Dr. Bray Links

Sunday, January 31, 2016

The nightmare of medicine is the absurd price we have to pay

A grandmother develops a boil that turns out to be a difficult-to-treat staph infection (MRSA). She needs high-powered antibiotics. A middle-aged man who received a blood transfusion decades ago now has hepatitis C and needs anti-viral medicine. A young woman with HIV develops golf-ball-size lesions in her brain, has toxoplasmosis and needs anti-parasite medicine.

The marvel of medicine today is that we can treat all three infections, and save the lives of these patients and countless millions of other Americans. Yet the nightmare of medicine today is the absurd price we have to pay.

Pfizer Pharmaceutical charges $56.31 per pill of Zyvox which treats the MRSA infection. So a 10-day treatment course costs over $1,000, equivalent to the cost of a dozen doctor visits.

Gilead Pharmaceutical charges $1,000 per pill of Sovladi to treat hepatitis C. So a 12-week treatment course costs over $84,000, equivalent to over a month’s hospital stay.

Turing Pharmaceutical charges $750 per pill for Daraprim to treat toxoplasmosis. So a course of treatment is hundreds of thousands of dollars, equivalent to providing health insurance to hundreds of individuals.

As an infectious disease doctor who sees the plight of such patients daily, I feel there is something wrong about the cost of medicines in our health care system. In a market-driven economy, I am OK with medical services to flourish and providers to prosper. But when there is price-gouging because a pharmaceutical company has monopoly on a drug, I feel someone has to step in.

Over the years, the government has regulated the payment from Medicare and Medicaid to providers. For the most common outpatient visit, doctors are paid $70, and for an average inpatient day, hospitals are paid over a thousand dollars. Now even insurance companies must apply 80 percent of the premium towards clinical care of patients. Yet government does not regulate the prices patients have to pay for medicines at the pharmacy.

This is not an accident, but by design. In fact, Congress specifically prohibits Medicare from negotiating lower drug prices with pharmaceutical companies. And so the irony is drugs are countless times cheaper overseas and across the border, since other countries sensibly negotiate with pharmaceutical manufacturers to get the best price for patients.

A few years ago during a family vacation to Canada, my father made sure to purchase his medicines at the pharmacy there. And recently when he needed a blood thinner, he called his sister in India to mail him the medicines. Ironically, it is the same manufacturer and the identical medicine that he would have had to pay far more for at his neighborhood drugstore.

Oftentimes drug manufacturers blame the high prices on research and development costs and the arduous FDA approval process necessary to bring a drug to market. Yet studies and a report in the Wall Street Journal show that is not the case. And much of the basic science research is conducted by government-funded researchers and agencies such as the National Institutes of Health.

Experts agree that drug pricing is not research- or manufacturing-cost driven, but rather profit-driven. Take the case of Daraprim and Turing Pharmaceuticals. A hedge fund manager purchased the company and raised the price of the drug from $13.50 a pill to $750 a pill overnight. Some pharmaceutical companies making cancer drugs and cholesterol drugs are doing the same.

As I watch patients and families forgo the optimal and sometimes the only treatment, I wonder how greed overrides sanity — even basic morality and humanity. What can we do?

Sadly the voice of the pharmaceutical lobby is Washington is louder than that of sick patients, the grandmother, the middle-aged man, and the young woman. They are us. Unless the public is outraged and raises a voice with Congress, the pharmaceutical companies will continue to reap a profit at the cost of patients’ pain — both physical and financial.


Health Professionals in the 21st Century ... "Agents of Change"

Healthcare transformation will require unprecedented changes in our thinking about prevention and treatment strategies.

The Academy of Integrative Health & Medicine (AIHM) is an international, interprofessional, member-centric organization that educates and trains clinicians in integrative health and medicine to assure exemplary health. The AIHM’s training incorporates evidence-informed research, emphasizes person-centered care and embraces global healing traditions. By combining science and compassion, the AIHM is transforming health care.


Should you spend money on alkaline water or is it snake oil?

In short, save your money and instead 1) use clean water and 2) eat more leafy vegetables (kale, collard greens, brussels spouts, broccoli). In addition to fresh, colorful fruits and vegetables, I recommend lots of steamed vegetables also. Along with the steamed vegetables, do not skimp on the healthy "undamaged" fats. The combination of these two encourage the removal of damaged fats and fat-soluble toxins including several types of sickness promoting mycotoxins. We are always trying to look for a shortcut to fix our sad SAD (standard american diet) diet. This SAD diet does contribute to a low level metabolic acidosis ... so clean it up rather than spending $5000 on drinking water. Our creator placed relatively neutral pH spring water on this planet for us to drink (just try giving your plants pH 9 water ... they die). Recurrent metabolic acidosis may be due to infections or weak kidney function as well. This should be looked into by a good physician or nephrologist.



Alkalinity Research I: Flora and Fauna

Although the research is clear that highly alkaline water has detrimental effects on plants and animals, there are not many studies with humans. A review of the literature turns up a variety of anecdotal evidence about the importance of pH to various living organisms, however, and as you might expect, optimal pH varies, depending on the organism. The scientific literature indicates pH is important for nutrition and vitality. For example:

  • Michigan State University studied greenhouse growth media (including the pH of that media), finding it is extremely important for the media pH to be properly adjusted prior to planting. Too high of a pH (greater than 6.5) increases the chances of micronutrient deficiencies. Too low of a pH (less than 5.3) results in calcium and/or magnesium and/or manganese toxicity.6
  • Ohio State University Extension Service reports that alkaline water affects a plant’s ability to obtain nutrients from the soil and can alter the soil’s pH over time.7
  • An ecological study in the Netherlands found that an influx of alkaline water led to the demise of a native plant called Stratiotes aloides L.8
  • Fish chronically exposed to alkaline soft water exhibit signs of stress (sometimes fatal), while fish in alkaline hard water experienced no such adverse effects, according to a study at the University of British Columbia.9
  • If you are a gardener, you can view a helpful illustration of the environmental effects of pH in your own garden. If your pH is low, your hydrangea produces pink flowers, but if your pH is high, you’ll get blue flowers. But what about us bipeds?

Alkalinity Research II: Humans

There has been a great deal of debate about battling cancer by making your body alkaline. This has become a focus of interest as cancer rates have skyrocketed (along with many other chronic, debilitating diseases), while our bodies have become more acidic from our processed-food diets. The scientific research about the benefits of alkalinity is by no means conclusive. PH appears to have a major influence on cell mitochondria:

Normal cells die under extremely alkaline conditions. A study published in the Journal of Biological Chemistry found that alkalosis (rising cellular pH) causes alkaline-induced cell death as a result of altering mitochondrial function.10
Another study out of Cornell University states that antioxidants have not proven to be effective against many neurodegenerative diseases, and they state it may be a result of how the mitochondria operate within the cell in certain pH conditions.11
There are some scientific studies that really argue against alkalinity, at least with respect to preventing or treating cancer. Consider the research by Robert Gilles, who has studied tumor formation and acidity.12 According to Gilles, tumors, by their very nature, make themselves acidic - even in an alkaline cellular structure. In other words, they make their own acidity. Scientists who are in the process of developing prototypes for potential new anticancer agents that selectively kill tumor cells by interfering with the regulation of intracellular pH , have found that alkaline treatments do NOT have the desired effect - but strongly acidic treatments do.13

Talk about fighting fire with fire - they are fighting acid-loving cancer cells with acid! LESS alkalinity inside a cancer cell seems to be what you want, not more. So, all of those salesmen promising alkaline water will lower your cancer risk are completely clueless when it comes to what the scientific research actually shows. Even more interesting is a 2005 study by the National Cancer Institute , which revisits the use of vitamin C (ascorbic acid) to treat cancer. They found that, in pharmacologic doses administered intravenously, ascorbic acid successfully killed cancer cells without harming normal cells.14 This is yet another example of cancer cells being vulnerable to acidity, as opposed to alkalinity . It’s clear that the relationship between alkalinity and cancer has been grossly oversimplified by those jumping to premature conclusions - and of course by those trying to profit off your fear. The bottom line is that alkaline water isn’t cancer’s magic bullet.

Balance Is Key

As is true with many things, in the end it’s a matter of balance. Water that is too acidic or too alkaline can be detrimental to human health and lead to nutritional disequilibrium. This was demonstrated in a Swedish well water study,15 which found both pH extremes to be problematic. Your body simply was not designed to drink highly alkaline water all the time. So I believe it’s best to be VERY careful when it comes to something as foundational as the water you drink on a daily basis. If you get it wrong, you could really cause yourself some major damage. It makes sense that you are designed to drink water that occurs naturally, which excludes alkaline water with pH levels of 8 and above.

And if you drink alkaline water all the time, you’re going to raise the alkalinity of your stomach, which will buffer your stomach’s acidity and impair your ability to digest food, as low stomach acid is one of the most common causes of ulcers. This can open the door for parasites in your small intestine, and your protein digestion may suffer. It also means you’ll get less minerals and nutrients over time - in fact, some of these health effects can already be seen in hardcore alkaline water drinkers. Alkalinity is also potentially a problem because it is antibacterial, so it could potentially disrupt the balance of your body’s beneficial bacteria.16

Living Water

What you want is pure water - water that is clean, balanced, and healthful, neither too alkaline nor too acidic. Ideally, the pH of your water should be somewhere between 6 and 8. And some of the most healthful waters in the world - that which emerge from mountain springs - are actually acidic in the range of 6.5 and would absolutely be my preference if it were readily available. This mountain spring water is 'structured' in a way that is not well understood. I hope to have more information about structured water in the near future.

If this is something that interests you there is a web site, FindaSpring.com, where you can find springs in your local area. That is “living water,” which is living in the same way that raw food is “ living food .” One reason I am such an advocate for eating plenty of fresh, organic raw food is for its biophotons. Biophotons are the smallest units of light, which are stored in and used by all biological organisms - including you. Vital energy finds its way into your cells from the biodynamic foods you eat.

In the same way that raw foods are alive with biophoton energy, natural water is “alive” in a similar way. If you really want to alkalinize your body, it would seem wise to encourage it with the highest quality water possible, which is obtained from vegetable juice. Green vegetable juices will help your body normalize your body’s pH naturally. If this is new to you and you are interested in more information, you can review my juicing manual for free. I cannot think of “living water” without thinking of the visionary work of Dr. Masaru Emoto , the Japanese researcher who experimented with the crystal forms of water. What he discovered is that different forms of energy influence water’s ability to organize into beautiful crystal forms.17

He demonstrated that water crystallization depends on the natural health of the water. He found that water from natural springs, healing water sources, etc., formed beautiful and complex crystalline geometries - like snowflakes. Water that had been distilled or polluted lost its inner order, and its ability to crystallize was profoundly disturbed. You wouldn’t want to eat dead food... so why would you want to drink dead water?



Many of you have probably heard of the ‘alkaline diet’. There are a few different versions of the acid-alkaline theory circulating the internet, but the basic claim is that the foods we eat leave behind an ‘ash’ after they are metabolized, and this ash can be acid or alkaline (alkaline meaning more basic on the pH scale).

According to the theory, it is in our best interest to make sure we eat more alkaline foods than acid foods, so that we end up with an overall alkaline load on our body. This will supposedly protect us from the diseases of modern civilization, whereas eating a diet with a net acid load will make us vulnerable to everything from cancer to osteoporosis. To make sure we stay alkaline, they recommend keeping track of urine or saliva pH using handy pH test strips.

In this two-part series, I will address the main claims made by proponents of the alkaline diet, and will hopefully clear up some confusion about what it all means for your health.


I don’t deny that many people have seen significant health improvements when switching to an alkaline diet, but there are many possible reasons for this not having to do with pH balance. Eating more fresh produce is rarely a bad idea, especially when it displaces nutrient poor processed foods. A person switching to an alkaline diet would significantly reduce their consumption of grains, which could cause dramatic health improvements for somebody with a leaky gut or gluten sensitivity. Dairy would also be minimized, which would help those with dairy sensitivities. And although pure sugar isn’t an acid-forming nutrient, many laypeople claim that it is, so alkaline diets tend to contain far less sugar than a standard Western diet.

Between the scientific evidence (or lack thereof) and the anthropological research, I think we can be confident that the acid load of our diets doesn’t negatively impact healthy people. For those with renal failure or similar conditions that affect kidney function, it’s a different story—there’s certainly room for manipulation of urine pH in the treatment of those conditions. But for someone with functioning kidneys, there should be no concern that an acid-forming diet will harm health.


And finally, we have the gold standard randomized clinical trials where protein has also been shown to benefit bone. For example, there’s a 2009 trial in the American Journal of Clinical Nutrition that found that in postmenopausal women, increasing protein from 10% of calories to 20% of calories improved intestinal calcium absorption and also decreased urinary DPD, which is a marker of bone breakdown, and an increased IGF-1, which, as we just talked about, has several different positive effects on bone health.

And then the last thing that I’m going to say is there was a really exhaustive review on this topic published in the Nutrition Journal in 2011 that looked at 55 different trials, 22 of them randomized clinical trials, and the authors’ conclusion was this: “A causal association between dietary acid load and osteoporotic bone disease is not supported by the evidence, and there is no evidence that an alkaline diet is protective of bone health.”


Dr. Bray - Talk 07 - Now Available!

Go over to the Medicine 2.0 page for full updated listings.

Medicine 2.0 - Talk 07 - 1/30/2016: I’m really inflamed!: Relationship between immune system dysfunction, chronic infections and inflammation

** The VIMEO password is "smile" **

The content presented focuses on areas of medicine that often require too much time for adequate education within the context of primary care visits, but are likely to have a large impact on health outcomes in the community. There are 12 talks coordinated by Dr. Christopher Bray. All content has been extracted from evidence-based published scientific data. Traditional alternative medicine is a mix of hearsay and pseudoscience, but also includes some very effective therapies. Often “thinking outside the box” is required to correct the course of chronic disease.

The fields of integrative medicine and functional medicine hold alternative approaches to maintenance of good health and treatment of disease accountable and require scientific evidence for endorsement and promotion of novel perspectives and therapies.

Dr. Bray has no conflicts of interest with any of the content presented. The presentations are not being used to "recruit patients" as he is not accepting new patients at the time of talks. The lectures are being made available for free. These lectures were delivered with the generous donation of facilities by Gainesville Health and Fitness Center. The primary intent was for community education and are wholly not-for-profit. Every effort was made to give credit to content creators of the material included in these talks.

For Talk 07, extracts from the following sources have been used within the guidelines of "fair use":

The Fat Summit
Dr. Mark Hyman

10 Steps to Reverse Autoimmune Disease
Dr. Mark Hyman

Daniel Amen M.D. Talks Brain Health
Dr. Daniel Amen

Congressman Tim Ryan Calls on Congress to Prioritize Healthy Foods

Congressman Tim Ryan Speaks at the Contemplative Sciences Center at the University of Virginia

ConsumerLab.com - Supplement Testing

Special thanks to the Institute of Functional Medicine (IFM):

Dr. Bray - Talk 06 - Now Available!

Go over to the Medicine 2.0 page for full updated listings.

Medicine 2.0 - Talk 06 - 1/16/2016: What’s in my water?: The impact of emerging endocrine disruptors and other chemical toxins on health

** The VIMEO password is "smile" **

The content presented focuses on areas of medicine that often require too much time for adequate education within the context of primary care visits, but are likely to have a large impact on health outcomes in the community. There are 12 talks coordinated by Dr. Christopher Bray. All content has been extracted from evidence-based published scientific data. Traditional alternative medicine is a mix of hearsay and pseudoscience, but also includes some very effective therapies. Often “thinking outside the box” is required to correct the course of chronic disease.

The fields of integrative medicine and functional medicine hold alternative approaches to maintenance of good health and treatment of disease accountable and require scientific evidence for endorsement and promotion of novel perspectives and therapies.

Dr. Bray has no conflicts of interest with any of the content presented. The presentations are not being used to "recruit patients" as he is not accepting new patients at the time of talks. The lectures are being made available for free. These lectures were delivered with the generous donation of facilities by Gainesville Health and Fitness Center. The primary intent was for community education and are wholly not-for-profit. Every effort was made to give credit to content creators of the material included in these talks.

For Talk 06, extracts from the following sources have been used within the guidelines of "fair use":

Water's Journey - The Hidden Rivers of Florida

Breast Cancer Fund | Prevention Starts Here

Food for Breast Cancer

Beyond Pesticides

TEDX (The Endocrine Disruption Exchange)

The Detox Project - Glyphosate Home Testing

Executive Summary to EDC-2: The Endocrine Society's Second Scientific Statement on Endocrine-Disrupting Chemicals

What Mainstream Medicine Gets Wrong About Hormones with Dr. Sara Gottfried

EWG's Skin Deep - Cosmetics Database

Tap Water Toxicity and Filters

Special thanks to the Institute of Functional Medicine (IFM):

Saturday, January 30, 2016

Vascular protection by tetrahydrobiopterin: progress and therapeutic prospects

Tetrahydrobiopterin (BH4) is an essential cofactor required for the activity of endothelial nitric oxide (NO) synthase. Suboptimal concentrations of BH4 in the endothelium reduce the biosynthesis of NO, thus contributing to the pathogenesis of vascular endothelial dysfunction. Supplementation with exogenous BH4 or therapeutic approaches that increase endogenous amounts of BH4 can reduce or reverse endothelial dysfunction by restoring production of NO. Improvements in formulations of BH4 for oral delivery have stimulated clinical trials that test the efficacy of BH4 in the treatment of systemic hypertension, peripheral arterial disease, coronary artery disease, pulmonary arterial hypertension, and sickle cell disease. This review discusses ongoing progress in the translation of knowledge, accumulated in preclinical studies, into the clinical application of BH4 in the treatment of vascular diseases. This review also addresses the emerging roles of BH4 in the regulation of endothelial function and their therapeutic implications.



Thursday, January 28, 2016

Sustained Transmission of Pertussis in Vaccinated Children in a Florida Preschool

"In September 2013, local county health officials in Tallahassee, Florida, USA, were notified of a laboratory-confirmed pertussis case in a 1-year-old preschool attendee. During a 5-month period, 26 (22%) students 1–5 years of age, 2 staff from the same preschool, and 11 family members met the national case definition for pertussis. Four persons during this outbreak were hospitalized for clinical management of pertussis symptoms. Only 5 students, including 2 students with pertussis, had not received the complete series of vaccinations for pertussis. Attack rates in 1 classroom for all students who received the complete series of vaccinations for pertussis approached 50%. This outbreak raises concerns about vaccine effectiveness in this preschool age group and reinforces the idea that recent pertussis vaccination should not dissuade physicians from diagnosing, testing, or treating persons with compatible illness for pertussis."


When 24 of 26 students (92%) developed pertussis who were fully vaccinated, while 2 of 5 students (40%) developed pertussis who were not vaccinated - does the vaccine work?

Wednesday, January 27, 2016

Anticholinergic Meds: Bad News For Aging Brains

Markedly Increased Risk

Over a mean follow-up of 7.3 years, 23% of all of the subjects developed dementia, and 19% were considered to have possible or probable Alzheimer's. Of those who showed signs of dementia, 79% ultimately went on to be diagnosed with Alzheimer's.

The risk was clearly associated with exposure to anticholinergic drugs, and it correrlated strongly with cumulative dose.

Among people with the highest and longest exposure, the risk of Alzheimer's was 77% higher than those who never took anticholinergics during the study period. Exposure to these drugs was expressed in terms of Total Standardized Daily Dose (TSDD) of 1095 or greater, based on a reference level of 5 mg oxybutyin representing 1 TSDD (Gray SL, et al. JAMA Intern Med. 2015; 175(3): 401-407).

Taking an anticholinergic daily for the equivalent of three years or more was associated with a 54% higher dementia risk than taking the same dose for three months or less.

Crowdfunded Research Shakes Medicine's Ivory Towers

On July 14, 2015,  the researcher--who is based at England's Keele University--launched an online campaign to support a clinical trial examining the impact of aluminum removal on people with Alzheimer's disease.  "The People's Trial for the People's Cure," is how he titled the campaign, underscoring the role the online "hive mind" in makingthe trial a reality.

According to the "aluminum hypothesis," exposure to this ubiquitous metal plays a key role in in the etiology of Alzheimer's disease. In a previously published successful pilot study in The Journal of Alzheimer's Disease in 2013, Exley and colleagues showed clinically significant improvements in the cognitive functioning of some Alzheimer's patients after 12 weeks of daily ingestion of silicon-rich mineral water, which supports the excretion of aluminum from the body.

The investigators saw their pilot study as a first step in a much needed rigorous test of the aluminum-Alzheimer's connection, warranting a larger clinical trial with a much bigger patient population (Davenward, et al. J Alzh Dis. 2013; 33(2): 423-430).

Alzheimer's disease is viewed as incurable and irreversible by many in mainstream neurology, and the role of aluminum in the etiology is considered controversial by conventional neurologists dismissing it outright, despite the fact that aluminum is a known neurotoxin. Furthermore, there are no promising drug therapies on the horizon for treating this devastating condition.
Combined these factors make Alzheimer's disease something of a backwater when it comes to research funding. Government institutions have been reluctant to commit significant resources to exploring "fringe" hypotheses.

Herpes zoster (shingles) is on the rise ... why?

"We used to have chicken pox parties where the children would get exposed to chicken pox at a safe age and adults would have their immunity boosted. Now with the advent of the childhood varicella vaccine, these exposures are virtually non-existent. The disease burden of primary varicella infection is being pushed to a more dangerous older age (if and when the vaccine immunity wanes) and older adults are no longer having their own immunity boosted by the exposure to children with chicken pox."

Hello. I am Dr. Craig Hales, a physician and epidemiologist at the Centers for Disease Control and Prevention (CDC). I am speaking with you as part of the CDC's Expert Video Commentary series on Medscape.

Herpes zoster rates among adults have been slowly rising over time in the United States and other countries. In the United States, herpes zoster rates have increased by 39% from 1992 to 2010 among adults older than 65 years of age.

Scientists have proposed various hypotheses to explain this increase. A common hypothesis is that the increase in herpes zoster is associated with the widespread vaccination of children against varicella.[1-5] However, a new CDC study that I will discuss today adds to a growing body of evidence that this is unlikely.

Let's start with some basics. Herpes zoster, also commonly known as zoster or shingles, is a painful skin rash. It is caused by the varicella zoster virus (VZV), which is the same virus that causes varicella disease (chickenpox). After a person recovers from varicella, the virus stays dormant in the sensory ganglia and can reactivate years later, causing zoster.

The reasons why the virus reactivates are not well understood. However, a person's risk for zoster may increase as immunity to VZV declines. This decline in immunity can occur as people get older or if they develop immunodeficiency because of certain medical conditions or medications.

Some scientists have suggested that exposure to varicella disease may boost a person's immunity to VZV and reduce the risk for VZV reactivation as zoster. Some studies have shown reduced risk for zoster in adults who are exposed to varicella, but other studies have not shown this effect.[6-10]

In the years following implementation of the childhood varicella vaccination program in the United States in 1996, rates of varicella in children fell dramatically. This led some scientists to speculate that increases in zoster in adults were the result of widespread vaccination of children against varicella, because adults have fewer opportunities to be exposed to varicella disease in children. However, this seems increasingly unlikely.

A recent CDC study, using Medicare data from 1992 to 2010, found that among adults aged 65 years or older, zoster rates were increasing even before the varicella vaccine was introduced in the United States.[1] Moreover, zoster rates didn't accelerate after the routine varicella vaccination program began.

We also examined whether there was a link between state varicella vaccination coverage and zoster rates. Zoster rates did not accelerate as states increased varicella vaccination coverage. In fact, zoster incidence was the same in states with consistently high vaccination coverage as it was in states with lower vaccination coverage.

Our study adds to a growing body of evidence showing that the increase in zoster rates is not a result of childhood varicella vaccination.[1,2,4,11] CDC continues to study the epidemiology of herpes zoster among adults and children and to monitor the effects of the US varicella and zoster vaccination programs.


"Like the wild-type (natural) virus, the attenuated (weakened) vaccine virus can reactivate and cause shingles."


Chickenpox (Varicella) Vaccine: This Is Why a Shingles Epidemic Is Bolting Straight at the U.S.

The incidence of adult shingles has increased by 90 percent from 1998 to 2013, following the release of the chickenpox vaccine for mass use. Shingles results in three times as many deaths and five times as many hospitalizations as chickenpox, and accounts for 75 percent of all medical costs associated with the varicella zoster virus.8

Even children are beginning to come down with shingles,9 as evidenced by school nurse reports since 2000, which was one of the concerns prompting Dr. Goldman to warn the CDC that it may be bringing about a shingles epidemic.

Prior to chickenpox vaccination, shingles was seen only in adults.


Shingles and Mother Nature’s Own Natural Vaccine


Mixed Opioid Agent Adds to Growing List of Therapies for IBS-D

Rifaximin (Xifaxan, Salix Pharmaceuticals) was also recently approved for IBS with diarrhea, and an interesting medical food, a slow-release peppermint oil formulation (IBgard, IM HealthScience), appears to significantly reduce severe abdominal symptoms of IBS with diarrhea as well as abdominal pain, according to news reports from Digestive Disease Week in 2015.

In addition, reports of a serum-derived bovine immunoglobulin (EnteraGam, Entera Health, Inc, among others) have also been given a "fair amount of traction" as a possible alternative treatment for IBS with diarrhea, Dr Johnson noted.

"Suddenly we have all these potential alternatives for [IBS with predominant diarrhea], plus the reporting requirements for alosetron have now been relaxed, so we have more opportunities for the treatment of our patients," he said.

"What the FDA will now do is look at what the best dose of eluxadoline might be, and we'll see if the pancreatitis issues that came up in these new studies raise a red flag because even though we are talking about very small numbers of patients, pancreatitis is a clinically significant event, and it could be that other drugs at least at this point in time have better safety profile," Dr Johnson concluded.


Chronic Fatigue Syndrome: Advancing Research and Clinical Education

CDC Grand Rounds Presents "Chronic Fatigue Syndrome: Advancing Research and Clinical Education," on Tuesday, February 16, 2016, at 1 p.m. (ET)
Grand Rounds button
Save the Date
CDC’s Public Health Grand Rounds Presents:
“Chronic Fatigue Syndrome: Advancing Research and Clinical Education”
Tuesday, February 16, 2016
1:00 p.m. – 2:00 p.m. ET
Global Communications Center (Building 19)
Alexander D. Langmuir Auditorium
Roybal Campus

Presented By:

Charles W. Lapp, MD
Medical Director
Hunter-Hopkins Center, P.A.
“Clinical Presentation of Chronic Fatigue Syndrome” 

Elizabeth R. Unger, PhD, MD
Chief, Chronic Viral Diseases Branch
Division of High-Consequence Pathogens and Pathology
National Center for Emerging and Zoonotic Diseases, CDC
“Public Health Approach to Chronic Fatigue Syndrome”

Anthony L. Komaroff, MD
Simcox-Clifford-Higby Professor of Medicine
Harvard Medical School
Senior Physician
Brigham and Women’s Hospital
“Lessons from the Institute of Medicine and NIH Pathways to Prevention Reports”

Avindra Nath, MD
Chief, Section of Infections of the Nervous System
National Institute of Neurological Diseases and Stroke
“Post-Infectious Chronic Fatigue Syndrome: Intramural Research at the National Institutes of Health”

For non-CDC staff interested in viewing the session:
live external webcast will be available.  For individuals who are unable to view the session during the scheduled time, the archived presentation will be posted 48 hours after each session. 

Do fungi play a role in interstitial cystitis (IC)?

PCR technology has been used in the study of the microbiome and really contributed to this revolution in understanding that we are an ecosystem of good healthy organisms - which has a significant impact on human health. Older culture methods of identifying infections are woefully inadequate for identification of many infectious diseases. Consider tuberculosis which requires months of intensive culture to identify this organism in culture. Not only are PCR techniques considerably faster at giving a actionable result, they are cheaper and can identify organisms that we never would have found with traditional culture technology. I really hope PCR diagnosis of infectious disease is adopted by the mainstream medical community quicker - it will truly usher in a revolution in understanding infectious disease and many previously difficult to treat conditions like IC.



Interstitial cystitis/bladder pain syndrome is characterized by waxing and waning symptoms of bladder pain and storage urinary symptoms.1 Symptom exacerbations among patients with IC/BPS, often called flares, well recognized by physicians and patients, have not been well characterized. Many patients and physicians attribute flares to an infection, and antibiotics are often prescribed.1 and 2 Following the culture status of women with IC/BPS for almost 2 years failed to provide evidence to support the bacterial etiology flare hypothesis.3 However, standard culture techniques have many limitations, including the fact that 99% of known bacteria cannot be cultivated using standard culture media techniques.4 Enhanced culture techniques are reportedly better (larger volumes, multiple media, multiple atmospheric conditions, longer incubation times) at capturing more bacterial and fungal species,5 and 6 while new culture independent methods (such as Ibis T-500 Universal Biosensor technology7) allow for the detection of up to 1% to 3% of the total microbiome without needing an a priori hypothesis of which species are present.

In this study we use a novel, state-of-the-art, culture independent method to compare the microbiota of the lower urinary tract in standard culture negative (for bacteria) female patient with UCPPS (ie IC/BPS) enrolled in the MAPP-EP study8 and 9 who reported a current flare at study entry compared to those women who did not.


There was also no significant difference in the number (percent) or specific genus composition of traditional uropathogens detected between groups (table 4). In patients with IC/BPS with negative standard plate cultures uropathogens were detected in 8.1% vs 9.4% of VB1 in flare vs nonflare cases, respectively. The corresponding values for VB2 specimens were 1.2% vs 3.9%. Univariate analysis revealed a significantly greater prevalence of fungi (Candida and Saccharomyces sp.) in the flare group (15.7%) compared to the nonflare group in VB2 (3.9%) (table 3, p=0.01). When adjusted for antibiotic use and menstrual phase, women who reported a flare remained more likely to have fungi present in VB2 specimens than women who did not report a flare (OR 8.3, CI 1.7–39.4). Representative VB2 heat maps by flare status were developed to illustrate the differences in VB2 between groups (see figure).


Monday, January 25, 2016

PBS episode on supplement quality

An investigation into the hidden dangers of vitamins and supplements, a multibillion-dollar industry with limited FDA oversight. FRONTLINE, The New York Times and the Canadian Broadcasting Corporation examine the marketing and regulation of supplements, and cases of contamination and serious health problems.


Using fully tested and "vetted" supplements is a must! Consumer Lab is one such organization that I personally use often to generate recommendations.


Supplement Quality Statement 2015
Christopher Bray MD PhD

Given the recent news about poor quality supplements found in many large retail stores, I wanted to comment on this situation. We live in a society where businesses reign supreme and often either set the rules or bend the rules to allow themselves to succeed financially. In many countries of the world, chemicals are deemed as unfit for human consumption or external use until proven safe. In our country, chemicals are assumed safe until proven unsafe (which is often extraordinarily difficult to do due to regulatory roadblocks). Also, our supplement manufacturers are not required to meet stringent independent quality control checks like in other countries (Commission E in Germany for example). Many do so voluntarily, which I strongly support.

As a consumer, we must assume that anything we buy has potential harm and only purchase trusted products and brands. Sometimes, this means researching companies, manufacturing practices, and product quality ourselves. Otherwise, this means relying on trusted third-party certification to research and test products for us. We must be careful consumers when it comes to supplements – especially herbal products. I have found that when patients buy unspecified vitamin D, fish oil, or other vitamins/mineral/herbs – they many times do not have the expected benefits. Upon questioning, they chose an untrusted (but less expensive) brand or incorrect doses or even the incorrect supplement altogether. Supplements should be treated like prescriptions. They should be exact brands, doses, composition, and taken as specified by your practitioner. It takes an expert integrative medicine physician to guide you with these.

I use groups like ConsumerLab.com who investigate the quality and accuracy of the supplements that I recommend. I also like to see supplement manufactures that use third party certification agencies to verify that their products are free of contaminants like heavy metals (which is a big problem with herbal supplements from China and India as well as rice from the US which often has arsenic).

My universal rule is that organic and raw food sources are usually superior to supplemental forms of nutrition. Sometimes supplements are needed and I provide my patients with a list of tested and "vetted" versions.


Toxic Element Contamination of Natural Health Products and Pharmaceutical Preparations:

New "medical food" prescription products

While I am not usually a fan of advertising specific products and I do not support individual brands. I think the idea of using medical foods to treat disease is a good approach for some people that simply can't implement appropriate dietary changes. I have no connections with the company - financial or otherwise. Perhaps this approach allows supplements to be "legitimate" treatment options for those physicians that doubt the relevance of supplements for treating disease.


Limbrel® is a prescription medical food product for the safe clinical dietary management of the metabolic processes of osteoarthritis under a physician's supervision.

Fosteum® PLUS is a prescription medical food product for the clinical dietary management of the metabolic processes of osteopenia and osteoporosis under a physician's supervision.

Vasculera® is a prescription medical food product for the safe clinical dietary management of the metabolic processes of chronic venous insufficiency (CVI) under a physician's supervision.

Vascuderm™ Stasis Kit contains the prescription medical food product Vasculera®, and Vascuderm™ Hydrogel Wound Dressing.

Rheumate™ is a prescription medical food product for the clinical dietary management of the metabolic effects of methotrexate therapy.


Sunday, January 24, 2016

The Fat Summit, January 25-February 1, 2016 - with Mark Hyman

In The Fat Summit, NY Times bestselling author Dr. Mark Hyman will interview 30+ of the world’s top experts, as they reveal the truth about fat – and what it really takes to lose weight, feel great, and reverse chronic disease.

Did you know?

  • All calories are NOT created equal. Science now shows that what you eat matters far more than how muchyou eat.
  • In 2015, the United States Dietary Guidelines Advisory Committee removed any recommendations to limit fat in the diet (after concluding that it doesn’t make us fat or sick!).*
  • Research indicates that sugars and carbs are the true causes of obesity and heart disease – not fats.
  • Eating more fat has been shown to improve brain function, help prevent dementia, and reverse type 2 diabetes.
  • Dietary fat actually supports weight loss by speeding up your metabolism, reducing hunger, and stimulating fat burning.

Experts include

  • Chris Kresser on Personalized Paleo
  • Deepak Choprah on Changing Your Gene Expression
  • Nick Ortner on the Psychology of Fat and Food Fear
  • JJ Virgin on Sugar vs. Fat for Health & Weight Loss
  • Marc David on Body/Mind Nutrition and The Slowdown Diet
  • Aseem Malhotra, MD on The Epidemic of Misinformation
  • Ronald Krauss, MD on The Role of Genetics in Diet
  • Walter C. Willeet, MD on The Science of Diet & Disease
  • …And many more.

Sign up and tune in January 25 to February 1 to discover the surprising truth about fat – and what it really takes to lose weight, feel great, and reverse chronic disease.


Fixing bile and gallbladder disease naturally

Nutrition and Supplements

These nutritional tips may help reduce symptoms:
  • Eliminate suspected food allergens, such as dairy (milk, cheese, and ice cream), wheat (gluten), soy, corn, preservatives and chemical food additives. Eggs, especially, may irritate the gallbladder. Your doctor may test you for food allergies.
  • Eat foods high in B-vitamins and iron, such as whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables.
  • Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers).
  • Avoid refined foods, such as white breads, pastas, and sugar.
  • Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy), or beans for protein.
  • Eat more fiber. Consider fiber supplements, such as flaxmeal (1 tsp, 1 to 3 times per day). Combine 1 heaping tsp. of flaxmeal in 8 oz. of apple juice for a drink high in fiber and pectin.
  • Use healthy cooking oils, such as olive oil or coconut oil.
  • Reduce or eliminate trans fatty acids, found in commercially baked goods, such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
  • Avoid alcohol, and tobacco. Some evidence suggests that people who drink caffeinated coffee have a lower risk of gallstones, though study results are mixed. Talk to your doctor before increasing your caffeine intake, as caffeine can affect several conditions and interact with medications.
  • If possible, exercise lightly 5 days a week.

You may address nutritional deficiencies with the following supplements:
  • A daily multivitamin, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.
  • Vitamin C, 500 to 1,000 mg daily, as an antioxidant and for immune support.
  • Phosphatidylcholine, may help dissolve gallstones. May interfere with some medications, including anticholinergic medications used in the treatment of Alzheimer's disease and glaucoma, among others. Talk to your doctor.
  • Alpha-lipoic acid, for antioxidant support. It's possible that alpha-lipoic acid could interact with some chemotherapy agents.
  • Magnesium, for nutrient support. Magnesium can potentially react with a variety of medications, including some antibiotics, blood pressure medicines, diuretics, muscle relaxers, and others. Large doses of magnesium may result in dangerously low blood pressure and slow breathing. People with kidney disease may have problems clearing magnesium from their body.
  • Taurine, for nutrient support. Taurine can potentially interact with lithium. People with a history of bipolar disorder should take taurine with extreme care.


Herbs are a way to strengthen and tone the body's systems. As with any therapy, you should work with your doctor before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). People with a history of alcoholism should not take tinctures. Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures singly or in combination as noted. If you are pregnant or nursing, speak to your doctor before using any herbal products.

A gallbladder attack can be a medical emergency. Do not use herbs to treat gallbladder disease on your own. Work with a trained herbal practitioner under the supervision of your doctors. The following herbs are sometimes used to treat gallbladder disease:
  • Green tea (Camelia sinensis), for antioxidant effects. You may also prepare teas from the leaf of this herb. Note: green tea extracts may contain caffeine. Look for decaffeinated products.
  • Milk thistle (Silybum marianum), for liver and gallbladder detoxification support. Patients with allergies to ragweed or a history of hormone-sensitive cancers should take milk thistle with caution.
  • Globe artichoke (Cynara scolymus), for support of gallbladder and liver function. Due to its ability to increase bile production, globe artichoke could trigger a gallbladder attack if there is bile duct obstruction. Talk to your doctor.
  • Turmeric (Curcuma longa) standardized extract, 300 mg, 3 times daily for support of liver function. High doses of turmeric can have blood thinning effects. Care should be taken if you are on other blood-thinning medications.

Grapefruit Juice and Statins

We determined the validity of current medical advice to avoid grapefruit juice consumption while taking 3 widely used statins. A daily glass of grapefruit juice increases blood levels of simvastatin and lovastatin by about 260% if taken at the same time (about 90% if taken 12 hours apart), and atorvastatin by about 80% (whenever taken). Simvastatin 40 mg, lovastatin 40 mg, and atorvastatin 10 mg daily reduce low-density lipoprotein (LDL) cholesterol levels in a 60-year-old man with an LDL cholesterol of 4.8 mmol/L by 37%, reducing ischemic heart disease risk by 61%. When simvastatin or lovastatin are taken at the same time as grapefruit juice, the estimated reduction in LDL cholesterol is 48%, and in heart disease is 70%. If the juice is taken 12 hours before these statins, the reductions are, respectively, 43% and 66%, and for atorvastatin, 42% and 66%. The increased rhabdomyolysis risk from grapefruit juice consumption due to the increased effective statin dose is minimal compared with the greater effect in preventing heart disease. Grapefruit juice should not be contraindicated in people taking statins.


Saturday, January 23, 2016

Healthy Diet May Improve Sleep Quality

A diet low in fiber and high in saturated fat and sugar is associated with lighter, less restorative sleep with more arousals, a new study has found.

The researchers suggest that adjusting diet to include more fiber and less saturated fat and sugar may be useful in the management of sleep disorders.

The study, published in the January issue of the Journal of Clinical Sleep Medicine, was led by Marie-Pierre St-Onge, PhD, Institute of Human Nutrition at Columbia University Medical Center, New York.

"We found that sleep quality appears to be affected by what we eat, with fiber and saturated fat particularly important factors," she told Medscape Medical News.


Friday, January 22, 2016

Duke Integrative Medicine Center

Integrative medicine avoids the false dichotomy between conventional and complementary medicine. New therapies are selected on the basis of their scientifically proven safety and effectiveness, regardless of their origin. The result is an array of services intended to tackle the complex dynamics contributing to your health. Often, the physical state is symptomatic of mental, emotional, social, spiritual, or environmental factors that only a comprehensive, personalized health plan can resolve.

At the core of integrative medicine is the concept of the partnership between patient and healthcare practitioner. With a preference for the least invasive and most natural therapies, the full range of the healing sciences is brought to bear on strengthening your innate healing response by physicians and providers trained in both conventional and integrative medicine. When you have recovered your health and vitality, we will help you maintain your wellness and prevent the onset or recurrence of disease.

At Duke Integrative Medicine, we operate our practice at the highest possible standards of excellence in a world-class facility — Duke University’s Center for Living Campus. Nestled in the woodlands of Duke Forest, and surrounded by serene meditation gardens, we offer quiet, soothing, contemplative spaces designed to calm and focus your senses and rejuvenate your spirit. Find your answers in our library under a cathedral ceiling, surrounded by walls of glass and views of nature, or visit with like-minded souls in our Integrative CafĂ©. Every feature of the environment is designed to nourish the wellness within.


Find an integrative medicine provider in Gainesville!

Tuesday, January 19, 2016

Prebiotic and Probiotic Regulation of Bone Health: Role of the Intestine and its Microbiome

There are many studies supporting a role for the gut and its microbiome in the regulation of bone density and health. Direct modulation of the quantity of bacteria present (through the use of antibiotics, germ-free mice) as well as addition of bacterial substrates (prebiotics) and addition of beneficial bacteria (probiotics) can affect measures of bone health and calcium metabolism. However, there is still much to learn regarding our understanding of the signaling pathways that link the microbiome and gut to skeletal health. Future studies should be directed at identification of the mechanisms by which the microbiome regulates osteoblast and osteoclast activities as a means for developing future natural treatments for osteoporosis. We envision that modulation of the intestine-microbiome interaction to improve bone health will play an important role in human health and allow physicians to reduce the dependence on current pharmacological interventions for osteoporosis (which can have unwanted side effects).


Dispel the myths ... please

QUESTION: What is the best nutritional product to help form strong bones?
FALSE. Countries with the highest consumption of milk are associated with the highest rates of osteoporosis. High animal protein intake causes increased calcium excretion, and that includes milk. Try a kale/spinach salad with almonds and tahini with a side of sauerkraut while sitting in the sun for your lunch break. Thanks dairy industry for brainwashing us.

QUESTION: What is the best food source of Vitamin D?
FALSE. Cows that stay outdoors and munch on grass ARE a good source of vitamin D. However, milk processing removes all remnants of the healthy fat soluble vitamins that are naturally produced in milk. A very small amount of Vitamin D2 - a vitamin D produced in fungi is added to milk, so that it can be labelled as "Vitamin-D fortified". However humans use the Vitamin D3 form. Sun is the best source of Vitamin D. And animals that are in the sun and not "inflammed" with chronic infections and systemic inflammation are a good source of Vitamin D. Wild fish are one of the best food sources of Vitamin D.

QUESTION: What is the best source of potassium?
ANSWER: Bananas.
FALSE. Most fruits and vegetables have potassium. Sodium is mostly entering out diet through processed foods. Too much sodium relative to potassium is a bad thing for our health. Try green vegetables and tomatoes which are much higher in potassium than bananas. Thanks Chiquita for brainwashing us.

QUESTION: What food is the best source of fiber?
ANSWER: Cereal or Fiber Gummies.
FALSE. Properly cooked beans and avocados are a very good source of fiber. Whole-food plant-based fiber is the best. Stop seeking processed food to save the day and stop believing what the commercials tell you - most cereals degrade to sugar very quickly causing insulin dysregulation and "fiber bars" are usually loaded with sugars and "damaged" plant oils. Whole-grains are a good source of fiber. But what is a whole-grain? If I make a cookie with 99% junk ingredients and add one grain of buckwheat to it, I can now label this as having "whole-grain goodness" and tell you "whole-grains are a great source of heart-healthy fiber". Don't fall for the advertising gimicks. Whole-grains have an ingredient list of one: that whole grain. You can buy steel cut oats or wheat berries and that has an ingredient list of one. You need the starch, the bran, and the germ all intact in one nice little package just like it was made in nature.

QUESTION: Whole-grain bread and cereal are the best source of whole grains, right?
ANSWER: Yes, I see the labels at the grocery store and that's what they tell me.
FALSE. See comments above.

QUESTION: Do acid-reflux medications stop reflux?
ANSWER: Yes, of course.
FALSE. Nexium. Prilosec, Prevacid - all these proton-pump inhibitors stop the production of acid, but do nothing to stop the process of reflux. Fixing reflux is possible, but not with acid reduction. If you want a temporary band-aid for the "burning" sensation, then acid reduction works. However, acid is necessary long-term for good digestion and "silent" reflux can still damage the vocal cords and esophagus.

QUESTION: Aren't all probiotics the same?
ANSWER: Yes, the hospital gave me Culturelle and that's just as good as all the others.
FALSE: There are literally thousands of combinations of healthy bacteria in the microbiome. To say that consuming one type of lactobacillus is the same as a probiotic like Prescript Assist shows a lack of understanding and respect for the natural biodiversity within the microbiome.

Let's please try and dispel all of these myths. They ultimately began as advertising slogans at one point, evolved into government policy through lobbying efforts (various public-service "councils" and generic-named PR-firms), and now are a firm part of our societal education. However, the truth is buried in quiet, unadvertised research freely available to all.

The Truth About Calcium and Osteoporosis

Calcium for bones? 
Findings from long term studies have cast doubt on the value of consuming the large amounts of dairy and calcium currently recommended. In particular, high calcium intake does not actually appear to lower a person's risk for osteoporosis (2). There is evidence that the recommended levels in the West are too high, with countries such as India, Japan and Peru having an average daily calcium intake of around 300 milligrams (mg) per day, less than half that in the Western world, and no increase in the incidence of bone fractures (3). If increased dairy consumption leads to reduced osteoporosis and fracture rates, then multi-country epidemiologic studies would show that countries with the highest dairy consumption - such as Australia, New Zealand, the United States and the UK - would have the lowest osteoporosis and fracture rates, yet this is not the case. Although the consumption of dairy products in the US is among the highest in the world, osteoporosis and fracture rates are simultaneously high (4,5).

Other areas of research also support this finding. A comprehensive literature review found that of 57 evidence-based scientific studies of the effect of dairy foods on bone health, "53% were not significant, 42% were favourable and 5% were unfavourable. Of 21 stronger-evidence studies, 57% were not significant, 29% were favourable and 14% were unfavourable" (6). In other words, despite the huge amount of money the dairy industry invests in research, there are many studies showing that milk has no benefit and that it has potentially negative effects.

In one study, a low intake of calcium (less than one glass of milk daily) was not associated with a significantly increased risk of any fracture, osteoporotic fracture or hip fracture, and no significant relationship was observed by age for low milk intake and hip fracture risk (7). There was also no difference in risk of fracture or osteoporosis between men and women.

In the Harvard Nurses' Study of 77,761 mostly white women aged 34-59 who were followed over a 12 year period, those who drank little or no milk compared to the high milk drinkers (three glasses or more) had no increase in risk of hip or arm fracture (8).

The bottom line is that the studies do not support what we are constantly told by the dairy industry, media, governments and dieticians. So why do we keep getting told this message? If it was so clear cut as to warrant a health message from government authorities, you would expect all the research to support it. Not only is this not the case, but there is also plenty of research to show the complete opposite.

It is simplistic to think that the calcium in our diet goes straight to our bones. The "calcium balance" is where the calcium intake from food is compared to the amount of calcium lost through excretion and unabsorbed mineral in sweat, faeces and urine. The remaining amount, whether positive or negative, is the calcium balance (9).

If a person's calcium balance is positive, there is an excess of calcium in the body, a proportion of which goes directly to increasing bone mineral density (10). If, however, a person's balance is negative, more calcium is lost than is consumed, and therefore calcium from bone mineral must be reabsorbed into the bloodstream to make up the difference (10). This causes a lowering of bone mineral density and therefore is a factor in the onset of osteoporosis and fracture risk in later life (10). The amount of calcium that is absorbed and retained in the body from dairy products is about 30% of the total calcium consumed (9).

A number of factors help explain this discrepancy. First, calcium absorption is inversely related to the amount of calcium consumed in the diet, with low levels of calcium intake resulting in the most efficient absorption rates 11. This phenomenon may be partly responsible for the fact that many non-dairy-consuming societies around the world have few adverse health effects (such as osteoporosis and fracture) even with relatively low calcium intake (12).

Dairy products contain significant levels of protein, fat (in cheese, cream, butter and full cream products), sugar (in flavoured milks and yoghurts), sodium and phosphorous, all of which reduce the bioavailability of the calcium they contain. The presence of proteins has been demonstrated to have a negative influence on calcium absorption. Protein in milk causes an increase in urinary calcium excretion (13). Some dairy products, especially processed cheeses, clearly increase the urinary excretion of calcium as a result of their increased sodium, sulphur-containing amino acid, and phosphorus content (14). Interestingly, high-fat dairy products such as cheese, butter, chocolate and ice cream have also been found to be acid-forming foods (like protein and alcohol) (15,16), and so the question is raised: how effective are dairy products at ensuring bone health and are there other, more effective, dietary alternatives?

What is good for the bone? 
While protein has a negative effect on calcium availability, magnesium and potassium, which are found in high concentrations in plants we eat as food, have been recognised as having a largely positive influence (17). These minerals appear to decrease the rate of bone attrition and urinary excretion of calcium from the body when present in moderate quantities. Milk has a poor calcium-to-magnesium ratio and contains low concentrations of potassium, while plant sources have a much higher concentration. Potassium appears to buffer the effects of acidic foods by protecting against calcium loss from the renal acid load of protein (6).

Vitamin D, derived primarily from sunlight, certain oils (including cod liver oil) and fortified foods (including dairy products), is the major nutritional factor affecting calcium absorption (4). Scientific studies have repeatedly shown that inadequate vitamin D levels result in impaired calcium absorption in the body (4,9). The role of vitamin D in milk is also found to significantly lower the risk of fracture (5). Many people in Western populations are now recognised as being deficient in vitamin D. (See "Vitamin D Rethinking Sunshine" - NOVA Magazine Issue 16.8 October 2009 at www.novamagazine.com.au (Articles archive)

The adequacy of non-dairy centred diets to support bone health has been demonstrated by a recent study conducted in Spain among adolescent males. It reported that a Mediterranean-type intervention diet based on fresh fruits and vegetables, olive oil, fish and legumes provided the same amount of dietary calcium as the subject's usual (baseline) diet, although the food sources of that calcium varied significantly.

The intervention diet also resulted in a significant increase in calcium absorption and retention, while significantly reducing the amount of calcium excreted in urine. This may be partially attributed to the lowered potential renal acid load of the diet, particularly from a high intake of fruit and vegetables (19,20). Therefore, the study concludes, the adoption of a Mediterranean-style diet low in dairy can assist in maximising peak bone mass and preventing osteoporosis without milk or other dairy products (21).

Perhaps the most important part of the bone mass equation is a healthy mixture of minerals from unprocessed plant foods and physical activity, particularly weight-bearing exercises (22,6).

In response to learning these facts about milk, many people ask me, "But where can we get our calcium?" No other animal on the planet experiences bone problems at the rate humans do. Most other animals get calcium from their normal, often vegetarian, diet. Our primate cousins, even those such as the gorilla, which are much heavier and stronger than us, get all the calcium they need from unprocessed plant foods and cows get theirs from grass and have an excess of calcium. So where should we be getting our calcium?


African Bantu women take in only 350 mg. of calcium per day. They bear nine children during their lifetime and breast feed them for two years. They never have calcium deficiency, seldom break a bone, rarely lose a tooth... How can they do that on 350 mg. of calcium a day when the (National Dairy Council) recommendation is 1200 mg.? It's very simple. They're on a low-protein diet that doesn't kick the calcium out of the body'.

At the other end of the scale from the Bantus are the native Eskimos.

If osteoporosis were a calcium deficiency disease it would be unheard of among these people. They have the highest dietary calcium intake of any people in the world - more than 2000 mg. a day from fish bones. Their diet is also the very highest in the world in protein - 250 to 400 grams a day. The native Eskimo people have one of the very highest rates of osteoporosis in the world.

In March, 1983, the Journal of Clinical Nutrition reported the results of the largest study of this kind ever undertaken. Researchers in Michigan State and other major universities found that, by the age of 65 in the United States:

  •   Male vegetarians had an average measurable bone loss of 3%
  •   Male meat-eaters had an average measurable bone loss of 7%
  •   Female vegetarians had an average measurable bone loss of 18%
  •   Female meat-eaters had an average measurable bone loss of 35%


The profitability of the global supplements industry probably plays its part, encouraged by key opinion leaders from the academic and research communities.14 Manufacturers have deep pockets, and there is a tendency for research efforts to follow the money (with accompanying academic prestige), rather than a path defined only by the needs of patients and the public. The research agenda and recommendations can also be influenced by the conflicts of interest that arise when leading academics have shares or management positions in companies making and marketing supplements.

While the study by Chapuy and colleagues has been influential,9 calcium and vitamin D supplements have been marketed well beyond the trial’s target population of older women in residential care with low calcium intake and low vitamin D concentration. By use of guidelines such as those by NOF and the International Osteoporosis Foundation (IOF), marketing now extends to all older people with dietary intakes below the recommended 1200 mg calcium and 800-1000 IU vitamin D daily. By this definition virtually the whole population aged over 50 is at risk.10 11 Most will not benefit from increasing their intakes2 3 10 11 12 13 and will be exposed instead to a higher risk of adverse events such as constipation, cardiovascular events, kidney stones, or admission for acute gastrointestinal symptoms.3 The weight of evidence against such mass medication of older people is now compelling, and it is surely time to reconsider these controversial recommendations.


These data suggest the role for calcium and vitamin D supplements in osteoporosis management is very limited. Neither calcium nor vitamin D supplements should be recommended for fracture prevention in community-dwelling adults, although vitamin D should be considered for prevention of osteomalacia in at-risk individuals.