I believe that medicine’s potential is much more than the version we see in the world today. A doctor should be an educator with the goal of bringing patients to a place of deeper understanding of who they are in the world. To me, medicine is ultimately about self-empowerment through self-knowledge and growth.
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Today, I’d like to share with you an important statistic of which most people are probably not aware.
The statistic is:
Most American adults are pre-diabetic or diabetic.
A full 50% of American adults meet the prediabetic or diabetic diagnostic criteria.
This means they have too much sugar in their blood.
That 50% number apparently doesn’t include the very early stages of prediabetes where fasting glucose, fasting insulin, and even sugar levels after eating are normal, but insulin after meals is elevated. These early stages are thought to go on for 5 or 10 years before prediabetes is typically noticeable with elevated fasting blood sugar.
Add this category to the 50% and we have a large majority of people who have problems digesting sugar.
To look at it from another angle, NHANES (National Health and Nutrition Examination Survey) says that only 12% of American adults are in optimal metabolic health.
Is it cheap, processed (industrialized) sugar (corn syrup)? Is it cheap, processed (industrialized) fat? Is it the stress of modern society? Is it the sedentary nature of modern life? Are there other issues as well?
Yes. Yes, yes, yes, and yes.
Some people would also add that it’s also a lack of clarity on how to treat prediabetes from a dietary standpoint.
There are two camps about how to approach diabetes with diet.
One group promotes a low-fat, low-calorie diet to treat diabetes. Part of the thinking is that fat coats the cell in an unfavorable way and makes it insulin resistant. You can find a TED talk where a caring doctor describes taking his patients off all fats and reversing diabetes that had been long-standing for years.
Another camp would protest and say the low-fat approach was never founded on science. Instead of fat restriction, these protesters are saying strict carbohydrate restriction shows promise. If you’re going to cut sugar, you have to greatly increase dietary fat. And that’s just what they call for. Low fat over there and high fat over here! And, I’ve seen a TED talk where a kind doctor is giving her patients advice to go on a high-fat, low-carb diet and describes reversing diabetes in patients and taking them off insulin.
So, which is it?
Do we cut out the fat or increase the fat to fight diabetes? There appear to be contradicting approaches.
Our “knowing” minds assume there must be a true and an untrue path, and we assume that we’re better off if we know which is which.
Camps develop. The pro-fat camp versus the anti-fat camp. Contradictions and camps are normal.
What if instead of trying to solve the contradiction we just let it be, compassionately. Contradiction is a reality. It can be allowed. It can be embraced. Happiest is he or she who sees the two camps and knows that both can be valid.
Have you heard of the intelligence of ignorance? As soon as you start to identify with the content of your knowledge, you become incredibly small. The truth is what we don’t know is without end. But if you remain open, if you remain honest about your ignorance, about how boundless our unknowingness is, then our intelligence remains alert to all possibilities. “If you always know that you don’t know, your intelligence will remain alert to everything.” (— Sadhguru). This is the intelligence of ignorance.
And in THAT intelligence we realize other possibilities: maybe it doesn’t matter what diet (or whatever) you are prescribed. Maybe it’s the presence of the caring, enthusiastic doctor and the patient’s trust in the intervention that are the difference makers.
These are the three keys:
Using these keys is a difference-maker in your health efforts.
“Life’s challenges are not supposed to paralyze you…
I want to start this bulletin with the acknowledgment that life can be extremely difficult, even unresolvable at times. From the personality’s perspective, our eventual annihilation is puzzling enough, but then there are day-to-day challenges that demand so much from us.
That’s not to neglect for one second the joy and beauty in life.
There is always something nearby worth our awe and full attention, but there is always a challenge around the next corner. There are simply two sides to every coin, and we all know it. Life is hard, tauntingly hard, actually. How do we transform these challenges? What are they supposed to be doing?
“…They’re supposed to help you discover who you are.”
— Bernice Johnson Reagon
Let’s next acknowledge now that life’s challenges are a puzzle that deserves our full attention. Mastering a fruitful response to them is worth every second given to the effort.
Did you ever think that life’s challenges seem to be like a provocation or a test? It seems almost like someone is trying to get a response out of us sometimes, doesn’t it?
And if you give into the provocation and give life a reaction, whether it be raging or pleading for something to change, it feels as if you are drained by the giving of your reaction. And vice versa: if you don’t react, you feel your energy is retained.
If life’s challenges are like a provocation, I say let’s treat them that way. If life’s circumstances or any other bully in your life is trying to manipulate a response out of you consider using the Grey Rock Method.
“Grey rocking, or the grey rock method, is a tactic some people use when dealing with abusive or manipulative behavior. It involves becoming as uninteresting and unengaged as possible so that the other person loses interest.
Some people anecdotally report that it reduces conflict and abuse.
The idea behind the technique is that abusive people enjoy [even need] getting a reaction from their victims. Refusing to give them this reaction makes interactions less rewarding.
In general, this means giving short, straightforward answers to questions and hiding emotional reactions to the things a person says or does.”
— Zawn Villines (MedicalNewsToday)
You basically act like a grey rock when you are taunted by a challenge: no reaction to anything. But don’t worry, when we use this technique we aren’t signing up to live an emotionless life, rather we acknowledge that we control our own emotions.
If we grey rock life’s provocations we have free energy with which to deeply engage with other aspects of life.
The power is with us, and we are keeping it. When the bully energy doesn’t get fed, the tendency to bully gets weakened. The more free we are from indulging in provocations the more free we are from the oppressive bully energy and the more free we are to engage deeply in our lives on our own terms.
Now imagine you take it a step further. Imagine instead of just being still outwardly and inwardly in the face of a challenge (grey rock), let’s say you added a step. Let’s say you let the provocation be a prompt to take the grey rock stillness and penetrate into the present moment very deeply. You then let yourself fill, ever so slightly at first and more later, with the power you are able to access through that penetrating.
It’s like you fill yourself with the light that comes from deep within in the present moment, a light that is born out of our own presence and is meant to be in the world. And we let that light be there in the face of that provocation while we remain still inwardly and outwardly.
This is using our own powers and activity to transform provocations into agents for the good: stimulating more light in the world.
This I’d like to call the White Rock Method. White works here in the sense that it is a combination of every hue in the visible light spectrum.
Take modern physicians with a grain of salt. Their education is not all-encompassing. How can it be? Modern information is too vast.
“A couple of hundred years back, a person who held a Bachelors of Science knew all there is to know in their field. Today, however, someone with a Ph.D. in biology may not even know all that is known about the nervous system of a fish!”
— Daniel Levitin, The Organized Mind
Recently one of the media’s go-to physicians who professes on infectious diseases at a big university and has written books on health was interviewed about his personal approach to health. He revealed with a guilty smirk that he is a junk food addict… and he has poor habits around exercise… and he doesn’t take supplements nor does he know anything about them.
Health expert?! Hmmmm. This man is advising people on when to take medicine? Let’s think about this.
It struck some people as being quite odd. It somehow even acted as a little bit of a wake-up call. What is this man’s expertise, actually? Why is he saturating the media? What exactly is a health expert anyway? Who would we want as our advisor?
Being subjected to his advice on health needs modern-age context.
Everybody and everything is more specialized these days. We have to understand an expert’s exact area of influence is actually quite small. It could be ridiculous to take any advice outside of that or to think that they deserve our attention outside of their area.
It would be like a cow farmer taking advice on his herd from an auto mechanic.
No offense, ma’am. Those grease marks tell me you have been working hard. Listen, I’ll admit there are some important cross-overs, like tending to the fluid levels, but there are some important differences too. Am I right?
Let me restate that. It could be ridiculous to take any advice outside of an expert’s sweet spot, which is more and more narrow as the information age exponentially expands.
It would be like a motorcyclist getting driving tips from a truck driver.
(I like metaphors.)
These are just different systems.
If all a doctor knows is one side of health (the approach using medication), and is advising on that one aspect, take his advice with a grain of salt. If the doctor only knows the pharmaceutical approach you have to first make a separate conclusion that you need that aproach. Then you are in the position to learn from him how to take it. You don’t want to learn from him whether or not you need it in the first place.
That would be like asking a rug salesman if you needed a rug.
(I told you I like metaphors.)
Doctors have a lot of their education delivered to them by the pharmaceutical industry which educates relatively narrowly, limited mostly to the relevance of their own interests. Our textbooks don’t drone on about lifestyle approaches. That’s left to the doctor’s ingenuity (aka, left out). Furthermore, advertisements lure the consumer–patient to conclude a pill just might be the answer they had been hoping for all along.
“Keeping it in context” comes from knowing some of these things. Who is benefitting? Who is acting behind the scenes? What’s not being represented?
The doctor who is best positioned to advise on a pharmaceutical intervention is one who not only is free from financial or personal gain from its use BUT also understands the nonpharmacologic approach well.
There are plenty of doctors out there who know the least amount of pharma you need is the right amount. Making a shift using lifestyle is the real thing. We all know it. Using drugs only as an add-on next to maximized lifestyle measures is still the modus operandi of the great physicians out there.
And remember, individual health is different from public health. There is no such thing as one size fits all in individualized health. No diet or drug is right for all people at all times. In fact, no same diet or drug regimen remains right for a single individual as time goes on.
The ideal physician health expert is a doctor with a strong vocational understanding of the profession and one who:
Someone operating with this total package is the physician of the future, free and focused on the pure intention of patient care. This is whose voice we’d like to amplify. Would the well-sponsored news programs even accept them?
Maybe we need a fictitious character to fill those shoes. They would have to have a face for TV and be well-spoken, of course. In any event, this is the type of person we’d like to see making the rounds on the news channels, representing us, guiding us, advising us, leading the way into the great unknown…’
…boldly going where no news program has gone before.
Achieving good health is just like achieving anything else worthwhile: effort matters and details matter. The more you can be in alignment, the more likely you will have optimal outcomes. A key step is being clear with yourself on why you want to be healthy.
Self-analysis that accompanies illness often leads us to virtue. It can be a means to recovery and good health. This is so because vice has a tendency to be catabolic and virtue restorative. Virtue can also be what you achieve with good health, your why. I want to share with you a few thoughts about virtues and medicine.
“Get me through this and I’ll correct my ways.” Just as Ebenezer Scrooge attained some serious Christmas perspective and exchanged his toxic ways for generosity and charity, illness often connects us to a priority check. When illness-induced priority checks have us looking in the direction of growth and virtue, things are clicking in a special way.
It seems to me there is no higher striving in the face of an illness than to be working at being courageous, hopeful, and in search of wisdom. That goes for the person facing illness as well as for the care team, on every level.
The medical provider knows virtue as a cornerstone of the vocation. Confidentiality, for starters, is a virtue. I would call it one aspect of temperance in speech. The provider protects the relationship and the patient with a virtue, by keeping the topic of the visit confidential.
The seven heavenly virtues combine:
A) Plato’s four cardinal virtues of:
with
B) the three theological virtues of:
Another name for temperance is moderation. With temperance, a person learns to command the body rather than be commanded by it. Toward the end of the Hippocratic oath, a reference is made to confidentiality, temperance in speech.
“Whatsoever I shall see or hear in the course of my profession, as well as outside my profession in my intercourse with men, if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets.”
Virtue as preventative medicine leads us right back to temperance. Moderation keeps us intact. Temperance in eating and drinking are clear examples.
Temperance in speech also keeps us healthy. First, consider that all codes of conduct, not just the doctor’s oath, have an entry about speaking in the right way. It’s fundamental. Buddha’s Eightfold Path has an entry to that end (right speech), and the Ten Commandments have two entries (taking the Lord’s name in vain and bearing false witness), to name a couple.
Care with speech and the power of words is often the topic of advice for patients, specifically self- speech. To borrow the phrase from Don Miguel Luiz’s 1997 Book The Four Agreements:
Be impeccable with your words
This is the first of his four agreements that lead to freedom and is worthy of being considered a profound preventative medicine cornerstone.
Be careful what you say, and how you say it. Be impeccable with your self-speech (this is huge for health).
Be impeccable with your speech to all others. Don’t lie; avoid the habit of speaking poorly about others. Whatever you say ultimately reflects back to you.
Studies show people are measurably happier and healthier if they consciously commit to speaking kindly throughout the day.
Part of this same topic is listening. We all know a doctor or nurse who is a good listener is crucial. And to listen to your inner voice is a critical aspect of being healthy. Intuition is such a wild card.
Listening needs silence. Be impeccable with this understanding. Listening to the body is a major protective attribute. It requires practice. Practicing daily exposure to silence will train it. It’s as good as any medicine in the cabinet, if not better.
Here’s to your good health, your alignment, and our striving together.
Humans Drink Alcohol. Alcohol sales in the United States have been rising for decades. 2021 US sales were just under $250 billion, and were close to the record sales of 2019.
The global alcoholic beverage market size was valued at $1.6 trillion in 2021. It’s not exactly in the top tier occupied by banking, health, telecom, food, and oil industries but it’s not too far off. The top 20 global industries start at $1.9 trillion.
With money like that on the line, it’s no wonder our general psyche is half convinced that alcohol has some sort of health benefit. Thanks, Industry, for helping us arrive at that fuzzy conclusion. But this is an unfair representation.
The statement could be made (as is done in a scientific paper from 2004) that “smoking and most especially nicotine, are, sometimes beneficial in certain diseases, including Parkinson’s, and Alzheimer’s… and nausea and vomiting of pregnancy.” It’s actually true, but hardly relevant to almost any health conversation.
The net cardiovascular, neurologic, psychological, and gastrointestinal toxicities from alcohol are massive and costly.
From world health policy:
“Alcohol use is a leading cause of death and disability worldwide and has been identified as one of the ten leading risk factors for the burden of disease. Alcohol use is associated with numerous harmful health and social consequences, including an increased risk of a range of cancers, stroke and liver cirrhosis. Alcohol also contributes to death and disability through accidents and injuries, assault, violence, homicide and suicide.
Alcohol is a modifiable risk factor and reductions in alcohol consumption would lead to an associated reduction in the burden of disease.”
Modern civilization makes us ill and alcohol plays a large role in that fact.
My personal observation: alcohol has a negative effect on a person’s personal and spiritual growth, just as anything from outside that is used to control one’s experience. The more intense the usage, the more intense the obstruction to our own evolution as a person.
The central takeaway for me is as follows. Industry leads us down a path that’s not in our best interest. It is not looking out for anythingother than its bottom line. They lied to us with refined sugar and tobacco. They do it with drugs, chemical agents, plastic products, food production practices, and on and on.
It’s more than a little sociopathic because they spend powerful dollars to make us wonder if their toxins are actually bad for us. It depends on the definition of “bad”, I can hear them say. It’s hard for us to tell because the science is fuzzy, they want us to believe. The jury is out, they say. They even go so far as to muddy the waters, by creating fuzzy science.
Two things can save us:
Ireland’s parliament is in the international news this spring because it has put into place new rules requiring “comprehensive health labeling of alcohol products” giving warnings concerning varied topics from calorie content to alcohol dependence to cancer and liver disease risks.
Industry has expressed concern. The United States and other countries have claimed that labels could be possible barriers to trade. It’s a predictable sociopathic response.
Experts are saying they expect in the not-too-distant future alcohol will be recognized as being as bad for your health as cigarettes are now. Labels will be ubiquitous.
Industry is feeling victimized, I suspect. Ireland of all places! The Irish have been known for their drinking. Recent stats describe 70% of men in Ireland are considered hazardous drinkers. That’s precisely why the policymakers are stepping in. Betrayal. St Paddy’s Day has always been a good day for the alcohol industry. Not anymore.
And this move is not new for Ireland. Other government policies over the last two decades, like changing the way alcohol is sold, for example, has seen the country’s rate of consumption of alcohol drop by almost 1/3 compared to the turn of the century.
On one hand, it looks like the government is battling industry to save the helpless citizen. Don’t be fooled. The government is not good inherently. Good people representing people’s health can make a difference in government, just as Industry can infiltrate government and open doors for policy that supports industry at the cost of our health.
We, the citizens, are the path.
The sociopath and the narcissist want our patronage and nothing more. They have no power. We have the power of our own patronage. Our seeming powerlessness is a great mirage. And it’s nothing but a manipulation, albeit a masterful one.
Start today with the realization that the way you carry yourself today is meaningful.
Stay alert. Be self-reliant.
And if it feels too overwhelming, plan B is to just be kind.
Historically, salt has been a precious commodity. “Not only did salt serve to flavor and preserve food, it made a good antiseptic, which is why the Roman word for these salubrious crystals (sal) is a first cousin to Salus, the goddess of health.”
Salt is of the earth. “People who are described as ‘the salt of the earth’ are those who are considered to be of great worth and reliability.”
With salt formation, solid form and stillness precipitate out of fluidity. In this way, salt is connected to wakefulness, our abstract grasping of concepts. Salt stimulates our thinking, our making connections, like an intricate web of roots.
Nowadays, public health representatives have us wary of salt; we associate it with heart disease. Less is better, we think. A salt-controlled diet (1500mg to 2300mg) such as the DASH diet is touted.
For some people this is smart. There are salt-sensitive people as well as people with kidney problems or heart failure who are best to stay in this zone. But not everyone.
Evidence shows that salt affects individuals differently and may not have as much of an impact on heart disease as once believed. Careful nuance is needed. The right amount of salt is different for everyone and some people need more! This bulletin will list several surprising benefits of salt ingestion.
The basic premise here is: Salt has important health benefits. It is not simply a toxin. Actually, sufficient salt is a critical part of a healthy diet. You might benefit from more salt in your diet!
First important distinction: We are not talking about high-sodium processed foods, by the way. Yes, we should avoid those. I am advocating a whole food diet — high in potassium (plant food) with sufficient unrefined salt (Real Salt, Himalayan Salt, and Celtic Sea Salt, for example, which are rich in trace minerals). One can’t really make a blanket statement about salt when there are such divergent pictures of diet.
Have a glance here at the top benefits of adequate salt, which in some people certainly could be more than 2 or 3000mg daily:
How to proceed? Let’s look at some specifics. Americans on average consume 3500mg or higher of salt (sodium chloride) daily. Is less sodium actually better or is it a higher potassium that’s needed?
A lot of studies aren’t actually comparing isolated high-salt diets to low-salt ones. The DASH diet is higher in potassium-rich foods and whole foods and lower in processed foods and alcohol. It’s this whole picture that is often tested against the standard American diet, higher in salt, yes, but distinct in other ways from the DASH diet as well.
And when we compare salt to salt?
There are times we have looked at lower salt diets compared with higher salt ones, and diets under 2300mg (low salt diets) often aren’t significantly better. Consider a 2015 study in JAMA Internal Medicine that found sodium intake wasn’t associated with a mortality benefit in a 10 year study in older Americans.
The truest statement science can make about it, and one that is often attached to studies, is “continued research on the effects of salt intake on heart health is needed — both in people with and without hypertension.”
Well, be informed that salt’s benefits are plentiful. Some people need more salt than they take. Who, you ask? Here are some possible signs you could have too little salt in your diet:
You might be underdoing it. If you’re not salt sensitive and if you don’t have kidney issues or heart issues we might need to talk about liberalizing sodium intake with a natural unrefined salt, especially if you are currently restricting it. Blood tests can be a guide. Some salt proponents say sodium should probably be in the upper range of normal, as should the chloride.
Two points.
What’s agreed upon:
Here’s to your pursuit of health and balance!
This old saying refers to “the once-common tradition of saloons in the US providing a ‘free’ lunch to patrons who had purchased at least one drink. Many foods on offer were high in salt, so those who ate them ended up buying a lot of beer.”
Not that there’s anything wrong with any of that.
You go ahead and enjoy yourself at the saloon. We’re just saying lunch in this case isn’t actually free.
In medical school at Georgetown University, a formative moment as a young doctor came for me when I was introduced by the pharmacology department to No Free Lunch which was “a US-based advocacy organization that did outreach to convince physicians to refuse to accept gifts, money, or hospitality from pharmaceutical companies because it claims that these gifts create a conflict of interest for providers. The group also advocated for less involvement of drug companies in medical education and practice in a variety of other ways.” (Wikipedia)
No more free pens, free sticky pads, or free lunch. No in-person meetings in the office with pharma sales reps. No dinners out at nice restaurants, no free tickets to events. It seemed right to me and to plenty of others.
Physicians who allow themselves to be accessible to sales reps have been dwindling. In 2008 80% of doctors were sales rep accessible while the number shrunk to 44% in 2017, in no small part to the work of groups like No Free Lunch.
A physician who would have meetings with the sales reps was a dream come true for the industry. Why? Because to see a representative meant your prescribing habits would change. They had access to reports on the prescriptions that you wrote. They could see your prescription pattern. They could see it change under their influence. And it did change.
It was common for doctors to report in surveys that they suspected their colleagues were probably swayed by the efforts of sales reps, but very few suspected they themselves were influenced. The prescribing statistics showed otherwise. These armies of narrowly trained experts on the one or two drugs they promoted altered the prescribing habits of the vast majority of doctors who gave them access.
The medications that were being presented were generally the new kids on the block. Altruism is not the intention of pharmaceutical salespersons. They are not making public service announcements. They are marketing products that could make money, with the side effect of driving up healthcare costs. Better to get your prescribing info from a nonbiased source, per recommendations of No Free Lunch.
No Free Lunch taught us to be critical thinkers. They taught us to realize that “new” is not synonymous with “proven.”
The tried-and-true medications had been around for a long time and were cheap. They didn’t and don’t have backers or handlers. They don’t have agents promoting them, neither do non-pharmaceutical and traditional approaches. No one canvases the medical offices touting the benefits of a no-added-sugar diet or of a comfrey compress to a sprained ankle. In fact, it’s the opposite. The cheap traditional approaches are too often tarnished by the representatives of the expensive modern way.
At the turn of the century (and millennium) the regulatory agencies (FDA) loosened their rules. Now doctors were not the only market for drug ads. Consumers could be told of the products and their indications. This was a major change.
Did you know the U.S. and New Zealand are the only countries that allow direct-to-consumer advertising that includes product claims? Most other countries don’t allow it at all. Canada does allow ads that mention either the product or the indication, but not both.
Who’s educating the consumer like No Free Lunch did us, doctors? Who is speaking up for the best health principles? A generation of doctors benefitted from the lesson to keep Pharma messaging in perspective. The consumer needs it too.
The massive Pharma marketing campaigns are persistent, pervasive, and persuasive. Media network revenue from pharma climbs every year; currently, it stands at $20 billion dollars annually.
Here’s a point to remember: they advertise the drugs that make them money. These ads are not public service announcements. According to a recent study published in JAMA, the majority of Pharma’s spending (68%) on the top-selling prescription drugs in 2020, was of ‘low added benefit’ for patients.
The direct-to-consumer advertising is no small part of why the US healthcare system spends more than any other country on healthcare. In 2021, the U.S. spent almost 18 percent of gross domestic product (GDP) on health care, nearly twice as much as the average of the 37 other high-income countries.
Research on prescription drug spending suggests that the United States consumes the most prescription drugs in the world. In 2019, the U.S. reported per capita spending of $1,229, whereas Canada only spent $879, Switzerland $894, and France $671.
It turns out Americans take more pills today than at any other time in recent history and far more than people in any other country. More than 131 million Americans take at least one prescription medication. The average number of medications taken among those who take prescription medications is four.
Medications are often very helpful, but they come with risks. A report in 2014 calculated 1.3 million people went to U.S. emergency rooms due to adverse drug effects, and about 124,000 died from those events. A similar report from the late 90s shows large numbers of deaths in the hospital from medication errors.
Then there’s the bottom line: number one in spending, number one in medication usage, but last in outcomes.
People in the United States experience the worst health outcomes overall of any high-income nation. Americans are more likely to die younger, and from avoidable causes, than residents of peer countries.
The main message is this: partaking in lesser solutions is also not addressing the real issues. The food system is so broken that the American menu has us choosing between junk food, processed food, or fast food. We have poor priorities as a nation. This is not random circumstance. This is the result of governmental policy. Cheap food, poor health, lots of drugs. That’s our formula.
Pharma industry is happy to provide relief to the broken system. We shouldn’t settle for that.
There are simple steps that can be taken. The first is to see the problem. It is a huge step to know the landscape. The other steps can follow, like to buy organic food when possible. It’s an investment in your health. “Local“ is an even bigger key. Go against cheap centralized industrial production of food. Be part of local efforts to produce good quality food. Be part of creating a vast army of intentional consumers, informed and with relentless principled behavior.
Here’s to your health, and your continuous striving.
Calcium is the most abundant mineral in the human body. Most of it is stored in the bones and the teeth. It is carried in the blood and has many important functions in addition to the formation of bone and teeth. It is essential in:
In nature, calcium is found primarily in limestone. Limestone is a sedimentary rock, forming from the accumulation of organic debris like shell and coral.
In medicine calcium supplementation has been a staple.
“Based on the published data, 61% of women aged >60 years received calcium supplements in 2003–2006 in the United States. As a result, calcium supplementation has become a billion dollar market in recent years and has been taken by millions of both men and women, children, adults, and the elderly wishing to improve their skeletal health.”
— Kelvin, Li. 2018 The good, the bad, and the ugly of calcium supplementation: a review of calcium intake on human health
In medicine old habits are hard to break. The implementation of new ideas takes a while to reach the practitioners and their patients.
As it turns out, calcium supplementation to prevent fractures or osteoporosis is not a good idea for anyone.
At a clinical roundtable at the practice this week we determined the need to actively start to recommend that all patients looking to prevent fractures or prevent bone loss be advised to stop taking calcium pill supplementation.
Within the last 6 years the major US preventative task force has said it does not recommend calcium or vitamin D supplements in healthy women without vitamin D deficiency. However, major medical groups like the Osteoporosis Foundation still recommends calcium supplements for people who can’t meet the recommended daily dose by diet alone.
We think only diet should be pursued and the goal can be more modest than the usual doses recommended. There is evidence that 500mg-700mg in the diet is sufficient. The UK uses the more modest total. The body absorbs more intensely to adjust for lower dietary intake.
We made the decision to adopt a new policy after a medical literature review was conducted, and found the recomendation stands even if osteoporosis and/or fractures are present.
The studies show calcium supplementation does not reduce fracture risk or bone loss, and it increases risk of cardiovascular diseases, kidney stones and other diseases like prostate cancer in men.
Dietary calcium is absorbed differently and slowly and doesn’t have the negative effects supplements do.
In fact, in some instances (like kidney stones and prostate cancer in men) supplementary calcium increases the risk while dietary calcium decreases the risk.
In case you need to hear it stated more clearly, the studies show mortality is increased in patient populations who supplement with calcium compared to those who don’t.
It’s a bit shocking and upsetting, and we are sorry for recommending this approach over the years. Be reassured that the trends towards worse outcomes aren’t large but enough to make this recommendation.
This all serves as a reminder of several pillars of health.
And what about the calcium in your multivitamin or in fortified foods? I think you should steer away from calcium supplementation.
How do you get calcium in the diet? Broccoli, bok choy, mustard greens are great. 3–4 serving per day of greens per day would be ideal and will provide all you need. Milk, cheese or yogurt are the most robust supply of dietary calcium. Dairy contains 300mg per serving if you can tolerate it. You don’t need much.
What does this mean for other supplements? Good question.There is good data that correcting D deficiency is wise. For bone health in addition to calcium in the diet, Vitamin D and vitamin K2 could be considered for bone health.
What else besides supplements? Stress relief with meditation/ attention focus exercises for a short while every am and pm will help you practice getting out of flight or fight mode.
And for Heaven’s sake, you have access to nature’s beauty, get some weight bearing exercise and go soak in the majesty of the burgeoning creation.
Who amongst us is not captivated by the intrigue and mystery behind the phenomenon of Pyramidal structures on the earth?
It is a phenomenon that goes far beyond the famous Great Pyramid of Giza, one of the Seven Wonders of the World. That’s just the tip of the… Pyramid Phenomenon.
Experts estimate there are thousands of pyramids all over the world. One researcher lists around 135 in Egypt, mostly in and around Cairo. And there are 240 in Sudan alone! Besides being found in several other African countries there are many others in North America, South America, Europe, Australia, and even Asia.
In fact, recently, new pyramids are being discovered with a fair degree of regularity thanks to the advances in satellite technology, like Google Earth. Many of the apparently new pyramids have been detected in remote overgrown areas and had been camouflaged by vegetative growth, until now.
What is the significance of the pyramid to our ancestors? How did the globe get covered with them? And please tell us why many of these pyramids have a similar design of stairs, tall flat towers, and huge 10-plus ton, perfectly cut stone for base and inside, all with no logical way for how they were so evenly put in place, and, in some cases, transported 50 to 100 miles from where they were quarried?
There’s surely more than meets the eye here. There are even claims that pyramids can be found in the ocean! And, there is talk of satellite photos of suspicious pyramidal structures in never-before-settled Antarctica!
The pyramid lives on in the modern psyche and culture, both artistically and practically.
We have the above, renowned French contribution; and, in addition, the pyramid sits on the back of the dollar bill: part of the Great Seal of the United States.
According to the State Department, which is the official keeper of the Seal, the pyramid symbolizes strength and durability. However, its significance goes far beyond that. (Since when is the State Department known for the ability to clarify a global mystery?)
Moreover, we have the much-debated food pyramid, which has evolved somewhat over the years.
I want to mention one final modern pyramid. Listen carefully because it involves you.
I’m talking about two pyramidal organizational charts in medicine that I think about every day. On one hand, there is a pyramid that orients to numbers. Patients make up the bottom layer of this pyramid. They are the largest category of people in the healthcare system. The middle layer is made up of primary care doctors (and support staff in primary care like the RNs and NPs). And at the top comes the highly trained specialist- these are fewer so they are at the top. As you go up this pyramid, the content of specialized information becomes greater but the knowledge of the patient becomes smaller.
Since we think of the top of the pyramid as being special, we might be confused into thinking the ones with the specialized information are the most important element in healthcare. This confusion must be avoided. It’s wrong.
That’s where we have to turn the pyramid upside down, so to speak. Contrast this first pyramid with a second, one that addresses the question: “what’s the point of the entire exercise?” In this pyramid the patient is at the top. The patient is the point. The primary care providers are the ones who have a longitudinal, relationship-based connection with the patient and help keep an eye on the individual goals and priorities. They are in direct service to the entire health of the patient and make up the layer just under the patient. And finally, the specialists and hospitals occupy the foundation of the pyramid, serving the primary care team and the individual patient through their special area of mastery.
The main point I’d like to emphasize again is that the patient is the point. Doctors should know by now that a paternalistic approach with any element of judgment or “top-down” orientation has no place. The correct orientation is to consider the profession to be a servant, cheerleader, and collaborator for the patient.
This view demands that any doctor-centered sentiment be abandoned. Patient-centered or even family-centered care should take its place. That’s having the right pyramidal organization with regard to medicine.
All this to say, the world is mysterious, and You Matter! In a simple way, acknowledging this seems to be a good cornerstone of a healthy philosophy.
We must not ever, ever, ever stop searching for errors in our theories, even our best ones: the ones that appear settled, which we can’t presently imagine being superseded.
— author Al Pittampalli
This is the expression of a healthy understanding of science. No number of observations are capable of proving a theory true if the very next observation could always render it false.
The possibility that the next observation changes everything is exactly what science holds. The quote above makes reference to a seemingly minority perspective in the scientific world… that science doesn’t settle.
It’s an uncomfortable postulation for many. Scientists are inspired by the hunt for knowledge, for arriving at conclusions certain to be true. Finding truths would mean progress, things on which a foundation, if not an empire, could be built.
But science herself doesn’t settle. Science measures and counts. Science observes. Bottom line: if science settles, she dies. With settling there is an invitation to stop observing. And this ceases to be scientific. Evolution and development don’t stop. Nature doesn’t stop, why should science?
Today’s answer is not certain to be tomorrow’s. For instance, the viewpoint of the observer can open new worlds. If the observer makes a shift and is capable of approaching the phenomena in a different way, things can be revealed in a different light. Consider how the viewpoint of quantum physics brought a disruption of so many existing foundational principles, but don’t make the mistake that quantum physics brings us to a destination. And who’s to say the phenomena themselves can’t change? Science would love to offer her services to watch for this.
Science is dispassionately awaiting the next data point.
If you show me a scientist who tells you that science is settled, I’ll show you a person denying the possibility that they could be mistaken. I’ll show you a person denying the limited nature of the human perspective. I’ll probably show you someone trying to sell you something.
Medical science is notorious for being influenced by the marketplace in which it attempts to position itself. Critics claim “what we see in the published literature is a highly curated version of what’s actually happened.”
What if there was an effort to repeat the findings reported in landmark medical studies? If science works the way we think it should there should be a high rate of reproducibility. What do you imagine would happen?
Well, that effort exists, and science is facing a “reproducibility crisis” where more than two-thirds of researchers have tried and failed to reproduce other scientist’s experiments. This is not new information.
In 2015 a large group of researchers set out to repeat 100 experiments published by leading psychology journals to see how often they would get the same results.
The answer was less than half the time.
Furthermore, researchers with the Reproducibility Project: Cancer Biology aimed to replicate almost 200 experiments from over 50 top cancer papers published from 2010 to 2012. Only a quarter of those experiments were able to be reproduced, the team reported in two papers published December 2021.
What’s going on here?
The bottom line is we as a human race have not arrived anywhere to be able to claim we have figured out much of anything. As a young doctor in training I was struck by just how often there aren’t good answers to important questions. Medicine is sure about its accepted approach, but that’s relevant only to current scientific observations, which are often curated and must be considered… far from settled.
Much, maybe all, of what we know will be at least partially corrected in time. Almost nothing lasts the test of time in science. It’s been said every 100 years nearly all accepted scientific theory is over turned.
The beauty is we don’t need settled science on which to build our foundation.
Accepted answers aren’t what matter because answers don’t have meaning outside of their very particular and limited circumstance. Living with the question invites the continual freshness of today’s information to arrive.
A science which deemphasizes settled conclusions will carry us much further.
When faced with questions we’re right to consider our best explanation, but as Pitampalli says we are wrong “to anoint it as ‘true’ or even ‘probably true,’ nor do we claim it as ‘justified’ in any sense.”
Anything less would threaten to bring us into the realm of crippling hubris and block important insight which is born each day and every second.
Here’s to living with questions into the future and refusing to settle.
