with contributions from Michael Ash BSc.DO.ND.DipION (ANH expert group)
Calcium supplements (particularly inorganic calcium carbonate), given in isolation, are a common treatment in orthodox medicine for conditions such as osteoporosis. Nutritional and functional medicine practitioners, for the past twenty years or so, have favoured more synergistic combinations of the range of essential nutrients needed for bone formation— adequate intakes of zinc, magnesium, manganese, boron, vitamin D, vitamin C, vitamin K2, folates and Vitamin B6. A British Medical Journal (BMJ) meta-analysis has finally brought into question, the pharma-favoured calcium treatment!
The BMJ meta-analysis was headed by Mark J Bolland, senior research fellow at the Faculty of Medical and Health Sciences at the University of Auckland, New Zealand. He and his team looked at 15 studies in order to investigate whether calcium supplements increased the risk of cardiovascular events, although it needs to be pointed out that the studies in question had not themselves been investigating data of this sort. Indeed the limitations of this type of analysis have already been highlighted by the Council for Responsible Nutrition.
According to the study authors:
The method of randomisation was stated in only seven trials.
Allocation concealment was explicitly described in four studies.
Ten studies gave details of participants who withdrew or were lost to follow-up.
Compliance was reported in all 11 trial level data studies, but the definitions for compliance differed between studies and were not always comparable.
Bolland and his team concluded that calcium supplements given in isolation, (a treatment still favoured by family doctors and clinicians of western-style, allopathic medicine, the world over) to women either with or demonstrating likelihood of developing osteoporosis are associated with an increased incidence of heart attack, and they have recommended that their vascular effects (possible arterial stiffening), ‘especially without vitamin D’, should be studied further.
The vitamin D factor
Osteoporosis is a complex disease whose development often involves multiple factors. Even in controlled clinical trials involving calcium and vitamin D, the fracture effects have been relatively small, although often statistically significant. Perhaps these data suggest that calcium supplementation, to be effective, requires the addition of vitamin D supplementation. It is well known that Vitamin D levels are generally too low in people of the northern hemisphere, especially those of an older generation.
Meaning that if a base line level of vitamin D was not collected at the start of the trial – and in this case it was not – the likelihood of getting confounding results increases exponentially leading to erroneous conclusions. Plus absence of Vitamin D alone, without the inclusion of other supportive nutrients (magnesium, potassium, Vitamin K2 etc) means that rather than seeing an increase in bone mineralisation there is an increase in soft tissue calcification.
The researchers pointed out that although the increased risk of cardiovascular disease is modest, the widespread use of calcium supplements means that even a small increase in incidence could translate into a large burden of disease in the population. They also, interestingly, point out the ‘modest overall efficacy’ of calcium supplements in isolation, in reducing fracture (about 10% reduction in total fractures). They suggest that a reassessment of the role of calcium supplements in the prevention and treatment of osteoporosis is warranted.
Nutritional Therapy protocols for osteoporosis rarely recommend calcium in isolation
For approximately two decades now, orthomolecular doctors, naturopaths and other practitioners of nutrition based therapies have kept abreast of research, and recognised the important role of vitamin D (which is also happens to be cardio-protective) and the range of other essential nutrients and co-factors in the absorption of calcium and the maintenance of bone tissue. Their protocols for such conditions as osteoporosis have long tended to reflect this knowledge, and calcium (particularly inorganic calcium carbonate) as an isolated supplement is rarely recommended.
Vitamin D, magnesium, potassium and vitamin K2 are crucial for calcium absorption, and deficiencies in vitamin D and magnesium in particular, are unfortunately rampant. These nutrients often prove to be the vital supplements to strengthen and maintain bone. They enable efficient utilisation of calcium already present within a reasonable diet. Vitamin K deficiency has been connected to the risk of vascular calcification. This research suggests that vitamin K2 is the key factor that gets supplemental calcium into the bones rather than into the heart and blood vessels.
Other important recommendations of nutrition-based protocols for osteoporosis are:- weight-bearing exercise (the ‘use it or you lose it’ principle), and the avoidance of high protein intakes. A high protein diet, typical in western countries, generates excess acid, which necessitates vital neutralisation through the use of sacrificial calcium, which the body will obtain from bone tissue. Fruit and vegetable intake, providing alkaline potassium salts, are recommended in order to offset any possible bone-damaging excess acidity.
Osteoporosis is a serious and often life-threatening disease. The sooner mainstream medicine can provide safer, effective, and biocompatible protocols such as these for osteoporosis (reflecting research that is, after all, already widely available), the better.
In the meantime, we look forward to further research into supplementation, through the use of well-designed studies, and of course careful analysis of clinical data too.