Maybe you two physicians will indulge a point. I've yet to see hard evidence that women need this much calcium, especially with no mention of magnesium. And precious few physicians ever do mention magnesium.

In fact, this much calcium without sufficient magnesium seems to actually pose a health risk, creating higher chance of developing hypertension, migraines, insomnia, back and neck pain, and calcified deposits in the breast.

What evidence do we have that, even with adequate magnesium intake (which hardly ever happens) that this much calcium is needed?

Gina Pera, journalist-author
Is It You, Me, or Adult A.D.D.?

Very interesting, Dr. Williams, but TMI! :-)

Here is the link to read free online: http://www.nap.edu/openbook.php?record_id=5776&page=1

My brief scanning of this decade-old document (obviously based on even-older information) tells me the "evidence" is full of uncertainties and questionable correlations.

For now, I'm holding off on the 1,000/mg calcium supplementation -- and expecting to see a major revision of this in about 5 years, when we see the disastrous health effects on women of all ages.

Hopefully, by then, we will have better diagnostics for determining an individual's vitamin/mineral deficiencies instead of coming up with one-size-fits-all recommendations.

Gina Pera, author
Is It You, Me, or Adult A.D.D.?

I think we can also rely on common sense, though, Dr. Williams. :-)

Far too many women I know, after starting calcium supplementation, have developed back aches, neck aches, every kind of aches, and they've had more trouble sleeping.

I find it very disturbing that none of their doctors had a clue that calcium (especially taken without enough magnesium) could be causing these problems. Even though the symptoms started almost immediately, the doctors did not make the connection.

We cannot treat people as if they were numbers. There has to be some room in the "Asperger's Syndrome" model of medicine-by-the-numbers for critical thinking.

Gina

Here's a link to the Magnesium Article on Medpedia: http://wiki.medpedia.com/Magnesium

As you can see, there is a section on hypomagnesemia, as well as hypermagnesemia. I would love to see this page added to, with references to evidence-based research! I, personally, am not familiar with much research in this area and would love to see these peer-reviewed references integrated into the article page!

Part I.

While I don't pretend to be a magnesium scientist and cannot hope, in one post, to point readers to the whole of magnesium research (much of which assumes a basic understanding of biochemistry), I can point to a few review papers and studies for further edification on the various points I've made.

(I use sequential numbers below to separate the studies. They do not correlate to my points in the previous post.)

I offer these studies simply as a courtesy. I do not consider it my job, as a layperson, to educate physicians about the importance of understanding magnesium or to cite chapter and verse as to the basics.

It is my firm understanding, based on reading through the science and being familiar with how pharmaceutical studies are conducted -- not to mention the narrow, disconnected focus that scientific researchers can bring to any given subject -- that we must approach these wholesale supplementations with calcium extremely cautiously. The risks are profound and surely outweigh any need to be "right."

We cannot extrapolate widely from narrow-focus studies that examine, for example, only bone density. We must look at the long-range and systemic effect of the over-abundance or deficiency of these minerals, which affect every cell in the body. And we also must be aware of the various lifestyle issues (alcohol consumption, diet, even the "hardness" of the water in a patient's geographic area) that affect these variables.

1.
(I can't find the link for this paper but will be happy to send the PDF to you if you can't find it in a literature search.)
Review paper by USC's Robert K. Rude, MD:
"Clinical Review Magnesium Deficiency: A Cause of Heterogenous Disease in Humans"
JOURNAL OF BONE AND MINERAL RESEARCH
Volume 13, Number 4, 1998

2.
Skeletal and hormonal effects of magnesium deficiency.
Rude RK, Singer FR, Gruber HE.
USC Keck School of Medicine, Los Angeles, CA, USA
J Am Coll Nutr. 2009 Apr;28(2):131-41.
http://tinyurl.com/y8bezen

Excerpt:
Magnesium (Mg) is the second most abundant intracellular cation where it plays an important role in enzyme function and trans-membrane ion transport. Mg deficiency has been associated with a number of clinical disorders including osteoporosis. Osteoporosis is common problem accounting for 2 million fractures per year in the United States at a cost of over $17 billion dollars.

The average dietary Mg intake in women is 68% of the RDA, indicating that a large proportion of our population has substantial dietary Mg deficits. The objective of this paper is to review
the evidence for Mg deficiency-induced osteoporosis and potential reasons why this occurs, including a cumulative review of work in our laboratories and well as a review of other published studies linking Mg deficiency to osteoporosis.

Epidemiological studies have linked dietary Mg deficiency to osteoporosis. As diets deficient in Mg are also deficient in other nutrients that may affect bone, studies have been carried out with select dietary Mg depletion in animal models. Severe Mg deficiency in the rat (Mg at 0.0002% of total diet; normal 0.05%) causes impaired bone growth, osteopenia and skeletal fragility. This degree of Mg deficiency probably does not commonly exist in the human population. We have therefore induced dietary Mg deprivation in the rat at 10%, 25% and 50% of recommended nutrient requirement. We observed bone loss, decrease in osteoblasts, and an increase in osteoclasts by histomorphometry. Such reduced Mg intake levels are present in our population. We also investigated potential mechanisms for bone loss in Mg deficiency. Studies in humans and and our rat model demonstrated low serum parathyroid hormone (PTH) and 1,25(OH)2-vitamin D levels, which may contribute to reduced bone formation. It is known that cytokines can increase osteoclastic bone resorption. Mg deficiency in the rat and/or mouse results in increased skeletal substance P, which in turn stimulates production of cytokines.

With the use of immunohistocytochemistry, we found that Mg deficiency resulted in an increase in substance P, TNF and IL1 . Additional studies assessing the relative presence of receptor activator of nuclear factor kB ligand (RANKL) and its decoy receptor, osteoprotegerin (OPG), found a decrease in OPG and an increase in RANKL favoring an increase in bone resorption.

These data support the notion at dietary Mg intake at levels not uncommon in humans may perturb bone and mineral metabolism and be a risk factor for osteoporosis.

CONTINUED

(CONTINUED FROM PREVIOUS)

5.
Although severe magnesium deficiency is uncommon, it has been induced experimentally. When magnesium deficiency was induced in humans, the earliest sign was decreased serum magnesium levels (hypomagnesemia). Over time, serum calcium levels also began to decrease (hypocalcemia) despite adequate dietary calcium. Hypocalcemia persisted despite increased parathyroid hormone (PTH) secretion. Usually, increased PTH secretion quickly results in the mobilization of calcium from bone and normalization of blood calcium levels. As the magnesium depletion progressed, PTH secretion diminished to low levels. Along with hypomagnesemia, signs of severe magnesium deficiency included hypocalcemia, low serum potassium levels (hypokalemia), retention of sodium, low circulating levels of PTH, neurological and muscular symptoms (tremor, muscle spasms, tetany), loss of appetite, nausea, vomiting, and personality changes."

Source:
Rude RK, Shils ME. Magnesium. In: Shils ME, Shike M, Ross AC, Caballero B, Cousins RJ, eds. Modern Nutrition in Health and Disease. 10th ed. Baltimore: Lippincott Williams & Wilkins; 2006:223-247.

6.
"Although decreased bone mineral density (BMD) is the primary feature of osteoporosis, other osteoporotic changes in the collagenous matrix and mineral components of bone may result in bones that are brittle and more susceptible to fracture. Magnesium comprises about 1% of bone mineral and is known to influence both bone matrix and bone mineral metabolism. As the magnesium content of bone mineral decreases, bone crystals become larger and more brittle. Some studies have found lower magnesium content and larger bone crystals in bones of osteoporotic women compared to non-osteoporotic controls (A).

Inadequate serum magnesium levels are known to result in low serum calcium levels, resistance to parathyroid hormone action, and resistance to some of the effects of vitamin D, all of which can lead to increased bone loss (see Calcium). A study of over 900 elderly men and women found higher dietary magnesium intakes were associated with increased bone mineral density at the hip in both men and women. However, because magnesium and potassium are present in many of the same foods, the effect of dietary magnesium could not be isolated (B).

More recently, a study in over 2,000 elderly individuals reported that magnesium intake was positively associated with total-body BMD in white men and women but not in black men and women (C).

Few studies have addressed the effect of magnesium supplementation on bone mineral density or osteoporosis in humans. In a small group of postmenopausal women with osteoporosis, magnesium supplementation of 750 mg/day for the first six months followed by 250 mg/day for 18 more months resulted in increased BMD at the wrist after one year, with no further increase after two years of supplementation (D).

A study in postmenopausal women who were taking estrogen replacement therapy and also a multivitamin found that supplementation with an additional 500 mg/day of magnesium and 600 mg/day of calcium resulted in increased BMD at the heel compared to postmenopausal women receiving only estrogen replacement therapy (E).

Presently, the potential for increased magnesium intake to influence calcium and bone metabolism warrants more research with particular attention to its role in the prevention and treatment of osteoporosis.

Sources:
A.) Sojka JE, Weaver CM. Magnesium supplementation and osteoporosis. Nutr Rev. 1995;53(3):71-74. (PubMed)
B.) Tucker KL, Hannan MT, Chen H, Cupples LA, Wilson PW, Kiel DP. Potassium, magnesium, and fruit and vegetable intakes are associated with greater bone mineral density in elderly men and women. Am J Clin Nutr. 1999;69(4):727-736. (PubMed)
C.) Ryder KM, Shorr RI, Bush AJ, et al. Magnesium intake from food and supplements is associated with bone mineral density in healthy older white subjects. J Am Geriatr Soc. 2005;53(11):1875-1880. (PubMed)
D.) Stendig-Lindberg G, Tepper R, Leichter I. Trabecular bone density in a two year controlled trial of peroral magnesium in osteoporosis. Magnes Res. 1993;6(2):155-163. (PubMed)
E.) Abraham GE, Grewal H. A total dietary program emphasizing magnesium instead of calcium. Effect on the mineral density of calcaneous bone in postmenopausal women on hormonal therapy. J Reprod Med. 1990;35(5):503-507. (PubMed)

I hope this is helpful!
Gina Pera, journalist-author

No, I don't believe it was answered, Dr. Bernstein. Obviously. :-)

And, in case you aren't familiar with the literature, mag deficiency is not rare, especially in young women who drink sodas and alcohol, consume few magnesium-rich foods, etc.

The point is, there can be no cut-and-dried answers about calcium supplementation. Not if the patient's overall health is to be considered. Questions must be asked, and details addressed.

Hi Robert,

Actually, no I am not "out of my field." But thanks for asking. ;-)

The literature is available for anyone to read, not just a good journalist who knows how to identify reliable sources and synthesize the facts.

Keep in mind: Sometimes specialists can be a little narrow-minded, not to mention myopic, lacking actual metrics, and a bit detached from actual patient outcome. I know it is sometimes more comforting to put one's confidence in the omniscience of one's physician. And if it is a competent physician, great. If not....

By the way, there are no blood tests to accurately assess for most vitamins and minerals.

I offer the information freely, well researched and with good intentions. Use it as you see fit, or don't. It's your life. ;-)

Gina, my blood tests are all normal except low Vit D and Calcium. Everything else is within the normal range for my condition, age and COPD. My COPD was caused by smoking 75 cigarettes a day for over 15 years. I quit cold turkey 14 years ago but the damage was done.

In 1999 i had a spontaneous left lung collapse with pneumonia, in 2000, i had a spontaneous right lung collapse with double pneumonia with 18 days hospitalized.

My lung collapses were caused by lifting something to heavy.

If i am doing fairly well today today, i must have had great medical care !!!!.

FYI, i am a Commercial Pilot max 18 PAX "small aircraft" and am also a parachutist with at least 15 jumps a year.

I see my personal MD every 3 months and if something goes wrong and i cannot reach him, i can be hospitalized within 2 hours of calling the ambulance due to the fact that i am considered as a priority medically handicapped person.

My mental faculties are #1 haha.

As far as what you posted, my MD is well aware of all you mentioned. I am also being followed by a Pulmonologist who completely agrees with the way my MD is treating me and the Magnesium level is a bit higher than a normal person without COPD and for that reason i am able to take Ca.

As you say, the accuracy of the blood tests is not perfect but it at least gives a good idea about what your system is getting or not.

I have had the following :

CT scanning, Scintigraphy and Polysomnography.

BTW, i live in Sherbrooke, Quebec. Canada and we have the Sherbrooke University Hospital Center which BTW is recognized as one of the best in North America. And that is where my specialists work.

A lot of research is done and many findings have resulted in treatments used today. Don't ask me which ones lol.

And that is where my specialists work.

Another thing, it does not cost me a penny for all of this great care.

I sincerely hope that in the USA, over a period of time, people will have as good access to medical care as we have here.

Regards,
Robert.

Here is a link to a BMJ editorial, which unfortunately also fails to mention magnesium (that will no doubt take another 10 years) but does include "several agents that are, or might be, used to treat osteoporosis....including bihosphonates, etc." Unfortunate.

http://www.bmj.com/cgi/content/full/341/jul29_1/c3856

excerpt:

Calcium supplements in people with osteoporosis

Should not be given without concomitant treatment for osteoporosis

The first 150 words of the full text of this article appear below.

In the linked systematic review (doi:10.1136/bmj.c3691), Bolland and colleagues assessed whether calcium supplements increase the risk of cardiovascular events in people with, or at risk of, osteoporosis.1 They found that calcium supplements increased the risk of myocardial infarction (hazard ratio 1.31, 95% confidence interval 1.02 to 1.67), but they found no significant difference in the risk of stroke, death, or the composite end point of myocardial infarction, stroke, or sudden death.

Let's bring another expert into the "discussion" (for those who are no longer interested in participating, I suggest you just sit quietly instead of calling for censorship; others might be interested in a fuller picture).

In fact, a cardiologist who specializes in this area might have something to contribute (including validation of my point that dietary habits should be assessed before "prescribing" calcium supplements):

Cardiologist Nieca Goldberg, MD, who directs the NYU Women’s Heart Program, recommends calcium supplements only to patients who don’t get much calcium in their diets.

“If they are eating a lot of low-fat dairy products or other foods with calcium, they may not need much supplementation,” she says. “People don’t always realize how much calcium they are getting in their diets.”

http://www.webmd.com/heart/news/20100729/study-calcium-may-increase-heart-attack-risk