Caregiver stress is the greatest stress, and biggest cause of premature aging. And we docs not only feel like caregivers, perhaps not as much as nurses or spouses, but controversies in medicine and talking to a person about why her doc's opinion may not be optimal causes me stress. That was what the week was like, talking to people about calcium and magnesium supplements, and what was missing in a study, about why you actually have to measure vitamin D3 levels (over 90% of vitamin D3 pills you buy have less than 50% of the level in the bottle as on the label) and what the estrogen breast cancer study said that was flawed, and how to help heart attack victims get healthy by lifestyle changes rather than surgery (a la the Cleveland Clinic’s Lifestyle180 program) but it ended today on a highlight—getting to work with the author of Mindless Eating, Brian Wansink (www.mindlesseating.org)on a 20-city tour to pick the original health nut (www.originalhealthnut.org). So lets me relate this week’s controversies and what I explained to patients who called me with these questions.
First if you are taking hormone therapy, should you stop or stay calm? Our YOU Docs answer: Don’t let the scary -- and flawed -- headline-grabbing new study about hormone therapy (HT) and breast cancer come between you and the pills that are cooling your hot flashes, helping you sleep and lighting up your sex life again. Before you freak out, take a deep breath and consider 3 crucial facts that much of the media overlooked:
- The study used unsafe (and those we no longer think should be much used) hormones.
The Women’s Health Initiative (WHI) studied women who took Prempro, a mix of conjugated equine estrogens (yup, from horses) and medroxyprogesterone acetate. This form of estrogen, by itself, seemed to slightly lower breast cancer risk in related WHI research (YES YOU READ THAT RIGHT. ESTROGEN ALONE LOWERED BREAST CANCER RISK). But adding this type of progesterone canceled this apparent benefit and screwed up other things, too.
- YOU can do better.
Check your Rx label. The YOU Docs recommend bioidentical estradiol and micronized progesterone plus 162 mcg of aspirin (half a regular aspirin or 2 low-dose tablets, together with a half glass o water before and after). With the right progesterone, this combo may reduce breast-cancer risk. So, incidentally, may aspirin.
- The right hormones for the right woman can be lifesaving.
Look, hormones aren’t for you if you’re at increased risk for breast cancer or heart disease. Otherwise, in our opinion good HT (see above) that includes aspirin can lower your risk for heart disease and breast cancer, keep your bones strong and your brain sharp.
And several of my existing patients asked me about Calcium supplements—my answer: Shake, rattle . . . and stall. If you've suddenly found yourself staring at your bottle of calcium pills—not sure whether to shake one out or skip it—you’re not alone. A new study claims that calcium tablets raise your heart-attack risk. What gives? Is calcium really dangerous? Useless? Both? Here’s why we YOU Docs think this supplement is still safe and essential—when you take it the right way and with the right stuff (make sure yours comes with magnesium and vitamin D3).
Let’s start with the facts. First, the researchers didn’t actually give calcium and check hearts. Instead, they analyzed 11 older calcium studies, none focusing on heart attacks. You can infer interesting things this way; they're just not always conclusive. Yup, 30% more heart attacks occurred in people over age 40 who took calcium pills—but while that sounds pretty big, in an analysis like this, it's not.
Second, there weren’t any extra heart attack-related deaths. Not that we wanted any! It's just that if there are extra heart attacks you'd expect a few extra deaths. Maybe, as a British Medical Journal editorial about the study suggested, the extra heart attacks were misdiagnoses—say, people who were logged into emergency rooms with "heart attack symptoms" but turned out to have severe digestive distress (it happens).
Third, about those missing bone benefits: This one's easy. The analysis included only studies where calcium supplements were taken alone. It excluded people who also took vitamin D3, which is essential for calcium absorption. Without D3, there's almost no way your body can absorb enough calcium to protect your skeleton. And it ignored magnesium intake.
We say: Don’t shoot your calcium pills to the round receptical based on this analysis, unless of course your calcium tablets don't have magnesium 200 mg at least per 600 mg of calcium and 500 to 1000IU of vitamin D3 per 600 mg of calcium. If your pills do not have magnesium and vitamin D3 with them, you have to add those or better yet, get better pills (you can find what we recommend at 360-5.com—see the Fab Five—you can see choices of 2 brands for each of Fab Five (we receive no payment for this). There’s strong evidence that calcium vital for bones and that calcium-rich foods (like low-fat dairy products) help your heart by keeping a lid on high blood pressure. For now, do calcium the right way:
Aim for 1,200 mg a day—and get as much as you can from food. Sip a glass of skim milk (300 mg), spoon up a cup of plain, low-fat, no-sugar-added yogurt (415 mg) or sprinkle your salad with low-fat cheese (200 mg for a quarter-cup). Not into milk products? Have calcium-fortified soy milk or orange juice (300 mg per cup), cooked spinach (290 mg per cup), sardines (370 mg in a 3.5-ounce tin!) or canned salmon (181 mg in 3 ounces). Sip mineral waters with good calcium levels (up to 108 mg per cup—check labels). Broccoli, kale, even Chinese cabbage contribute, too.
Add vitamin D and magnesium. You need 1,000 IU of D (1,200 IU over 60) for maximum calcium absorption (and many other reasons: D also helps prevent osteoarthritis, reduces your risk of certain cancers, fights inflammation, and regulates blood pressure). You also need 400 to 500 mg of magnesium. Why? Because it keeps calcium from making you constipated, and because if there actually are any cardio risks from calcium, magnesium probably counters them.
Now the Big breakthrough of the week health-wise, at least illness treatment wise: FSH receptors on blood vessel cells of almost all with cancer not on normal peoples’s cells or on arterial cells of people with other illnesses—imagine a targeted treatment for many cancers –wow the promise is there, but much more work is needed.
And yes I did get to coach several people to health…a few new patients with severe coronary artery disease as well as my usual group using the Enforcer e-coaching site—but I’ve just about run out of room this week—so I talk about that next week.
And the most fun of the week, other than the time I got to spend with Nancy (my wife)—the work with Brian Wansink. We discussed how easy it is for each person to change from unhealthy mindless eating (the name of his book) to healthier portion size—buy and only serve on 9 inch or smaller plates, keep the leftovers in another room, put snacks in baggies an never eat from the carton or bag. And best of all, in our Cleveland Clinic and Healthcorps approach to changing school foods and health education, young Brian is going to help us redesign lunch rooms. He promises just a redesign will have kids loving to choose apples and walnuts and not be as likely to help the nasty chip companies (not all chip companies are nasty—some make baked) addict them to body poisons.
So a great ending to the week…remember small choices make a big difference to how your genes function.