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Dr. Carl Reich M.D. "The Calcium Factor"
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  • Dr. Carl Reich M.D. "The Calcium Factor"   Celcius   7y  
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    Dr. Carl Reich M.D. "The Calcium Factor"
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    Date: 7/20/2007 6:43:21 PM   ( 7y ago )
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    The Calcium Factor

    Also read:

    Calcium & Weight Loss
    Calcium -What it is, what it does
    Calcium Against Syndrome X Diseases & More

    "Of course, all of these diseases may have many causes, but they also all have one thing in common - calcium deficiency." - Robert Heaney, M.D.

    In this section, we present some remarkable research about calcium and disease. This research demonstrates that the lack of calcium and magnesium (and vitamin K and sunshine) may contribute to a large number of illnesses. We will discuss the work of Dr. Lawrence Resnick, one of the most prominent modern researchers in the field. But let's start by looking at the work of a pioneer who developed an entire theory of disease based on calcium: Dr. Carl Reich, M.D.

    Probing the Mystery of Disease

    In the early 1950's, Dr. Carl Reich, during his post-graduate studies, began to suspect that a number of imba lances and diseases could be traced to deficiencies in certain vitamins and minerals, particularly calcium.

    In 1954, he began treating his patients with nutritional supplements. Patients with a variety of symptoms such as chronic asthma, constipation, leg cramps and sinusitis experienced rapid relief when treated with elevated calcium and vitamin D, as well as a full spectrum of basic nutrients.

    Encouraged, Reich began to treat more patients with his nutritional therapy. A whole host of symptoms such as indigestion, headaches, muscle pain, constipation and migraines were successfully treated with calcium and other nutrients. He also came to believe that a number of diseases as diverse as chronic arthritis, rheumatoid arthritis, ileitis and colitis, asthma, hypertension, heart spasms, diabetes, Alzheimer's disease, Parkinson's disease, Lou Gehrig's disease, and even cancer, were all in some way related to calcium deficiency.

    The connection, according to Reich, was in an individual's response to physical or emotional stress. When the body is under stress, the autonomic nervous system sends out various messages to internal organs; for example, the blood vessels can be stimulated to dilate or constrict, the heart can beat faster, and the digestive system can slow down. Reich reasoned that many diseases were due to an imba lanced stimulation of the internal organs by the nervous system. And the roots of this imba lanced response, he believed, were deficiencies in certain key nutrients, especially calcium and, secondarily, vitamin D.

    Individual response to stress is a complex topic. Some people take all kinds of stress in stride - even seem to thrive on it - while others react badly, often developing debilitating symptoms or, over the long term, serious diseases. Reich's theory may partly explain why people respond to stress so differently.

    Reich theorized that a lack of dietary calcium would lead to an over-constrictive response to stress in specific tissues. For example, an over-constrictive response in muscles surrounding blood vessels would lead to hypertension or migraines; constriction of muscles in the lungs would cause asthma. Reich believed angina was related to constriction of the coronary arteries, while ileitis and colitis meant there was a constriction of the gastrointestinal tract. Obviously, this is an oversimplification of complex physiology, but Dr. Reich's treatments became widely known, suggesting some validity of his approach.

    Dr. Reich's Special Advantage

    Dr. Reich had a special advantage over the scientific and medical communities: he got to test his theories with real people for many years. Regularly, he saw proof that calcium, magnesium and vitamin D were very often the key factors in disease.

    Reich also used substantial doses of vitamin D. Reasoning that mankind's consumption of calcium and other minerals, as well as exposure to the sun, has decreased with evolution. His treatment program also included the use of other vitamins and minerals.

    Reich perceived, and further research confirms, that the lack of vitamin D is one of the major nutritional deficiencies of our time. This deficiency, estimated at 40 to 50 percent of the U.S. population ( New England Journal of Medicine, 1998), dramatically compounds the already existing deficiency in calcium. Without vitamin D, calcium cannot be absorbed into the body or perform its tasks properly in the bloodstream. This deficiency, combined with a low calcium intake, contributes to a lot of very disturbing statistics: a very high osteoporosis rate, hip fracture rate, and a skyrocketing onset of Syndrome X diseases, as well as an increase in other disease patterns discussed by Dr. Reich.

    Calcium Takes Center Stage

    Building on the pioneering work of Dr. Reich, in 1999, in his published work The cellular ionic basis of hypertension and allied clinical conditions (Prog Cardiovasc Dis. 1999 Jul-Aug;42(1):1-22), Dr. Lawrence Resnick proposed a unifying hypothesis with calcium at center stage. His work goes back almost a decade, and is well represented in the medical literature and is often cited by his peers.

    Resnick's hypothesis states that when the level of calcium inside the cells becomes elevated, combined with a decrease in intracellular magnesium, cellular functioning is impaired and the cell is likely to become diseased. The hypothesis goes on to state that Syndrome X diseases are closely related to this impairment in cellular functioning.

    Simply stated, too much calcium inside the cells is a disaster in the making. Calcium is normally supposed to be at very low levels inside the cells: 10,000 times less than the levels of calcium in the fluid surrounding the cells. The body uses the difference between the concentration of calcium in the cell and the calcium in the bloodstream as a signaling mechanism among the cells. When the difference in concentration is correct, proper signaling between cells can occur.

    If the intracellular calcium level (calcium inside the cells) is too high, however, the signaling response is blunted. As a result, the cells can no longer regulate themselves, grow less responsive to stimuli, become calcified and begin the dying process. And this deterioration of the cells can lead to a host of serious diseases. Resnick L. The cellular ionic basis of hypertension and allied clinical conditions. Prog Cardiovasc Dis. 1999 Jul-Aug;42(1):1-22.

    Syndrome X

    These metabolic alterations of cellular calcium and magnesium alter and damage the function of the body tissues. In certain diseases, there is incontrovertible evidence that intracellular calcium is elevated and intracellular magnesium is deficient. These include Type II diabetes, hypertension, cardiac hypertrophy, insulin resistance, and hyperinsulinemia. These conditions represent the infamous "Syndrome X." Obesity is also considered one of the Syndrome X diseases. Researchers propose that adequate dietary calcium and magnesium, by preventing high levels of intracellular calcium, may be protective for a whole host of obesity related conditions.

    Dr. Resnick and other researchers, including the Zemel Group, have discovered that all the conditions in Syndrome X are characterized by an underlying impairment of intracellular calcium. In addition, they found that when excessive amounts of intracellular calcium were lowered, there was a clinical improvement in blood pressure, insulin resistance, platelet aggregation and left ventricular hypertrophy. Resnick L. The cellular ionic basis of hypertension and allied clinical conditions. Prog Cardiovasc Dis. 1999 Jul-Aug;42(1):1-22.

    What Causes the Syndrome X Diseases?

    The critical role of calcium in regulation of cellular actions needs to be ba lanced with magnesium. Magnesium provides the balancing and relaxation effects that offset the constrictive effect of calcium. Reduced intracellular magnesium leads to an excess of intracellular calcium and exaggerates calcium-induced stimulation. The elevated intracellular calcium sends out a message to "tighten up," and the message goes to the contractile apparatus of cells, causing them to constrict.

    As an example, these messages lead to alterations in the smooth muscles surrounding blood vessels. This in turn leads the blood vessels to constrict, causing restriction of blood flow. This can ultimately result in arterial stiffness and/or hypertension.

    In the heart, these mineral metabolic imbalances lead to overwork and exhaustion of the heart muscle, as the heart must work harder to pump the blood throughout the body. This is called "cardiac hypertrophy." In the blood platelets, whose function is to regulate the clotting of blood when necessary, these same metabolic imba lances lead to increased blood "stickiness" and the potential for deadly blood clots. The stickiness of blood also impedes circulation and reduces oxygen and nutrient availability to the cells all over the body.

    In larger, active muscle tissues, the calcium/magnesium imba lances can lead to insulin resistance, a common condition associated with diabetes. In the beta-cells of the pancreas, where insulin is produced, these mineral deficiency symptoms can lead to insulin abnormalities and diabetes.

    In other endocrine tissues, where hormones are generated, these same metabolic alterations can lead to associated hormone problems. In certain nerve cells that respond to stress, called sympathetic nerve cells, it can lead to stress diseases and increased nervous activity, as well as a hyper-responsiveness to stimuli and anxiety syndromes.

    Resnick's simple hypothesis explains how a broad range of diseases are associated at a fundamental cellular level, through imba lances of calcium and its companion nutrients.

    "All together, whichever aspect of hypertensive disease that was assessed, the higher the intracellular calcium, and the lower the intracellular magnesium, the more severe the clinical manifestation of each individual tissue abnormality measured; the level of blood pressure, cardiac mass (enlargement of the heart), arterial stiffness, abdominal visceral fat ("beer belly"), hyperinsulinemia, and even fasting and chronic average level of blood glucose." - Dr. Lawrence Resnick

    GLOSSARY OF TERMS

    Intracellular: inside the cell.

    Extracellular: outside the cell (in the fluid surrounding the cells).

    Type II Diabetes: The most common form of diabetes. In Type II diabetes, either the body does not produce enough insulin or the cells have become desensitized to insulin.

    Hypertension: Excessively high blood pressure, especially arterial blood pressure.

    Cardiac Hypertrophy: Overwork and exhaustion of the heart muscle.

    Insulin Resistance: When the body does not respond adequately to insulin (insulin is the blood Sugar hormone produced by the pancreas).

    Hyperinsulinemia: Too much insulin in the bloodstream.

    Blood Platelets: Also known as thrombocytes, are large cells found in the bone marrow. They are the key clotting mechanism for an injury.

    Platelet Aggregation: The tendency of blood platelets to form clots in the blood vessels. This can lead to blockage of the vessel resulting in stroke.

    Triglycerides: The chemical form in which most fat exists in food as well as in the body. They are also present in blood plasma.

    Resnick's Cellular Mineral Hypothesis Is Similar to Carl Reich's

    It is interesting to note the similarities between Dr. Resnick's mineral hypothesis of diseases with that of Dr. Carl Reich. It turns out that Reich died before Resnick published his research, but he had already figured out that calcium and magnesium deficiency was at center stage in a number illnesses, and he presented a hypothesis remarkably similar to Resnick's.

    Like Reich, Resnick also prescribed high doses of calcium and vitamin D, and used a full range of vitamins and minerals, including of course, magnesium, and told his patients to spend time in the sun.

    Cellular Overload

    What causes cells to become overloaded with calcium? A lack of dietary magnesium, vitamin D, vitamins K1 and K2 and calcium are only part of the answer. When there is insufficient calcium in the diet, the body responds by withdrawing calcium from the bones (bone resorption). The bones act as kind of a "bank" for calcium. At the time when Reich was doing his research, scientists believed that calcium deficiency could be fully and completely compensated by bone resorption, and that the bone-supplied calcium would fill all the needs of the body's metabolic machinery.

    Of course, without new deposits, the body cannot continue to withdraw from any bank without consequences: In this case, the consequence is osteoporosis. Reich however, believed that there were immediate medical effects of calcium deficiency that went far beyond the risk of osteoporosis. His theory was that when the body was forced to take calcium from the bones, the metabolic processes suffered. This conceptual leap was obvious to Reich because he saw his patients dramatically responding to calcium and vitamin D therapy (along with magnesium and other nutrients) on a daily basis. And the responses were immediate, as it often is with buffered vitamin C.

    These concepts are only now becoming more obvious to scientists and doctors. New research demonstrates that dietary calcium can protect against certain types of hypertension, colon cancer, the absorption of cadmium and lead and certain other toxic metals. In addition, of course, calcium can provide long-term protection against osteoporosis. Higher calcium and vitamin K1 and K2 also prevent calcium from being deposited in the wrong places such as soft tissues and joints (tissue calcification). Diseases in which calcification occurs include arthritis, rheumatism, sclerosis, periodontal disease, and Alzheimer's disease.

    The Calcium Paradox Appears to Explain Calcification

    Parathyroid hormone or PTH, is a hormone produced by the parathyroid gland. PTH works to maintain adequate blood levels of calcium at all times. Any decrease in blood calcium levels will stimulate the parathyroid gland to secrete PTH, which then removes calcium from the bones and delivers it to the blood to maintain critical levels. PTH thereby facilitates such critical metabolic functions as the activity of the heart and brain. However, PTH can be inefficient in its action and often floods the blood with too much calcium. Excess blood calcium is excreted by the body through the urine, and is also deposited into soft tissues, where it contributes to tissue damage.

    The "calcium paradox" refers to the observation that excess blood calcium via PTH, may lead to a number of unwanted health conditions such as calcification of joints, cartilage, and other tissues, bone spurs, plaque in the blood vessels, obesity, the Syndrome X diseases, colon cancer, gingivitis and even Alzheimer's disease - all of which can result from an overactive PTH mechanism.

    These conditions represent the body's maladaptive coping mechanisms that are activated by dietary calcium deficiency. It is our contention, as Resnick stated, and based on the research we quote here, that the diseases that result from this faulty bodily response can either be prevented or greatly reduced by simply maintaining a higher dietary intake of calcium, combined with the optimum amounts of vitamin D, magnesium and vitamin K.

    The Role of Calcium and Associated Nutrients in Disease Prevention

    If we add other related Syndrome X diseases, we will have covered an overwhelming percentage of the illness that occurs in the U.S. Obesity, of course contributes to many illnesses, including all the Syndrome X diseases, which are all related to each other. But obesity also relates to cancer, especially to hormone-sensitive cancers. Clearly, we are looking at a broad range of conditions which cause much of the morbidity and mortality in the U.S.

    IMPORTANT SAFETY CAUTION ABOUT CALCIUM & SODIUM INSENSITIVE HYPERTENSION

    Generally, all of the health conditions we have discussed, except for a certain rare type of high blood pressure called sodium insensitive (high rennin) high blood pressure, can probably be helped with calcium and magnesium therapy. In salt-sensitive hypertension, sodium is worsening the calcium entry into the cell and the elevated blood pressure may be reduced with supplemental calcium. However, in salt-insensitive hypertension, there are compensatory membrane phenomena that reverse this, and extra calcium may need to be restricted. Too much calcium can worsen this type of hypertension and cause a blood pressure crisis. If you have been diagnosed with hypertension, it is important that you consult with your doctor about supplemental calcium. (See Editor's Note citing the work of Hans.)

    Editor's Note on Calcium Supplementation

    Of all the ideological conflicts in nutritional medicine, one area where there is huge disagreement is whether to supplement with calcium or not.

    Leaders and opinion makers I respect have criticized supplementation of additional calcium despite increasing RDA's and dozens of studies showing benefits for osteoporosis prevention. Evidence exists that higher intakes of calcium minimize expression of such conditions as cancer of the colon and breast, and hypertension and obesity, all of which are multifactorial in causation and have a calcium deficiency component. The higher RDA's are a result of studies showing that higher levels are required to maintain calcium ba lance. J. Nutrition. 133: 249S-251S 2003

    If we go back to the very basic issues, calcium deficiency is firmly established, as summarized from Kelley's Textbook of Internal Medicine (Fourth Edition, Chapter 470, pg. 3111, 2000) as presented on page 8. We are a population deficient in calcium, as defined by federal based requirements. It is one of the most significant nutritional deficiencies that exist. Other paramount nutritional deficiencies that are talked about here include vitamin D, magnesium and vitamin K, especially vitamin K2. Since all of these nutrients work together to optimize calcium biochemistry, and since calcium is such a critical structural and regulatory molecule, functional problems associated with deficiencies are likely be much greater, as clinical effects are compounded by multiple deficiencies of these related nutrients. The odds are that most of us are deficient in one or more of these nutrients.

    Why do we need so much calcium when other cultures don't? There are some other cultures that exhibit much lower calcium consumption and lower osteoporosis? Our culture wastes calcium via high protein, high phosphorus and acidifying diets. These are big factors and cannot be overlooked. Jaffe R, Brown S. Acid-Alkaline ba lance and its effect on bone health. Intl J Integrative Med, 2001; 4 (6): 7-18.

    Also, our consumption of pasteurized milk, being our major food source of calcium, may exaggerate magnesium deficiency because the ratio of calcium to magnesium is so high at 9:1. As I will show, magnesium deficiency compromises some of calcium's function, so milk may be worsening both calcium and magnesium deficiency in some patients. There are also recent findings that suggest that milk may not be the best source of calcium for healthy bones, as seen in the Nurse's Study done at Harvard, although numerous other studies show benefit for bones.

    So why are leading orthomolecular doctors, who are opinion leaders, and internationally-known authoritative figures, anti-calcium or let's say, calcium antagonists? Because these doctors are concerned about calcium accumulation in the vascular system and in soft tissues over many years, and they blame dietary calcium. Also, these doctors are well aware of the vast magnesium deficiencies that exist and are afraid that supplemental calcium will compete with magnesium for absorption.

    I will quote from the very prestigious textbook Modern Nutrition in Health and Disease (9th Edition, edited by Maurice Shils, James Olson, Moshe Shike, Catherine Ross. 1999, Lippincott Williams & Wilkins). (All quoted text is italicized.)

    With advancing age, humans commonly accumulate calcium deposits in various damaged tissues, such as atherosclerotic plaques in arteries, healed granulomas, and other scars left by disease or injury, and often in the rib cartilages as well. These deposits are called dystrophic calcifications and rarely amount to more than a few grams of calcium. These deposits are not caused by dietary calcium, but by local injury, coupled with widespread tendency of proteins to bind to calcium.

    Our opinion is that higher dietary calcium, via the calcium paradox, and magnesium and other minerals such as boron, and especially vitamin K, will prevent much of the dystrophic calcification.

    Calcification, which usually occurs intracellularly in tissues other than bones and teeth is generally a sign of tissue damage, cell aging and cell death. As cells lose control of calcium regulation and are unable to maintain low intracellular calcium, cellular function must degenerate.

    It is worth explaining that calcium binds to a large number of cell proteins, which result in the activation of their function. By binding with oxygen atoms of glutamic acid and aspartic acid residues projecting from the peptide backbone, calcium stiffens the protein molecule and fixes its tertiary structure. Hence the cell keeps cytoplasmic concentration very low, and when it wants to activate these calcium-associated enzymes, it allows calcium to enter and uses calcium in a regulatory manner. When calcium generally "leaks" into cells it means the cells are sick and failing to regulate calcium and this will initiate a further loss of function of the cell.

    These calcium-associated proteins range from those involved in cell movement and muscle contraction to nerve transmission, glandular secretion, and even cell division. In most of these situations calcium acts as both a signal transmitter from the outside of the cell to the inside, and an activator of the functional proteins involved. In fact, ionized calcium is the most common signal transmitter in all of biology. It operates from bacterial cells all the way up to cells of highly specialized tissues in higher mammals.

    There is concern that high calcium intake would produce relative magnesium deficiency, and this has been observed in rats but not humans. Calcium intake does not affect magnesium retention in humans. However the reverse, hypocalcemia, can occur as a result of magnesium deficiency. (Summarized in Shils, et al., Modern Nutrition in Health and Disease, 1999.)

    Hypercalcemia refers to an elevation of calcium in blood and is generally reported wherein there is large consumption of calcium to raise the pH in peptic ulcer disease, but not for the normal diet. In Africa , the nomadic pastoral Masai tribe diet consists mostly of milk from the herds and flocks, and they consume 5000 mg of calcium per day or more, which is 5 or more times what the industrial population consumes. The Masai tribe are not known to have unusually high incidence of hypercalcemia or kidney stones. (Shils, et al., Modern Nutrition). They probably have another good source of magnesium.

    The theory presented by Heaney and others that prehistoric man consumed a lot of calcium is also presented in the Shils text and referenced to in Eaton's New England Journal of medicine article. (Eaton SB, Konner M. N. England J. Med. 1985:312 283-289) Therein it is stated that:

    Early man derived calcium from roots, tubers, nuts, and beans in quantities believed to exceed 1500 mg per day, and perhaps twice this amount when consuming food to meet the caloric demands of a hunter/gatherer of contemporary body size.

    Such a well-known text and nutritional source as Modern Nutrition presents generally accepted nutritional concepts which must be accepted by a wide range of experts. So their opinions represent a consensus of academic thinking. In these cases, the concepts generally agree with the citations from Dr. Westin Price's work, the Okinawa program by Willcox B, Willcox C, and Suzuki M., and the theoretical and research conclusions from a host of other researchers presented in this newsletter.

    The health benefits of pasteurized milk have become highly questioned due to significant research correlations with cardiovascular risk, prostate cancer, MS, bovine leukemia virus and more. The exact cause is still uncertain, but proteins altered by the heat of pasteurization and other potential causes are cited. Raw milk and yogurts are probably better choices. It is interesting to note that much of civilization grew up surrounded by flocks of goats and other milk-bearing animals. Such animals have fed hungry families for millennium, and our genetic constitution must have adjusted to some degree. (The Untold Story of Milk, Ron Schmid, N.D., 2003, NewTrends Publishing).

    Calcium critics should probably direct their concerns towards commercial milk and milk products rather than the calcium they contain.

    Responses to Common Criticisms of Calcium Supplementation:

    Criticism: None of the studies strongly support calcium supplements as contributing to weight loss. They do support dairy calcium, meaning calcium found in non-fat diary.

    Response: The original study was made when yogurt was added to the diet of hypertensive patients with no other dietary changes. On average, over 10 lbs was lost by participants in one year. These results lead to an interest in calcium and weight loss. Shortly afterwards, animal studies in which calcium was increased from .1% to 2% resulted in a reduced weight gain in both lean and overweight Zucker rats. Extensive biochemistry studies followed to delineate the mechanism involved. Both calcium from milk products and calcium salts were used (summarized in Calcium Intake and Reduction in Weight or Fat Mass, Mass J. Nutr. 33: 249S-251S 2003). In a two year study, mineral bone mass was tested. 54 women completed a two year trial. Calcium intakes were low, 781+- 212 mg per day, compared to dietary reference of 1000 mg per day. The primary calcium source was dietary calcium from dairy (67%). Dietary calcium ratio to energy (calories) negatively predicted changes in body weight and body fat, but not for lean mass. This means the more calcium, the less fat accumulated without reductions in protein levels. Dairy calcium predicted the changes as well as did non-dairy calcium; the research on fat storing enzymes and alterations in body temperature by calcium works independent of the source of calcium.

    Another very important point is that this relationship of lowered body weight to calcium intake occurs in low, but not high calorie diets.

    "Calcium intake did not predict changes in weight or fat mass in the group with calorie intakes above the mean. On the other hand calcium, but not calories, negatively predicted changes in weight and fat mass in calorie intakes below the mean."

    So you can't stuff yourself and expect calcium to protect you. This indicates that one should be moderate in food consumption in order to get calcium to work for your biochemistry.

    "Clearly if dairy products are added to a diet without compensation for energy intake, one is likely to gain weight."

    We would like to emphasize that this is not a magic bullet for immediate weight loss, but a long term solution which may generally aid patients to gain advantage over the slow weight gain that accompanies aging. Calcium could turn around that increase in girth, when consumed with a moderate diet, and even turn that to a slight weight loss, according to the researchers we cite.

    However, aggressive interventions as described on page 1 might be tried under medical supervision, and may produce dramatic results as the study cited, with a milk diet.

    Also, notable benefit may follow the use of a highly buffered form of calcium, magnesium and potassium formula in relationship to food cravings.

    Criticism: The low incidence of obesity in ancient people and underdeveloped countries is directly proportional to activity levels and lack of food or lack of refined food.

    Response: There are obviously many factors and exercise is certainly got to be a big one. The calcium effect is a statistical factor. We have tried to emphasize that by relying on some of the analysis in the abstracts. Not everyone will respond and this is a long term potential solution of potentially great magnitude. Also, one might appreciate OUR model that winter brings hibernation in hibernating animals. I suspect that we (humans) also have some of those hibernation characteristics. Perhaps because not enough vegetables and other rich sources of dietary calcium are being consumed, and less time is spent in the sun, humans may have retained the ability to conserve reserves by reducing fat burning, thereby conserving energy in the form of fat "for a sunny day" or for the spring and summer season. Just as the old adage goes, normally we save our resources "for a rainy day" and the body does the same by conserving fat and reducing fat burning when sunshine and calcium (a marker for vegetable consumption) are in short supply. There is data that vitamin D also has an inverse relationship to obesity. Hence, lack of vegetables (high in calcium) and sunshine would signal the body to go into a modified hibernation mode, slowing down metabolism for the winter season. So that's our hibernation theory.

    We have presented expert "textbook" opinions on the safety of calcium supplementation, along with the probable explanation of the calcium paradox and clinical benefits from higher levels. However, more needs to be said on safety.

    Certain medical conditions might be related to or worsened by increased dietary calcium, but this is not clear from the literature from what we have seen. It is plausible that in patients with renal failure there could be preferential mineralization in vascular tissue instead of bone. Kidney failure, as with other serious illness may require special consideration on a case by case basis. In other disease states, abnormal calcification of vessels and tissues as described in complex animal studies by Hans Selye ( Calciphylaxis, 1962, The University of Chicago Press) may occur, but again we think the weight of the evidence by far, suggests safety and benefit for RDA, and even somewhat higher levels for the general population.

    Since we have presented statistical findings, we cannot appropriately determine which patients will respond. It is likely that a portion will not respond and this may well be related to metabolic type. Since some significant groups may not respond, the data for those that do respond would thus be understated, because it would represent average numbers (per individual). Hence a more profound response might be expected from responders.


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