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Low-Dose Calcium & Vitamin D Pills Do Not Prevent Fractures

The U.S. Preventive Services Task Force analyzed studies on the effects of vitamin D and calcium pills on bone strength (Annals of Internal Medicine, published online February 26, 2013). They found no evidence that pills containing 400 international units of vitamin D and 1,000 milligrams (mg) of calcium help prevent bone fractures. They advise healthy older women not to take these low doses of calcium and vitamin D supplements to prevent fractures. Half of post-menopausal women will suffer an osteoporosis-related fracture in their lifetimes.

HIGHER DOSES? Studies on higher doses of calcium and vitamin D are contradictory and therefore, they do not have data to make recommendation for high dose calcium and vitamin D pills.

Calcium is necessary to keep bones strong and vitamin D helps bones absorb calcium. We have no data to show that taking calcium pills, by themselves, helps to prevent or treat osteoporosis or fractures. Calcium pills can increase risk for kidney stones. In some people, calcium pills can raise blood calcium levels. This can cause irregular heartbeats including atrial fibrillation, heart attacks, and sudden death from a heart attack (see the report below).

Vitamin D is necessary for everyone. Food will not provide enough vitamin D to keep you healthy. 1000 to 2000 IU daily is adequate for most people who do not get at least 15 minutes of sun exposure a few times a week.

MY RECOMMENDATIONS: To keep bones strong, you should eat a healthful diet, exercise, and try to get at least 15 minutes a day of sun exposure. If your blood level of hydroxy Vitamin D is below 75 nmol/L, you need to take vitamin D pills or get more sunlight. Instead of taking calcium pills, eat calcium-rich foods, such as leafy green vegetables, beans, sardines and low- fat dairy products.

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Calcium Pills Associated with Increased Heart Attack Death Rate

Taking calcium pills is associated with increased chance of dying, particularly from a heart-attack (British Medical Journal, published online February 13, 2013). The higher the dose of calcium, the greater the chances of suffering a heart attack. This study agrees with other recent studies showing that calcium pills may be associated with increased heart attack risk. No increase in stroke risk was shown in this study.

The highest intakes of calcium (>1400 mg/day) were associated with higher risk for death from everything. Women with the highest intake of calcium (>1400 mg/day), who also took calcium pills, were 2.5 times more likely to die than women who had similar intakes, but were not taking pills. Another recent study showed that calcium pills, but not calcium from foods, is associated with an increased death from heart attacks in men but not in women (JAMA Intern Med, published online February 4, 2013).

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Mediterranean Diet Reduces Heart Attack Risk

A study from Spain shows that people who eat a Mediterranean-style diet have a 30 percent lower chance of dying from heart attacks over five years than people on a low-fat diet (The New England Journal of Medicine, Feb 25, 2013). The Mediterranean diet helped to prevent heart attacks and strokes, even though the people did not reduce their intake of calories.

All of the people in the study were at high risk for heart attacks. They were either diabetic or had three of the following heart attack risk factors: smoking, high blood pressure, high LDL (bad) cholesterol, low HDL (good) cholesterol, overweight, or family history of heart attacks.

THE STUDY: Men and women 55 to 80 years of age, with no heart disease but at high risk for heart attacks, were divided into three groups:
• Mediterranean diet supplemented with olive oil, one liter per week
• Mediterranean diet supplemented with nuts, 30 g of mixed nuts per day
• Low-fat diet

Both of the Mediterranean diet groups had reduced incidence of heart attacks and strokes (compared to the low-fat group), even though the patients did not lose weight. Most of them were already taking statins, blood pressure or diabetes drugs to lower their heart disease risk.

MEDITERRANEAN DIET: The traditional Mediterranean diet contains fruits, vegetables, cereals, nuts and olive oil; and a moderate amount of fish and poultry. Wine with meals is allowed in moderation. Dairy products, red meat, processed meats, bakery products and sweets are severely restricted or avoided. In this study, the participants ate:
• at least three servings a day of fruits,
• at least two servings of vegetables,
• fish at least three times a week,
• beans, peas and lentils, at least three times a week.
Participants who drank were allowed up to 14 glasses of wine per week.

This is basically the diet that I have recommended for many years. I also think that you should restrict fried foods and use primarily water-based cooking methods. See http://drmirkin.com/heart/8614.html

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This week's medical history:
Van Gogh’s Yellow Coronas

For a complete list of my medical history biographies go to Histories and Mysteries

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Recipe of the Week:

Basque Beans

You'll find lots of recipes and helpful tips in The Good Food Book
- it's FREE

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March 3rd, 2013
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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