An excellent blogpost on the Vitamin D topic by Michael Eades MD.
http://www.proteinpower.com/drmike/supplements/sunshine-superman/
Newswise — Negative health effects linked to taking too much supplemental calcium are on the rise, according to a commentary appearing in an upcoming issue of the Journal of the American Society Nephrology (JASN). The incidence of the so-called milk-alkali or calcium-alkali syndrome is growing in large part because of widespread use of over-the-counter calcium and vitamin D supplements.
The milk-alkali syndrome arose in the early 1900s when patients ingested abundant amounts of milk and antacids to control their ulcers. This practice increased individuals’ risk of developing dangerously high levels of calcium in the blood, which could cause high blood pressure and even kidney failure. The incidence of the milk-alkali syndrome declined when newer ulcer medications became available, but it appears to be on the rise again thanks to increased use of over-the-counter calcium and vitamin D supplements used mainly as preventive and treatment measures for osteoporosis. In many cases, patients with the syndrome require hospitalization.
Stanley Goldfarb, MD and Ami Patel, MD (University of Pennsylvania School of Medicine) recommend changing the name of the milk-alkali syndrome to the calcium-alkali syndrome because the condition is now associated with a large intake of calcium, not milk. Postmenopausal women, pregnant women, transplant recipients, patients with bulimia, and individuals who are on dialysis have the highest risks of developing the calcium-alkali syndrome due to various physiological reasons.
According to the authors, the obvious preventive strategy against the calcium-alkali syndrome is to limit the intake of calcium to no more than 1.2 to 1.5 grams per day. “Calcium supplements taken in the recommended amounts are not only safe but are quite beneficial. Taken to excess is the problem,” said Dr. Goldfarb. “Even at the recommended dose, careful monitoring of any medication is wise and yearly determinations of blood calcium levels for those patients taking calcium supplements or vitamin D is a wise approach,” he added.
The authors reported no financial disclosures.
The commentary, entitled “Got Calcium? Welcome to the Calcium-Alkali Syndrome,” (doi 10.1681/ASN.2010030255) is available online at http://jasn.asnjournals.org. A detailed article on this commentary will also be included within the June issue of ASN Kidney News.
The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.
Founded in 1966, the American Society of Nephrology (ASN) is the world’s largest professional society devoted to the study of kidney disease. Comprised of 11,000 physicians and scientists, ASN continues to promote expert patient care, to advance medical research, and to educate the renal community. ASN also informs policymakers about issues of importance to kidney doctors and their patients. ASN funds research, and through its world-renowned meetings and first-class publications, disseminates information and educational tools that empower physicians.
A biochemistry reminder from the International Journal of Obesity (2007) 31, 559–561.
Abstract:
A 59-year-old man undergoing weight loss with very low calorie diets (VLCD) attempted to drive a car, which was fitted with an alcohol ignition interlock device, but the vehicle failed to start. Because the man was a teetotaller, he was surprised and upset by this result. VLCD treatment leads to ketonemia with high concentrations of acetone, acetoacetate and 
-hydroxybutyrate in the blood. The interlock device determines alcohol (ethanol) in breath by electrochemical oxidation, but acetone does not undergo oxidation with this detector. However, under certain circumstances acetone is reduced in the body to isopropanol by hepatic alcohol dehydrogenase (ADH). The ignition interlock device responds to other alcohols (e.g. methanol, n-propanol and isopropanol), which therefore explains the false-positive result. This ‘side effect’ of ketogenic diets needs further discussion by authorities when people engaged in safety-sensitive work (e.g. bus drivers and airline pilots) submit to random breath-alcohol tests.
acetone, alcohol, breath-test, driving, ignition interlocks, VLCD
A thoughtful, factual reply to an only seemingly balanced, but really tendentious article (see New York Times cartoon accompanying it – which is what most will retain from it). Please read, redistribute and comment. The original New York times article prompting the letter that follows is here.
I will update if and when letter is printed in the NYT. For more on the Independent Doctors of New York/IDNY, please go to our web site.
>>Re: Ms. Rabin’s article “When Doctors Stop Taking Insurance” ?
The answer to why many doctors are no longer accepting health insurance payments is both simple and complex. .
The simple answer: Health insurance companies are for-profit organizations that answer to their boards and shareholders, not patients, to make sure their bottom line is a healthy, black line. The CEOs of these companies make millions in salary, and many more millions of dollar are spent on TV and print advertising needed to lure and keep patients. Each of these takes money away from the medical care they could AND should provide their patients and reasonable reimbursements to physicians.
The complex answer: If for-profit insurers paid physicians a reasonable usual and customary rate (UCR), physicians would be much more receptive to accepting insurance reimbursement. But this is not the case. The for-profit health insurance industry made up their own UCR by bankrolling the company (Ingenix) that was supposed to supply real-world UCRs. However, use of the UCRs developed by Ingenix was found to be fraudulent in New York State, and for-profit health insurers were fined $350 million and required to pay an additional $50 million to create a the new “Fair Health” UCR. Despite this ruling, the insurers found a way around this by jointly declaring that their UCRs would be a percentage of what Medicare pays–the low reimbursement rate the government provides to keep our tax burden for health care low. So, it’s acceptable for insurance companies to get together to set fees, whereas if two doctors get together and discuss fees, it’s considered an antitrust violation.
Today’s young doctors come out of medical school $150,000 to $200,000 in debt. Then there are the expenses of starting and running a medical practice, which are very high. Malpractice insurance often increases yearly in most states due to a failure to enact medical malpractice tort reform (the exceptions are Texas and California who lead the nation in this bold effort to keep medical costs down). Rent and the cost of staff also increase yearly. Yet, insurance reimbursements have not increased in years and there is no law requiring increases linked to inflation or other accepted economic indicators.
Until something is done to reign in the for-profit health insurers, more and more physicians will “opt out” and patients will have less and less access to their physician of choice.
William Rosenblatt MD
President, Independent Doctors of New York
Suite 1D
308 East 79th Street
New York, NY 10075
212-570-6100
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Maurice Preter, MD is a European and U.S. educated psychiatrist, psychotherapist, psychopharmacologist, neurologist, and medical-legal expert in private practice in Manhattan. He is also the principal of Fifth Avenue Concierge Medicine, PLLC, a medical concierge service and health advisory for select individuals and families.
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