IN DEPTH: About Heart Risks, Calcium, and Food Fortification

All right, what are the foods and food  supplements that are touted as beneficial for your heart?

Easy:

• Vitamins: E , B complex, D, K
• Compounds and polyphenols: CoEnzymeQ10, Resveratrol, Flavonol, Soy
•  Minerals: Selenium, magnesium
• and many more…

However, this post is more interested  in  turning the question around:  Are  some food supplements   damaging your heart ? 

This question is made even more relevant because of the nutrient fortification program of the food industry.   Fortification is everywhere, “healthy” minerals or vitamins are added at the food plant, and find their way  into your refrigerator:

1. Calcium, supposed to be good for your bones. It is Added  to your milk, yogurt, and many other dairy products
2. Then there is this anemia fighter:   Iron
3. Then there is this immune system Booster: Zinc
4. and many more, according to loose interpretations of FDA ruling

What does that mean for you?

By the time you have two cups of milk and a slice of cheese , you have more than 100 % of the current recommended allowance.

Let us do ourselves the favor of taking supplementation seriously, and go beyond the easy one liners!

What’s the big deal? Could be plenty.

This post will focus on the impact of these additives, particularly on Calcium, on your heart health.

Dairy plant, where Calcium is added

Lack of Calcium has been implicated traditionally in Osteoporosis [3,4,5], the disease of brittle bones affecting many post menopausal women and others :  In the words of Wikipedia; “Osteoporosis affects 55% of Americans aged 50 and above. Of these, approximately 80% are women.”

Swiftly came the governmental response:  Fortify our foods with added Calcium:

The Federal Drug Administration put up some principles of fortification:

Quoting [5]

1.  A nutrient(s) listed in paragraph d)(3) of this section may appropriately be added to a food to correct a dietary insufficiency recognized by the scientific community to exist and known to result in nutritional deficiency
2. Is present at a level at which there is a reasonable assurance that consumption of the food containing the added nutrient will not result in an excessive intake of the nutrient, considering cumulative amounts from other sources in the diet.

Sounds great, but,  “… correct[ing] a dietary insufficiency recognized by the scientific community to exist and known to result in nutritional deficiency”  is totally dependent on the science of the day.

It is not that the milk industry did not issue some warnings [6,7].  But then again, maybe they did not want to spend the money to involve fortification in the processes. Therefore, they seem to have been promptly ignored

So here we are, in 2012, some 20 years after the start of food fortification programs, and the benefits of calcium fortification are questioned. Risks have emerged [8-17]. In a nutshell, calcium supplements or calcium food fortification  can provide the building blocks for calcification of the cardiovascular system. Some other studies which have found Calcium harmless. But, since research papers only tell you so much, we will take note of the trends, and for Calcium supplementation/fortification, the bulk of the more recent studies say: Slow down!

So what now?

So, if you have heart health issues and want to limit yourself to the 100% of the Recommended Daily Allowance (RDA), you have to be careful. Never mind outright supplementation.

But Calcium is rarely taken alone, it usually has one or two companions: Vitamin D and/or Magnesium.

Does taking vitamin D alleviate the risks of dietary calcium induced calcification? This study published in the British Medical Journal [13] does not think so. Quoting its conclusion:

“…Calcium supplements with or without vitamin D modestly increase the risk of cardiovascular events, especially myocardial infarction…”

Other studies concur on the necessary new caution. What about taking Calcium, Magnesium, and Vitamin D?:  Susan Enfield in the New Hope Blog reports [15] :

“……If we consume too much calcium without sufficient magnesium… not only will we create stress within the body but the excess calcium won’t be utilized correctly and may become toxic. Magnesium keeps calcium dissolved in the blood. Too much calcium and too little magnesium can cause some forms of arthritis, kidney stones, osteoporosis and calcification of the arteries, leading to heart attack and cardiovascular disease…”

So thinks Pramod Vora [16] an intregrative nutritionist, using very concurrent language.

According to the Nutrients  [14]

“…The development of vascular calcification is a complex process that is not only dependent on the physio-chemical effects of calcium and phosphate, but also on factors that can regulate the differentiation of smooth muscle cells to osteoblast-like cells; similar to those in osteogenesis...”

Here you have it, the body can sometimes be confused and grow bone-like calcification structure on endothelial substrates, including heart valves. [15,17]

I know you will read often about the “wisdom of the body.”  There is no doubt that the body was designed with an inherent capacity for returning to homeostatic balance. There is also no doubt that sometimes the body has it wrong, that is particularly apparent for autoimmune diseases. So vascular calcification is another example of the body malfunctioning.

Unfortunately, not all the calcium ending up carpeting the cardiovascular system comes directly from the dietary supply. Sometimes the cardiovascular disease robs the bones of their calcium….Here comes the Vitamin K, which, among other things, keeps the calcium in the bones [18]. So cardiovascular and bone health depend on a balance maintained by Vitamin K to modulate the processes. Vitamin K is in charge of keeping the Calcium in  your bones where it belongs!

Have you seen vitamin K in the fortification of dairy products? I have not…Vitamin D, yes. Vitamin D and Magnesium are often present in the food fortification formulas.

But the ratio of Calcium to Magnesium can be  5:1 ! Such a ratio will result in excess calcium from dietary sources free to cause trouble on your cardiovascular system [15].

So the good folks who rely on FDA regulations to ensure proper nutritional fortification better look at the tables of nutritional content carefully.

And that is only for Calcium issues.

What about another favorite additive: Iron? Just ask Elizabeth Wallings from Natural News…See the issues brought up by the  Genome News Network [19,20]

Zinc? See LiveStrong [21].

Vitamin E? (See References 22-25) Here the story seems to  be more about little or no benefits, than damage, if you exclude blood pressure issues.  If  one uses the Vitamin E full spectrum, particularly Tocotrienols, there might be some benefits (26).  But do you get the full spectrum of vitamins E in your fortified food? Doubtful at best.

In defense of food fortification, though, one could use the example of commercial white bread which, in the over-milling and other harsh processes, had lost most of its nutrients. So the government intervened and added dietary fiber, iron, B vitamins, micronutrients, essential fatty acids, and folic acid.

Wikipedia, in its “white_bread” entry claims that the addition of folic acid alone “…the rate of neural tube defects has decreased by approximately one-third in the US, resulting in a cost savings of an estimated $33.7-125 million annually..”

Laudable, and this is the spirit in which the fortification laws were passed. However, the FDA is not capable or willing to restrain excesses like adding calcium to orange juice. Orange juice never had calcium in its pristine state!

Since fortification is currently the law of the land, you must keep abreast of news from clinical and fundamental nutrition as our knowledge progresses.

Feel free to compare this post and CBS’s on the same topic [27]

This is one of our goals at the Medical News Digest,

Keep tuned and talk to your PhD in nutrition!

Sources:

1. medinewsdigest ; “8 ingredients to prevent heart disease” ; April  2012
2. wellnessletter ; Univ. Berkeley ; “Should Anyone Still Take Vitamin E?” ; 2009
3. Center For Disease Control and Prevention ; “Calcium and Bone Health”; 2011
4. Surgeon General Report ; “Bone Health and Osteoporosis”
5. FDA Regulation and Policy on Fortification 21 CFR 104.20 – STATEMENT OF PURPOSE.
6. Dietary Council ; “Letter to the FDA / D o c k e t s Management B r a n c h” ; HFA-305
7. DairyCouncilofCalifornia ; “N U T R I E N T F O R T I F I C A T I O N : Panacea or Pandora’s Box?”, 2006
8. HoustonChronicleArchives ; “FDA considers furor over food fortification” ; 1988
9. International Journal Of  Angiology ;“Risk factors for progression of calcific aortic stenosis and potential therapeutic targets”; 2008
10. Heart ; “Calcium supplements: bad for the heart?”; 2012
11. Harvard Health ; “Calcium beyond the bones”, 2010
12. British Medical Journal ; “Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis.” ; July 2010
13. British Medical Journal  ; “”Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women’s Health Initiative limited access dataset and meta-analysis.” ; April 2011
14. Nutrients ; “”Is Excess Calcium Harmful to Health?”; Robin M. Daly and Peter R. Ebeling ; 2010
15. New Hope ; “”Time to ditch the 2:1 calcium-magnesium ratio” ; March 2012
16. Space-age ; Pramod Vora  on Calcium supplementation 2012
17. Osteoporosis ; “Vascular calcification and osteoporosis—from clinical observation towards molecular understanding” ; 2007
18. Nutrition ; “Vitamin K and bone health ” ; 2001
19. Natural News ; “High Iron Linked to Heart Attack Risk and More”; Elizabeth Walling, 2011
20. Genome News Network ; “Heart Disease: Iron in the Arteries” ; 2003
21. Livestrong  ; “ZINC OVERDOSE & HEART RATE” ; 2010
22. Current opinion in lipidology ; “Vitamin E revisited: do new data validate benefits for chronic disease prevention?” ; 2008
23. Office of Dietary supplements/vitamin E ;2011
24. Circulation Heart Failure ;””Vitamin E supplementation and the risk of heart failure in women.”; 2012
25. New England Journal of Medicine ;Vitamin E supplementation and cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators.”; 2000
26. EmaxHealth ; “Some Vitamin E Supplements Help Reduce Cardiovascular Risk” ;2011
27. CBS ;””Foods Fortified For Heart Health”; March 2009