Vit D + Calcium: Too Much Of A Good Thing?
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Vit D + Calcium: Too Much Of A Good Thing?
- Myth: you can’t get too much calcium!
- Myth: you must get as much vitamin D as possible!
Let’s tackle calcium first:
❝Calcium is good for you! You need more calcium for your bones! Be careful you don’t get calcium-deficient!❞
Contingently, those comments seem reasonable. Contingently on you not already having the right amount of calcium. Most people know what happens in the case of too little calcium: brittle bones, osteoporosis, and so forth.
But what about too much?
Hypercalcemia
Having too much calcium—or “hypercalcemia”— can lead to problems with…
- Groans: gastrointestinal pain, nausea, and vomiting. Peptic ulcer disease and pancreatitis.
- Bones: bone-related pains. Osteoporosis, osteomalacia, arthritis and pathological fractures.
- Stones: kidney stones causing pain.
- Moans: refers to fatigue and malaise.
- Thrones: polyuria, polydipsia, and constipation
- Psychic overtones: lethargy, confusion, depression, and memory loss.
(mnemonic courtesy of Sadiq et al, 2022)
What causes this, and how do we avoid it? Is it just dietary?
It’s mostly not dietary!
Overconsumption of calcium is certainly possible, but not common unless one has an extreme diet and/or over-supplementation. However…
Too much vitamin D
Again with “too much of a good thing”! While keeping good levels of vitamin D is, obviously, good, overdoing it (including commonly prescribed super-therapeutic doses of vitamin D) can lead to hypercalcemia.
This happens because vitamin D triggers calcium absorption into the gut, and acts as gatekeeper to the bloodstream.
Normally, the body only absorbs 10–20% of the calcium we consume, and that’s all well and good. But with overly high vitamin D levels, the other 80–90% can be waved on through, and that is very much Not Good™.
See for yourself:
- Hypercalcemia of Malignancy: An Update on Pathogenesis and Management
- Vitamin D-Mediated Hypercalcemia: Mechanisms, Diagnosis, and Treatment
How much is too much?
The United States’ Office of Dietary Supplements defines 4000 IU (100μg) as a high daily dose of vitamin D, and recommends 600 IU (15μg) as a daily dose, or 800 IU (20μg) if aged over 70.
See for yourself: Vitamin D Fact Sheet for Health Professionals ← there’s quite a bit of extra info there too
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Your Future Self – by Dr. Hal Herschfield
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How do you want to be, one year from now? Five years from now? Ten years from now?
Now, how would you have answered that same question one, five, ten years ago?
The reality, according to Dr. Hal Herschfield, is that often we go blundering into the future blindly, because we lack empathy with our future self. Our past self, we can have strong feelings about. They could range from compassion to shame, pride to frustration, but we’ll have feelings. Our future self? A mystery.
What he proposes in this book, therefore, is not merely the obvious “start planning now, little habits that add up”, etc, but also to address the underlying behavioral science of why we don’t.
Starting with exercises of empathy for our tomorrow-self (literally tomorrow, i.e. the day after this one), and building a mindset of “paying it forward”—to ourself.
By treating our future self like a loved one, we can find ourselves a lot more motivated to actually do the things that future-us will thank us for.
The real value of this book is in the progressive exercises, because it’s a “muscle” that most people haven’t exercised much. But when we do? What a superpower it becomes!
Bottom line: if you know what you “should” do, but somehow just don’t do it, this book will help connect you to your future self and work as a better team to get there… the way you actually want.
Click here to check out Your Future Self, and start by gifting this book to future-you!
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Hormones & Health, Beyond The Obvious
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Wholesome Health
This is Dr. Sara Gottfried, who some decades ago got her MD from Harvard and specialized as an OB/GYN at MIT. She’s since then spent the more recent part of her career educating people (mostly: women) about hormonal health, precision, functional, & integrative medicine, and the importance of lifestyle medicine in general.
What does she want us to know?
Beyond “bikini zone health”
Dr. Gottfried urges us to pay attention to our whole health, in context.
“Women’s health” is often thought of as what lies beneath a bikini, and if it’s not in those places, then we can basically treat a woman like a man.
And that’s often not actually true—because hormones affect every living cell in our body, and as a result, while prepubescent girls and postmenopausal women (specifically, those who are not on HRT) may share a few more similarities with boys and men of similar respective ages, for most people at most ages, men and women are by default quite different metabolically—which is what counts for a lot of diseases! And note, that difference is not just “faster” or “slower””, but is often very different in manner also.
That’s why, even in cases where incidence of disease is approximately similar in men and women when other factors are controlled for (age, lifestyle, medical history, etc), the disease course and response to treatment may vary considerable. For a strong example of this, see for example:
- The well-known: Heart Attack: His & Hers ← most people know these differences exist, but it’s always good to brush up on what they actually are
- The less-known: Statins: His & Hers ← most people don’t know these differences exist, and it pays to know, especially if you are a woman or care about one
Nor are brains exempt from his…
The female brain (kinda)
While the notion of an anatomically different brain for men and women has long since been thrown out as unscientific phrenology, and the idea of a genetically different brain is… Well, it’s an unreliable indicator, because technically the cells will have DNA and that DNA will usually (but not always; there are other options) have XX or XY chromosomes, which will usually (but again, not always) match apparent sex (in about 1/2000 cases there’s a mismatch, which is more common than, say, red hair; sometimes people find out about a chromosomal mismatch only later in life when getting a DNA test for some unrelated reason), and in any case, even for most of us, the chromosomal differences don’t count for much outside of antenatal development (telling the default genital materials which genitals to develop into, though this too can get diverted, per many intersex possibilities, which is also a lot more common than people think) or chromosome-specific conditions like colorblindness…
The notion of a hormonally different brain is, in contrast to all of the above, a reliable and easily verifiable thing.
See for example:
Alzheimer’s Sex Differences May Not Be What They Appear
Dr. Gottfried urges us to take the above seriously!
Because, if women get Alzheimer’s much more commonly than men, and the disease progresses much more quickly in women than men, but that’s based on postmenopausal women not on HRT, then that’s saying “Women, without women’s usual hormones, don’t do so well as men with men’s usual hormones”.
She does, by the way, advocate for bioidentical HRT for menopausal women, unless contraindicated for some important reason that your doctor/endocrinologist knows about. See also:
Menopausal HRT: A Tale Of Two Approaches (Bioidentical vs Animal)
The other very relevant hormone
…that Dr. Gottfried wants us to pay attention to is insulin.
Or rather, its scrubbing enzyme, the prosaically-named “insulin-degrading enzyme”, but it doesn’t only scrub insulin. It also scrubs amyloid beta—yes, the same that produces the amyloid beta plaques in the brain associated with Alzheimer’s. And, there’s only so much insulin-degrading enzyme to go around, and if it’s all busy breaking down excess insulin, there’s not enough left to do the other job too, and thus can’t break down amyloid beta.
In other words: to fight neurodegeneration, keep your blood sugars healthy.
This may actually work by multiple mechanisms besides the amyloid hypothesis, by the way:
The Surprising Link Between Type 2 Diabetes & Alzheimer’s
Want more from Dr. Gottfried?
You might like this interview with Dr. Gottfried by Dr. Benson at the IMCJ:
Integrative Medicine: A Clinician’s Journal | Conversations with Sara Gottfried, MD
…in which she discusses some of the things we talked about today, and also about her shift from a pharmaceutical-heavy approach to a predominantly lifestyle medicine approach.
Enjoy!
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Top 10 Foods That Promote Lymphatic Drainage and Lymph Flow
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Melissa Gallagher, a naturopath by profession, recommends the following 10 foods that she says promote lymphatic drainage and lymph flow, as well as the below-mentioned additional properties:
Ginger
Ginger is a natural anti-inflammatory, which we wrote about here:
Ginger Does A Lot More Than You Think
Turmeric
Turmeric is another natural anti-inflammatory, which we wrote about here:
Why Curcumin (Turmeric) Is Worth Its Weight In Gold
Garlic
Garlic is—you guessed it—another natural anti-inflammatory which we wrote about here:
The Many Health Benefits Of Garlic
Pineapple
Pineapple contains a collection of enzymes collectively called bromelain—which is a unique kind of anti-inflammatory, and which we have written about here:
Bromelain vs Inflammation & Much More
Citrus
Citrus fruits like oranges, lemons, and grapefruits are rich in vitamin C, which can help support the immune system in general.
Cranberry
Cranberries contain antioxidants and anti-inflammatory compounds, which we wrote about here:
Health Benefits Of Cranberries (But: You’d Better Watch Out)
The video also explains how cranberry bioactives inhibit adipogenesis and reduces fat congestion in your lymphatic system.
Dandelion Tea
Dandelion is a natural diuretic and anti-inflammatory herb, which we’ve not written about yet!
Nettle Tea
Nettle is a natural diuretic and anti-inflammatory herb, which we’ve also not written about yet!
Healthy Fats
Healthy fats like avocado, nuts, and olive oil can help reduce inflammation and support the immune system.
Fermented Foods
Fermented foods, such as kimchi and sauerkraut, contain probiotics that can improve gut health, which in turn boosts the immune system. You can read all about it here:
Making Friends With Your Gut (You Can Thank Us Later)
Want the full explanation? Here’s the video:
Click Here If The Embedded Video Doesn’t Load Automatically!
How was the video? If you’ve discovered any great videos yourself that you’d like to share with fellow 10almonds readers, then please do email them to us!
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Plant vs Animal Protein
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Plant vs Animal Protein: Head to Head
Some people will obviously have strong ideological opinions here—for vegetarians and vegans, it’s no question, and for meat-eaters, it’s easy to be reactive to that and double-down on the bacon. But, we’re a health and productivity newsletter, so we’ll be sticking to the science.
Which is better, healthwise?
First, it depends how you go about it. Consider these options:
- A piece of salmon
- A steak
- A hot dog
- A hot dog, but plant-based
- Textured soy protein (no additives)
- Edamame (young soy) beans
Three animal-based protein sources, three plant-based. We could render the competition simple (but very unfair) by pitting the hotdog against the edamame beans, or the plant-based hot dog against the piece of salmon. So let’s kick this off by saying:
- There are good and bad animal-based protein sources
- There are good and bad plant-based protein sources
Whatever you choose, keep that in mind while you do. Less processed is better in either case. And if you do go for red meat, less is better, period.
Picking the healthiest from each, how do the nutritional profiles look?
They look good in both cases! One factor of importance is that in either case, our bodies will reduce the proteins we consume to their constituent amino acids, and then rebuild them into the specific proteins we actually need. Our bodies will do that regardless of the source, because we are neither a salmon nor a soy bean, for example.
We need 20 specific amino acids, for our bodies to make the proteins we will use in our bodies. Of these, 9 are considered “essential”, meaning we cannot synthesize them and must get them from our diet,
Animal protein sources contain all 9 of those. Plant based sources often don’t, individually, but by eating soy for example (which does contain them all) and/or getting multiple sources of protein from different plants, the 9 can be covered quite easily with little thought, just by having a varied diet.
Meats are #1!
- They’re number 1 for nutritional density
- They’re number 1 for health risks, too
So while plant-based diet adherents may need to consume more varied things to get all the nutrients necessary, meat-eaters won’t have that problem.
Meat-eaters will instead have a different problem, of more diet-related health risks, e.g.
- Cardiovascular disease
- Metabolic disorders
- Cancers
So again, if eating (especially processed and/or red) meat, moderation is good. The Mediterranean Diet that we so often recommend, by default contains small amounts of lean animal protein.
Which is better for building muscle?
Assuming a broadly healthy balanced diet, and getting sufficient protein from your chosen source, they’re pretty equal:
- Vegan and Omnivorous High Protein Diets Support Comparable Daily Myofibrillar Protein Synthesis Rates and Skeletal Muscle Hypertrophy in Young Adults
- A mycoprotein-based high-protein vegan diet supports equivalent daily myofibrillar protein synthesis rates compared with an isonitrogenous omnivorous diet in older adults: a randomised controlled trial
(both studies showed that both dietary approaches yielded results that showed no difference in muscle synthesis between the two)
The bottom line is…
Healthwise, what’s more important than whether you get your protein from animals or plants is that you eat foods that aren’t processed, and are varied.
And if you want to do a suped-up Mediterranean Diet with less red meat, you might want to try:
A Pesco-Mediterranean Diet With Intermittent Fasting: JACC Review Topic of the Week
^This is from a review in the Journal of the American College of Cardiology, and in few words, they recommend it very highly
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California Is Investing $500M in Therapy Apps for Youth. Advocates Fear It Won’t Pay Off.
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With little pomp, California launched two apps at the start of the year offering free behavioral health services to youths to help them cope with everything from living with anxiety to body acceptance.
Through their phones, young people and some caregivers can meet BrightLife Kids and Soluna coaches, some who specialize in peer support or substance use disorders, for roughly 30-minute virtual counseling sessions that are best suited to those with more mild needs, typically those without a clinical diagnosis. The apps also feature self-directed activities, such as white noise sessions, guided breathing, and videos of ocean waves to help users relax.
“We believe they’re going to have not just great impact, but wide impact across California, especially in places where maybe it’s not so easy to find an in-person behavioral health visit or the kind of coaching and supports that parents and young people need,” said Gov. Gavin Newsom’s health secretary, Mark Ghaly, during the Jan. 16 announcement.
The apps represent one of the Democratic governor’s major forays into health technology and come with four-year contracts valued at $498 million. California is believed to be the first state to offer a mental health app with free coaching to all young residents, according to the Department of Health Care Services, which operates the program.
However, the rollout has been slow. Only about 15,000 of the state’s 12.6 million children and young adults have signed up for the apps, school counselors say they’ve never heard of them, and one of the companies isn’t making its app available on Android phones until summer.
Advocates for youth question the wisdom of investing taxpayer dollars in two private companies. Social workers are concerned the companies’ coaches won’t properly identify youths who need referrals for clinical care. And the spending is drawing lawmaker scrutiny amid a state deficit pegged at as much as $73 billion.
An App for That
Newsom’s administration says the apps fill a need for young Californians and their families to access professional telehealth for free, in multiple languages, and outside of standard 9-to-5 hours. It’s part of Newsom’s sweeping $4.7 billion master plan for kids’ mental health, which was introduced in 2022 to increase access to mental health and substance use support services. In addition to launching virtual tools such as the teletherapy apps, the initiative is working to expand workforce capacity, especially in underserved areas.
“The reality is that we are rarely 6 feet away from our devices,” said Sohil Sud, director of Newsom’s Children and Youth Behavioral Health Initiative. “The question is how we can leverage technology as a resource for all California youth and families, not in place of, but in addition to, other behavioral health services that are being developed and expanded.”
The virtual platforms come amid rising depression and suicide rates among youth and a shortage of mental health providers. Nearly half of California youths from the ages of 12 to 17 report having recently struggled with mental health issues, with nearly a third experiencing serious psychological distress, according to a 2021 study by the UCLA Center for Health Policy Research. These rates are even higher for multiracial youths and those from low-income families.
But those supporting youth mental health at the local level question whether the apps will move the needle on climbing depression and suicide rates.
“It’s fair to applaud the state of California for aggressively seeking new tools,” said Alex Briscoe of California Children’s Trust, a statewide initiative that, along with more than 100 local partners, works to improve the social and emotional health of children. “We just don’t see it as fundamental. And we don’t believe the youth mental health crisis will be solved by technology projects built by a professional class who don’t share the lived experience of marginalized communities.”
The apps, BrightLife Kids and Soluna, are operated by two companies: Brightline, a 5-year-old venture capital-backed startup; and Kooth, a London-based publicly traded company that has experience in the U.K. and has also signed on some schools in Kentucky and Pennsylvania and a health plan in Illinois. In the first five months of Kooth’s Pennsylvania pilot, 6% of students who had access to the app signed up.
Brightline and Kooth represent a growing number of health tech firms seeking to profit in this space. They beat out dozens of other bidders including international consulting companies and other youth telehealth platforms that had already snapped up contracts in California.
Although the service is intended to be free with no insurance requirement, Brightline’s app, BrightLife Kids, is folded into and only accessible through the company’s main app, which asks for insurance information and directs users to paid licensed counseling options alongside the free coaching. After KFF Health News questioned why the free coaching was advertised below paid options, Brightline reordered the page so that, even if a child has high-acuity needs, free coaching shows up first.
The apps take an expansive view of behavioral health, making the tools available to all California youth under age 26 as well as caregivers of babies, toddlers, and children 12 and under. When KFF Health News asked to speak with an app user, Brightline connected a reporter with a mother whose 3-year-old daughter was learning to sleep on her own.
‘It’s Like Crickets’
Despite being months into the launch and having millions in marketing funds, the companies don’t have a definitive rollout timeline. Brightline said it hopes to have deployed teams across the state to present the tools in person by midyear. Kooth said developing a strategy to hit every school would be “the main focus for this calendar year.”
“It’s a big state — 58 counties,” Bob McCullough of Kooth said. “It’ll take us a while to get to all of them.”
So far BrightLife Kids is available only on Apple phones. Brightline said it’s aiming to launch the Android version over the summer.
“Nobody’s really done anything like this at this magnitude, I think, in the U.S. before,” said Naomi Allen, a co-founder and the CEO of Brightline. “We’re very much in the early innings. We’re already learning a lot.”
The contracts, obtained by KFF Health News through a records request, show the companies operating the two apps could earn as much as $498 million through the contract term, which ends in June 2027, months after Newsom is set to leave office. And the state is spending hundreds of millions more on Newsom’s virtual behavioral health strategy. The state said it aims to make the apps available long-term, depending on usage.
The state said 15,000 people signed up in the first three months. When KFF Health News asked how many of those users actively engaged with the app, it declined to say, noting that data would be released this summer.
KFF Health News reached out to nearly a dozen California mental health professionals and youths. None of them were aware of the apps.
“I’m not hearing anything,” said Loretta Whitson, executive director of the California Association of School Counselors. “It’s like crickets.”
Whitson said she doesn’t think the apps are on “anyone’s” radar in schools, and she doesn’t know of any schools that are actively advertising them. Brightline will be presenting its tool to the counselor association in May, but Whitson said the company didn’t reach out to plan the meeting; she did.
Concern Over Referrals
Whitson isn’t comfortable promoting the apps just yet. Although both companies said they have a clinical team on staff to assist, Whitson said she’s concerned that the coaches, who aren’t all licensed therapists, won’t have the training to detect when users need more help and refer them to clinical care.
This sentiment was echoed by other school-based social workers, who also noted the apps’ duplicative nature — in some counties, like Los Angeles, youths can access free virtual counseling sessions through Hazel Health, a for-profit company. Nonprofits, too, have entered this space. For example, Teen Line, a peer-to-peer hotline operated by Southern California-based Didi Hirsch Mental Health Services, is free nationwide.
While the state is also funneling money to the schools as part of Newsom’s master plan, students and school-based mental health professionals voiced confusion at the large app investment when, in many school districts, few in-person counseling roles exist, and in some cases are dwindling.
Kelly Merchant, a student at College of the Desert in Palm Desert, noted that it can be hard to access in-person therapy at her school. She believes the community college, which has about 15,000 students, has only one full-time counselor and one part-time bilingual counselor. She and several students interviewed by KFF Health News said they appreciated having engaging content on their phone and the ability to speak to a coach, but all said they’d prefer in-person therapy.
“There are a lot of people who are seeking therapy, and people close to me that I know. But their insurances are taking forever, and they’re on the waitlist,” Merchant said. “And, like, you’re seeing all these people struggle.”
Fiscal conservatives question whether the money could be spent more effectively, like to bolster county efforts and existing youth behavioral health programs.
Republican state Sen. Roger Niello, vice chair of the Senate Budget and Fiscal Review Committee, noted that California is forecasted to face deficits for the next three years, and taxpayer watchdogs worry the apps might cost even more in the long run.
“What starts as a small financial commitment can become uncontrollable expenses down the road,” said Susan Shelley of the Howard Jarvis Taxpayers Association.
This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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Seven Steps to Managing Your Memory – by Dr. Andrew Budson & Dr. Maureen O’Connor
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First, what this is not: a “how to improve your memory” book of the kind marketed to students and/or people who want to do memory-themed party tricks.
What this book actually is: exactly what the title and subtitle claim it to be: seven steps to managing your memory: what’s normal, what’s not, and what to do about it.
Drs. Budson & O’Connor cover:
- which memory errors can (and usually do) happen at any age
- how memory changes with normal aging, and
- what kinds of memory problems are not normal.
One thing that sets this book aside from a lot of its genre is that it also covers which kinds of memory loss are reversible—and, where appropriate, what can be undertaken to effect such a reversal.
The authors talk about what things have (and what things haven’t!) been shown to strengthen memory and reduce cognitive decline, and in the worst case scenario, what medications can help against Alzheimer’s disease and other dementias.
The style is halfway between pop-science and a science textbook. The structure of the book, with its headings, subheadings, bullet points, summaries, etc, helps the reader to process and remember the information.
Bottom line: if you’d like to get on top of managing your memory before you forget, then this book is for you.
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