Indoor Air Pollution

indoor air pollutionIndoor air pollution is one of the most overlooked threats to human health. Households in developing countries might be the hardest hit. Because children spend almost eighty percent of their time indoors, they are the most likely victims. In the past several years it has been determined that conditions ranging from asthma, headaches and fatigue to allergic reactions, hormone imbalances and central nervous damage may be attributed to indoor air quality—or, rather, the lack of it. Most of us realize that outdoor air quality can affect health, but few pay attention to the indoor air…unless it smells bad.

In a paper supported by the University of Medicine and Dentistry of New Jersey and printed in the British Medical Bulletin in the early 2000’s, Junfeng (Jim) Zhang and Kirk Smith allowed that the ubiquitous character of indoor air pollution “…may contribute to increasing prevalence of asthma, autism, childhood cancer, medically unexplained symptoms, and perhaps other illnesses.”   Because the sources of indoor pollution are not expected to abate in the near future, particularly those associated with tobacco use, we can expect to voice concerns for a long time. The authors add that “…risks associated with solid fuel combustion coincide with risk associated with modern buildings.”

It is absurd that indoor air quality should be so poor that it causes sickness and disease, yet that appears to be more the rule than the exception in modern times.  Nobody would think of running a tractor-trailer or a tour bus in the living room, but the pollution effect is the same.  Most of us are unaware of the problem because a single major source of indoor pollution can’t be fingered. Despite this unrecognized threat, indoor pollution is twice as bad as outdoor, according to studies performed by the Bloomberg School of Public Health at Johns Hopkins.  Others put the rate at five times. There are so many sources of indoor pollution that have become part of our daily lives that we never question them. Have you thought about the unpronounceable ingredients in your cleaning products and other household chemicals, like the pesticides you use in the yard? How about your cosmetics and the smelly things you plug into the wall to hide other smelly things?  Got new carpet or upholstery? Oh, yeah, there are more, such as the aroma of hot tar being applied to the new roof at your children’s school…while school’s in session. The activity may be outdoors, but the sickening smell is certainly indoors.

The influx of biological pollutants is hard to manage.  Molds, bacteria, viruses, animal dander, skin particles (yes, even human), pollen and dust mites are everywhere.  You can see airborne particles in that beam of sunshine coming through the window, but you can’t identify any of them.  Some can breed in the stagnant water that sits in your humidifier, or where water has collected in your ceiling tiles, insulation or carpet.  These things can cause fever, chills, cough, and chest tightness, among other symptoms.  Even when we do what we think is good for the family, we may do the opposite.  Burning the woodstove or fireplace might save money on the heating bill (though the fireplace is suspect), but how about the junk it puts into the air?  You can’t win, eh?

In our attempts to conserve energy, we have sealed our houses so tightly that nothing can get in and less can get out.  Once we change the air pressure dynamics of our houses, we have allowed intruders to enter.  Radon and soil gases are most common, and they creep through the cellar floor.  Mechanical ventilation can help to get the junk out and bring at least some fresher air in.  Not only does insulation contribute to the tightness of our homes, but also it brings problems of its own in the form of irritating chemicals.

Increasing ventilation is one of the easiest steps to improving indoor air quality.  Even in the dead of winter it’s a good idea to open the front and back doors simultaneously once a day to let fresh cold air in and the stale reheated air out.  Pathogens grow in an environment that is warm, dark and damp.  Your hot-air heater is a prime breeding ground for colds and the like.  The American Lung Association and the Mayo Clinic have recognized air filters as being sufficiently effective to allay at least some of the problem.   Using a vacuum with a HEPA filter is another prudent intervention.

Concerning household cleaners, we all know that anything natural costs more than anything man-made, and that mindset is hard to figure out.  Why do we have to pay for things that are left out?  In the mean time, note that vinegar-water concoctions are just as good as many commercial products at cleaning our homes—even the commode.  Who cares if it smells like salad?

But what might just be the best air cleaner on the planet is a collection of house plants.  Formaldehyde is a major contaminant of indoor air, originating from particle board, carpets, window coverings, paper products, tobacco smoke, and other sources.  These can contribute to what has been called “sick building syndrome.”  The use of green plants to clean indoor air has been known for years.  This phytoremediation has been studied with great intensity in a few laboratories across the globe, where it was learned that ferns have the greatest capability of absorbing toxins.  (Kim, Kays. 2010)  As is the case with many endeavors, there is a hierarchy of plants that does the job.  After the ferns, the common spider plant (Chlorophytum comosum) was found best at removing gaseous pollutants, including formaldehyde.  Way back in 1984 NASA released information about how good the spider plant is at swallowing up indoor air pollution.  The heartleaf philodendron partners well with Chlorophytum.  Dr. Bill Wolverton, retired from NASA, has a list (  Areca and lady palms, Boston fern, golden pothos and the dracaenas are at the top.  Plants with fuzzy leaves are best at removing particulates from smoke and grease, and some are even maintenance-free (almost), including the aloes, cacti, and the aforementioned spider plants, pothos and dracaenas, the last sometimes called the corn plant.

For more information, try these resources:

Indoor Air Pollution Increases Asthma Symptoms (Johns Hopkins Bloomberg School of Public Health)

Pollution at Home Often Lurks Unrecognized (12/26/2008, Reuters Health) by Amy Norton

Air Purifiers and Air Filters Can Help the Health of Allergy and Asthmas Sufferers (S. A. Smith)

Indoor Air Pollution Fact Sheet (08/1999, American Lung Association)

An Introduction to Indoor Air Quality (Environmental Protection Agency)


Br Med Bull (2003) 68 (1): 209-225.
Indoor air pollution: a global health concern
Junfeng (Jim) Zhang and Kirk R Smith

Environmental and Occupational Health Sciences Institute & School of Public Health, University of Medicine and Dentistry of New Jersey, NJ

Indoor air pollution is ubiquitous, and takes many forms, ranging from smoke emitted from solid fuel combustion, especially in households in developing countries, to complex mixtures of volatile and semi-volatile organic compounds present in modern buildings. This paper reviews sources of, and health risks associated with, various indoor chemical pollutants, from a historical and global perspective. Health effects are presented for individual compounds or pollutant mixtures based on real-world exposure situations. Health risks from indoor air pollution are likely to be greatest in cities in developing countries, especially where risks associated with solid fuel combustion coincide with risk associated with modern buildings. Everyday exposure to multiple chemicals, most of which are present indoors, may contribute to increasing prevalence of asthma, autism, childhood cancer, medically unexplained symptoms, and perhaps other illnesses. Given that tobacco consumption and synthetic chemical usage will not be declining at least in the near future, concerns about indoor air pollution may be expected to remain.

Nippon Eiseigaku Zasshi. 2009 May;64(3):683-8.
[Indoor air pollution of volatile organic compounds: indoor/outdoor concentrations, sources and exposures]. [Article in Japanese]
Chikara H, Iwamoto S, Yoshimura T.
Fukuoka Institute of Health and Environmental Sciences, Mukaizano, Dazaifu, Fukuoka 818-0135, Japan. [email protected]

In this review, we discussed about volatile organic compounds (VOC) concentrations, sources of VOC, exposures, and effects of VOC in indoor air on health in Japan. Because the ratios of indoor concentration (I) to outdoor concentration (O) (I/O ratios) were larger than 1 for nearly all compounds, it is clear that indoor contaminations occur in Japan. However, the concentrations of basic compounds such as formaldehyde and toluene were decreased by regulation of guideline indoor values. Moreover, when the sources of indoor contaminations were investigated, we found that the sources were strongly affected by to outdoor air pollutions such as automobile exhaust gas. Since people live different lifestyles, individual exposures have been investigated in several studies. Individual exposures strongly depended on indoor concentrations in houses. However, outdoor air pollution cannot be disregarded as the sources of VOC. As an example of the effect of VOC on health, it has been indicated that there is a possibility of exceeding a permissible cancer risk level owing to exposure to VOC over a lifetime.

Environ Sci Technol. 2009 Nov 1;43(21):8338-43.
Uptake of aldehydes and ketones at typical indoor concentrations by houseplants.
Tani A, Hewitt CN.
Institute for Environmental Sciences, University of Shizuoka, Shizuoka 422-8526, Japan. [email protected]

The uptake rates of low-molecular weight aldehydes and ketones by peace lily (Spathiphyllum clevelandii) and golden pothos (Epipremnum aureum) leaves at typical indoor ambient concentrations (10(1)-10(2) ppbv) were determined. The C3-C6 aldehydes and C4-C6 ketones were taken up by the plant leaves, but the C3 ketone acetone was not. The uptake rate normalized to the ambient concentration C(a) ranged from 7 to 19 mmol m(-2) s(-1) and from 2 to 7 mmol m(-2) s(-1) for the aldehydes and ketones, respectively. Longer-term fumigation results revealed that the total uptake amounts were 30-100 times as much as the amounts dissolved in the leaf, suggesting that volatile organic carbons are metabolized in the leaf and/or translocated through the petiole. The ratio of the intercellular concentration to the external (ambient) concentration (C(i)/C(a)) was significantly lower for most aldehydes than for most ketones. In particular, a linear unsaturated aldehyde, crotonaldehyde, had a C(i)/C(a) ratio of approximately 0, probably because of its highest solubility in water.

Proc Am Thorac Soc. 2010 May;7(2):102-6.
Indoor air pollution and asthma in children.
Breysse PN, Diette GB, Matsui EC, Butz AM, Hansel NN, McCormack MC.
Department of Environmental Heath Sciences, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA. [email protected]

The purpose of this article is to review indoor air pollution factors that can modify asthma severity, particularly in inner-city environments. While there is a large literature linking ambient air pollution and asthma morbidity, less is known about the impact of indoor air pollution on asthma. Concentrating on the indoor environments is particularly important for children, since they can spend as much as 90% of their time indoors. This review focuses on studies conducted by the Johns Hopkins Center for Childhood Asthma in the Urban Environment as well as other relevant epidemiologic studies. Analysis of exposure outcome relationships in the published literature demonstrates the importance of evaluating indoor home environmental air pollution sources as risk factors for asthma morbidity. Important indoor air pollution determinants of asthma morbidity in urban environments include particulate matter (particularly the coarse fraction), nitrogen dioxide, and airborne mouse allergen exposure. Avoidance of harmful environmental exposures is a key component of national and international guideline recommendations for management of asthma. This literature suggests that modifying the indoor environment to reduce particulate matter, NO(2), and mouse allergen may be an important asthma management strategy. More research documenting effectiveness of interventions to reduce those exposures and improve asthma outcomes is needed.

HortScience 45: 1489-1495 (2010)
Variation in Formaldehyde Removal Efficiency among Indoor Plant Species
Kwang Jin Kim1, Myeong Il Jeong, Dong Woo Lee, Jeong Seob Song, Hyoung Deug Kim, Eun Ha Yoo, Sun Jin Jeong and Seung Won Han

The efficiency of volatile formaldehyde removal was assessed in 86 species of plants representing five general classes (ferns, woody foliage plants, herbaceous foliage plants, Korean native plants, and herbs). Phytoremediation potential was assessed by exposing the plants to gaseous formaldehyde (2.0 µL·L–1) in airtight chambers (1.0 m3) constructed of inert materials and measuring the rate of removal. Osmunda japonica, Selaginella tamariscina, Davallia mariesii, Polypodium formosanum, Psidium guajava, Lavandula spp., Pteris dispar, Pteris multifida, and Pelargonium spp. were the most effective species tested, removing more than 1.87 µg·m–3·cm–2 over 5 h. Ferns had the highest formaldehyde removal efficiency of the classes of plants tested with O. japonica the most effective of the 86 species (i.e., 6.64 µg·m–3·cm–2 leaf area over 5 h). The most effective species in individual classes were: ferns—Osmunda japonica, Selaginella tamariscina, and Davallia mariesii; woody foliage plants—Psidium guajava, Rhapis excels, and Zamia pumila; herbaceous foliage plants—Chlorophytum bichetii, Dieffenbachia ‘Marianne’, Tillandsia cyanea, and Anthurium andraeanum; Korean native plants—Nandina domestica; and herbs—Lavandula spp., Pelargonium spp., and Rosmarinus officinalis. The species were separated into three general groups based on their formaldehyde removal efficiency: excellent (greater than 1.2 µg·m–3 formaldehyde per cm2 of leaf area over 5 h), intermediate (1.2 or less to 0.6), and poor (less than 0.6). Species classified as excellent are considered viable phytoremediation candidates for homes and offices where volatile formaldehyde is a concern.

*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.

Laundry: A Toxic Venture

laundry productsWe like to think of ourselves as clean and fresh-smelling.  But at what price?  Although suspect for several years, the gentle aromas wafting from our laundry appliances are giving us more than we asked for—pollution.  Venting the dryer outside contributes to the air many of the same chemicals emanating from vehicle and industrial exhausts, but better-smelling.  If the dryer is vented indoors into a bucket of water for lack of a suitable alternative, the effect is concentrated to a much smaller environment.  Although dozens of potentially harmful compounds have been identified in laundry fragrances, from soap to dryer sheets, none, by law, needs to be listed on the product label.  We don’t know what we’re getting for our money, but you can bet it’s more than we bargained for.

The emissions from a dryer are not regulated or monitored.  “If they’re coming out of a smokestack or tailpipe, they’re regulated…” says the lead author of a study performed at the University of Washington.  Reporting in the 2011 online edition of Air Quality, Atmosphere and Health, Anne Steinemann, an environmental engineering professor at the university, found more than two dozen volatile organic compounds emitted through laundry vents.  Of these, seven are named as hazardous air pollutants, two of which are known carcinogens described by the EPA.  Acetaldehyde and benzene enjoy zero safe exposure level.  “These products can affect not only personal health, but also public and environmental health.  The chemicals can go into the air, down the drain and into water bodies,” Steinemann added.   To get a clearer picture of the problem, the aldehydes emitted by using a particular, though unnamed, brand of detergent represents three percent of that emitted by automobiles in the study area (King County, WA).  If combined, the top five brands of laundry products would account for six percent of vehicular aldehyde emissions.  (Steinemann. 2011)

Let’s start with the aldehydes and benzenes.  Acetaldehyde occurs naturally in coffee, breads and ripe fruits, and arises from normal plant metabolism.  It’s produced by the oxidation of alcohol, and is blamed for hangovers.  The liver converts ethanol to acetaldehyde through enzymatic activity.  Occurring also in tobacco smoke, acetaldehyde enhances the addictive effect of nicotine.  It is a probable carcinogen in humans.  (U.S. EPA. 1994)

Benzene is an important industrial solvent, once used as an additive to gasoline to increase octane ratings and to eliminate knocking, but still used to manufacture plastics and synthetic rubber, and, occasionally, some drugs.  Its carcinogenic property is well-established.  It can be formed wherever incomplete combustion of a carbon-rich substance occurs, as in forest fires and volcanoes, and in vehicle exhausts.  Its use in the United States is now limited, although it is making a minimal comeback since tetraethyl lead has been eliminated from vehicular fuel.   (Federal Register. 2006)

Although they can make your clothes soft and cuddly, fabric softeners are some of the most toxic substances around.  Because there are limited alternatives to these handy chemicals, few people are willing to give them up, and even fewer are likely to relate health problems with their use.  If you say they’re made from natural ingredients, remember that arsenic is all natural.  The chemicals in softeners in particular are designed to stay on the clothes for a while, and are absorbed through the skin as well as inhaled.  Because the dryer sheets are heated, they emit their chemicals into the vented air, either outside, inside, or both.  The chemicals that create the softening effect are strong smelling and pungent, so need to be masked with fragrances that are chemically just as bad.

What are some other noxious / toxic ingredients in laundry and other household products and their after effects?  Benzyl acetate in softeners causes pancreatic disease.  Camphor and ethanol affect the central nervous system.  Ethyl acetate affects the kidneys and skin.  Limonene is a sensitizer that is not to be inhaled, although we do anyway, but not on purpose.  The list goes on.  More than ninety-five percent are made from petrochemicals, and may present as neurological maladies, allergic reactions, birth defects, and cancer, not to mention sinusitis and asthma.

What to do?  Look for detergents that have no scent.  If they can’t be found in the supermarket, try a health food store or look online.  There are at least two multi-level marketing firms that offer them; one starts with an “S” and the other with an “A.”  To soften clothes, add a quarter cup of baking soda to the wash water.  The same amount of white vinegar can prevent static cling and still soften fabric…and won’t smell like a salad.

Those aromatic thingies you plug into an outlet?  Chuck ‘em.  Got petroleum-based candles that hide the mackerel miasma?  Dump ‘em.  Find out what’s in your underarm deodorant / anti-perspirants, the furniture polish, the toilet bowl cleaner, shampoo, and even toothpaste.  What makes your trousers wrinkle-free and stain-free, or your baby’s clothes fireproof, or the new sofa stain-resistant?  Nobody would have thought that “April Fresh,” “Ocean Mist,” and “Orange Honey” could be so dangerous.  We might be able to answer a few questions if we keep track of who gets sick and the materials to which they are exposed.  Manufacturers are not required to list ingredients in fragrances, so consumers are at the mercy of the establishment.


Anne C. Steinemann, Lisa G. Gallagher, Amy L. Davis and Ian C. MacGregor
Chemical emissions from residential dryer vents during use of fragranced laundry products
Air Quality, Atmosphere & Health   DOI: 10.1007/s11869-011-0156-1Online First™

University of Washington (2008, July 24).
Toxic Chemicals Found In Common Scented Laundry Products, Air Fresheners.

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Acetaldehyde-induced cardiac contractile dysfunction may be alleviated by vitamin B1 but not by vitamins B6 or B12.
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Heisterberg MV, Menné T, Andersen KE, Avnstorp C, Kristensen B, Kristensen O, Kaaber K, Laurberg G, Henrik Nielsen N, Sommerlund M, Thormann J, Veien NK, Vissing S, Johansen JD.
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*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.

Exposure To Motor Lubricants & Solvents

car-engineMuscle car plus motor head does not equal muscle head, although it could. The first pair evokes positive images for those who remember Holley carburetors, dual exhausts, Hurst shifters and four on the floor (gears, that is). The muscle cars of the 60’s were exciting to drive and fun to work on. That was an era when there was enough room in the engine compartment to swing a socket wrench. Of course, without air conditioning there was plenty of space to climb inside and yank a Champion or two. Considering that engine oil is to a car what blood is to the human body, you can bet that oil changes were dutifully timed events. Unlike blood, oil has changed over the years. Modern engine oils have viscosity-index improvers, antioxidants, dispersants, corrosion and foam inhibitors, and anti-wear agents that were absent half a century ago. Also some oil formulations vary from state to state. In the past, wearing oil and grease on hands and clothes was a badge of honor, an announcement that proclaimed mastery over a demanding technology. Today, protective gloves need to be the order of the day.

Mechanics and other auto workers who are exposed to used crankcase oil have experienced skin rashes, blood effects similar to anemia, headaches and tremors. Along with used oil, they are exposed to other chemicals/toxins common to the auto industry, including fluids, metal particles and fumes. Used oil may contain chemical constituents that result from the internal combustion process, such as the polycyclic aromatic hydrocarbons (PAH) associated with benzene and related suspect carcinogenic compounds. Systemic effects of exposure to used oils and automotive fluids may include elevated blood pressure, aberrant red blood cell values (caused by lead exposure), stress to the liver (as indicated by irregularities in enzyme markers), and skin rashes (Clausen and Rastogi, 1977). In mechanics who work with new cars, interior cabin materials present no less a threat to health. Exposures to high concentrations of the aliphatic hydrocarbons that render the appealing “new car smell” are found to accumulate in the body (Yoshida, Jan 2010 and Aug 2010).

What’s the big deal?

There is more than one route to internal toxicity. You can swallow almost anything, inhale too many other things, and absorb more than a handful of the remaining damaging substances available to the environment. Compounds that contain only hydrogen and carbon are called hydrocarbons. The number of atoms of either element can change to make a different substance, one of the simplest being CH4, known as methane. During the refining of petroleum, one kind of hydrocarbon can be converted to another, giving us gasoline, naphtha, kerosene, lubricating oils and more. Adding chlorine to the C-H backbone reduces flammability and increases stability, resulting in chlorinated hydrocarbon solvents that can be used to clean, degrease and thin almost anything. At high temperatures that vary according to the compound, they give off seriously toxic gases and can enter the body through the skin.

Most foreign substances are unable to penetrate skin, the outer layer of which is an effective barrier to most inorganic particles. But damage to the stratum corneum, whether by abrasion, exposure to U-V light, or by chemical insult, can allow penetration. Lubricating oils, some waxes, and greases can induce primary irritations and photosensitivity to skin. The severity depends on the nature of the oil, the integrity of the skin, the frequency and length of contact, and individual susceptibility. Certain size molecules of chlorinated and simpler hydrocarbons, and of those with a greater number of carbon atoms than hydrogens, are more apt to enter skin than others (Riihimaki and Pfaffli, 1978) (Babu et al, 2004).

Among the riskier materials are automotive and industrial solvents made with trichloroethylene or tetrachloroethylene, known to penetrate the skin and suspected of being carcinogenic. Up to the 1970’s, trichloroethylene was used directly on humans as a general anesthetic and as a wound disinfectant. Believe it or not, it was also used as a flavoring agent for coffee. This nonsense was halted in 1977. Today it’s being used as a degreaser, as a cleaner for textiles, as an additive to inks and paints, and as an ingredient in PVC (the polyvinyl chloride in plastic plumbing). At least it won’t catch fire. Strangely, the metabolites of trichloroethylene are identical to those that follow the chlorination of municipal water supplies, namely chloral, chloral hydrate, monochloroacetic acid, and di- and trichloroacetic acids (Simon, 2005).

Tetrachloroethylene is also known as perchloroethylene, most commonly used in dry cleaning.  Exposure, either respiratory or dermal, may cause depression of the CNS, liver and kidney damage, impaired memory and headaches (DHHS, 1991). Like trichloroethylene, it is non-flammable and stable. Earlier in its history it was used in commercial refrigerants and auto air conditioners. But it’s an excellent solvent for organic materials such as the greases and lubricants used in the automotive industry…and it dissolves fats from skin, resulting in skin irritation.

Does It Hurt?

Once in the body, either through the skin or the nose, these hydrocarbons attack the cell membrane and the proteins that prevent entry of toxic compounds. A bodyguard enzyme called ATP-ase directs cell traffic by letting food and energy in, and by escorting wastes and toxins to the door. Another of its jobs is to control the balance of sodium and potassium. Sodium tells a cell to contract so you can pick up a tool, and potassium tells it to relax so you can put it down again. Chlorinated solvents, though, attack the fats from which the membrane is made and cause it to lose its shape and to resemble a half deflated basketball. Now, it can’t do its job and you get tired quickly and your thinking becomes foggy. Once ATP-ase gets dissolved by chlorinated hydrocarbons, any work that requires muscle power becomes more and more difficult. There are no alternatives to crankcase oil, but there are optional solvents and degreasers. Read the labels, wear gloves, and protect your eyes. No matter how thick-skinned we think we are, we really aren’t.


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*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.

Calcium and CVD, Is There a Connection?

dairy-productsIs there a difference between, “I have blue paint in my bedroom,” and “My bedroom walls are painted blue?”  A gallon of paint in the closet or on the floor in your bedroom verifies the first quote. An empty can and blue walls verify the second. Maybe this isn’t the best analogy, but you can apply it to the calcium in your body, which is either part of your bones or used as an electrolyte, or not. It’s either where it belongs, or not. The body has a remarkable system for keeping the concentrations of calcium in the blood and tissues just right, for ensuring that calcium is where it belongs. If the balance gets upset, certain organs will suffer. You see, besides bones and teeth, calcium helps muscles by keeping nerve impulses firing properly; otherwise the muscles can twitch and cramp. This is the last thing we want to happen to the heart muscle. If necessary, calcium is drawn from bone, where ninety-nine percent is stored, to maintain body pH in times of calcium deficiency. The protein-bound calcium of the blood is a secondary reservoir of calcium, usually becoming available locally to meet needs, as in clotting after getting cut. In the electrophysiology of the heart, calcium works with sodium to enable a heartbeat.

Research on calcium in the last ten years, particularly on supplements, has raised eyebrows about calcium intake and the form in which it is taken. Whether inadvertently or by design, co-factors that enhance calcium bioavailability and absorption from supplements were overlooked by some researchers and the supplements were accused of causing heart attacks. One study, published in the British Medical Journal in 2008, decided that adverse cardiac events were attributable to calcium supplements. The study included almost fifteen hundred women over seventy years old, and reported that those who used calcium supplements experienced more heart problems than those who did not (Bolland, 2008). Neither health conditions, smoking habits, environmental and lifestyle status, prior illnesses, family history, dietary regimens, type of supplement used (carbonate, malate, citrate, etc.), nor other influences were scrutinized. Later study by the same group added vitamin D to the equation and arrived at the same conclusion, that calcium supplements with or without vitamin D modestly increased the risk of cardiovascular episodes, but only in women who did not take calcium supplements regularly and scrupulously prior to the study. It seems, then, that the sudden onrush of calcium nutrition was too much for the body of a geriatric subject, who might even have suffered a different pathology, to handle at one time, and that instead of moving to bone, the mineral clogged up the works (Bolland, 2011). These papers recommended that the role of calcium supplementation in the management of osteoporosis be reassessed. But it doesn’t stop here.

Critics of these studies question the accuracy of the conclusions by closely examining coronary artery calcification, wondering how the calcium got there in the first place, when it’s supposed to make bone, not arterial plaques. When comparing / contrasting dietary calcium and supplemental calcium, the results were similar:  there is no support for the hypothesis that high calcium intake increases risk for coronary artery calcification, held to be a definitive measure of atherosclerosis burden (Samelson, 2012) (Prince, 2011).

We know that vitamin D is necessary for the absorption of calcium and that its insufficiency is common in the northern latitudes. Oddly, insufficiency also occurs in the sub-tropical areas of the planet, partly because of sun avoidance and partly because of sunscreen use, though other factors weigh in, such as cloud cover, altitude and air pollution. Vitamin D is supposed to regulate serum calcium and phosphorus concentrations. In the absence of vitamin D, only about 10% of calcium is absorbed. Maybe the rest goes to places where it doesn’t belong, like your arteries. But you have to get enough vitamin D to make a difference.  The 400 IU used in the study (Bolland, 2011) is barely enough to prevent outright deficiency.

An inflammatory model of CVD has challenged the cholesterol model, and vitamin D plays a role in sequestering the cascade of activities that lead to cardiac episodes. When monocytes rush to the site of inflammation they become macrophages that swallow oxidized LDL and then provide the basis for plaque formation, part of which is trapped calcium. Because vitamin D can suppress macrophage cholesterol uptake, it can interrupt the foam cell cycle and subsequent plaques (Oh, 2009), thereby disrupting the cardiac incident. That’s cool. Hold on, there’s more…vitamin K. Most of us consider blood clotting and vitamin K in the same thought. While that’s true, this compound, associated with green leafy vegetables, does a few more things. There is evidence that low vitamin K levels are associated with reduced bone mineral density and increased arterial calcification (Jie, 1996). Concurrent work shows that vitamin K is able to escort calcium to the place where it belongs—bone. Although deficiency of this vitamin is infrequent, insufficiency is common, and that almost certainly would account for the presence of calcium where it isn’t supposed to be (Vermeer, 2000). Proteins that rely on vitamin K for their activity have shown the ability to inhibit vascular calcification. Even accounting for smoking, diabetes, age, dietary habits and other factors, it was found that subjects with the highest vitamin K levels in the menaquinone form (vitamin K2) experienced fewer incidents of all-cause mortality (Geleijnse, 2004), especially coronary heart disease (Beulens, 2009).

Humans can absorb only about 500 mg of supplemental calcium at a time, with the citrate form having better assimilation than the carbonate. Taking it with food, which encourages stomach acid formation to aid mineral metabolism, practically evens the field (Heaney, 2001, 1999). Considering that calcium is essential to human health, that dairy is not a significant player in most adult diets, that some vegetables high in calcium are also high in oxalates that bind the calcium,  that produce with available calcium contains only small amounts, and that too many of us shun beans for social reasons, supplementation remains the option. Get a dietitian to look at your diet and determine your calcium sources and values. Then take a supplement to bring daily intake up to about a thousand milligrams.  By monitoring vitamins D and K, too, vascular calcification becomes a relative non-issue. An important matter, though, remains for those taking warfarin. It might thin your blood and prevent a clot, but it also interferes with the activity of the proteins supported by menaquinone, and replaces the clot with a plaque.


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