistamine.
  3. Eat plenty of purple berries,  such as blueberries, blackberries and elderberries,  for their anti-inflammatory benefits. Try making a refreshing fruit smoothie with frozen blueberries, or add a spoonful of elderberry jam onto your morning cereal.
  4. Drink peppermint tea. Peppermint contains a substance called rosmarinic acid, a powerful antioxidant that blocks production of allergy-producing leukotrienes.
  5.  Ensure you’re getting plenty of immune-boosting nutrients. Vitamin B6 and zinc play an important role in balancing histamine levels and supporting the immune system.
  6. Increased sunlight in the summer results in higher levels of pollution in urban areas, causing the immune system to react. A good all-round antioxidant supplement can increase your resistance. Try one that includes vitamins A, C and E, selenium and zinc.
  7. For stubborn symptoms, the amino acid methionine, in combination with calcium, can act as an effective anti-histamine. Try taking 500mg l-methionine and 400g calcium twice daily.
  8. Food intolerances can sometimes make symptoms worse. Try limiting common culprits such as wheat and dairy products for a couple of weeks to see if symptoms begin to improve.
  9. Omega-3 oils are one of nature’s best anti-inflammatory nutrients. Include oily fish in your diet at least twice weekly, and supplement with a good quality fish oil or flaxseed oil.
  10. Anti-inflammatory bromelain, a nutrient found in pineapple, is thought to be helpful for hayfever sufferers.  Try fresh pineapple, but be sure to eat the core too, as this part is highest in bromelain. Bromelain is available in supplement form. For best results, I often recommend taking bromelain alongside quercetin.

Written by Nadia Mason, BSc MBANT NTCC CNHC

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Calcium and Vitamin D may reduce abdominal fat

A new trial has found that calcium and vitamin D may decrease levels of abdominal fat in overweight adults.

Abdominal fat is linked with a higher risk of several diseases, including heart disease, hypertension and type 2 diabetes. Reducing excess levels of this type of fat is crucial for those wanting to improve their long-term health.

Fresh Orange Juice fortified with calcium and vitamin D may help reduce abdominal fat
Fresh Orange Juice fortified with calcium and vitamin D may help reduce abdominal fat

The trial, published in the American Journal of Clinical Nutrition, was carried out by researchers at Massachusetts General Hospital, in Boston. It tested the effect of fortified orange juice on the fat levels of 171 healthy overweight and obese adults between the ages of 18 and 65.

The research team carried out two double-blind, placebo-controlled trials. One trial tested a regular Calcium and Vitamin D (CaD) fortified orange juice. The second trial tested a reduced calorie (‘lite’) CaD-fortified orange juice. Abdominal fat or ‘visceral adipose tissue’ (VAT) was measured by x-ray before and after the trial.

The trials lasted 16 weeks, during which each participant drank three 240ml glasses of orange juice fortified with 350mg calcium and 100IU vitamin D per day. The control groups drank unfortified regular or unfortified ‘lite’ orange juice.

The results showed that abdominal fat in those drinking the regular fortified orange juice decreased by 12.7cm2 on average. Those who drank the unfortified juice saw a decrease on just 1.3cm2.

In addition, those who drank the fortified ‘lite’ juice saw a decrease in abdominal fat of 13.1cm2, compared with just 6.4cm2 in the unfortified ‘lite’ juice control group.

“Our results suggest that, in overweight and obese adults, a moderate reduction in energy intake and supplementation of calcium and vitamin D in juice beverages lead to a reduction in intraabdominal fat”, concluded the researchers.

Many experts believe that calcium and vitamin D are involved in the healthy metabolism of fat. It is also thought that calcium might accelerate weight loss by binding to fat in the intestine and removing it from the body.

“A large portion of the population is deficient in vitamin D, and dietary calcium intake often does not meet current recommendations,” the researchers stated.

To improve your calcium levels, you should ensure that you are eating plenty of calcium-rich foods, and that you are absorbing the mineral effectively. Rich sources of calcium include dairy, sardines and salmon, leafy greens such as mustard greens, and green vegetables such as broccoli. Calcium absorption also requires adequate dietary magnesium, phosphorus, and vitamin A, C and D.

Calcium citrate is believed by many to be the most efficiently absorbed form of calcium, rather than the cheaper carbonate form. For those supplementing vitamin D, the emulsified form is often considered to be well absorbed.

Written by Nadia Mason, BSc MBANT NTCC CNHC

References

Jennifer L Rosenblum, Victor M Castro, Carolyn E Moore, Lee M Kaplan. Calcium and vitamin D supplementation is associated with decreased abdominal visceral adipose tissue in overweight and obese adults. American Journal of Clinical Nutrition. January 2012.

Image courtesy of Paul

 

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The importance of vitamin D for calcium utilisation in the body

 In January  I wrote about the benefits of combined calcium and vitamin D supplements for fracture prevention.  Many adults, particularly women, are interested in eating for bone strength and prevention of osteoporosis (or brittle bones).

Many people still assume that a higher calcium intake is key for osteoporosis prevention.  As you can see from the posts linked above there are many nutrients that interact to protect our bones.  Calcium is, indeed, very important for bones however, recent evidence (1) seems to suggest that increasing calcium intakes may not help bone strength if the body is deficient in vitamin D, or body levels are insufficient.  This is a worrying concern since, as you will know from my past posts on vitamin D, most people in the UK have insufficient levels of this crucial vitamin.

This recent study (1) explored the importance of dietary calcium intake and blood serum vitamin D status with regards to bone mineral density in about 5000 women and men.  The researchers found that among men and women vitamin D status seemed to be the dominant predictor of bone mineral density relative to calcium intake.  The study highlights the importance of vitamin D and its ability to help the body utilise calcium efficiently, thus helping to explain why increasing calcium intakes alone is not always a successful way of dealing with osteoporosis prevention. 

Calcium is vital for bone mass, but nutrient interactions do need to be taken into account.  “The study supports the idea that correcting inadequate blood levels of vitamin D is more important than increasing dietary calcium intake beyond 566 mg a day among women and 626 mg a day among men for better bone mineral density” (2).  It seems that only women with the very lowest vitamin D levels seemed to benefit from higher calcium intakes.

Again, this adds to the evidence for the importance of vitamin D, to recap: most people in the UK do not get enough vitamin D and have insufficient/deficient levels in their blood.  There is no current consensus about the amount of daily vitamin D intake necessary to maintain blood levels at around 40-50 nmol/l (which is currently seen as optimal by many medical practitioners).  Most adult (age 18 and over) individuals in the UK would probably require a supplement of around 2000iu vitamin D daily.  It is always a good idea to check with a medical doctor prior to starting any supplement regimen.  Higher doses, up to 5000iu daily, may well be useful but I would not recommend such a regimen unless under the supervision of a medical doctor who can monitor blood levels regularly.  When looking for vitamin D supplements two forms are generally available.   Cholecalciferol, known as vitamin D3, and ergocalciferol or vitamin D2. Cholecalciferol is generally taken to be the more potent, easily absorbed and preferred form of vitamin D.

 (1)Bischoff-Ferrari HA et al.  2009.  Dietary Calcium and Serum 25-Hydroxyvitamin D Status in Relation to BMD Among U.S. Adults. Journal of Bone and Mineral Research.  24 (5): 935- 942

(2)Press release.   USDA/Agricultural Research Service (2010, March 15). Vitamin D and calcium interplay explored. ScienceDaily. Retrieved March 15, 2010, from http://www.sciencedaily.com­ /releases/2010/03/100312133716.htm

Written by Ani Kowal

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Combined vitamin D and calcium supplements for fracture prevention

Vitamin D and calcium are important for bone health.  With regards supplementation with these nutrients to prevent fracture the research to date has often been conflicting and inconclusive.  However, very recent evidence published in the British Medical Journal (1) has found that supplementation with both of these nutrients together is effective in fracture prevention.



The authors of the study conclude “This individual patient data analysis indicates that vitamin D given alone in doses of 10-20 µg is not effective in preventing fractures. 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”.  The research (1) looked at data from seven major randomised trials with a total of 68,517 participants (men and women aged between 47 and 107 years old).



In a press release (2) professor John Robbins, one of the study authors said: “What is important about this very large study is that goes a long way toward resolving conflicting evidence about the role of vitamin D, either alone or in combination with calcium, in reducing fractures,” “Our WHI research in Sacramento included more than 1,000 healthy, postmenopausal women and concluded that taking calcium and vitamin D together helped them preserve bone health and prevent fractures. This latest analysis, because it incorporates so many more people, really confirms our earlier conclusions.”



Fractures are a major cause of disability, loss of independence and death for older people –  fractures can often be the result of osteoporosis, a disease characterized by low bone mass and bone fragility.  Professor Robbins says (2)This study supports a growing consensus that combined calcium and vitamin D is more effective than vitamin D alone in reducing a variety of fractures,” “Interestingly, this combination of supplements benefits both women and men of all ages, which is not something we fully expected to find. We now need to investigate the best dosage, duration and optimal way for people to take it.”



In an editorial (3), written about this recent research, in the British Medical journal Dr Sahota writes about the implications of the current evidence in clinical practice saying: “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. 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”. 


As mentioned in many of my previous posts on vitamin D, most of the UK population are probably suffering from insufficient or deficient vitamin D levels. 


 


Fragility fractures cause excess mortality, substantial morbidity, and related health and social issues and financial problems in older people.  Risk of fracture is higher in institutionalised older people than in community dwelling older people of the same age. This reflects a greater risk of falls and lower bone mineral density in these populations.  Vitamin D insufficiency and deficiency is common in older people, particularly in residential and care homes.


The current study (1) suggests that “Daily calcium and vitamin D supplementation, even at doses as low as 10 µg of vitamin D daily, significantly reduces the risk of fracture”  the effective dose of supplements in the study was 1000mg calcium + 20micrograms vitamin D (the equivalent of 800iu).  Recent work with vitamin D suggests that up to 5000iu daily for adults may be required to keep blood levels of vitamin D optimal.  I would suggest most individuals in the UK would require around 2000iu vitamin D daily.  Higher doses may be useful but I would not recommend such a regimen unless under the supervision of a medical doctor who can monitor blood levels.


 


(1)The DIPART (vitamin D Individual Patient Analysis of Randomized Trials) Group.  2010.   Patient level pooled analysis of 68 500 patients from seven major vitamin D fracture trials in US and Europe.  BMJ.  340:b5463 doi:10.1136/bmj.b5463
(2)Press release: University of California – Davis – Health System (2010, January 15). Benefits of calcium and vitamin D in preventing fractures confirmed. ScienceDaily. Retrieved January 15, 2010, from
http://www.sciencedaily.com/releases/2010/01/100114143325.htm
(3) Sahota O.  2010.  Reducing the risk of fractures with calcium and vitamin D.  BMJ.  340:b5492


Written by Ani Kowal


 

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Calcium supplements may help women who suffer from PMS

Specific figures vary but it has been estimated that anywhere between 80-95% of the western female population experience premenstrual syndrome (PMS) to some level with up to about 35% seeking some kind of medical help.  Premenstrual syndrome, or PMS, is the presence of physical and/or psychological symptoms 1-2 weeks prior to the start of your period (menstruation).  These symptoms will typically be relieved within 2 days of the start of your period.



Over 150 different PMS symptoms have been described in various sources of literature! These can range from irritability, anxiety, mood swings and depression to fluid retention, breast tenderness, stomach bloating and headaches.  Symptoms may vary in nature and intensity between monthly cycles.  PMS is complex and varied, affecting individual women in different ways, it is definitely not predictable or easy to categorise.



There is no clear or definitive cause of PMS.  This accounts for the number and variety of symptoms that occur in women and also makes treatment difficult.  It seems that there may be many plausible factors at play including:
- Hormones
- Neurotransmitters (brain chemicals – a group of hormones formed within nerve cells)
- Prostaglandins (a type of fatty acid produced by the body that act in a similar way to hormones)
Diet and lifestyle



There is a lot that I could write about PMS and nutrition and I hope to revisit the topic in the very near future but today I wanted to look at the role that calcium supplementation may play in the treatment/prevention of this distressing condition.



Calcium has been implicated by many scientists as being important in PMS.  Women who consume more calcium from their diet seem less likely to suffer from PMS than women who consume little calcium (1) and low levels of calcium in the blood have been linked to an increased likelihood of suffering with PMS (2).  A number of well carried out clinical studies have found that calcium supplements can relieve PMS symptoms in women (3,4,5)



Recent evidence published this year (6,7,8) has also found that calcium supplementation is very useful in the treatment of PMS.  One of these studies (8) compared the effects of hormone therapy (dydrogesterone) with a calcium and vitamin D supplement in women with severe PMS and found that the nutritional supplement was as effective as the dydrogesterone for the treatment of PMS.  This was a well designed trial which involved over 150 women.  The women were randomly assigned to take a tablet containing either 5 mg of dydrogesterone, 500 mg of calcium plus 200 mg of vitamin D, or a placebo twice daily from the 15th to the 24th day of the cycle for 2 cycles.  Treatment with dydrogesterone or calcium plus vitamin D decreased symptom severity in a similar way.  The authors conclude that “Treatment with dydrogesterone or calcium plus vitamin D had a similar effect on symptom severity in women with PMS”. 



In the UK it is currently recommended that women aim to include 700mg of calcium per day into their daily diet.  In the USA, however the recommendation is 1000mg daily.  The National Diet and Nutrition Survey (NDNS) of adults aged 19-64 (9) found that many women in the UK are not achieving adequate daily calcium intakes.  Calcium plays a role in hormone and neurotransmitter responses in the body.  This may account for some of the benefits that women with PMS gain from calcium supplementation, especially mood and pain related symptoms.  The hormone fluctuations which occur in PMS may also interfere with the way that calcium is regulated in the body causing low circulating levels which may lead to worsened PMS symptoms.



If you suffer with PMS it might be worth trying 500mg calcium daily for 3 menstrual cycles, as well as trying to boost your dietary calcium intakes, to see if you get any relief.  Good dietary sources of calcium include:nuts, especially almonds, and seeds especially sesame seeds, milk and dairy products, dried fruit (especially figs), canned fish and broccoli (The calcium found in plant foods such as pulses and wholegrain cereals does not represent a good source of available calcium – this is because these sources contain phytates which lock up the calcium and limit the amount that the body can absorb)


If you decide to take supplemental calcium it is always advisable to take magnesium as well, since the two minerals work closely together in the body and a balance is needed, magnesium deficiency has also been implicated in PMS.  For every 500mg calcium 250mg of magnesium is advised.  Vitamin D is essential for the efficient absorption of calcium into the body and also regulates blood levels of calcium.  Some studies suggest that blood vitamin D levels are lower in women with PMS and that women with the lowest vitamin D intakes are more at risk of suffering from PMS than women with the highest intakes (10).  Many supplements are available that combine these three nutrients.



For information on PMS and support please visit National association for premenstrual syndrome (NAPS) website.  NAPS is the only advocacy group in the world promoting the interest of PMS sufferers



1.  Bertone-Johnson ER et al.  2005.  Calcium and vitamin D and risk of incident premenstrual syndrome.  Arch Intern Med.  165:1246-1252. 
2.Shamberger RJ.  2003.  Calcium, magnesium and other elements in the red blood cells and hair of normals and patients with premenstrual syndrome.  Viol Trace Elem Res.  94:123-129.
3.Thys-Jacob S et al.  1989.  Calcium supplementation in premenstrual syndrome: a randomised crossover trial.  J Gen Intern Med.  4:183-189.
4.Penland, JG.  Johnson, PE.  1993.  Dietary calcium and manganese effects on menstrual cycle symptoms.  Am J Obstet Gynecol.  168:1417-1423
5.Thys-Jacobs, S et al.  1998.  Calcium carbonate and the premenstrual syndrome: effects on premenstrual and menstrual symptoms.  Premenstrual Syndrome Study Group.  Am J Obstet Gynecol.  179:444-452 
6. Whelan AM et al.  2009.  Herbs, Vitamins and Minerals in the Treatment of Premenstrual Syndrome: A Systematic Review.  Can J Clin Pharmacol. 16(3):e407-e429.
7. Ghanbari Z et al.  2009.  Effects of calcium supplement therapy in women with premenstrual syndrome. Taiwan J Obstet Gynecol. 48(2):124-9.
8. Khajehei M et al.  2009.  Effect of treatment with dydrogesterone or calcium plus vitamin D on the severity of premenstrual syndrome. Int J Gynaecol Obstet. 105(2):158-61.
9.Henderson L et al.  2003.  The National Diet and Nutrition Survey: Adults aged 19-64 years.  HMSO London.
10.Bertone-Johnson, ER.  Hankinson, SE.  Benedich, A.  et al.  2005.  Calcium and vitamin D and risk of incident premenstrual syndrome.  Arch Intern Med.  165:1246-1252
Written by Ani Kowal

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