0:01 calcium and vitamin D have been
0:04 recommended universally for osteoporosis
0:05 prevention and treatment by the World
0:07 Health Organization the bone health and
0:09 osteoporosis Foundation medical colleges
0:11 across the board the Women's Health
0:12 Initiative a study that came out in the
0:14 early 2000s and changed a lot of things
0:16 around the way we treat hormones and the
0:19 way we use vitamin D and calcium as well
0:21 it supported that recommendation and
0:23 what's awesome about this video and the
0:26 new data is that we now have 20year data
0:28 going back and looking at long-term
0:30 followup from this massive Tri that was
0:31 published at least some of the early
0:34 Publications in the early 2000s so when
0:36 we have long-term data on studies this
0:38 big this is really really important data
0:40 to go through now I'm going to tell you
0:43 exactly how we use calcium and vitamin D
0:46 in our program but before we do that I
0:48 want to go through this study and I want
0:49 to talk about sort of what it showed
0:51 originally and all of the data that we
0:54 have now on multiple follow-up studies
0:55 that were all put together in this one
0:57 study that I reviewed today now this new
0:59 study was just published on May 1st of
1:02 2020 4 there's a really important part
1:04 of this study that talks about hormones
1:05 and I'm going to do in a different video
1:07 but in this video I want to talk about
1:09 what really isn't probably not as
1:11 controversial but not nearly talked
1:13 about as much which is the calcium and
1:16 vitamin D trial so the initial goal of
1:17 the calcium and vitamin D intervention
1:19 of the Women's Health Initiative was to
1:22 look at the reduction of hip fractures
1:24 total fractures and possibly Adverse
1:25 Events which I know a lot of you are
1:27 interested in particularly in heart
1:29 attack cardiovascular disease
1:31 calcification of vessels particularly
1:33 the coronary arteries the arteries that
1:35 feed blood to your heart um kidney
1:37 stones and other stuff so there's a lot
1:38 of concern around calcium
1:40 supplementation and the Women's Health
1:41 Initiative used kind of what I would
1:43 consider Antiquated calcium
1:45 supplementation in calcium carbonate and
1:47 not a lot of vitamin D so 400 IU of
1:49 vitamin D and so the question is is man
1:52 do we see these risks that we're
1:53 concerned about with calcium
1:54 supplementation that people talk about
1:56 all the time with heart attacks and so
2:01 forth so this trial was big it had 36
2:04 6,282 women in it and they were randomly
2:06 assigned to either Placebo or
2:08 intervention and again they had a th000
2:10 milligrams of calcium carbonate and 400
2:14 IU of vitamin D3 or Placebo now here's
2:16 an issue when they designed the trial
2:18 they didn't want people to not want to
2:20 do the intervention and they also had a
2:21 hard time probably finding people that
2:22 weren't already on some kind of
2:24 supplementation even back then and so
2:26 they allowed personal supplementation of
2:30 calcium and vitamin D up to I think a
2:32 milligram of calcium and 600 IU of
2:34 vitamin D that I think was then later
2:37 increased to 1,000 IU of vitamin D so
2:38 that's one of the big criticisms of this
2:40 trial because you could imagine if you
2:42 had a placebo but someone was already on
2:44 something that's identical to the
2:46 placebo or even higher dose than what's
2:48 in the placebo that could really confuse
2:50 your results and and I think that really
2:52 did confuse the results as you'll see so
2:53 when the initial publication came out
2:55 this was a 7-year intervention and they
2:57 were looking again Placebo versus the
2:59 intervention of calcium and d and what
3:01 what they found is that the intervention
3:03 did not significantly affect hip
3:05 fracture rates meaning that vitamin D
3:07 and calcium did not reduce hip fractures
3:11 in this massive trial but remember that
3:14 people in the placebo group were also
3:15 probably taking calcium and vitamin D so
3:18 how could there be a difference right so
3:19 this is again one of the opportunities
3:22 you have here is to look at subgroups
3:24 and because they had this all very well
3:26 charted out hopefully you can actually
3:28 take a look at people who weren't taking
3:30 their own supplementation who were on
3:32 the placebo compared to those that were
3:34 on the intervention so not only is that
3:36 important but also potentially
3:38 differences in age groups are important
3:40 and so when you look in the data here
3:42 what you can see is that the data do
3:44 show that there was a reduction in
3:47 fracture in the over 60y old Group which
3:48 kind of makes sense because you don't
3:50 see that many fractures uh in the 50 to
3:52 59 year old group hopefully what's
3:53 interesting though is that in that
3:55 original study they did show that there
3:57 was an increase in fracture in the
3:59 younger group with calcium and vitamin D
4:01 now how could that possibly be well I
4:03 imagine that probably at that point in
4:04 time because not as many people were
4:06 taking vitamin D and calcium back then
4:08 so my guess is that those were
4:09 individuals that probably already had a
4:11 pre-existing diagnosis they probably
4:13 already have bone health issues and so
4:15 you were probably exposing them to a
4:17 little bit of bias and already having a
4:18 risk for fracture and there also weren't
4:20 that many fractures another issue we see
4:22 here around supplementation studies or
4:24 any intervention that involves a patient
4:26 actively taking a pill especially if
4:29 it's multiple pills is compliance now
4:31 they used self-reported compliance
4:32 obviously these people weren't locked in
4:35 a a ward for years and you know given
4:37 pills so they had to report whether or
4:40 not they took the uh supplementation and
4:42 so probably there's some bias there
4:43 people don't like to admit that they
4:45 don't take stuff but for the people that
4:47 admitted not taking at least 80% of
4:50 their pills there was also a difference
4:52 in the outcome so for people that were
4:54 compliant meaning that they took over
4:56 80% of what they were recommended to
4:58 take that they said they did have a
5:01 reduction in hip fracture across all age
5:03 groups compared to those that uh were on
5:06 Placebo so again it's really deceiving
5:08 when the study says there's no
5:10 difference but when you look at people
5:11 who actually took the supplement there
5:13 was a difference so confusing and this
5:15 is why reading headlines and reading
5:17 abstracts do not give you all the
5:19 information that you need to interpret
5:20 research and then the final thing that I
5:21 thought was really important is that
5:23 when you did finally remove those that
5:24 were taking their own home
5:26 supplementation did you see an
5:27 improvement in hip fracture and the
5:29 answer is yes although they looked at
5:30 this statistically a couple of different
5:33 ways and in one Avenue it did meet
5:34 significance in the other Avenue it
5:37 didn't so certainly there was a trend
5:39 and yes it was statistically significant
5:40 kind of so then what about bone material
5:42 density well bone materal density was a
5:44 little bit mixed there was an
5:46 improvement in total hip bone mineral
5:48 density and those that were taking the
5:50 calcium and vitamin D intervention
5:52 versus those on Placebo but this was not
5:54 true elsewhere in the spine so only in
5:55 the total hip did you see that
5:57 difference all right so I said this was
5:59 a follow-up study though right so up
6:01 till now I've only talked about the
6:03 original publication back in the early
6:06 2000s so the follow-up study actually
6:09 the first one came out 11.1 years after
6:10 the intervention and there was no
6:12 statistically significant effect of
6:14 calcium plus vitamin D on hip fractures
6:15 again this is the statement that they
6:18 make right but again if you look into
6:21 the data you have to see then that those
6:23 that were adherent to the uh medication
6:25 the supplementation the intervention did
6:27 see a reduction in hip fracture so how
6:30 misleading it's so frustrating uh that
6:31 the authors would choose to put the
6:33 other statement first where they could
6:35 just say if you take calcium and vitamin
6:37 D there's going to be a decrease in
6:38 fracture risk however if you aren't
6:40 compliant with your supplementation then
6:42 you're not going to see that Improvement
6:44 fracture risk so I I think that this
6:45 certainly could have been said better
6:46 and I think the headlines could have
6:49 read it better uh but ultimately this
6:51 11-year follow-up did show that there
6:53 was an improvement in hit fracture risk
6:55 with calcium and vitamin D alone now
6:57 this study also talked about the risks I
6:58 think this is really important because
7:00 this is long-term data on taking a
7:02 calcium supplementation at what I would
7:04 consider to be a pretty high dose and
7:06 they did a really good job of collecting
7:08 data on risks what kind of bad outcomes
7:11 occurred and so this is really important
7:13 but before we get there if you're having
7:14 a hard time putting together all of this
7:16 information and you're just confused
7:19 about what to do sign up for our free
7:21 master class we run this thing every you
7:23 think week or every other week uh we're
7:25 doing it as often as we can because
7:27 people have found it so helpful we've
7:29 had tens of thousands of people now go
7:30 through this master class and again it's
7:32 totally free and you can watch me put
7:35 together how we uh look at all the
7:36 different evidence the things that we
7:38 put into a program for our patients and
7:40 then answer questions for about 15
7:41 minutes so if you haven't done it and
7:43 you're struggling with bone health and
7:44 all the information that you're
7:46 receiving please sign up for the master
7:48 class it'll really help things to get
7:50 straightened out for you so then in this
7:52 long-term data what about the heart
7:54 attacks what about the heart disease
7:56 what about calcification so what's
7:58 really cool here is that they were able
8:00 to look at this track all these data and
8:02 show that there was no significant
8:05 effect on overall mortality meaning that
8:08 patients didn't die more often from
8:10 being in the uh intervention group
8:12 rather than the placebo group there was
8:14 actually a trend toward being protective
8:16 in total mortality but we can't say that
8:18 that's a real finding there was also no
8:20 significant effect on cardiovascular
8:23 events meaning heart attacks or on
8:25 calcification so looking at
8:27 calcification in the coronary arteries
8:29 there was no effect of having been on
8:31 the supplement versus not having been on
8:33 the supplement the only thing that did
8:35 stand out though is that there was a 17%
8:36 increase in kidney stones in the
8:38 intervention and that's actually not
8:40 surprising so then what's the takeaway
8:42 from these long-term complications well
8:44 I think that the kidney stone takeaway
8:46 is that when you use calcium carbonate
8:48 and calcium citrate there's evidence to
8:50 show that you get a spike in blood
8:52 calcium levels that's not true when you
8:55 use microcrystalline hydroxy appetite
8:56 complex products it's not true when you
8:58 use other Whole Food forms like algae
9:00 Cal products
9:01 another algae based calcium because
9:03 Whole Food forms your body knows more
9:05 what to do with and your body can better
9:08 process those things that calcium versus
9:10 if you get it in a calcium carbonate or
9:11 calcium citrate form so I'm not
9:13 surprised to see the increase in kidney
9:15 stones now I'm happy to see that there
9:18 was no increase in overall mortality
9:20 cardiovascular events all the things
9:22 associated with coronary artery
9:24 calcification but we do also have to
9:26 remember that those studies didn't
9:28 actually break down who was adherent who
9:30 wasn't who had their own supplementation
9:32 at home Etc so maybe take it with a
9:34 grain of salt because we need to really
9:36 dig into those data more and those
9:38 studies didn't do that okay so what's
9:39 the overall big picture here on calcium
9:41 and vitamin D what does this study
9:43 actually help us to do well for me it
9:45 helps to reinforce the fact that we need
9:47 probably calcium and vitamin D if we
9:49 want to optimize our bone health and I
9:51 get a little uh Kickback here from
9:53 people who say that they're getting it
9:54 all through diet and it is totally
9:56 possible to get it all through diet but
9:57 you have to remember that people that
9:59 have osteoporosis and osteopenia are
10:02 starting from a disadvantaged starting
10:05 point they have a pathologic condition
10:07 kind of just means that they need to be
10:10 super physiologic in their dosing either
10:11 coming through food or coming through
10:14 supplementation so this is why we do use
10:16 calcium and you can look at our best
10:19 calcium in 2024 uh conversation because
10:20 we have kind of shifted how we use
10:22 calcium in our practice but we
10:24 definitely do use it in conjunction with
10:25 supporting getting the right amount of
10:27 calcium through diet now vitamin D is
10:29 also interesting so vitamin D we're
10:31 using less of now and I have a whole
10:33 video on this as well and you can watch
10:36 that video to understand where we have
10:38 made a change from being pretty
10:42 aggressive about using um uh vitamin D3
10:44 and and looking at 25 hydroxy D in blood
10:47 versus where we are now and remember too
10:50 though that the Improvement in calcium
10:52 and vitamin D for hip fracture is really
10:54 subtle and the Improvement in bone
10:57 mineral density is also really subtle
10:59 and that's why I would argue that this
11:01 is not the only tool that you should
11:02 consider there are so many different
11:04 things you can do that are more powerful
11:06 than calcium and vitamin D even from a
11:08 supplement perspective there are
11:10 supplements that will independently
11:12 improve bone mineral density more than
11:14 calcium and vitamin D I also think that
11:16 in general osteoporosis is not a Calcium
11:18 deficiency it might be a vitamin D
11:20 deficiency but usually there are other
11:22 things going on that you need to uncover
11:24 before calcium and vitamin D can really
11:27 be effective so remember that an
11:30 osteoporosis diagnosis isn't the the end
11:31 but deciding to reverse it is a
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