Supplemental Calcium: To Take Or Not To Take

Dr. John D. Carr MD

The question of whether to take supplemental calcium to treat or prevent osteoporosis is discussed often in the media and in our practice. The current dogma is that since bone contains alot of calcium, if you lose bone (osteopenia or osteoporosis), then supplementing with calcium will correct the problem.

The truth is that bone loss does NOT represent a calcium deficiency. The only reason to take extra of anything is if the body is deficient in the substance. The reason that most women (and a growing number of men) lose bone is primarily because they lose the hormones necessary to grow bone, especially testosterone.

Testosterone is the most important bone building hormone in the human body. The primary reason that bone loss occurs in peri-menopause and beyond is not that women suddenly stopped ingesting enough calcium. It is that the production of the bone building ovarian hormones (i.e. testosterone, estradiol and progesterone) diminishes significantly during this time period, causing the rate of bone loss (osteoclastic activity) to exceed the rate of bone building (osteoblastic activity).

In addition to the loss of hormones, with advancing age there is usually a decrease in physical activity necessary to build bone. Despite the current recommendations, walking is just not enough. Bone, like muscle, grows in response to resistance training (weight training). Walking, though better than sitting on the couch, is not a sufficient enough stress on the bone to cause the osteoblasts to lay down new bone.

Adequate vitamin D is necessary for absorption of dietary calcium and the formation of bone. Vitamin D is the most common deficiency I see in my practice. How much vitamin D should you take? Nobody can answer that without testing blood. I have seen patients on the golf course all day in sunny Southern California still significantly deficient in vitamin D. One patient in particular who golfed 6 days per week was taking 21,000 units of vitamin D daily and his blood tests showed he was still deficient!

Remember that taking supplemental calcium is not without risks. Many of you will remember the media hype about a medical report last summer suggesting that calcium supplementation may increase the risk of heart attacks. The report was from the British Medical Journal which reported on a survey of fifteen trials in which participants (all over age 40) were given at least 500 mg of elemental calcium per day. The researchers concluded that calcium supplements increase the risk of myocardial infarction by about 30% over five years.

Remember that calcium is part of plaque, the hard material that builds up in the lining of our blood vessels. You may have heard of a test called a Coronary Calcium Score, which is a CAT scan test that detects the amount of plaque in the blood vessel walls. Where there is calcium, there is plaque. If there is too much calcium in the blood, it can stick to blood vessel walls.

Many patients do not understand that the calcium level detected in blood tests is NOT a reflection of the amount of calcium in the bone. There is a very narrow range of calcium that the body needs in order to be healthy (approximately 8.5 to 10.2 depending on the lab). Ingesting a few thousand milligrams of calcium in a pill is too much to be taken up by the bones rapidly enough. The excess calcium will stick to tissues, including the lining of blood vessels, and contribute to plaque formation.

So how much extra calcium should one take? That is like asking what size shoe should one wear-it depends completely on the individual. In the active person with good vitamin D and hormone levels the answer is none. You didn't need calcium supplementation in your 20's because you had optimal levels of bone building hormones, were likely more physically active, and still youthful enough to convert sunlight to vitamin D. Age should not be an excuse for not having everything necessary to build bone. As far as using drugs for bone loss, we don't advocate them. You don't develop a Fosamax deficiency, so why would you take drugs that have nothing to do with the normal, healthy bone buidling process, and can have very serious side effects. 


In most cases, the real key for healthy bones is to stay active while eating a balanced, healthy diet and maintaining great vitamin D and hormonal levels. If you would like to have your hormonal levels evaluated by our office, please call us at 760-779-5511.

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How To Lay The Groundwork For A Healthy & Successful Pregnancy

Dr. Bev Blessing FNP, PHD

We hear a lot these days about the impact of the mother's diet, obesity, medications, exercise, diseases, and genetic influences on the pregnancy outcome. As a result, we as providers want to work with women well before pregnancy occurs to help lay the groundwork for a healthy and successful pregnancy. A pre-conception visit with your provider to discuss your plans for pregnancy will prove quite valuable in helping you identify risk factors and make any necessary changes in medications or diet and exercise before getting pregnant. 

 The following tips developed by the CDC (Centers for Disease Control) provides valuable information about things that you can do immediately, and things to discuss with your provider during that visit. It also has some excellent resource information.

Before Pregnancy

By the Centers for Disease Control & Prevention

5 Steps to Get Ready for a Healthy Pregnancy

1. Take 400 micrograms (mcg) of folic acid every day for at least 1 month before getting pregnant to help prevent birth defects.
2. Stop smoking and drinking alcohol.

3. If you have a medical condition, be sure it is under control. Some conditions include asthma, diabetes, oral health, obesity, or epilepsy. Also be sure that your vaccinations are up to date.
4. Talk to a health care professional about any over-the-counter and prescription medicines you are taking. These include dietary or herbal supplements.
5. Avoid contact with toxic substances or materials that could cause infection at work and at home. Stay away from chemicals and cat or rodent feces.

Click on the links below for info on getting ready for a healthy pregnancy.

Planning

Preconception Care:  Learn why it’s important to be healthy before getting pregnant. Learn how to create a reproductive life plan. And find out what your health care provider should do at regular pre-pregnancy visits.

Sexual Health: Sexual health requires a positive and respectful approach to sexuality and sexual relationships
Women's Health: Find tips to improve women's health, safety, and quality of life.

Preventing Problems

Folic Acid: Folic acid is a B vitamin that can help prevent major birth defects. Take a vitamin with 400 micrograms (mcg) of folic acid every day, starting before you become pregnant.
Smoking during pregnancy is the single most preventable cause of illness and death among mothers and infants. Learn more about the dangers of smoking and find help to quit before you get pregnant.

Alcohol: When a pregnant woman drinks alcohol, so does her unborn baby. There is no known safe amount of alcohol to drink while pregnant. If you’re planning a pregnancy, stop drinking alcohol now.
Diabetes: Poor control of diabetes during pregnancy increases the chance for birth defects and other problems for your baby. It can cause serious complications for you, too.
High Blood Pressure: Existing high blood pressure can increase the risk of problems when you become pregnant.
Bleeding Disorders: Bleeding and clotting disorders can cause serious problems for women. These problems include heavy menstrual bleeding (a disorder called menorrhagia), bleeding and clotting complications in pregnancy, and miscarriage. If you have a bleeding disorder or have heavy menstrual bleeding, talk to your health care provider. 
Sexually Transmitted Diseases (STDs): Learn about the harmful effects of STDs and find out how to protect yourself and your baby against infection.
Bacterial vaginosis (BV) - Chlamydia - Genital Herpes - Gonorrhea - Hepatitis - Human Immunodeficiency Virus (HIV) - Human Papillomavirus (HPV) - Pelvic Inflammatory Disease (PID) -Syphilis - Trichomoniasis

Vaccinations: Talk to your doctor about vaccinations (shots). Many are safe and recommended before and during pregnancy, but some are not. Having the right vaccinations at the right time can help keep you and your baby healthy.
Medications:  Taking certain medications during pregnancy might cause serious birth defects for your baby. Talk to your doctor or pharmacist about any medications you are taking. These include prescription and over-the-counter medications and dietary or herbal supplements.
Violence can lead to injury and death among women in any stage of life, including during pregnancy. Learn more about violence against women. 
Click here to find out where to get help for yourself or someone else.

Genetics and Family History

Genetics: Understanding genetic factors and genetic disorders is important in learning more about preventing birth defects, developmental disabilities, and other unique conditions in children.
Genetic Testing: Before you become pregnant, you might get blood tests (genetic tests) for certain inherited diseases. You and your partner can be tested to see if you carry a gene that is linked with a disease that could be passed on to your children.
Family History: Family members share their genes and their environment, lifestyles, and habits. A family history can help you learn about possible disease risks for you and your baby.
Genetic Counselor: Your doctor might suggest that you see a genetic counselor if you have a family history of a genetic condition or have had several miscarriages or infant deaths.

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The Solution For Unhealthy Bones Is To Optimize The Hormones That Build Bone

Dr. John D. Carr MD

The human skeleton is a remarkable living tissue, existing in a delicate balance of bone growth (osteoblastic activity) and bone resorption (osteoclastic activity). There are many factors that influence this delicate balance including physical activity, vitamin D levels, certain medications, and most importantly, hormones. Hormones such as testosterone, growth hormone and estradiol stimulate the cells responsible for bone growth, the osteoblasts. In order for bones to stay healthy, the osteoclasts resorb old or defective bone in order to make room for the new bone being layed down by the osteoblasts.


As we age the hormones necessary to stimulate bone growth diminish, and thus our ability to grow new bone decreases. This occurs abruptly in women as they approach menopause, but occurs in men over a period of time as well.

If nothing is done, that is if the hormone deficiencies are not identified and treated using bio-identical hormones, then the activity of the osteoblasts diminishes, and bones get weaker. The solution is to optimize the hormones that build bone, the hormones that accomplished this very well for you for decades, the hormones that God or Nature put in your body for healthy bones. The solution is NOT to take drugs that INHIBIT OSTEOCLAST ACTIVITY, thus not allowing for normal bone remodeling. It is true that bones will get thicker if these cells are inhibited, but the bone becomes less healthy, even brittle, because they do not stimulate bone growth.

The drugs most commonly used to treat osteoporosis, the so-called bisphosphonates (Fosamax, Actonel and Reclast) can have serious side effects including atrial fibrillation, esophagitis (for the oral forms), and may even increase the risk of esophageal cancer. In addition, they can increase the risk of fractures! If you understand the brief description of bone growth and turnover above, then it should make sense that if a drug inhibits the body’s ability to remove old or defective bone, then the bones will become weaker over time. This is especially true if the body is deficient in those substances such as hormones that are necessary for bone GROWTH.

The bottom line is that, in my opinion, these drugs should be banned. We grow healthy bones by engaging in resistance exercise (sorry, but walking is not enough), having optimal levels of vitamin D through supplementation, avoiding drugs such as prednisone which cause bone loss, and using bioidentical hormones when necessary to stimulate bone growth and NOT disrupt bone remodeling like these drugs do.


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Dr. Blessing's Healthy Eating Tips: Eating Dried Plums Helps With Osteoporosis

Dr. Bev Blessing FNP, PHD 

I love articles which show how we can do simple things to reduce our health risks. This article which was published by Science Daily showed significant improvement in osteoporosis prevention by individuals eating 6-10 prunes per day. Here's a hint: start slowly and drink plenty of fluids. Please note that the participants in the study also took calcium and Vitamin D. Check out the article below:


ScienceDaily (Aug. 26, 2011) — When it comes to improving bone health in postmenopausal women -- and people of all ages, actually -- a Florida State University researcher has found a simple, proactive solution to help prevent fractures and osteoporosis: eating dried plums.

"Over my career, I have tested numerous fruits, including figs, dates, strawberries and raisins, and none of them come anywhere close to having the effect on bone density that dried plums, or prunes, have," said Bahram H. Arjmandi, Florida State's Margaret A. Sitton Professor and chairman of the Department of Nutrition, Food and Exercise Sciences in the College of Human Sciences. "All fruits and vegetables have a positive effect on nutrition, but in terms of bone health, this particular food is exceptional."

Arjmandi and a group of researchers from Florida State and Oklahoma State University tested two groups of postmenopausal women. Over a 12-month period, the first group, consisting of 55 women, was instructed to consume 100 grams of dried plums (about 10 prunes) each day, while the second -- a comparative control group of 45 women -- was told to consume 100 grams of dried apples. All of the study's participants also received daily doses of calcium (500 milligrams) and vitamin D (400 international units).

The group that consumed dried plums had significantly higher bone mineral density in the ulna (one of two long bones in the forearm) and spine, in comparison with the group that ate dried apples. This, according to Arjmandi, was due in part to the ability of dried plums to suppress the rate of bone resorption, or the breakdown of bone, which tends to exceed the rate of new bone growth as people age.

The group's research, was published in the British Journal of Nutrition. Arjmandi conducted the research with his graduate students Shirin Hooshmand, Sheau C. Chai and Raz L. Saadat of the College of Human Sciences; Dr. Kenneth Brummel-Smith, Florida State's Charlotte Edwards Maguire Professor and chairman of the Department of Geriatrics in the College of Medicine; and Oklahoma State University statistics Professor Mark E. Payton.

In the United States, about 8 million women have osteoporosis because of the sudden cessation of ovarian hormone production at the onset of menopause. What's more, about 2 million men also have osteoporosis.

"In the first five to seven postmenopausal years, women are at risk of losing bone at a rate of 3 to 5 percent per year," Arjmandi said. "However, osteoporosis is not exclusive to women and, indeed, around the age of 65, men start losing bone with the same rapidity as women."

Arjmandi encourages people who are interested in maintaining or improving their bone health to take note of the extraordinarily positive effect that dried plums have on bone density.

"Don't wait until you get a fracture or you are diagnosed with osteoporosis and have to have prescribed medicine," Arjmandi said. "Do something meaningful and practical beforehand. People could start eating two to three dried plums per day and increase gradually to perhaps six to 10 per day. Prunes can be eaten in all forms and can be included in a variety of recipes."

The U.S. Department of Agriculture funded Arjmandi's research. The California Dried Plum Board provided the dried plums for the study, as well as some funding to measure markers of oxidative stress.

Read this article on Science Daily website here.

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Dr. Blessing's Book Reviews: “The Help” by Kathryn Stockett

Dr. Bev Blessing FNP, PHD

A few weeks ago I went on a road trip with my husband and some very dear friends.  I tend to get a little bored sitting in the back seat watching the scenery go by, so I decided that it would be much easier if I listened to a book on my IPOD.  I chose The Help, by Katherine Stockett. This book was written in 2009 and at the time received rave reviews. It has recently been released as a movie, and I thought it would be a good idea to read the book before I saw the movie. 

The Help is a fictional work that takes place in Jackson, Mississippi, and has three main characters. The audio version was read by women who all had rich southern accents. The story was a fully developed narrative that lets the reader explore the relationships of these southern women during the sixties to other women, to their children, to their “help”, to their white family employers, to their husbands, etc. But the story was about much more than relationships. It was a reminder to the reader that that even in the face of overwhelming odds, a little courage from a few can change an entire world. We are reminded also that acceptance of the status quo by the majority doesn’t necessarily make it right. Overall, I thoroughly enjoyed the book. But I am somewhat biased because this book is a close reflection of the times and the area of the country where I was raised as a child.

I grew up in the south, and in fact still have family in Alabama and Mississippi. When I was a child, my brothers and I often spent our summers with our grandparents in Tuskegee, Alabama. Tuskegee was much like the author’s version of life in Jackson, Mississippi. It was a simple life. The details of the story reminded me of much that I had come to know during that time.  I loved hearing the southern drawls and the general feel of the story. I had to remind myself time and again that it was a fictional work. There were times that I felt the story was somewhat cliché, and at other times I thought it was a thoughtful work, highlighting some very poignant issues. By the time I reached the end of the book, I was sad to have it be over.  I had come to know these women and loved them for their strengths, and their weaknesses. I loved their flaws, as well as their courage.  


What was interesting was how I felt as I was reminded of those times. The late fifties and early sixties in the south was a time of great change. We had forced desegregation of the schools, Martin Luther King marches in Atlanta, the killing of Medgar Evers, and the assassination of President Kennedy to name a few.    And yet as a child, I was unaware of the significance of some of these events. Now as an adult, I can better appreciate what was going on and the enormous amount of change that has occurred over the last forty five years. Throughout this book, I was reminded of people in my life like Shug and Janie, who taught me how to shell peas, and pick berries for cobblers. From them I learned how hard it was to pick cotton and that working inside the house was always going to be the better choice. (I hadn’t thought so prior to working a few hours in the fields.) During those times, I would hear from them words of wisdom that would later mold my character and passion to help and nurture others.
  
The book left me a little unsettled, however. (I believe most good books do cause us to ponder opportunities for change.) I began to wonder how much my own biases affected the way that I treated others. Even today I wonder how much do I truly appreciate the differences in people outside my immediate circle? Am I still unaware of the people that interact with me laterally, and treat them as if they are not there? I surely hope not. But I can tell you this much. I am committing to wake up to opportunities to better appreciate others in my life. To take the time to say thank you and to really mean it. 


In closing, I hope you take the time to read this book. I think you will enjoy being reminded of the some of the changes that our country has gone through. I know you will be encouraged by seeing the incredible strengths that we as women have and how when we are willing, we can change the world.    


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Want To Burn Belly Fat? Study Shows Aerobic Exercise Is Your Best Bet

Dr. Bev Blessing FNP, PHD

I ran across this fantastic article regarding jogging and belly fat. Belly fat and muffin tops are some of the most frustrating issues for many of us women today. In the past we have felt that it was the resistance training that was the most benefit for toning the body. The following study from Duke University does a head to head study comparing aerobic exercise, with weight training, and a combination of both, looking at the effect on belly fat. In the study, aerobics did the best, burning 67% more calories. The aerobic participants in the study only exercised an equivalent to jogging 12 miles per week. Since jogging is free, this is a very cost effective option for aerobic exercise. Weight resistance is still needed for improving lean muscle mass, but aerobic exercise is a great start. Now the only issue is finding my jogging shoes. 


Duke University Article:
Aerobic Exercise Bests Resistance Training At Burning Belly Fat
By Duke Medicine News and Communications


Aerobic exercise is your best bet when it comes to losing that dreaded belly fat, a new study finds.

When Duke University Medical Center researchers conducted a head-to-head comparison of aerobic exercise, resistance training, and a combination of the two, they found aerobic exercise to be the most efficient and most effective way to lose the belly fat that’s most damaging to your health.

This isn’t the fat that lies just under your skin and causes the dreaded muffin top. Belly or abdominal fat -- known in scientific communities as visceral fat and liver fat -- is located deep within the abdominal cavity and fills the spaces between internal organs. It’s been associated with increased risk for heart disease, diabetes, and certain kinds of cancer.

“When it comes to increased health risks, where fat is deposited in the body is more important than how much fat you have,” says Duke exercise physiologist Cris Slentz, PhD, lead author of the study published today in the American Journal of Physiology.

“Our study sought to identify the most effective form of exercise to get rid of that unhealthy fat.”

The Duke study showed aerobic training significantly reduced visceral fat and liver fat, the culprit in nonalcoholic fatty liver disease. Aerobic exercise also did a better job than resistance training at improving fasting insulin resistance, and reducing liver enzymes and fasting triglyceride levels. All are known risk factors for diabetes and heart disease.

Resistance training achieved no significant reductions in visceral fat, liver fat, liver enzyme levels or improvements in insulin resistance. The combination of aerobic with resistance training achieved results similar to aerobic training alone.

“Resistance training is great for improving strength and increasing lean body mass,” says Slentz. “But if you are overweight, which two-thirds of the population is, and you want to lose belly fat, aerobic exercise is the better choice because it burns more calories.”

Aerobic training burned 67 percent more calories in the study when compared to resistance training.

The eight-month study followed 196 overweight, sedentary adults (ages 18 to 70) who were randomized to one of three groups: aerobic training; resistance training or a combination of the two.

The aerobic group performed exercises equivalent to 12 miles of jogging per week at 80-percent maximum heart rate. The resistance group performed three sets of 8 to 12 repetitions three times per week.

All programs were closely supervised and monitored to ensure maximum effort in participation.

While the training programs were rigorous and substantial, Slentz says their previous research leads him to believe similar results could be achieved with a more moderate aerobic exercise program.

“What really counts is how much exercise you do, how many miles you walk, and how many calories you burn,” he says. “If you choose to work at a lower aerobic intensity, it will simply take longer to burn the same amount of unhealthy fat.”


You may read the original article here.

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Annual Mammograms Now Recommended For Women Beginning At Age 40

Dr. Enrique Jacome MD

Due to the high incidence of breast cancer in the US and the potential to reduce deaths from it when caught early, The American College of Obstetricians and Gynecologists (The College) recently issued new breast cancer screening guidelines that recommend mammography screening be offered annually to women beginning at age 40. Previous College guidelines recommended mammograms every one to two years starting at age 40 and annually beginning at age 50.


According to Jennifer Griffin, MD, MPH, who co-authored The College guidelines, the change in mammography screening for women beginning at age 40 is based on three factors: the incidence of breast cancer, the sojourn time for breast cancer growth, and the potential to reduce the number of deaths from it. The time period between when a breast cancer may be detected by a mammogram while it is very small and before it grows big enough to become symptomatic is known as the sojourn time. Although the sojourn time of individual cancers can vary, the greatest predictor is age. Women ages 40-49 have the shortest average sojourn time (2-2.4 years), while women ages 70-74 have the longest average sojourn time (4-4.1 years).


"Although women in their 40s have a lower overall incidence of breast cancer compared with older women, the window to detect tumors before they become symptomatic is shorter, on average," said Dr. Griffin. The five-year survival rate is 98% for women whose breast cancer tumors are discovered at their earliest stage, before they are palpable and when they are small and confined to the breast. "If women in their 40s have annual mammograms, there is a better chance of detecting and treating the cancer before it has time to spread than if they wait two years between mammograms."


The College continues to recommend annual clinical breast exams (CBE) for women ages 40 and older, and every one to three years for women ages 20-39. Additionally, The College encourages "breast self-awareness" for women ages 20 and older. Enhanced breast cancer screening, such as more frequent CBEs, annual MRI (magnetic resonance imaging), or mammograms before age 40, may be recommended for women at high risk of breast cancer. Breast MRI is not recommended for women at average risk of developing breast cancer.


Breast cancer is the second leading cause of all cancer-related deaths among American women. The incidence of breast cancer in the US declined 2% each year between 1999 and 2006, and deaths from breast cancer have also declined steadily over the past two decades. Evidence suggests the drop in breast cancer rates is most likely due to fewer women getting mammograms and therefore not being diagnosed, as well as a significant drop in women using hormone therapy for menopausal symptoms. "The good news is that fewer women are dying from breast cancer because of earlier detection and improved treatments," said Gerald F. Joseph, Jr, MD, Vice President for Practice Activities of The College.


The College's breast cancer screening guidelines also address clinical breast exams and breast self-awareness:


Clinical Breast Exam
Studies on CBEs suggest they can help detect breast cancer early, particularly when used along with mammograms. Thus, The College recommends that women ages 40 and older have an annual CBE performed by their physician. Although the benefit of CBEs isn't clear for those younger than age 40, The College continues to recommend that women ages 20-39 have a CBE every one to three years.


Breast Self-Awareness
The traditional breast self-exam (BSE) has shifted toward a newer concept called "breast self-awareness." BSE is performed in a systematic way on a regular basis, typically monthly. Breast self-awareness, on the other hand, is women understanding the normal appearance and feel of their breasts, but without a specific interval or systematic examination technique. The College endorses educating women ages 20 and older regarding breast self-awareness.


"The goal here is for women to be alert to any changes, no matter how small, in their breasts, and report them to their doctor," said Dr. Griffin. "Although we've moved away from routinely recommending BSEs, some women will want to continue doing them and that's OK."


According to The College, there is no consensus on the upper age limit for mammograms, although the benefits of screening declines with increasing age compared with the harms of overtreatment. Women ages 75 and older should discuss with their doctor whether to continue getting mammograms, said Dr. Griffin.

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