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Are Calcium Supplements Bad For Your Heart?

>> Tuesday, October 29, 2013

It is well known that adequate calcium intake is important for bone health at all ages.  Calcium supplementation is common, with 43% of American adults (and 70% of postmenopausal women) regularly taking calcium supplements.  However, there is a lot of confusing information out there, with some studies suggesting that calcium supplements may increase the risk of heart disease.

A recent article in the New England Journal of Medicine provides an excellent discussion around the controversies of calcium supplementation and heart health.   Here are some key points:

1.  The recommended daily calcium intake for Canadian adults:

  • age 19-50: 1,000 mg of elemental calcium per day (see #4 below re the meaning of 'elemental' calcium)
  • men age 51-70: 1,000 mg
  • women age 51-70: 1,200 mg
  • adults over 70 years: 1,200 mg

2.  The evidence suggesting that calcium supplements may increase the risk of cardiovascular disease is inconsistent - in other words, we still don't have a definitive answer to this question.  Compiled data from several studies pooled together (called 'meta-analyses') have suggested increased risk, while a large randomized controlled trial called the Women's Health Initiative (WHI) did not show an increased risk.  (Randomized controlled clinical trials provide more trustworthy evidence than meta-analyses do, so the fact that the WHI didn't show an increased risk carries weight.).  

It has been speculated that a sharper increase in blood calcium levels after eating a calcium supplement may result in increased cardiovascular risk, but this has not been proven. 

3.  Given that it is still not clear whether calcium supplements increase cardiovascular risk or not, getting the recommended calcium intake from food and beverages is the preferred approach.  

We consume about 300mg of elemental calcium per day from non dairy sources.  Here are some examples of dairy and non-dairy calcium sources: 
  • 1 cup of milk: 300 mg
  • 1 serving of yogurt (100g): 100 mg
  • 1 oz cheddar cheese: 200 mg
  • 1 cup low fat cottage cheese: 200 mg
  • 1 cup raw broccoli: 43 mg
  • 1 cup raw kale: 100 mg
  • 1 slice bread (commercially prepared): 30-70 mg
  • fortified breakfast cereal - varies widely - check the label!

4.  If you need to use calcium supplements over and above dietary intake to reach your recommended calcium intake, check the label for the mg of elemental calcium, as this is the value that is important.  Calcium supplements come in many different forms (calcium carbonate, calcium gluconate, calcium citrate etc), and each type of calcium supplement contains a different percentage of elemental calcium.  If your supplement doesn't say how many mg of elemental calcium it contains, here is a guide: 
  • calcium carbonate: contains 40% elemental calcium (so, if your supplement is 750mg of calcium carbonate, it contains 300 mg of elemental calcium)
  • calcium citrate: contains 21% elemental calcium
  • calcium gluconate: contains 9% elemental calcium

Follow me on twitter! @drsuepedersen © 2013


White Wine Poached Salmon with Quinoa and Arugula

>> Thursday, October 24, 2013

Isn't the title just enough to get your mouth watering?!  I came across the original recipe on Epicurious, and I have modified it below to trim down on the calories while maintaining the flavor.  

Sometimes when I come across a great looking recipe, all it takes is one esoteric ingredient that I have to hunt for to make me lose interest.  This recipe calls for harissa, a North African hot chili sauce.  Instead, you can use a generic hot sauce; in that case, you can also play with the recipe below by adding a little garlic, caraway seed, and/or coriander to get a little closer to the flavor of harissa.


  • 1 cup white wine
  • 4 skinless salmon fillets (3 ounces each)
  • 1 white onion, sliced
  • 3 sprigs thyme
  • 1/2 cup quinoa 
  • 1/2 cup canned chickpeas, rinsed and drained
  • 1/4 cup raisins
  • 1 teaspoon turmeric
  • 1 teaspoon ground cumin
  • 1 teaspoon ground cinnamon
  • 1 teaspoon paprika
  • 1 teaspoon cayenne pepper
  • 2 cups arugula
  • Juice of 2 lemons
  • 4 tablespoons harissa (or generic hot sauce)
  • 1/2 cup cilantro leaves

  • Directions: 

    1.  In a large pot, boil wine and 4 cups water.

    2.  Add salmon, onion and thyme. Reduce heat to simmer; poach salmon until cooked through, about 7 minutes.   Remove salmon; cool. 

    3.  In another large pot, boil 4 cups water. Add quinoa and cook until tender, about 11 minutes (or according to package directions); drain.

    4.  Mix quinoa, chickpeas, raisins and spices in a bowl; cool.

    5.  Toss quinoa-chickpea mixture with arugula. Dress salad with lemon juice. Season with salt and freshly ground black pepper.

    6.  Divide salad and poached salmon among 4 plates. Top each salmon fillet with 1 tablespoon harissa, and garnish with cilantro.  

    Makes 4 servings.  Per serving: 

    • calories: 388
    • fat: 12g
    • protein: 24g
    • carbs: 33g


    Follow me on twitter! @drsuepedersen © 2013


    Risk of Cancer After Nuclear Accidents

    >> Monday, October 21, 2013

    With the recent Fukushima disaster (pictured above), the topic of nuclear disasters is at the forefront of all of our minds.  Nuclear accidents are a terrible tragedy on so many levels, from the damage done to the environment, to the effects on wildlife, the people, the society, and the economy of the country affected.    Once the initial period of damage control and clean up is tended to, the work and surveillance of the population from a health standpoint has only just begun.  A recent article in the Canadian Medical Association Journal provides a poignant reminder of this fact.

    The article by Dmytriw and Pickett describes the case of a man who developed a glioblastoma brain tumor which occurred 24 years after his exposure to the Chernobyl nuclear disaster in 1986.  The Chernobyl power plant disaster remains the worst accident at a nuclear power plant in history, resulting in radioactive fallout covering large parts of the western former Soviet Union.  While the studies in the 4 years after Chernobyl found an increased incidence of leukemia, thyroid cancer did not show to be significantly increased until 16 years after the Chernobyl accident, at which time the risk was found to be 4.3 times that of the general population.  These papillary thyroid cancers were also found to be more aggressive in their behavior than typical papillary thyroid cancers.

    Going beyond this time frame into today, now 27 years after Chernobyl, it is hard to quantify the risk of tumors caused by Chernobyl, as follow up of people who lived in the affected area becomes very difficult.  An increased risk of breast cancer and brain tumors has been suggested, but difficult to prove definitively.  In terms of distance from Chernobyl that can put a person at risk, the United Nations Scientific Committee on the Effect of Atomic Radiation (UNSCEAR) has indicated that individuals who lived as far as 2,000 km away from Chernobyl may develop cancer beyond the minimum latency times normally associated with exposure to radiation.

    The bottom line?  As health care providers, we must remember to ask about exposure to nuclear accidents, remembering that tumors can develop more than 20 years after exposure.  If you are a person that has been exposed to a nuclear disaster such as Chernobyl or Fukushima, make sure your health care providers over the long term are aware.

    Finally, cases of cancer that arise among people who were exposed to nuclear accidents should be reported to the appropriate authority, with the patient's consent.

    The Fukushima Registry for cases of cancer amongst people who were living in Japan at the time of the Fukushima disaster is accessed by emailing

    The Chernobyl Registry for cases of cancer amongst people who were living in Ukraine, Belarus or Russia around the time of the Chernobyl disaster is accessed by emailing (for Russia or Belarus) and (for the Ukraine).

    Twitter @drsuepedersen © 2013


    Aircraft Noise Exposure May Increase Heart Disease and Stroke Risk

    >> Tuesday, October 15, 2013

    Regular readers will know that I often talk about pollutants and chemicals in our environment that may adversely affect our health (from water bottles to soup cans to the soap we use, and many more).  I came across some interesting articles in my reading this week that add to the literature suggesting that even noise pollution may be dangerous to our health.

    In the recent edition of the British Medical Journal, there are two studies and an editorial review discussing the risk of stroke and heart disease for people who live in proximity to airports.

    As Dr Fiona Godlee, editor in chief of the journal writes:

    The first study compared hospital admissions and mortality rates for stroke, coronary heart disease, and cardiovascular disease from 2001-05 in 12 London boroughs and nine districts west of London. The researchers found increased risks of stroke, coronary heart disease, and cardiovascular disease for both hospital admissions and mortality, especially among the 2% of the study population exposed to the highest levels of daytime and night time aircraft noise.

    In the second study, researchers at the Harvard School of Public Health and Boston University School of Public Health analysed data for over six million older American Medicare recipients (aged 65 years or more) living near 89 US airports in 2009.
    The researchers found that, on average, zip codes with 10 decibel (dB) higher aircraft noise had a 3.5% higher cardiovascular hospital admission rate. The association remained after adjustment for socioeconomic status, demographic factors, air pollution, and roadway proximity.

    An accompanying editorial says the results have implications for planners when extending airports in heavily populated areas or planning new airports.

    As noted in the editorial by Professor Stansfeld, 

    These studies provide preliminary evidence that aircraft noise exposure is not just a cause of annoyance, sleep disturbance, and reduced quality of life but may also increase morbidity and mortality from cardiovascular disease. The results imply that the siting of airports and consequent exposure to aircraft noise may have direct effects on the health of the surrounding population. Planners need to take this into account when expanding airports in heavily populated areas or planning new airports.

    Follow me on twitter! @drsuepedersen © 2013


    Taking On Dr Oz And His 15 Superfoods

    >> Monday, October 7, 2013

    My colleague Dr Yoni Freedhoff pointed out a great article on his blog this week, speaking out against Dr Oz and his health claims. The article is written by pharmacist Scott Gavura, who started his own blog in response to frustrations with the growing use of pseudoscientific products and practices - in other words, use of (usually expensive) supplements and products for betterment of health that do not actually have any substantial science to support their use.

    Scott goes on to do a reality check on all 15 items on Dr Oz's list of Superfoods, from raspberry ketones to green tea to chia, acknowledging the benefits of some of these substances, but also pointing out where data are lacking, and where there may also be some potential harms.

    Scott echoes my own concerns about Dr Oz:

    What frustrates me the most about Dr. Oz is that he should know better. He’s a heart surgeon, (who continues to treat patients), an academic, and a research scientist, with literally hundreds of publications to his name. He has gone through the peer review process more times than most health professionals. There is little reason to expect, based on his pre-television history, that he’d be willing to build a platform to offer demonstrably bad health advice. And that’s a shame, because with a show in 118 countries that reaches over 3 million viewers in the USA alone, it could be a powerful tool for providing good health information to those seeking it. And more often than not, that opportunity is squandered.

    Out of respect for a colleague, I think, our profession has been quiet about Dr Oz for too long.  However, more and more, we are seeing all manner of health care professionals speak out about his inappropriate use of his title as a physician to tout supplements and substances that do not have scientific evidence behind them, and in some cases (such as in the case of the HCG diet) could do harm (read here about the potential harms of HCG).  

    The sad reality is that the voice of medical bloggers speaking out against these practices is diminutive in comparison with Dr Oz's capital backing and marketing power.

    Follow me on twitter! @drsuepedersen © 2013



    I am excited that you have arrived at my site, and I hope you are too - consider this the first step towards a Healthier New You!! As a medical doctor, Endocrinologist, and obesity specialist, I am absolutely passionate about helping people with weight management. Though there is certainly no magic cure for obesity, there IS a successful treatment plan out there for you - it is all about understanding the elements that contribute to your personal weight struggle, and then finding the treatment plan that suits your needs and your lifestyle. The way to finding your personal solution is to learn as much as you can about obesity: how our toxic environment has shaped us into an overweight society; the diversity of contributors to obesity; and what the treatment options out there are really all about. Knowledge Is Power!!

    Are you ready to change your life? Let's begin our journey together, towards a healthier, happier you!!

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