Dr. John Day, Cardiologist

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How Much Calcium Do You Really Need?

No one wants brittle bones or to be hunched over.  While the American Dairy Association would have us believe that the answer is to drink more milk, some studies suggest that more milk might actually make things worse.  Popping calcium supplements instead may just increase your risk of a heart attack.  In this article, I’m going to share six things you need to do for strong bones and attempt to answer the question, how much calcium do you really need?

My Calcium Story

The milk industry had convinced me that “got milk” meant “got healthy bones.”  My favorite was this commercial where Mr. Miller’s arms fall off because he did not drink his milk.

For years I tried to follow our government’s advice and get my 3 servings of dairy each day for calcium.  Also, for the first 40+ years of my life I suffered from acid reflux.

When I was young I thought heartburn was “normal” so I never mentioned it to my parents.  As an adult I would buy the “Costco packs” of omeprazole (Prilosec) to make sure I always had enough on hand for my heartburn symptoms.

I also frequently got food stuck in my esophagus.  I thought this was something I had to live with as it was present from my earliest childhood memories.

In my early 40s, while racing to finish lunch prior to a surgery, I got a small bean stuck in my esophagus.  I could not dislodge the bean.  I was panicked because my nurse was paging me to start a surgery.

Fortunately, my partner was able to help me with the surgery as I needed an urgent endoscopy to remove the bean.  I had the endoscopy done without any sedation so that I could get back to my patients.  With the endoscope, my gastroenterologist could clearly see that my esophagus was severely inflamed, narrowed, and scarred from years of untreated eosinophilic esophagitis (EE).

I was put on a steroid and a high dose of Nexium.  I was also told that eosinophilic esophagitis is often due to food allergies and that it was usually a waste of time to try and find the specific food allergen.

Shortly after this time I hit my health crisis.  As part of my turn around, I cut out sugar, processed carbs, dairy, and animal meat except for an occasional wild fish.

I’m really not sure what “cured” me of acid reflux and eosinophilic esophagitis.  Perhaps it was the diet or the nearly 40 pound weight loss that came from eating this way.

Regardless, it is interesting to note that both lifelong conditions did go away when I changed my diet.  If I occasionally have dairy, the heartburn symptoms may come back.  While I have never been tested for food allergies, I suspect that I may have a food allergy to dairy.

When I discovered this possible food allergy to dairy, I started taking calcium supplements to ensure I was getting my recommended 1,000 mg of calcium each day.  However, after seeing the studies linking calcium supplements to heart attacks, I stopped these supplements.  Am I putting myself at risk of developing osteoporosis?

How Much Calcium Do You Really Need?

Our government recommends 1,000 mg of calcium each day for adults.  Older Americans need to target 1,200 mg.

Having enough calcium is critical for our bones and teeth.  If there is not enough calcium, the body may pull it from our bones. Osteoporosis occurs when our bone mineral density is low.

Interestingly, the U.S. and Northern Europe have the highest dairy intake in the world. Despite this high dairy consumption, the U.S. and Northern Europe also have the highest rates of osteoporosis and hip fractures.  If dairy is the only answer, how do you explain these findings?

Do We Really Need 1,000 mg of Calcium Daily?

Is 1,000 mg of calcium really our daily target?  What will happen if we don’t reach this number?

Of course, there is a certain amount of calcium that we need each day in our diet.  Studies of animals who are deprived of calcium consistently show that they develop osteoporosis.

When researchers have looked at this question, they have been very surprised.  Getting the targeted amount of calcium, either through dairy or calcium supplementation, does not decrease the risk of bone fractures.  Surprisingly, some studies have even shown that getting more calcium may actually increase your risk of fractures.

Non-dairy eating cultures, like Asia, typically get very low amounts of calcium in their diets.  Indeed, in countries like China where 92% of people are lactose intolerant, their risk of fractures may be six times lower than the U.S.!  Of course, these are studies of Chinese eating their ancestral diet, which was real food, rather than a “modern” diet.

The bottom line is that we really don’t what the right amount of calcium is.  For example, some studies suggest that 300 mg may be okay for physically active Asians eating an ancestral diet.  For those of us living in the “modern world,” the number is probably much higher.  As everyone has different calcium needs, please speak with your healthcare provider to determine what the right number is for you.

What Are the Best Non-Dairy Sources of Calcium?

Contrary to what the milk industry would have us believe, there are also natural non-dairy sources of calcium.  For example, the following things are all very high in calcium:

1. Mineral water

2. “Greens” (spinach, broccoli, kale, etc.)

3. Sardines and canned salmon

4. Sesame seeds

5. Almonds

6. Legumes

7. Oranges

To put the recommended 1,000 mg of daily calcium into perspective, you could get 100% of your daily needs from 143 almonds.  Likewise, you could hit the same 1,000 number with either 6 oz of tofu or four cups of cooked spinach.  As you can see, by combining your daily greens with almonds, legumes, and fruit you can easily hit the daily calcium goal.

Since I have been tracking my daily calcium intake with the free Cronometer app on my smartphone, I consistently crush the 1,000 mg goal without the need for dairy.  For example, I hit 165% of my calcium target yesterday (1,675 mg) mainly from lots of greens and natural mineral water with some legumes, almonds, and fruit.

6 Ways to Prevent Osteoporosis

If dairy and calcium supplements are not the only answer to preventing osteoporosis, how can we prevent this debilitating condition?  As no one wants to walk around hunched over, let me suggest six strategies to prevent osteoporosis.

1. Stay Physically Active

Physical activity is the best way to keep your bones strong.  Weight bearing activities like walking, hiking, running, dancing, skiing, weight lifting, etc. are particularly important.

You would think that Tour de France cyclists would have exceptionally strong bones from all of their grueling training.  Interestingly, world class athletes performing non-weight bearing sports, such as swimming or cycling, often have much weaker bones.

The same is true for astronauts.  Within just a few days in space astronauts will lose 20% of their bone mass.

Gravity really is our friend.  Weight bearing exercises are critical for bone health.

2. Get Enough Vitamin D

Vitamin D is critical for healthy bones.  Studies show that your risk of osteoporosis is also determined by your latitude.  For example, the farther you live from the equator the higher your risk of osteoporosis.  Sadly, the strong media messages warning us of the dangers of sun exposure and skin cancer may actually be increasing our risk of osteoporosis.

Unfortunately, if you live in a higher latitude city, like our family in Park City, it is simply impossible to get all of your vitamin D needs from the sun alone.  There are some foods, like salmon, which are very high in vitamin D.  Besides fish, other natural sources of vitamin D include milk, eggs, and mushrooms.

For most people living in higher latitude cities, vitamin D supplements are often required to maintain normal vitamin D levels during portions of the year.  To find out if you are vitamin D deficient, please speak with your physician about getting tested.

3. Get Enough Vitamin K2

An often overlooked aspect of good bone health is vitamin K2.  Most people have simply never even heard of vitamin K2.

The role of vitamin K2 is to put calcium in your bones and keep it out of your arteries where it can cause heart disease.  Indeed, studies have shown that getting enough vitamin K2 in your diet not only strengthens your bones and teeth but also prevents heart disease.

The very best food source of vitamin K2 is natto or fermented soy beans.  Natto is considered a delicacy in Japan. Perhaps this helps to explain why osteoporosis and heart disease are so much lower in Japan than the rest of the world.

We can also get some vitamin K2 from the conversion of vitamin K1 to K2 by our bodies.  Foods high in vitamin K1 are greens like spinach, broccoli, and kale.  Other foods high in vitamin K2 include liver, eggs from grass fed chickens, and some cheeses like gouda and brie.

To read more about vitamin K2 and see if you have these 9 signs of vitamin K2 deficiency, please read the article I wrote on this subject.

4. Get Enough Calcium

While our government recommends at least 1,000 mg of calcium daily for most adults, we really don’t know exactly how much calcium we need each day.  If you do take calcium supplements, some studies suggest that supplementing calcium alone may increase the risk of osteoporosis.  Calcium may be most beneficial when it is consumed with the right amount of vitamins D, K2, A.

When tracking your calcium intake from food, don’t forget about the contribution from water.  Indeed, the “harder” your water, the higher your daily dose is of calcium and magnesium.

5. Avoid Very High Protein Diets

Although the science has not fully been worked out, some studies suggest that diets off the chart in protein may weaken bones.  Indeed, studies show that the excessive amounts of protein that some people eat puts them at higher risk of hip fractures.

6. Avoid Soda Pop

Did your Mom tell you that soda pop was bad for your bones?  It turns out that this advice may be true.

Many researchers feel that the phosphoric acid in soda pop alters the phosphorous/calcium balance in the body.  Perhaps this is why many studies have shown that soda drinkers are more likely to have osteoporosis and fractures.

Instead of soda pop, choose water instead.  Mineral or “hard water” is very high in natural calcium.  As long as you are not drinking reverse osmosis water, you are getting some calcium in every glass you drink.

Disclaimer

Please discuss how much calcium, vitamin D, vitamin K2, and vitamin A you need with your physician.  Also, please work with your physician to minimize your risk of osteoporosis.  Do not self diagnose or treat based on anything that you read in this article.

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9 Signs You May Have Vitamin K2 Deficiency

You may have a vitamin K2 deficiency.  Sadly, few people have even heard about this vitamin.  In this article, I share the nine signs of vitamin K2 deficiency and what you can do now to reverse a vitamin K2 deficiency.

What is vitamin K1?

Most people have heard of vitamin K.  This is vitamin K1.  Vitamin K1 is important for blood clotting.  Vitamin K1 comes primarily from green leafy vegetables.

How much vitamin K1 do you need?

Many experts feel that the current recommended dose of vitamin K1 is too low to prevent disease.  The current government recommendations are for just 90 mcg of vitamin K per day.  To put this in perspective, you can easily get 10 times the amount of vitamin K the government recommends from just one cup of cooked kale or spinach.

What is vitamin K2?

Vitamin K2 is different than K1.  The main role of vitamin K2 is to put calcium where it belongs in the body, like your teeth and bones, and keep it out of your brain, heart, and other places where it can cause premature aging and an early death.

Do you need to worry about getting enough vitamin K2?

Historically, it was felt that you did not need to worry about a vitamin K2 deficiency.  The reasoning was that your body would make all the vitamin K2 it needed from vitamin K1.

New research suggests this may not be the case.  Most people eating a Western diet are deficient not only in vitamin K1 but K2 as well.

Unfortunately, there not a good test to see if your have a vitamin K2 deficiency.  There are also no government recommendations on how much vitamin K2 you need.  To help assess for a possible vitamin K2 deficiency, below are nine signs that you may have a vitamin K2 deficiency.

9 Signs You May Have Vitamin K2 Deficiency

1. You bruise or bleed easily.

Vitamin K was named “K” after the German word “Koagulation” or clotting.  If you are deficient in vitamin K1, you will bruise or bleed easily.

As much of the vitamin K2 in your body comes from the body’s conversion of vitamin K1 to K2, if you have a vitamin K1 deficiency you will also have a vitamin K2 deficiency.  To ensure enough vitamin K2 for your body, make sure you eat a large serving of green leafy vegetables every day.  Kale, spinach, or broccoli are all excellent choices.

2. You have osteoporosis or broken bones.

Many studies have linked low K vitamins to a higher risk of low bone mass, osteoporosis, or fractures.  Vitamin K2 is especially important for normal osteocalcin function. Osteocalcin is a protein critical for healthy bones.

As vitamin K2 is critical for good bone health, this could explain why the Japanese and Chinese have much lower rates of osteoporosis or fractures even though few eat calcium-rich dairy.  Indeed, the Japanese and Chinese both eat diets very high in green leafy vegetables and fermented soy, such as natto, which has the highest known levels of vitamin K2 of any food.

3. Your mouth is full of cavities.

Vitamin K2, through its effects on osteocalcin, not only strengthens your bones but your teeth as well. In our research of Chinese centenarians, one study of rural Chinese centenarians showed that centenarians eating a diet high in the K vitamins, without any processed carbohydrates, were able to keep all of their teeth at age 100 despite never brushing.

4. You have heart disease.

Vitamin K2 may be one of the most overlooked strategies to decrease your risk of heart disease.  Based on the Rotterdam Study of 4,807 people, those with the highest dietary intake of vitamin K2 had a 57% lower risk of heart disease.

5. You have diabetes or pre-diabetes.

Through complex mechanisms, vitamin K plays an important role in regulating glucose.  Indeed, getting enough of the K vitamins can cut your diabetes risk by 51%.

6. You have an autoimmune disease.

The K vitamins may also play a role in autoimmune diseases.  One study showed that vitamin K2 may not only prevent osteoporosis in people suffering from rheumatoid arthritis, but that it may also help to put rheumatoid arthritis into remission.

7. You are becoming forgetful.

A low vitamin K diet is linked to dementia and Alzheimer’s Disease.  This may be due to calcium plaque build up in the brain from a vitamin K2 deficiency.

8. You have taken a lot of antibiotics.

Antibiotics not only kill the bad bacteria but your healthy gut bacteria as well.  If you have recently been on antibiotics, probiotics and fermented foods may help you to restore the beneficial vitamin K producing gut bacteria.

9. You take Coumadin (warfarin)

While Coumadin (warfarin) is very effective at preventing blood clots, it can also cause a vitamin K2 deficiency.  This medicine works by blocking vitamin K.

If your doctor has prescribed this medication, it is still important to eat green leafy vegetables for optimal health.  In order to do so, you will have to work very closely with your healthcare provider.  If you eat the exact same amount of vitamin K in your diet each day, then your health care provider can dose your Coumadin (warfarin) appropriately.

How do you get enough vitamin K2?

The very best way to prevent a vitamin K2 deficiency, is to eat a large serving of green leafy vegetables every day.  Green leafy vegetables are sky high in vitamin K1.  Your body will then convert vitamin K1 to vitamin K2.

Fermented foods, like fermented soybeans, sauerkraut, and some cheeses, such as brie or gouda, can all be good sources of vitamin K2.  Even though yogurt and kefir are also fermented foods, the grocery store variety contains the wrong bacteria for vitamin K2.

Other good sources of vitamin K2 include liver and grass fed chicken eggs.  Of all these sources, nothing even comes close to the amount of vitamin K2 found in natto or fermented soybeans.

Indeed, one serving of natto has enough vitamin K2 for an entire week. Not only is natto loaded with vitamin K2, but this fermented food may also help your gut flora.

Natto is a delicacy in Japan.  Unfortunately, most Westerners cannot tolerate the taste.

While natto certainly isn’t my favorite food, I have learned to tolerate it.  I have eaten a spoonful of fresh natto everyday for the last few years.  You can find fresh natto at your local Asian food store.

Can you get too much vitamin K?

Fortunately, I could find no reported cases of vitamin K toxicity from eating too many green leafy vegetables.  Unlike other fat soluble vitamins, very little vitamin K is stored.  Thus, vitamin K toxicity from food isn’t known to develop.  On the other hand, it is always possible to overdose on vitamin K from supplements.

Ongoing Vitamin K2 Studies

I have recently learned of a study being done in the Netherlands to test the effect of vitamin K2 in reversing heart disease.  This study will be the first high quality study to be done on this important vitamin.

Hopefully, vitamin K2 will be shown to reverse coronary calcification or plaque build up in the arteries of the heart.  Any reversal of heart disease will be measured very accurately by CT scans.

This study is expected to be completed by the end of 2018.  Until that time, I will continue to “enjoy” my spoonful of fresh natto each morning.

Take Home Message

The key message of this article is that vitamin K1 and vitamin K2 deficiency is common in the Western world.  This is a very preventable condition.

To prevent or reverse a vitamin K2 deficiency, make sure you have a heaping serving of green leafy vegetables every day.  Also, some fermented foods and grass fed dairy may also help you to get enough vitamin K2 in your diet.

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