The New England Journal of Medicine (NEJM) published a study which I want to use to focus your attention on a topic I want to address in this newsletter. The topic has three sides - bone density, calcium and vitamin D. Headlines about this study lead readers to think that calcium supplements, even those with a modest amount of vitamin D, don’t really reduce the risk of osteoporosis. That is clearly not true and not what this study shows.

Also, the office will be closed from this Friday until Monday April 10. Hopefully either the rain will end by then or you have developed a strong friendship with a boat builder named Noah.

Best, Michael Carlston, M.D.
www.carlstonmd.com 
707-545-1554

The infamous report came from an ongoing study collecting data from American nurses. Investigators reported an insignificant effect on bone health from taking calcium supplements. There were major problems in the study design that are likely to lead to the wrong conclusion. In addition, few articles in the media, commenting on this study, were written with sufficient depth of understanding and critical thinking. This again leads to misinterpretation.

The point of any interventional study is to determine if that intervention had an impact. In this case there was no clear intervention. Most of those in the intervention group did not take their calcium supplements. If they did, their risk of bone breakage was reduced. Many of those in the placebo group took calcium supplements on their own. Even worse, many in the placebo group started taking prescription medicine to increase bone density. Another problem was that, not only did the study subjects take a mediocre form of calcium; their intake of vitamin D was too low.

Before I completely mislead you myself into thinking that I believe this study has no merit, lets backtrack a bit.

At issue here was the ability of calcium supplements to improve bone health. This is difficult to assess because many factors interact. Exercise is massively important. Avoiding an extremely acid diet (i.e. high meat content) helps. Avoiding too much vitamin A helps. Vitamin D is without a doubt one of the most important factors in bone health.

As I wrote in January, we are rapidly growing in our appreciation of the many benefits of vitamin D. Simultaneously we are learning how common vitamin D deficiency is. One untoward consequence of protecting our skin from the damaging effects of the sun (not to mention 24 days of rain in one month) is that our skin doesn’t get enough light to make much vitamin D. Some investigations suggest that our ancestors commonly received 10,000 iu of vitamin D from their daily sun exposure.

As of March 20, most US medical laboratories increased their “normal” levels of vitamin D. The lower limit had been 8 ng/ml but in light of all the new research, it is now 32 ng/ml. The majority of patients I’ve checked for vitamin D levels have been deficient.

Finally, I am actually pleased about this study I have been criticizing as, despite its limitations, it helps spread the understanding that it is a mistake to simply consider calcium intake as the be all and end all of bone health.

It has come to my attention that a significant portion of my patient population, despite your wise desire to limit use of potentially harmful medication, have fallen prey to a common bad health habit. I am referring to the scourge of antibiotic soap.

The idea is that using a soap that kills all of those evil, threatening bacteria out there will keep you from getting sick. Wrong, wrong and wrong.

Study after study, many in the best medical journals in the world, show that using antibacterial soap does not reduce the risk of infection. A hospital surgical setting, with its sterile environment, with a bacterial vacuum open to any intruders, is a different matter. Washing your hands with regular soap reduces the risk of the most common infectious disease (diarrhea, colds, pneumonia, skin infections) by around 50%. Using antibacterial soap does not add to that considerable benefit.

In fact, using antibacterial soap is potentially harmful. The increasing prevalence of bacteria that are resistant to antibiotics is a growing and frightening problem. It is best not to use them but when you decide to, you really want them to work.

In my medical career, I have had three different patients with one of the most severe forms of antibiotic resistant bacterial infection. The first was 10 years ago. She was paralyzed, on high doses of steroids with a severe bed sore that had gone all the way into her pelvic bone. She had spent a lot of time in hospitals. Given her circumstances, it made sense that she could be a victim of this nasty infection.

Both of the other two patients I have seen in the past few months. One is an adult and the other an infant. They do not know each other. What is most disconcerting is that both of them were otherwise healthy and the only hospital contact either of them had was one emergency room visit for the infant. This means that, in our community, at the present time, acquiring such an infection is not so hard to do.

There has also been speculation that the rise in melanoma could have something to do with antibacterial soaps. These soaps contain chemicals that sensitize the body’s tissues to light. This might increase the rate of melanoma.

Many bacteria do good things for us. They make vitamins. They strengthen our immune system. When you take an antibiotic, many bacteria, good and bad are killed. The really nasty ones that can survive the antibiotic then have room to spread out and raise a big nasty family.

Sorry to disappoint some of you but I should also add that artificial nails are the best thing you can do to grow lots of bacteria on your hands. So, if you have artificial nails and are prone to infections, you might want to change your style.

There will always be lots of bacteria around. They will never fill the endangered species lists. The best idea is to wash your hands with soap and water and encourage the growth of good bacteria in your body by taking probiotics.