The People's Perspective on Medicine

861 Dealing with Medical Flip Flops

Tune in to our radio show on your local public radio station, or sign up for the podcast and listen at your leisure. Here’s what it’s about:

It can be infuriating to follow health advice for years and later learn that the experts have changed their minds. Medical recommendations on diet are notoriously subject to flip-flops.

For many years, experts implied that to be really healthy we’d all give up coffee, but the evidence from research has shifted that opinion. Coffee, it seems, has more benefits than risks in general.

Another reversal has affected calcium supplements. Although they were supposed to build strong bones, that seems less certain now. What’s more, people taking calcium pills seem more likely to have heart attacks–a very serious side effect of a seemingly innocent supplement.

We also consider saturated fat and salt, two other areas where dietary advice is turning topsy-turvy.

Guests: Robert J. Davis, Ph.D., is an award-winning health journalist and founder and editor in chief of His books include The Healthy Skeptic and Coffee is Good For You. He also teaches at Emory University’s Rollins School of Public Health. The photo of Dr. Davis was taken by Mria Dangerfield.

Sabine Rohrmann, PhD, MPH, is Professor of Epidemiology and Prevention at the Institute for Social and Preventive Medicine at the University of Zurich. Her research on calcium and cardiovascular risk was published in Heart on May 23, 2012.

Michael Castleman is a medical journalist and author of more than a dozen books. His latest, co-authored with Amy Joy Lanou, PhD, is Building Bone Vitality: A Revolutionary Diet Plan to Prevent Bone Loss and Reverse Osteoporosis.

Walter Willett, MD, DrPH, is Chairman of the Department of Nutrition and Frederick John Stare Professor of Epidemiology and Nutrition at Harvard University’s School of Public Health.

Jan Staessen, MD, PhD, FESC, FAHA, is Professor of Medicine and Head of the Studies Coordinating Centre of the Laboratory of Hypertension at the Campus Sint Rafael in Leuven, Belgium. The research on sodium, blood pressure and fatal outcomes was conducted by the European Project on Genes in Hypertension and published in the Journal of the American Medical Association on May 4, 2011.

The podcast of this program will be available the Monday after the broadcast date. The show can be streamed online from this site and podcasts can be downloaded for free for four weeks after the date of broadcast. After that time has passed, digital downloads are available for $2.99. CDs may be purchased at any time after broadcast for $9.99.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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JB: In my area TPP airs between 7:00am and 8:00am on Saturday mornings. You can access this thru your smartphone or via radio which in my case is a public radio station. You can also go on the Internet at and connect that way.

I don’t get all this quibbling about TYPES of calcium when you can’t even get the extra calcium one needs via supplements to handle conditions like osteoporosis and stress fractures anymore. I and many others just need to know where to get the most dietary calcium(other than from milk) with the fewest calories.
What day and time does The Peoples’ Pharmacy air? I seem to only hear it by accident.

I looked at a container of low-fat cottage cheese (a milk product I can hold down) and a serving only has 15% of the daily value of calcium. I need advice and ideas I can take to my doctor for how to approach the 1,500 mg. of calcium I was taking in supplements to help keep the stress fracture on the top of my femur (thigh bone) from opening up again.
What are you women who used to take calcium supplements to stave off osteoporosis eating to get extra calcium? I’d appreciate ideas from anyone.
Thank you very much,
Jefferson B – tutorjb1

You brought up a valid point re. the absorption of calcium.
What about Mag. intake separately, to support the Cal. absorption?

Very interesting topic. I would like more information on types of calcium, since there several different types of calcium. Are some types of calcium better than others?

I love your radio show! The calcium information came at the perfect time. For the past year I’ve been taking 1,500mg. of calcium per day as Tums to try to prevent the stress fracture on the top of my femur from re-opening. I’ve also recently been diagnosed as having hardening of the arteries around my heart and plaque build-up inside it, I’ve stopped the Tums and am looking for ways to get more calcium in my diet, That’s difficult because drinking milk makes me sick so I stopped drinking it decades ago.
Please supplement this story with good dietary sources of calcium other than milk such as almonds and sardines. No food I’ve seen approaches the 1,500mg. of calcium I was getting from Tums and stress fractures(particularly in one’s hip)hurt so involve doctors, drugs and travel to them. causing more pain and resulting in large expense.
I love your show so can hardly believe it comes out of Durham,N.C. as I graduated from UNC,Chapel Hill,N,C. Everything as good as The Peoples Pharmacy always seems to come from someplace far away or that I’ve never heard of.
Congratulations, Joe and Terry! A pharmacologist and a medical anthropologist must make a great pair as your show proves,
JB – tutorjb1

I also checked the results of the salt study by the NIH and even contacted their personnel regarding the blood pressure numbers. As it turned out the reduction of systolic and diastolic numbers were very small for those who went on a restricted or lower salt diet. When I asked NIH how can a conclusion be made between hypertension and low sodium diets given the very small change in blood pressure numbers I never got an answer.
Now that’s blood pressure. However, there are other studies that supposedly concludes that high salt intakes affects the artery elasticity and therefore can result in higher blood pressure. Here we need more positive proof that indeed it was the salt and not other contributing factors that caused the hardening arteries.

The discussion about the recent publication in JAMA regarding sodium intake was superficial at best. The hosts gave too much credence to this study and failed to point out that the CDC and a number of extremely qualified researchers have directly questioned its results.
Simply acknowledging that people disagree with the findings of this study does not cut it; explain why there are disagreements with the study if you are going to highlight it as a major scientific finding. Having the author of the article acknowledge a few of the lesser short-comings of the study design is insufficient.
The flippant acceptance of this single study by the People’s Pharmacy is especially notable given that the entire episode’s central theme was about medical flip-flopping with a caveat that no single study should guide public health decisions.
The NY Times covered the controversy of this study well, and as responsible journalists, The People’s Pharmacy would be wise to follow their lead on the issue of dietary sodium before claiming that this JAMA study may demonstrate that dietary salt is beneficial.
Dear Alex,
No one ever said salt was beneficial. The results of the study demonstrated that low sodium excretion (the best determinant of salt intake) is associated with a higher risk of cardiovascular mortality. This is not the first time such an association has been uncovered.
Speaking of the New York Times. You may wish to read this op-ed piece just recently published:
Alex, you should know that the Cochrane Collaboration represents the highest level of scientific scrutiny of studies. Last year the this independent and objective organization published the following conclusion:
“we do not know if low salt diets improve or worsen health outcomes.”

The issues were well raised but no solutions or recommendations given. I kept waiting for Joe or Terry to ask, “so what is your recommendation?” It left me hanging….

I’ve been following Vivian Goldschmidt’s blog re osteoporosis for some time now. Many of her assertions are authenticated in today’s program, but some are not, specifically, the role of acid/alkaline balance in osteoporosis, and recommendation of organic calcium supplements, which also addresses the concern of absorption, as mentioned in a prior comment. Thanks for the program; I’ll look into the Castleman book, and also Adelle Davis, as suggested above.

Hi, I read part of the article where it says sodium excretion is inversely proportional to CVD. We all have 100mg/dl of chloride ions in the blood stream. We are all halogen technology. They have to do a study differentiating sodium from chloride as the culprit for saying sodium is at cause for the CVD. Science says that HCl has the same effect as NaCl invitro, ie. no sodium is present. It is very likely that chloride ions are the cause of CVD because they strongly repell water and cause swelling. In Oct. 1985, they did a 6 patient study for me with 4 sodium salts showing that only sodium chloride raised blood pressure. This was ignored! You have to run all the parameters to know if the correlation is with sodium or chloride ions in this case. Somebody has to do this. HCl really has the same effect as NaCl and there is no sodium! If you do this I will teach you a simple way to erase the halogen effect. Thank you.

I am concerned that you show talked about Calcium in general terms, making the term vague. There are many types of calcium, and one specifically mentioned was calcium carbonate. That’s chalk. Have you researched calcium oratate? What about calcium derived from raw bone meal?
My experience with calcium is this: In 1978 I literally crushed my left thigh bone during an auto accident, to the point the doctors wanted to amputate my leg. Never mind what I told them, but I had been drinking, and still do, a fortified protein-calcium drink. After 28 days in traction, and four months in a cast, my leg repaired itself better than it originally was. The doctor was amazed at my recovery and asked for the drink formula. Xrays prove my claim.
Additionally, in 1985 I fell from a tree and crushed my T12 vertebrae. The doctor wanted to insert a metal bar. I said no way. Of course he informed me I wouldn’t recover, and after 10 days in the hospital sent me home in a brace with lots of pain pills. Four years ago I had an occasion to have my back Xrayed for an unrelated incident. The doctor noted the previous injury and told me my vertebrae had mended stronger that any metal bar could have done. Xrays prove this also.
I’m seventy years old, going on 25, and as physically active as a forty year old. I work at a grocery store doing maintenance, just built a five foot high by forty foot long retaining with 82 lb. blocks, work a garden and landscape the yard. I can bench press 150 lbs. In other words, I stay physically active. And that’s after have a quad by-pass three years ago. Oh, I forgot to mention, I take at least fifteen supplements daily. And that’s because of in depth research on them.
Now, have those experts tell me about calcium and other supplements again. They don’t research people like me. I’ll bet their subjects eat and drink sugar, flour products, lots of omega 6 and little omega 3. I don’t.

I found the information on salt intake quite interesting. Recently, I reduced my salt intake somewhat, and I noticed that my average or normal blood pressure levels dropped slightly lower. The question I have is how do you monitor how much salt one should intake.

Enjoyed the program, but disappointed.
Calcium experts never said a word about calcium ABSORPTION. Modern diets full of processed, highly refined foods ruin the natural digestive process, and with no stomach acids, no digestive enzymes, no digestive juices, and
sluggish digestion, you won’t have much absorption.
Read Adelle Davis.

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