The document discusses the debate surrounding calcium supplementation, emphasizing that dietary sources are preferable for calcium intake, as standard supplements may increase cardiovascular disease risk. It highlights the importance of microcrystalline hydroxyapatite combined with vitamins and minerals for bone health without the same risks, supported by research showing it is more effective than traditional calcium supplements. The text also underscores the role of other nutrients like vitamin D and K in calcium absorption and overall bone health.

1. The Calcium Supplement
Controversy
By James O’Keefe, MD
Chief Medical Officer and Founder
CardioTabs
Presents

2. 2
• Calcium is best obtained from dietary
sources
• Standard calcium supplements may
increase risk of CV disease
• MicroCrystalline HydroxyApatite, along
with vitamins and minerals, may help to
improve bone health without increasing CV
risk
Key Messages

3. 3
• Calcium is the most ubiquitous mineral in
the human body
• Only 30% of the US population consumes
the Recommended Dietary Allowance of
calcium
• We absorb only about 30% of calcium from
foods depending on the specific source
• The body will demineralize its own skeletal
system to maintain serum calcium levels
Calcium 101

4. 4
According to the
US Surgeon
General’s Report,
one in two
Americans over
age 50 is
expected to have
or to be at risk of
developing
osteoporosis
Osteoporosis

5. 5
• 1,000 mg for adults age 19-50
• 1,000 mg for males age 51-70
• 1,200 mg for females age 51-
70
• 1,200 mg for all adults age 71
and older
Daily Recommended Intake

6. 6
Ancestors
Ethnographic and
anthropological
studies indicate that
adult human hunter-
gatherers consumed
most of their calcium
in the form of bones
from animals,
including small and
large mammals, birds,
fish, reptiles etc.
Hunter-Gatherer’s Diet

7. 7
• Dairy foods and beverages account for about 70% of all
dietary calcium intake among Americans
• On an evolutionary time scale, dairy is a relative “new-
comer” to the hominin diet
• Cow’s milk has up to four times more
calcium than human milk, and this might
contribute to problems with iron and zinc
absorption
• Consequently, chronic dairy consumption
may have potential benefits as well potential
hazards, which will require much more research
to fully understand
Obtain Calcium from Dairy?

8. 8
• Approximately 60% of middle-aged US women
regularly use calcium supplements
• The likely mechanism whereby calcium
supplements increase CV risk is recurrent acute
spiking in serum calcium levels
• Elevated serum calcium concentrations
are associated with carotid artery
plaque thicknessarterial and aortic
calcification, and incidence of MI
Mono-Nutrient Calcium Supplements

9. 9
Strong epidemiologic associations exist between
decreased bone mineral density and increased risk
of both cardiovascular (CV) disease and CV death
Mono-Nutrient Calcium Supplements and Heart Disease

10. 10
Other possible mechanisms that have
linked calcium supplements with CV
disease include:
– Acceleration of coronary artery
calcification
– Induction of a hypercoagulable state
– Effects on arterial stiffness
– Parathyroid hormone
Mono-Nutrient Calcium Supplements II

11. 11
In contrast, calcium from dietary sources or bone
ingestion results in much smaller changes in
circulating calcium levels
Consuming Bone

12. 12
The homeostatic balance between various
minerals appears to play a significant role in
bone, vascular and overall health
The Right Ratio of Minerals and Nutrients
Magnesium
Sodium/Potassium
Vitamin K
Vitamin D

13. 13
• Vitamin D plays a major role in both
intestinal calcium absorption and bone
health
• In large meta-analyses calcium
supplementation was most effective for
preventing hip fractures when it was
combined with vitamin D
• Intake of protein plus calcium and/or
vitamin D may reduce fracture rates
through a mechanism independent of bone
density
Vitamin D

14. 14
• The benefit of vitamin K on bone may not be due
to its ability to increase BMD, but rather to its
effects at increasing bone strength
• The oxidation of vitamin K results in:
– Activation/carboxylation of bone metabolism of matrix
Gla protein (MGP)
– Gamma-carboxylation of osteocalcin
• A recent meta-analysis concluded:
– While vitamin K1 improved bone health, vitamin K2 was
even more
– High vitamin K2 levels were associated with reduced:
• Vertebral fractures by ~60%
• Hip fractures by 77%
• All non-vertebral fractures by ~81%
Vitamin K

15. 15
• Deposits calcium in appropriate locations like
bones and teeth
• Prevents calcium from depositing in locations
where it does not belong, such as the soft tissues
• K2 as MK-7:
– Fermented dairy foods contain vitamin K2 as MK-7
– Research has shown to be a highly effective form
– MK-7 increases the percentage of osteocalcin
Vitamin K2

16. 16
• Dietary intakes of both potassium and
sodium are important factors in CV health
• Reducing excessive sodium intake is
associated with resultant decreased urinary
calcium excretion, which may help to
prevent against bone demineralization
• Moderate sodium diet (2 to 3 g/day) in
conjunction with a high potassium intake (>
3g/day) might derive the optimal CV
benefits for the general population
Sodium/Potassium

17. 17
• Magnesium acts as a protective agent
against soft tissue calcification and may
reduce risk of MI
• Circumstantial and experimental evidence
have implicated magnesium deficiency in
osteoporosis
• Optimal dietary magnesium intake is about
7 to 10mg/kg/day, approximately a 2:1
calcium-to-magnesium ratio
Magnesium

18. 18
We are genetically adapted to consume a large
proportion of our dietary calcium from bones,
where calcium is absorbed along with a matrix of
nutrients including:
– Magnesium
– Phosphorus
– Manganese
– Zinc
– Iron
– Copper
– Collagen protein
– Osteocalcin
Consuming Bone Supplements

19. 19
MCHA
– Is the actual form of calcium found in bone
– Produces less of an acute spike in blood
calcium levels
– Stimulates bone osteoblast cells
– Contains virtually all of the
essential building blocks
of bone
– Highly absorbed
– Not just slows bone loss, but
builds bone
MicroCrystalline HydroxyApatite (MCHA)

20. 20
MCHA Thickness Study
In a placebo controlled randomized trial
women who took 1,000 mg of calcium in
the form of hydroxyapatite in conjunction
with oral vitamin D showed a significant
increase in bone thickness whereas those
who took 1,000 mg of a standard calcium
supplement did not

21. 21
MCHA Bone Loss Prevention Study
• HydroxyApatite (HA) was more effective than
calcium carbonate at preventing bone loss
– 40 randomly assigned osteoporotic patients
– 1400 mg calcium /daily
– After 20 months of treatment the loss of trabecular
bone was 0.8 +/- 0.5% in the (HA) group versus 1.8
+/- 0.7% in the calcium carbonate group.

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BONE Essentials features MCHA combined with
vitamin D, K2 as MK-7, potassium, magnesium
and other essential vitamins and minerals to:
– Support bone health
– Promote bone density
– Be well absorbed
– Support heart health
BONE Supplement