What Did Dr. Oz Leave Out About Strontium?

Let me preface today's blog with a head's up that I spent 5 hours researching this subject before writing the blog. It's a little technical, but I thought the detail was important. 

Although I may have a pretty good handle on the subject, I may also have missed something that wasn't available on the internet. Please feel free to comment if you feel I missed something.

Last Thursday, Dr. Oz told his audience about four supplements, extensively researched by his staff, which he highly touts as anti-aging supplements. The four were resveratrol, vitamin D, fish oil, and strontium. Please see my previous blogs about fish oil (Tuesday, April 10, 2012 titled ‘Et tu fish pills?’) and Vitamin D (Tuesday, March 20, 2012 titled ‘What's The Big Deal About Vitamin D? It turns out quite a bit.’   

At a later date, I'll write about resveratrol. In the interim, please note that one of the leading, if not the number one in the world, resveratrol researcher, Depak Das at the University of Connecticut, was dismissed from his university post because he was found to have repeatedly falsified his resveratrol research data. This has thrown the entire field of resveratrol research into dispute and a major conference that was scheduled in India called Resveratrol 2012 was cancelled late last year as he was one of the top experts expected to present. Enough about resveratrol for now; today, let's have some fun with strontium.

Dr. Oz recommended that women take 680 mg of strontium each day separated from the calcium he also recommends they take.  Of course, he made no reference to recent studies that suggest potential harm from taking calcium (see my blog from Friday, May 25, 2012, 'Calcium Pills Raise Concerns -- Again!'). He mentioned on the show that strontium has been studied in Europe and that the studied form is not available in the U.S. 

Here's what he didn’t share. The form of strontium studied in Europe was strontium ranelate, a synthetic salt that combines strontium with ranelic acid.  The studies done in Europe were good studies and one of the studies was published in the New England Journal of Medicine, a peer reviewed prestigious journal published by the Massachusetts Medical Society and associated with Massachusetts General Hospital, the premiere Harvard affiliated public hospital. See reference below.

The study involved the consumption of 2 grams of strontium ranelate each day for a period just short of five years. The strontium clearly increased bone density on scans and decreased fracture risks in post-menopausal women. It was generally well tolerated except for increased nausea and diarrhea during the first three months of administration.  All study participants also consumed calcium and Vitamin D at different dosages.  As a result of the study, the drug was approved and is only available by doctor prescription for dispensing by a pharmacist to people at high risk of fractures in Europe, and requires strict medical supervision. 

Why strict medical supervision? Strontium competes with calcium and magnesium and displaces them. What that does to your bone health and overall health has not been studied and is unknown.  There are reports that it can cause a condition called osteomalacia, which involves the softening of the bones caused by defective bone mineralization secondary to inadequate amounts of available phosphorus and calcium, or because of overactive resorption of calcium from the bone, often as a result of hyperparathyroidism. In other words, taking strontium may interfere with your normal function of calcium uptake by bones.

A review of comments from users found on the internet included, a doctor “urged caution and told me about the deaths due to 'hypersensitivity syndrome' and a second consultant told me she was still not happy with calculation of DEXA scores.” The reference to the DEXA scores is that when doing the diagnostic DEXA Scan tests for osteoporosis, the test results are apparently skewed by the use of strontium.  There were many comments that indicated no problems.

So why isn’t it available in the U.S.? The answer is because the French company that owns the patent has not pursued FDA approval. The apparent reason for this and the one most often cited is that the FDA would require some homegrown research before approving it and the company doesn’t want to foot the bill. So you can’t get it here.

Of course, some entrepreneurial folks decided that if you can get the synthetic strontium ranelate here, they should cook up some strontium citrate because as it has no synthetic compound involved (ranelic acid is synthetic and citrate is not) and therefore can be sold as a supplement here in the U.S.  How did they come up with the recommended 680 mg dose? Apparently, strontium ranelate contains 680 mg of strontium. How much strontium does strontium citrate contain? I can’t tell you.

Also, what’s the difference between the way citrate and ranelate act in your body? I don’t know and nor does anyone else because it hasn’t been studied. Let’s look at an example of two other different chemical molecules binding together. Sodium when combined with chloride becomes sodium chloride, the salt we eat. When sodium is combined with citrate, it becomes monosodium citrate, a salt used to prevent anticoagulation of stored blood. Different chemicals when combined create different compounds.

So what’s the biggest problem with taking strontium citrate to prevent or treat osteoporosis? Beyond some of the concerns cited above, it’s never been studied and reported on in humans.

There was a study begun in the U.S. at University of California Davis Medical Center a few years ago that was meant to be completed and results reported in 2010, but the study, named the Scope Study, has mysteriously disappeared.  I’m not kidding. There are conspiracy theories all over the internet regarding what happened to this study. Some claim the bisphosphonate companies got to them. Just theories with no evidence whatsoever to support them. My experience is when a research institute goes mum on a study, it’s often due to something going wrong with the study.  Nonetheless, the results never came out. That gives me pause to ever recommend such a drug under such circumstances.  

Furthermore, while strontium ranelate was studied with 680 mg of strontium, studies with far less amounts have never been reported. If it is actually good for you, could less work just as well?

Strontium is present in our food supply. For example, it is available in vegetables such as spinach, lettuce, carrots, peas, beans, potatoes and celery. Wheat, barley and other grains used to make bread also have significant levels of strontium. According to one source I found, flour, grains and breads average 2,150 mg per gram of stable strontium.

So as always, before taking a pill containing a super high dose of a mineral which has not been studied for a prolonged period of time, you should increase your intake of foods containing that mineral that have been used for millions of years.

It is important to remember that high-dose strontium is essentially a bone drug, and, as with all bone drugs, it is only indicated when there is a clear high risk of fracture defined as a 20% likelihood of a major osteoporotic fracture over the next 10 years.

The bottom line is that the long-term safety and efficacy of strontium citrate has not been evaluated on humans in large-scale medical trials.

That’s why once again I say shame on Dr. Oz for recommending it to the general population without good science to support what is available in the U.S. It only serves to make people more anxious and confused that maybe they have misssed something. It is often dangerous to experiment on your own body.

By the way, here are the chemical structures for strontium ranelate and strontium citrate. Do they look similar? If no, it's because they are not. One, ranelate binds with two atoms of strontium, while the other, citrate, only binds with one atom.

Strontium Ranelate 

 

Strontium Citrate

MDPrevent

References:

Meunier PJ, Roux C, Seeman E, et al. The effects of Strontium Ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis. NEJM 2004 350;459 -68

Reginster JY, Seeman E, DE Vernejoul MC, et al . Tropos Study. J Clin Endocrinol Metab 2004–1774. Strontium ranelate reduces the risk of nonvertebral fractures in post-menopausal women with osteoporosis.

Calcium Pills Raise Concerns -- Again!

If you've heard me say it once, you probably have heard me say it many times -- taking dietary supplements in the absence of known deficiency is a mistake. One of the more controversial supplements I've rallied against has been calcium. Most women are told by their doctors, particularly as they get older, to take calcium supplements, usually about 1,000 mg.

When I give lectures, I often ask of the audience whose doctor adjusted their calcium recommendation based on the calcium the individual consumes through his or her food. The answer is almost always that none of their doctors made any such adjustment. I've always considered this problematic because why supplement at all if you are getting sufficient calcium in your diet, and why not adjust when you are getting calcium from other sources.

My real concerns about calcium began to grow almost two years ago when studies began to emerge challenging the wisdom of taking this supplement.  Specifically, these studies linked calcium supplementation with increased heart attack risks. Some studies suggested the mechanism for this, calcium supplements, were contributing to calcification, or hardening, of the heart.

So a new study that just came out should be of no surprise to my patients.

The large European study showed that people taking calcium supplements had nearly double the risk of heart attack as individuals not taking any dietary supplements. Among 23,980 participants in the European Prospective Investigation into Cancer and Nutrition (EPIC-Heidelberg) study, the hazard ratio for heart attack in those using calcium supplements, compared with nonusers of supplements, was increased according to Sabine Rohrmann, MD, of the University of Zurich in Switzerland, and colleagues.

"This study suggests that increasing dietary calcium intake from diet might not confer significant cardiovascular benefits, while calcium supplements, which might raise MI risk, should be taken with caution," the researchers concluded. In an accompanying editorial, two New Zealand physicians went further and suggested that use of calcium supplements should be actively discouraged.
 
This was an imperfect study as it was an observational study that relies on self-reporting. Nevertheless, once again, the red flag rises over taking calcium pills, or any dietary supplement for that matter. The evidence continues to mount that at best they confer no benefit, and at worst, they are harmful.

Eat a Mediterranean diet consisting of fruits, vegetables, beans, nuts, and some whole grains, add in some wild fish and save yourself some money from not buying unnecessary pills.