Licorice: The Good And The Bad

Licorice: The Good And The Bad

Almost everyone knows about licorice as a food and candy. What many people do not know, however, is that licorice is also a potent and valuable herbal medicine, widely used as a therapeutic agent.

According to Natural Medicines database, licorice (Glycyrrhiza glabra) can be used for the following conditions: “Orally, licorice is used for gastric and duodenal ulcers, sore throat, bronchitis, chronic gastritis, dyspepsia, colic, menopausal symptoms, Addison’s disease, cough, osteoarthritis, osteoporosis, systemic lupus erythematosus (SLE), and for bacterial and viral infections. It is also used orally for cholestatic liver disorders, nonalcoholic fatty liver disease, hyperkalemia, hypertonia, malaria, tuberculosis, abscesses, food poisoning, diabetes insipidus, chronic fatigue syndrome (CFS), postoperative recovery, contact dermatitis, and hypercholesterolemia.” And, in Traditional Chinese Medicine, licorice is included in nearly all herbal formulas for the purpose of “harmonizing” the various herbs incorporated in the mixture.

That’s the good news. The bad news is that any substance, herbal or otherwise, that exerts a therapeutic (or pharmacologic) action, will also exhibit the potential for adverse effects as well.

If you suffer from low blood pressure, a natural substance that increases blood pressure can be considered beneficial, but if you suffer from high blood pressure, that same natural substance’s hypertensive action can be considered an “adverse effect.”

Whole licorice, whether from food or in supplements, can theoretically raise blood pressure. It contains a substance called glycyrrhizin which, when taken in large enough quantities, exerts an action in the body similar to the hormone aldosterone. This hormone causes fluid retention, loss of potassium, and increased blood pressure.

How concerned should you be about this?

The answer, for most people, is less concerned than you might initially think. For one thing, much of the food or candy we buy it not really licorice at all–it contains anise oil, which imparts the characteristic smell and taste we call “black licorice.”

In addition, much of the licorice used in supplements has had the glycyrrhizin removed. This results in a product called “DGL,” which stands for deglycyrrhizinated licorice. Supplements containing DGL, for example, are widely used for treating gastric and duodenal ulcers.

Does that mean there are no products that contain “whole” licorice? No, not at all. Whole licorice is still used in various products. It may still be found, for example, in liquid cough and asthma remedies, functioning as an expectorant. As mentioned above, it is widely used in Chinese herbal remedies. And, licorice root is in the PhytoTech supplement, Mushroom Extract Complex.

The question, then, is how much whole licorice is too much?

Dosages of whole licorice in the range of 5 to 15 grams per day is generally thought to be acceptable for no more than a few weeks. For long-term use, about 0.3 grams (300 mg) of licorice root daily should be safe for most adults.

“Current evidence indicates that individuals who wish to take whole licorice on a long-term basis without any risk of these side effects should not consume more than 0.2 mg of glycyrrhizin per kilogram of body weight daily. For a person who weighs 130 pounds, this works out to 12 mg of glycyrrhizin daily. Based on a typical 4% glycyrrhizin content, this is the equivalent of 0.3 grams of licorice root.” (reference: For a person weighing 184 lbs, the safe amount of whole licorice, or licorice root, would be 427 mg.

It is understood that “small amounts” of licorice is not a problem for those with high blood pressure. The question, of course, is what does “small amount” mean. Based on the above calculation, we can say that for an adult, levels below 300 to 427 mg per day should not be a problem.

Another reference source, Natural Medicine, presents the following information: “. . . long-term use (months to years) or intake of large amounts (up to 20-30 grams) can increase the risk of adverse effects such as hypertension and hypokalemia. In people with hypertension, cardiovascular or kidney conditions, or a high salt intake, intake of as little as 5 grams [per] day can cause these problems.” They also point out that “. . . when used orally in amounts commonly found in foods. Licorice has Generally Recognized as Safe (GRAS) status in the US “ (Note: 5 grams is equal to 5,000 mg.)

How much is in PhytoTech Mushroom Extract Complex? The label states the content is 44 mg per serving of licorice root, and the recommended dose is 2-3 servings per day–well within the safe range.

It is noteworthy, by the way, to point out that the PhytoTech Mushroom Extract Complex label provides the actual quantitative information of all five herbal ingredients. Not all products provide this information, often presenting only qualitative listings, under the heading “proprietary blend.”

In summary, for those concerned about licorice and hypertension, small amount of whole licorice, or licorice root, even when used long term, should not be a problem. Small amounts can be defined as less than 500 mg per day. The amount in products such as PhytoTech Mushroom Extract Complex (44 mg, 2-3 times a day), is only one-tenth that level.

Additional References:

(1) comments from Dr. Alan Gaby, published in his book: Gaby, Alan R., M.D.. Nutritional Medicine (Second Edition). Alan R. Gaby, M.D., 04/2017

“. . . Compounds present in Glycyrrhiza glabra (licorice root) potentiate the effects of glucocorticoids and mineralocorticoids by slowing the rate of their catabolism.4–8 Thus, in non-adrenalectomized patients, glucocorticoid and mineralocorticoid activity can be increased by administering licorice root extracts. Prior to the introduction of synthetic steroids, licorice root was one of the standard treatments for Addison’s disease.9 Licorice root is also a viable alternative to cortisol in patients with mild hypoadrenalism.
I have seen about 15 patients with a clinical picture suggestive of mild hypoadrenalism in whom treatment with a licorice tincture led to improvements in symptoms such as fatigue, hypotension, and poor stress tolerance. The usual dosage was 2–6 drops twice a day of a 1:1 or 1:2 tincture, or 6–10 drops 2–3 times per day of a 1:3 tincture.
Potential adverse effects of licorice root include hypokalemia and hypertension. These side effects are extremely unlikely with the low doses I have used. Nevertheless, I advise patients taking licorice root to consume abundant amounts of fruits and vegetables (or to supplement with 200–300 mg/day of potassium) and to monitor their blood pressure. Patients taking glucocorticoids or mineralocorticoids should, in most cases, not take licorice root. The dosages of licorice I have used are unlikely to interact with dehydroepiandrosterone (DHEA), although a much larger dose of licorice (100 g/day for 9 weeks) was found to decrease serum DHEA-sulfate levels in healthy men but not in women.”

(2) Selected references from Natural Medicines database:

Mechanism of Action
“General: The applicable part of licorice is the root. Although licorice contains saponins, flavonoids, isoflavonoids, flavones, and chalcones, the main active constituent is considered to be glycyrrhizin, otherwise known as glycyrrhizic acid or glycyrrhizinic acid (59755, 59773, 59806, 59854, 59891). Glycyrrhizic acid content of licorice preparations is typically around 2-3 mg/gram (0.2% to 0.3% w/w), but can vary from 0.026-98 mg/gram (15598, 15600). . . .

“Anti-cancer effects: Licorice is used in combination with other herbs to treat prostate cancer. In human research, a combination product including licorice was used to reduce prostate specific antigen (PSA) levels (6286). Licorice may also be useful for other types of cancer. In an animal model, licorice extract inhibited colon cancer growth (59763). A mechanism of action is not clear. However, the metabolite glycyrrhetinic acid has been shown to reduce cellular adhesion and induce cell death in tumor cells in laboratory research (59804). Also, the licorice flavonoid glabridin has been shown to inhibit cellular migration, invasion, and angiogenesis in laboratory research (59813). . . .

“Immunomodulatory effects: In human research, consumption of a licorice herbal tincture stimulated immune cells, as quantified by CD69 expression on CD4 and CD8 T cells (32825). In animal research, an herbal product containing licorice increased the number of leukocytes in the spleen and liver and increased splenic natural killer toxicity. However, in this study, the product did not affect the production of inflammatory cytokines or other agents (59710). Furthermore, in laboratory research, the aglycone derivative of glycyrrhizin, beta-glycyrrhetinic acid, inhibited human complement activity (59904). . . .”

Natural Medicines, Somerville, MA 02144 USA

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Ginseng and Impotence

Ginseng, Yohimbe and other herbs for impotence and sexual function.

Question: Dear Mr. Goldberg, I have seen reports on the internet but wanted to consult an expert . . . Do you recommend Ginseng for impotence? If yes, is only panax ginseng recommended? If yes, how many milligrams do you recommend a day if I prefer caplets. Are the drops better? If so, how much do you recommend a day? . . .

Answer: Panax ginseng is indeed the type traditionally recommended for this purpose, although other forms of ginseng, especially American, are now being used as well. The choice of liquid or capsule is a personal one. Capsules can more easily be standardized, but liquids have the advantage of being self-sterilizing, readily bio-available, and potentially more potent due to the extraction process.

That said, dosage remains an inexact science due to lack of product to product standardization and controlled clinical trials. I suggest you avoid products that are claimed to be super potent at one extreme, and potentially weak (teas, “whole food” concentrates, etc) at the other extreme. Stick with reputable brands.

I can recommend the following:
Liquid: Willner Chemists Phyto-Tech Chinese Red Ginseng, Code 57023, 1 fl oz
Capsules: Nature’s Way, Korean Ginseng Extract Standardized, Code 29725, 60 Vcaps
Capsules: Solgar, Korean Ginseng Extract Standardized, Code 28297, 60 Vcaps

Now, the question, do I recommend ginseng for impotence? I think it is important, first, to get a medical evaluation of the problem, and try to identify any underlying causes. Ginseng is an adaptogenic herb, and the Panax form is known to be invigorating, anti-stress, increasing vitality and energy, etc. A full description is providfed in our Phyto-Tech Herbal Supplement Reference Guide, on page 34 in the Summer catalog. Thus, it’s benefit in treating impotence, even if indirect, is obvious. Whether or not ginseng, alone, will solve the problem, however, is problematic.

I think a more comprehensive approach is usually necessary. This starts with a good multivitamin multimineral supplement, such as Willvite.

There are many other supplements that have been shown to be of value relative to concerns about sexual function, libido, etc. Many companies have combination products designed specifically for this purpose:

The product Male Virility (Phyto-Tech Code 57731, 1 fl oz) is a good example. Phyto-Tech™ Male Virility contains Maca Root 97 mg, Epimedium Herb 75 mg, Fresh Wild Oat Seed 75 mg, Tribulus Seed 75 mg, Yohimbe Bark 50 mg, Saw Palmetto Berry 17 mg, American Ginseng Root 17 mg, Vitamin B12 60 mcg, L-Arginine 20 mg, Pine Park Extract 5 mg. More detail can be found on page 71 in the summer catalog.

On that same page, you will find information on a study titled “Fenugreek and Sexual Function.” This is an impressive study, and the use of fenugreek should definitely be considered for this condition. (Willner Chemists Phyto-Tech Fenugreek liquid extract, Code: 57081). “. . . doctors said this is the first published study of fenugreek seed extract and male hormone deficiency, and that fenugreek may help improve sexual function in aging men.” (For more information, read about it here:

Another herb to consider is Maca Root. “A native Peruvian herb, Maca’s traditional use for enhancing overall vigor and fertility has been confirmed by animal studies showing it promotes libido, sexual potency and energy.” Maca Root is available as a liquid extract, 1 fl oz (500 mg per 30 drops), Phyto-Tech Prod Code: 57076.

Another adaptogenic herb, ashwagandha, has been shown effective as well, and I suspect the mechanism could be very similar to that of ginseng. The new study reveals this herb boosts sexual desire and satisfaction in women as well as men.
In India, Ayurvedic doctors have long used ashwagandha to treat sexual dysfunction in men and women. In this study, 50 healthy, sexually active women age 21 to 50 who reported having sexual difficulties, took 300 mg of ashwagandha twice per day, or a placebo.

After eight weeks, compared to placebo, women taking ashwagandha reported greater improvement in physical and emotional measures including arousal, lubrication, orgasm, and satisfaction.

Discussing the findings, doctors said earlier studies had found ashwagandha helped improve sexual function in men, but that this is the first placebo controlled trial to demonstrate significant positive effects on sexual function in women. Ashwagandha is a calming agent; an “adaptogen,” doctors explained, that promotes body balance, particularly by increasing or decreasing key hormones to bring them to appropriate levels.
PhytoTech Ashwagandha Root 1:1.5 (1 fluid ounce, product code: 57008)

Finally, I will mention another herb well known for its effect on treating impotence. Yohimbe Bark. In the case of yohimbe, the problem is perhaps that it is too effective–preparations consisting of the active ingredient, yohimbine, is actually a drug. In response to a question from one of our customers about the yohimbe bark contained in Male Virility, I provided the following information:

“ . . . here is the answer to your question about the product, Male Virility and one of it’s ingredients, yohimbe bark.

“First, some important information. “Yohimbe” is the name of a plant (an evergreen tree). The bark of this tree contains, among other things, an indole alkaloid, “yohimbine.” Yohimbine, in its isolated, standardized form, is available as a drug, while yohimbe or yohime bark, is a plant or herbal supplement that contains a small amount of naturally occuring yohimbine.

It is important to note that almost all (if not all) clinical trials and/or reports of toxicity and side-effects are associated with “yohimbine,” not “yohimbe.”

“While this does not mean it is impossible for the very small amount of actual yohimbine present in the small amount of yohimbe bark present in Male Virility to exert pharmacological action, it is unlikely that this level will lead to noticeable side effects or drug interactions. More on this in a moment.

“The other factor to take into consideration is that in a product like Male Virility, yohimbe bark is only one ingredient among many and the effect of the product is dependent upon the synergistic effect of this combination of ingredients, not on one ingredient alone.

While some of what Consumer Reports presents in their annual anti-supplement issue is helpful and valid, they do the public a disservice by over emphasizing the supposed dangers of supplements. I think you realize that.

“Now, getting back to your concerns, you are correct to question whether or not a supplement that might contribute, either in a positive or negative way, to the same health conditions you are currently taking medication for (anti-depressants, hypertension, etc). You should ask your doctor and/or your pharmacist. To make sure you receive a meaninful reply, however, you should be careful to point out that you have taken the product in the past, with no noticeable side effects, and have no side effects now. You should point out that the product contains only a small amount of “yohimbe bark,” not “yohimbine.” Ideally, show the doctor the full label.

“Unfortunately, many doctors are unfamiliar with herbal therapies, and try to cover up their lack of knowledge with a knee-jerk rejection of such products. I hope you will not encounter that in this instance because yohimbine is a long-used, well studied and well recognized substance.”

Yohimbe Bark is available as a stand alone product in the Willner Chemists Phyto-Tech line (Code: 57009) I am going to provide a copy of the monograph for your reference:

Yohimbe Bark 1:3
Yohimbe Bark is a well known treatment form male impotence and is traditionally used as an aphrodisiac.
Who might benefit from this herbal supplement? Those men suffering from impotence and inability to perform.
Yohimbe is for impotence in men. It increases blood flow into the penis and can help sustain an erection. It can help men who cannot get an erection and for those who cannot maintain an erection. Constant use of Yohimbe, however, can create irritability and aggravate the prostate. Try to not use it more than a few days in a row. It is possible to have success if used the day results are desired. If the impotence is not a vascular problem, Yohimbe will not work. If stress is a related issue, add Kava Kava Root.
Phyto-Tech™ Yohimbe Bark 1:3 is a tincture of Yohimbe Bark (Pausinystalia yohimbe), in pure grain alcohol and deionized water. It provided 333 mg/ml (30 drops).
More potent preparations, typically containing higher, standardized levels of the alkaloid yohimbine, are available, but these products are best used only under the supervision of a physician. High doses of the yohimbine alkaloid can cause potentially dangerous side effects.
Yohimbe bark (not yohimbine alkaloid) has a long history of use for many conditions.
The following dosage for Phyto-Tech™ Yohimbe Bark 1:3 is recommended: For chronic impotence, take 15-30 drops 2-3 times daily, or as needed, in juice or water. For more immediate results, take 20-40 drops, once or twice, only, within a day’s time.
Cautions: Use caution if you have high blood pressure; do not use if you have chronic inflammation of reproductive organs or prostate; do not use long term; may potentiate pharmaceutical MAO-inhibitors;
1 fl oz, Prod Code: 57009

Don Goldberg

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Synthetic vs Natural Vitamins

Synthetic vs Natural Vitamins

I received this email recently:

“I hope this email finds you well. I am a writer for the website . . . and we are currently working on an article regarding synthetic versus natural vitamins. I found your research, “The Best Supplements for your Health” extremely helpful on the topic. . . I was hoping to speak with you regarding the process of synthesizing vitamins. There is a lot of research on there that suggests most companies create synthetic vitamins from ground mineral rocks or limestone, given the accessibility and cheap nature of the rock. Is this how all synthetic vitamins are made or just certain cheap, “over the counter” options that are mass produced (like Centrum)? When you recommend vitamins to your clients, are there specific brands you rely on? I am finding it hard to locate the specific steps taken in the lab by most pharmaceutical companies that process vitamins. Given the lack of regulation by the FDA, I am finding it hard to be pointed in the right direction without the help of a doctor.”

The writer was kind enough to send me a draft of their article, and, overall, I thought it was fine. But some of the questions in the above inquiry worried me. I felt those points needed clarification.

(1) “There is a lot of research on there that suggests most companies create synthetic vitamins from ground mineral rocks or limestone, given the accessibility and cheap nature of the rock.” To the contrary, there is no research suggesting this. Instead, there are companies using this as a marketing pitch attempting to promote their type of mineral supplement (usually calcium) over others. So the first thing to note is that this is not “research.” The second thing to note is that this has nothing to do with vitamins–it is directed only towards mineral supplements (calcium, magnesium, etc). Third, it has nothing to do with the “cost” of rock. If anything, it has to do with potency (and not the way you might think–more on this in a moment). Fourth, it has nothing to do with “synthetic versus natural,” as what could be more “natural” than Mother Nature’s own rock (limestone)?

Before we delve into the greater questions of how vitamins are synthesized, FDA regulation, and recommendations, I think it will help to elaborate on this first question. We will use calcium as an example

Calcium is an essential nutrient, and is present in various foods. Most of us fail to get sufficient calcium from the unfortified foods in our diet, however. Many of us avoid calcium-rich foods such as dairy products due to lactose intolerance and/or milk protein allergies. So we rely on calcium containing nutritional supplements. One problem with calcium supplementation, however, is that the amount needed, compared to most other nutrients, is large–from 800 to 1200 mg. How do we fit that much calcium into a tablet or capsule?

You have to understand, first, that calcium is not available in pure form–it has to be obtained as a compound associated with other substances. The more room the other substance occupies, the less room you have for calcium. The goal, therefore, is to find a calcium containing compound that contains the highest proportion of calcium so that you can take as small a number of tablets as possible.

The best solution is calcium in the form of calcium carbonate. This form of calcium provides 40% calcium by weight. This means that you need 2,000 mg of calcium carbonate to get 800 mg of calcium. This can be obtained from two tablets! What’s important at this point is that you understand that all other forms of calcium–calcium citrate, chelated calcium, “food grown” calcium, etc–contain less calcium. Often, the chelated or “food” forms have, at best, around 10% calcium. That means you would need 8,000 mg of chelated calcium rather than 2,000 mg of calcium carbonate. This translates to a significantly greater number of tablets to obtain the same amount of calcium.

For many people, the idea of taking 8 tablets rather than 2 tablets is a deal breaker.

There must be a trade-off, you say. And you are correct. Here it is: the high potency calcium carbonate (limestone, oyster shell, etc) form of calcium will only be properly broken down and absorbed in the presence of gastric hydrochloric acid. This means you have to take the supplement with meals. If you can do this, this form of calcium is just as good, if not better (fewer tablets, lower cost, highly stable, etc) than other forms.

If you do not want to worry about this, then you want to use another form of calcium. I usually recommend calcium citrate. Chelated or “food grown” calcium is fine also, with two exceptions–they may be more expensive, and, for various marketing purposes, an attempt often made to imply that, in some way, the calcium has been imbued with some type of super-powers, or increased potency, due to the “growth” process. As you will see in the next section of this discussion, calcium is calcium. Period.

(2) Regarding “synthetic versus natural vitamins” and “the process of synthesizing vitamins.” Since, with a few exceptions, there is no difference between “synthetic” and “natural” vitamins, and the supposed “made from cheap rocks” premise is inaccurate, it follows that the processes involved the synthesizing various vitamins (and minerals) is inconsequential and irrelevant.

(See appendix for additional discussion on this topic)

It’s irrelevant because from a molecular, chemical and therefor biological standpoint, there is no difference between a synthetic and natural vitamin. (I will mention the exceptions in a moment). If you stop and think about it, you will easily understand why. From a chemical standpoint, once the molecular structure has been determined, all substances that conform to that structure will have the same function. Ascorbic acid is ascorbic acid. The only difference, depending on the purity, might be the trace impurities that could be present.

Another way to look at this is that all vitamins and essential minerals have that designation because they are essential to life and must be obtained from outside sources. We cannot make vitamin C by ourselves; we have to obtain it from food (or supplements). What happens if we fail to obtain adequate levels of any particular vitamin? We develop a “deficiency disease.” Rickets, Beriberi, Pellagra, Scurvy to name a few. One of the best known is scurvy, resulting from a vitamin C deficiency. The fact is that you can cure scurvy equally well with food rich in vitamin C as well as “synthetic,” pure vitamin C in supplement form. What better proof can we ask for?

As we said in our book, “With a few exceptions-such as vitamin E, natural beta-carotene, and vitamin B12-all of the vitamins used in dietary supplements are synthetic.” Why are there exceptions? The answer lies in the fact that substances like vitamin E do not actually have only one molecular structure–they exist in nature as a mixture of isomers, and each isomer can have a slightly different action–tocopherols differ from tocotrienols, for example. So we suggest looking for vitamin supplements that specify natural vitamin E (d-alpha-tocopherol, or mixed tocopherols, natural beta carotene, etc).

Mixing synthetic vitamins with food concentrates, yeast cultures and other “grown” substances may be nice in the sense that you have the benefit of other healthy nutrients and accessory food factors in the mixture, but be cautious when this is accompanied by claims that the process in some ways alters the inherent potency or activity of the vitamin itself. This is often done, because when you include a significant amount of food concentrates in the tablet, the actual quantity of the vitamins must decrease.

So the choice is yours–either low vitamin/mineral potency, with the benefit of added food concentrates and extracts, or high vitamin/mineral potency, without the extract food concentrates. You can’t have it both ways.

For therapeutic purposes, the high potency is often more important. You can always supplement with a “green drink” smoothie, or something similar if you are not able to get your other food factors from a healthy diet.

As far as finding the methods used to synthesize vitamins, I used to use a book titled “The Merck Index.” I assume it is still available.

(3) “Given the lack of regulation by the FDA.” Oh, do I hate to see this statement. Please, please stop repeating this inane, incorrect and misleading statement. The correct statement, when appropriate, is that dietary supplements are not regulated by the FDA the same way drugs are regulated. Which is only to be expected, as you can make therapeutic claims for drugs, and you cannot make therapeutic claims for food supplements. The agency is not called The Food and Drug Administration without good reason. Regulations are in place to adequately regulate the purity, potency, safety etc of food supplements. Check the reference articles in the reference library section for more information, or go to

Don Goldberg, R.Ph.
March 2016


Many years ago, when food allergies was gaining recognition as the cause for most of what ails mankind, a “hypoallergenic” vitamin C product was heavily marketed to alternative physicians. It was claimed to be made from a non-corn derived source of vitamin C.

Corn? Is vitamin C made from corn? And, if so, would that mean that people who are allergic to corn should be concerned about this?

Well, as it turns out, in the process of synthesizing vitamin c (ascorbic acid), one of the initial “building blocks” of the ascorbic acid molecule is glucose. Where did they get the glucose? From corn syrup. So corn syrup was one of the starting materials, and after a number of chemical reactions, separations and purifications, they ended up with pure ascorbic acid, or vitamin C. A pure, white crystalline powder.

Was there any corn in that pure vitamin C. Hard to believe. And, when someone is allergic to corn (or anything else for that matter), they are allergic to the protein, not the carbohydrate, fat, ash, etc in the offending material. Was there any corn protein (from the corn syrup starting material) left in the final, purified, white crystalline ascorbic acid? Hard to believe.

But they sold a lot of non-corn ascorbic acid.

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Risk of Dying?

I don’t get it.

I just read a report from Reuters Health (October 1, 2015) titled “For seniors, hearing trouble linked to greater risk of death.”

It seems a study in the journal, JAMA Otolaryngology–Head and Neck Surgery, concluded that “Older adults with hearing impairment may have a higher risk of dying than people with normal hearing.”

They “looked at data on 1,666 adults from a nationally representative survey conducted in 2005-2006 and 2009-2010, as well as death records through the end of 2011.”

“The people included in the analysis were all over age 70 and had undergone hearing testing. Using World Health Organization criteria to define hearing impairment, and accounting for individuals’ age, the researchers found that people with moderate or severe hearing impairment had a 54 percent greater risk of dying than those with normal hearing. Mild hearing impairment was linked to a 27 percent increased risk.”

Even after adjusting for various health variables, “the study team found that people with moderately or severely impaired hearing had a 39 percent higher risk of death than those without hearing problems, and those with mild hearing impairment had a 21 percent greater risk.”

Sorry, but I don’t get it. I would have thought that all of these people, regardless of their hearing problems, would have a 100% risk of dying.

Don Goldberg

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Can Diet, and Dietary Supplements, Delay Onset of Dementia and Alzheimer’s Disease?

Can Diet, and Dietary Supplements, Delay Onset of Dementia and Alzheimer’s Disease? New Research says Yes!

Alzheimer’s disease is now the sixth leading cause of death in the United States. There are few things worse than watching a loved one suffer from this condition. In turn, Alzheimer’s disease accounts for 60% to 80% of all dementia cases. “Therefore,” according to Martha Clare Morris, Rush University Medical Center, Chicago, “prevention of cognitive decline, the defining feature of dementia, is now more important than ever. Delaying dementia’s onset by just 5 years can reduce the cost and prevalence by nearly half.”

Surprisingly, Dr. Morris and her colleagues found that modifying the diet may significantly slow cognitive decline among aging adults, even when the person is not at risk of developing Alzheimer’s disease. This finding, published online in the journal Alzheimer’s & Dementia, is in addition to a previous study by the same research team that found that this diet modification may reduce a person’s risk in developing Alzheimer’s disease.

In fact, the recent study shows that older adults who followed the “MIND” diet more rigorously showed an equivalent of being 7.5 years younger cognitively than those who followed the diet least.

This is pretty impressive. Researchers are spending millions and millions of dollars looking for drugs that will combat Alzheimer’s disease, and it turns out that modifications to our diet could be more effective than any drugs we have come up with so far?

So what is this miraculous diet? They call it the “MIND” diet. It’s a hybrid of the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets. Both diets, by the way, have been found to also reduce the risk of cardiovascular conditions, like hypertension, myocardial infarctions, and stroke.

The MIND diet has 15 dietary components, including 10 “brain-healthy food groups” and 5 unhealthy groups: red meat, butter and stick margarine, cheese, pastries and sweets, and fried or fast food. Not that surprising so far, is it? I think most of us already know that saturated fat, hydrogenated oils, and sugar-laden foods are considered unhealthy. So these “5 unhealthy groups” does not seem unexpected.

What are the 10 “brain-healthy” food groups? To benefit from the MIND diet, a person would need to eat at least 3 servings of whole grains, a green leafy vegetable and one other vegetable every day — along with a glass of wine — snack most days on nuts, have beans every other day or so, eat poultry and berries at least twice a week and fish at least once a week.

In addition, the study found that to have a real shot at avoiding the devastating effects of cognitive decline, he or she must not only eat the good foods, but also limit intake of the designated unhealthy foods, especially butter, sweets and pastries, whole fat cheese, and fried or fast food.

The one thing I did find surprising is that berries are the only fruit specifically to be included in the MIND diet. They specified blueberries, saying that they are “one of the more potent foods in protecting the brain.” But they acknowledge, based on earlier research, that strawberries would be expected to work well also. I would think all highly colored berries would prove beneficial.

While this is encouraging, what is troubling is the fact that just a short time ago, another study was published showing that few adults in the U.S. eat enough fruit and vegetables to meet government recommendations. Overall, less than 15% of adults eat enough fruit dailty to meet the guidelines, and even fewer adults eat enough vegetables.

These results were reported in a study by the National Center for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control and Prevention (July 10, 2015).

Could this lack of adequate intake of fruits and vegetables be related to the increased incidence of Alzheimer’s disease and dementia? More important, is this new research showing the connection between fruit and vegetable intake with Alzheimer’s prevention going to provide enough motivation for people to modify their diet? Sadly, I doubt it. So what are we to do?

The ideal solution, without question, is to eat more fruit and vegetables, while cutting back on saturated fats and sweets. For those who cannot, or will not, do this, there are a variety of nutritional supplements that provide a healthy alternate. Here are some examples.

Phyto-Antioxidant Extracts

These products contain isolated or concentrated extracts of plants, vegetables and fruits that can be taken in supplement form. They provide many of the active flavonoid antioxidants normally contained in those plant sources, but in high potency form.

Antiox Phyto Complex II
(Willner Chemists, No. 63745, 90 Veggie Caps)
Some of the most powerful, broad-spectrum antioxidants are those found in plants. This supplement contains a blend of several of the most potent plant-derived phyto-antioxidants available, in a high potency, professional strength veggi cap.
Phyto-Tech™ Antiox Phyto Complex II Capsules contains 375 mg of the following: Acai Berry Concentrate, Mangosteen Fruit Extract, Goji Berry, Pomegranate, Green Tea Leaf Extract, Grape Skin Extract, Grape Seed Extract.

Antiox Phyto Blend
(Willner Chemists, No. 57551, 1 fluid ounce)
Some of the most powerful, broad-spectrum antioxidants are those found in plants. This supplement contains a blend of several of the most potent plant-derived phyto-antioxidants available, in a convenient liquid extract.
Phyto-Tech™ Antiox Phyto Blend contains the following: Acai Berry 4:1, Mangosteen Extract, Goji Berry Extract, Pomegranate 40%, Glycerin Vegetable, Water Pure Deionized, Raspberry Flavor Natural.
This convenient liquid concentrate can be added to almost any beverage, even cocktails.

Food Based Multivitamin Supplements

Many companies provide “whole food” or “food based” multivitamin supplements. These products supply not only pure vitamins and minerals, but also associated food factors and food concentrates rich in phyto nutrients and phyto antioxidants. Here are some examples:

Whole Earth & Sea (Natural Factors)
Men’s Multivitamin & Mineral (No. 64965, 60 tablets)
Men’s 50+ Multivitamin & Mineral (No. 64967, 60 tablets)
Women’s Multivitamin & Mineral (No. 64964, 60 tablets
Women’s 50+ Multivitamin & Mineral (No. 64966, 60 tablets)
Bone Structure Multivitamin & Mineral (No. 65117, 60 tablets)

DaVinci Labs
Spectra Infinite (No. 56734)

Earth Source Multi (No. 13411, 180 tablets)

Garden of Life
Mens Multi Organic Kind (No. 64563, 120 tablets)
Womens Multi Organic Kind (No. 64567, 120 tablets)

Food Concentrate Powders

Lastly, there are supplements that consist of mixtures of dehydrated, concentrated vegetables and fruits. These products are perhaps the closest to a replacement for the lack of dietary fruits, vegetables and other healthy foods. They can serve as stand-alone meal replacements, perhaps along with a regular multivitamin supplements, or as a supplement to what may be a less than optimal diet.

DaVinci Labs
Spectra Reds (No. 45587, 11.4 ounces powder)
Spectra Purples (No. 51484, 11.6 ounces powder)
Spectra Oranges (No. 52730, 10.6 ounces powder)
Spectra Greens (No. 42432, 12.6 ounces powder)

The above products are only examples of the various categories of supplements. You are welcome to discuss your options with the pharmacists and nutritionists as Willner Chemists for additional recommendations.

Don Goldberg, R.Ph.

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What’s wrong with you people? Why aren’t you eating your fruits and vegetables?

What’s wrong with you people? Why aren’t you eating your fruits and vegetables?

We are told, over and over again, that there is no need for multivitamin supplements–it’s a waste of money, a scam, nothing but “expensive urine, a nefarious hoax foisted upon a gullible public by snake oil selling ne’er do wells! Why? Because all you need to do is eat a well balanced diet. What could be more simple, more easy?

This anti-supplement mantra surfaces every time there is talk about multivitamin supplements. Ignored is the fact that study after study, survey after survey, government or private, shows that people do not do it! They just don’t.

The most recent evidence of this is provided by the Centers for Disease Control and Prevention (CDC). “Fruit and vegetable intake has been persistently low for years but we just recently developed a way to look at how each state is doing” in terms of meeting recommendations, said lead author Latetia V. Moore of the National Center for Chronic Disease Prevention and Health Promotion at the CDC.

They report that less than 15 percent of adults in the U.S. eat enough fruit daily to meet federal recommendations. The number for vegetables is even lower. Please note that we are talking big time low, 15 percent and lower–that is heavy duty low!

On average, in 2013, half of the respondents actually consumed fruit less than once daily, and vegetables less than 1.7 times daily. Bear in mind that during this time, nutritionists have been emphasizing how important fruits and vegetables are to our overall health and well being. “Fruits and vegetables are major contributors of important nutrients that are typically lacking from Americans’ diets and they can protect against many leading causes of illness and death like heart disease, stroke and some cancers,” Moore said. “Eating fruits and vegetables in place of foods that are high in calories, added sugars, and solid fat can also help with weight management.”

Yes, we need to continue to encourage people to increase their intake of fruits and vegetables. But at the same time, we need to face up to certain realities. The fact is, for whatever reason, eating well is not easy. Recognizing this, we should be encouraging people to take a daily multivitamin multimineral supplement, not discouraging them. In fact, a phyto-nutrient rich antioxidant supplement, to further compensate for the lack of fruits and vegetables, should probably be a part of the daily regimen as well.

There is no need for dieticians to fear that people will interpret this to mean they can “substitute” a vitamin supplement in place of a healthy diet! People, obviously, are already not choosing a healthy diet. So what is there to fear. Focus, instead, on doing whatever is necessary to improve their nutrient levels–even if it means endorsing the use of vitamin supplements.

Don Goldberg, R.Ph.

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Did we loose our way while shopping for vitamins?

Sometimes, I wonder . . .

Do we sometimes loose site of what really matters? Do we let ourselves get so caught up in marketing hype that we forget to question, to apply basic common sense before falling in step with the crowd?
I wonder about this, for example, when I observe the effect of current marketing efforts on nutritional supplement trends.
For example. We all understand and appreciate the importance of essential vitamins and minerals. We know they cannot be made within our body–that they have to be obtained from foods.
We also understand that it is necessary for foods to be broken down so that these essential nutrients can be made available to the body. We call this digestion. It starts in the mouth, with chewing, and the action of numerous digestive enzymes and pH changes throughout our digestive tract. Different vitamins and minerals are absorbed in different ways. Some are passive and some are active (vitamin B12 and “intrinsic factor, for example). In each case, our body has developed it’s own complex mechanisms to free up the vitamins and minerals from food.
In fact, we have learned over time that there are other measures we can take to enhance the bioavailability of nutrients from food. Cooking, for example, can increase the digestibility of our food. Other techniques, such as fermentation, are effective as well.
In recognition of the importance of freeing up these essential nutrients from their food matrix, we attempt to enhance the digestive process by ingesting exogenous digestive enzymes in supplement form. These supplemental enzymes further assist in the breakdown of food, increasing the availability of proteins, fats and carbohydrate as well as freeing up the micronutrients for enhanced absorption.
Science has revealed the actual identity of many of these essential nutrients–the vitamins and minerals we need so badly. We know their molecular structure. And that’s not all–we can obtain these nutrients in pure form. Isn’t it wonderful? We can now prevent scurvy not only by eating oranges, but also by taking pure vitamin C tablets! We can prevent beriberi, pellagra, rickets, anemia etc by taking pure vitamins as an alternative to various foods.
In fact, studies on certain nutrients have shown that the pure nutrient is sometimes better absorbed than the same nutrient from food. Folic Acid is a well known example of this.
What I wonder about, then, is why we ignore this, and shun supplements that contain pure nutrients? Why do we embrace, instead, supplements that contain vitamins and minerals supposedly bound to food. Why do we take pure, isolated vitamins and minerals that are potent and ready to be used by the body and take a step backwards, mixing them with various food substances?
Perhaps it has something to do with the concept of “natural?’
Natural is good. Synthetic is bad. That is the mantra. The distinction between natural and synthetic, when it comes to vitamins, however, is very blurred. The processes involved in deriving “natural” vitamins, in meaningfully high potencies, seems to me to be little different from those employed in the “synthesis” of many of the same pure vitamins.
In fact, I suggest that perhaps the word “pure” is much more meaningful in this regard than the word “synthetic.” (. . . or “USP.”)
This is not to say that “food” complexed vitamin supplements are not of value. There are many additional co-factors that occur in nature alongside the vitamins and minerals. It makes sense that these co-factors may exert synergistic actions, and have biological activity of their own.
As is usually the case, however, there is a tradeoff. The more room taken up by the food, the less room there is for the actual vitamins and minerals.
So I have to wonder. Why take pure vitamins and minerals and make them less pure? Why take a high potency, highly bioavailable, economically priced vitamin mineral supplement and dilute it with food?
Food is good. And I recommend taking your vitamin/mineral supplements with meals. That way, you get your vitamins and your food.
Don Goldberg


“Folic acid absorption appears to be enhanced by gastric hydrochloric acid.1 However, achlorhydric individuals were found not to have low serum folate levels (even though folic acid absorption was reduced),2 apparently because achlorhydria leads to small-intestinal overgrowth of bacteria that synthesize folate.3
“The bioavailability of folic acid, when administered at usual doses, is close to 100%. At a dose of 5 mg, 93% was absorbed by healthy volunteers,4 and at a dose of 1,000 mg/day at least 10% was absorbed.5 The absorption of poly-glutamate forms of folate (the forms present in food) is less than that of synthetic folic acid,6 perhaps in the range of one-third to one-half.7,8 In developing recommendations for folate intake, the absorption of food-derived folate has been estimated to be half that of folic acid.”

Gaby, Alan R., MD. Nutritional Medicine. Alan R. Gaby, M.D., 01/2011. VitalBook file.
The citation provided is a guideline. Please check each citation for accuracy before use.

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Where have you been?

I’m still here. I’ve been busy trying to transition from the radio show, which we ended after over eighteen years, into web based “social media.” The problem is that I’ve never understood the appeal of “social media,” never been comfortable with it, and find it difficult to utilize. I thought the best approach would be to use an e-newsletter approach, as we have accumulated a large number of emails over the years, but that has not worked out. I set up a facebook page (willner.chemists.ny) and I started to “tweet.” Actually, I find Twitter to be the most promising, as it combines some of the benefits of the e-newsletter concept without many of the headaches. So I urge you to “follow” me on Twitter. The Twitter address is @willnerchemists.

Here are links to some of the articles I have recently written for Twitter:

Fructose and High Fructose Corn Syrup: Toxic or Tortured Logic?
I’ve always been somewhat uneasy about the recent demonization of fructose and high fructose corn syrup. Fructose occurs naturally in fruit, and is one-half of the sucrose (sugar) molecule. I certainly do not encourage or condone the over indulgence of refined sugar and/or high sugar foods. Calorie-dense and nutrient-poor foods, whether the empty calories are from unhealthy fats (saturated, hydrogenated, trans, etc) or refined carbohydrates, is what we should worry about . . . Read More!

Are you minding your PQQ’s? Maybe you should be!
PQQ (pyrroloquinoline quinone) is an exciting “new” micronutrient that you will be hearing a lot about in the future. Similar to CoQ10, PQQ affects mitochondrial function. The mitochondria are the parts of cell that generate energy. They are often called the “cellular power plants.” They are involved in other critical cellular functions as well, including cell growth. Recent interest has focused on energy, cardiac function, aging, longevity and mental health. . . Read More!

Restless Leg Syndrome and Nutritional Supplements
Restless legs syndrome is defined as “a neurological disorder characterized by a periodic need to move the legs in order to relieve an unpleasant or uncomfortable sensation in the legs. . . What causes this problem? . . . Read More.

Don Goldberg

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What would be the best multivitamin for me?

“I haven’t taken vitamins since my last pregnancy in 1994. I am a 53 year old woman in good health. The only medication I take Is synthroid for hypothyroidism. What would be the best multivitamin for me? And what other supplements do you recommend? I recently started listening to your radio show. I love it but I am not sure where to start? Thanks in advance for your help.”

I haven’t taken vitamins since my last pregnancy in 1994. I am a 53 year old woman in good health. The only medication I take Is synthroid for hypothyroidism. What would be the best multivitamin for me? And what other supplements do you recommend? I recently started listening to your radio show. I love it but I am not sure where to start? Thanks in advance for your help.

Yes, the number of choices can be overwhelming. But let’s see if we can simplify it for you and others who may share your concern. We will start by pointing out that you are in “good health” except for the hypothyroidism.

I will also point out that when it comes to the choice of your basic multivitamin, multi mineral and possible other “base” supplements, the choices are often the same, regardless of whether or not you have other health problems. The reason for this is that my approach is to establish a “nucleus” or base supplement regimen, and then add to it, as necessary, to address any specific health problems you may have. No health problems? No additional supplements necessary.

In your case, due to your age, you do not need a high level of iron in your supplement. So I would look for a product that contains no more than the recommended daily value (18 mg) at most.

I will also make the assumption that your reason for taking a multi is along the lines of “insure adequate or optimal intake of all the essential nutrients.” You want to grow old, and you want to remain relatively healthy while doing so.

And, finally, I have to assume that your diet is “average.” Good but not great. If you are a vegetarian, don’t eat dairy, eat a lot of dairy and red meat, never eat vegetables and fruit, etc, your needs will be different.

So we arrive at the following conclusion. You need a basic, balanced multivitamin supplement. You need supplemental calcium and magnesium and, perhaps, extra vitamin D. You will probably benefit from two additional supplements: an omega-3 fish oil supplement, and a phyto antioxidant blend.

The most difficult choice is the first one, the multivitamin. The reason for this is that there are many options: form, dose, green, all-in-one. Let’s look at each option.

Form. You can get multivitamins in capsule, tablets, powder and liquids. If you cannot swallow tablet and capsules, you might prefer the convenience of powders and liquids. With powders and liquids, however, you have greater stability concerns, flavor (taste) considerations, and liquids are usually lower potency. Some people find it easier to swallow a capsule than a tablet, but tablets are usually less expensive and contain the highest dose. The same daily dose, for example, that you get in six capsules will fit into four tablets. You will see a variety of other marketing claims touting one form over another, but a properly formulated, properly manufactured tablet will work just fine.

Dose. You can get a one-a-day multi. You can get two-a-day, three-a-day, four-a-day, and even six-a-day multivitamin supplements. What is the difference? One obvious difference is that the more you take, the greater the amount (and perhaps variety) of nutrients you will get. It is easy to fit all of the vitamins and trace minerals into one or two tablets or capsules. But calcium and magnesium are required in higher quantities, and these will not fit into a one or two per day multi. I will discuss this further in a moment, under the “all-in-one” heading. The one thing I strongly urge you not to do is choose a one-per-day multi. Here is the reason. Most of the vitamins and trace minerals in a one-per-day multi are water soluble. They will be absorbed relatively easily and quickly and reach peak blood levels within an hour or so. Then, they begin to be excreted, and whatever does not get absorbed into the tissues during that time finds its way into the toilet bowl. In other words, after half the day, you no longer are getting any benefit from the multi. If you divide your daily dose into at least a twice per day dosages, you are now getting roughly double the benefit! I suggest a minimum of two-per-day, one with breakfast and one with dinner.

Green. Many multivitamin supplements are now being marketed as “food grown,” “food based,” and similar terms. This is nice. Nothing beats food as a source of your essential vitamins and minerals, and including as much food concentrate in the multi as possible is no doubt a good thing. Just we warned that the more food concentrates you include, the less room you have left for the actual vitamins and minerals themselves. So the good news is that this type of multi contains a lot of healthy food-derived cofactors, etc but the bad news is that they are usually lower in potency. To get potencies similar to the “non-green” multi preparations, you many need to take a larger number of tablets or capsules. This is fine if you are willing to do so.

All-In-One. As I said earlier, you cannot obtain the full daily dose of calcium and/or magnesium in a one or two per day multivitamin supplement. There is just not enough room. And it makes no sense to me to take several hundred percent of the U.S. Daily Value of the B-vitamins, while only taking 20% of the Daily Value of calcium and magnesium. So you have two choices. You can take a separate calcium-magnesium supplement, with a dose of two or more per day depending on the type and quality, or you can take a multivitamin supplement that includes the full dose of calcium and magnesium all in the one product. Of course, the daily dose of this “all-in-one” multi has to be higher, to accommodate these added ingredients–usually four tablets daily or six capsules daily.

The total number of tablets, whether you take a separate multi and a separate calcium-magnesium may end up being the same, but many people prefer the convenience of the all-in-one type of product.

So you can narrow down your choice by making four choices as defined above: What form do you prefer? How many are you willing to take each day? Do you want a straight multivitamin multi mineral supplement, or one that includes food concentrates? And do you want everything in one product, or a separate multivitamin and a separate calcium-magnesium?

If you call Willner Chemists (800 633 1106) pre-armed with this information, or stop by one of the Willner Chemists stores in Manhattan or Atlanta, one of the pharmacists or nutritionists will easily and quickly provide you with appropriate options. I am not going to mention specific products here, as we carry numerous quality brands at Willner Chemists. The recommendations might vary from one time to another depending on several factors including which brands might be on sale at the time.

I will provide an example of the “all-in-one” multivitamin multi mineral that is under the Willner Chemists brand. It is called “Willvite,” and the four per day dose provides everything, including calcium and magnesium, in the proper balance and potency.

There are, of course, other supplements that relatively healthy adults might want to take in addition to a multivitamin, calcium and magnesium. I would suggest the following three supplements should be part of most general regimens:

(1) An omega-3 fish oil supplement. The type chosen depends on your diet and health. If you have heart disease, inflammatory conditions, etc, I suggest a high potency EPA/DHA concentrate. If you are healthy, or if you do not eat fish, a “whole” fish oil concentrate might be appropriate.

(2) Vitamin D. At this time, the consensus of opinion is that most of us do not get enough vitamin D. And vitamin D is being increasingly targets as important in the prevention of many serious health problems. Most multivitamins do not contain more than 400 IU of vitamin D, so additional vitamin D is indicated. Many experts consider 800 to 1,000 IU per day as the new “minimum” dose. You can get vitamin D as a stand alone supplement, or you can get omega-3 fish oil supplements with added vitamin D. Natural Factors and Nordic Naturals are two brands that have that combination.

(3) Phyto Antioxidants. Increased antioxidants appear to be beneficial in numerous health conditions, from macular degeneration to aging. Most multivitamin supplements provide the standard vitamin and mineral antioxidants such as vitamin C, vitamin E, zinc and selenium. But many of the powerful antioxidants are those found in plants–the flavonoids and polyphenols found in grape skin, green tea, berries, fruits and vegetables. “Phyto” refers to plants, and a “phyto-antioxidant” supplement is a perfect complement to the regular multivitamin supplement. I recommend the Willner Chemists Phyto-Tech “Antiox Phyto Complex” (liquid filled capsule) or “Antiox Phyto Blend” (dropper bottle liquid).

On the one hand, I have provided a recommendation of what you might call a basic, or “nucleus” nutritional supplement regimen, suitable for almost everyone. A multivitamin, calcium-magnesium (either separate or included in the multivitamin), omega-3 oils, extra vitamin D, and extra “phyto” antioxidants. On the other hand, everyone is different, and everyone has unique needs. The challenge of decided on a multivitamin pales when compared to getting qualified and factual guidance on the remainder of your supplement requirements tailored to your unique health, diet and medical needs. You will not find this guidance in health food stores. You will not find it from your multilevel marketing salesman. You will find it at Willner Chemists.

Don Goldberg, R.Ph.

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Safety of Calcium Supplements Confirmed

Expert Panel Confirms Safety of Calcium Supplements in Relation to Cardiovascular Disease

Calcium Supplements Remain a Valuable Tool For Maintaining Bone Health

Last year, a report was published that surprised most people, patients and doctors alike. It seemed to indicate that calcium supplements increased the risk of cardiovascular disease. Why was this so surprising? For one thing, the benefits of calcium supplementation were widely accepted, with its effect on bone health at the top of the list. For another, it just doesn’t make sense. The report concluded, for example, that only calcium from supplements seemed to be the problem, not calcium from food. The study was far from conclusive, being observational in nature, and had many short comings. Many experts urged caution, and suggested we should not over react. But that did not stop the popular press.

While studies such as this should not be taken as the final word, they certainly should be looked at. There may be lessons to be learned. It may be that it is inadvisable to take a high dose of calcium, via supplements, all at one time, for example. Some people do that. The report may merely highlight the importance of not taking calcium alone, i.e. without magnesium, vitamin D, vitamin K, etc. It may be that some people make the mistake in thinking “if 1,000 mg a day of calcium is good, 2,000 mg a day is better.” We don’t know. At the least, it suggests that more investigation and research might be appropriate.

Such research has been ongoing, and the following findings published in Advances in Nutrition indicated that calcium supplements can indeed be used, safely and effectively, to achieve and maintain bone health by people who do not get optimal calcium from their diet. The following summary of results was posted on the website of the Council for Responsible Nutrition (

Individuals who do not obtain recommended intake levels of calcium through dietary sources can safely utilize calcium supplements to achieve optimal bone health, an expert panel concludes. These findings appear in the November online edition of Advances in Nutrition, a journal that highlights the significance of recent research in nutrition and illustrates the central role of nutrition in the promotion of health and prevention of disease.

Responding to questions raised last year about a possible link between calcium supplements and a potential increased risk of cardiovascular disease, an expert panel composed of academic and industry experts in the fields of nutrition, cardiology, epidemiology, bone health, and integrative medicine convened on Nov. 10 and 11, 2011 in Washington, D.C.

The panel collected and examined the available body of scientific literature, including randomized controlled trials (RCTs) and observational data, assessing whether long-term use of calcium supplements could promote the occurrence of strokes, coronary heart disease, heart attacks and other forms of cardiovascular disease, and cross-referenced these findings with four of the Bradford-Hill criteria for causal interference: strength, consistency, dose-response and biological plausibility. The panel concluded that the available science does not suggest an increased risk for cardiovascular disease from calcium supplement use.

“There is a strong body of evidence from a variety of rigorous scientific studies reinforcing the benefits of calcium in promoting bone growth and maintenance. After reviewing the entire scope of scientific literature for calcium, we are now more confident than ever in both its health benefits and safety,” said panelist Robert P. Heaney, M.D., Osteoporosis Research Center, Creighton University Medical Center. “Consumers can feel confident about the safety of their calcium supplements and should continue taking them with confidence. They should, however, be aware of how much calcium their diets provide, and then supplement accordingly.”

In addition to Dr. Heaney, panel experts included: Stephen Kopecky, M.D., Division of Cardiovascular Diseases, Mayo Clinic; Kevin Maki, Ph.D., Provident-Biofortis; John Hathcock, Ph.D., former senior vice president, scientific and international affairs, Council for Responsible Nutrition (CRN); Douglas MacKay, N.D., vice president, scientific and regulatory affairs, CRN; and Taylor Wallace, Ph.D., senior director, scientific and regulatory affairs, CRN.
The CRN Foundation, the educational non-profit affiliate for CRN, the dietary supplement industry’s leading trade association, commissioned the panel after results from a meta-analysis of RCTs, and reanalysis of the Women’s Health Initiative by researchers at a New Zealand laboratory, prompted concern about a potential association between calcium supplement use and a small increase in risk for adverse cardiovascular events. However, a number of issues with the meta-analysis and accompanying studies—such as exclusion of the majority of RCTs which indicate calcium has no effect on the cardiovascular system; large reliance on unpublished data; failure to appropriately ascertain cardiovascular events; and a lack of information on known cardiovascular risk determinants—warranted a complete examination of the scientific literature.
The CRN Foundation assembled the expert panel to study the findings of this analysis in context with the larger body of scientific research on calcium.

“In light of our safety findings combined with the well-documented benefits of calcium, we urge physicians to continue recommending calcium supplements to their patients as appropriate, as our review of the scientific literature further reinforces the valuable role of calcium in helping consumers maintain bone health,” said the Mayo Clinic’s Dr. Kopecky. “Building and maintaining calcium is vital for all age groups—young children to adolescents to adults and the elderly must obtain adequate amounts of calcium, either through diet or supplementation. For those who are unsure if they need to supplement their diets with additional calcium, make sure to discuss your current nutritional picture with your physician.”

Supporting the expert panel’s conclusion is the recent “Framingham Study,” published online in the Nov. 7 American Journal of Clinical Nutrition by Elizabeth Samelson, Ph.D., et al., which also looked at the association of calcium and coronary artery calcification and found that “…calcium intake from diet and supplements appeared to neither increase nor decrease vascular calcification, which is a measure of cardiovascular risk…The use of calcium supplements is important for many older adults to ensure adequate intake for bone health.”1

The Institute of Medicine currently suggests women ages 19 through 50 and men up to 71 obtain a Recommended Dietary Allowance (RDA) of 1,000 milligrams calcium daily; women over 50 and men 71 and older should obtain 1,200 milligrams daily to ensure they are meeting their daily needs for strong, healthy bones. Calcium is popular among U.S. consumers, and according to CRN’s most recent survey of U.S. adults, 17 percent indicate they take a calcium supplement.

(The Council for Responsible Nutrition (CRN), founded in 1973, is a Washington, D.C.-based trade association representing dietary supplement manufacturers and ingredient suppliers. In addition to complying with a host of federal and state regulations governing dietary supplements in the areas of manufacturing, marketing, quality control and safety, our 75+ manufacturer and supplier members also agree to adhere to additional voluntary guidelines as well as CRN’s Code of Ethics. Visit The CRN Foundation was established in 2009 as a non-profit 501(c)(3) organization for the purpose of educating people about the beneficial, safe and responsible use of dietary supplements and their ingredients as part of a culture of wellness.)

1 Samelson, E.J., Booth, S.L., Fox, C.S., et al. (2012). Calcium intake is not associated with increased coronary artery calcification: the Framingham Study1–3. Am J Clin Nutr, 96(5), 1-7.

Don Goldberg

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