On May 15, 2003 the Council for Responsible Nutrition (CRN), a trade association of companies producing nutritional supplements, asked that the Federal Trade Commission and the Food and Drug Administration "take appropriate enforcement action" against Bob Barefoot, enjoining him "from disseminating . . . fraudulent health claims for coral calcium."

Various media organizations have taken a cue from CRN, including ABC's Good Morning America, which aired a piece even before the association's letter was actually sent. It was a classic "hit" piece, relying heavily on a retired psychiatrist who was described this year by a California court as being "biased, unqualified and beyond credibility." A Washington Post story that followed the CRN's announcement by a few days was more balanced, conceding that "Coral calcium marketers and their critics agree on two points: Calcium plays an important role in the body, and Americans aren't getting enough of it." Nevertheless, the Post went out of its way to find and quote skeptics who refuse to consider seriously a growing amount of scientific evidence that coral calcium does indeed provide significant health benefits.

To listen to the critics, one might conclude that scientists were unanimous in denying the benefits of coral calcium. Nothing could be farther from the truth. Examples abound.

As is nearly always the case in performing scientific research, there are differences of opinion among scientists who have investigated the role that coral calcium plays in maintaining good health. The fact that CRN agrees with the scientists who are skeptical about coral calcium's benefits doesn't change the fact that others including several noted Japanese scientists believe that it is a major contributor to good health and to longevity worldwide.

The fact that critics, including the CRN, have chosen to side with one group of scientists in the debate over the benefit of coral calcium is no justification for government enforcement action that would bar Bob Barefoot from publicizing the views of those who take the other side.

1. Governmental Statements

* The U.S. Food and Drug Administration (FDA) increased the recommended daily value for calcium from *00 milligrams (mg) to 1.000 mg. This move, in response to the growing evidence of the health benefits of calcium. also points to an increasing gap between the recommended daily amount of calcium and the amount Americans actually consume. According to the U.S. Department of Agriculture's "Continuing Survey of Food Intake by Individuals," an estimated 90 percent of adult women don't get enough calcium in their diets. Eighty (80) percent of teenage girls fall short, as do 73 percent of adult men and 68 per cent of teenage boys. Thirty (30) percent of children five and under fail to meet the minimum. Since the FDA's announcement, there has been a growing consumer demand for more sources of calcium.

• Primary prevention of colorectal cancer includes exercise, low-fat diet rich in fruits and vegetables, fiber (called into question but useful for reducing risk of heart disease), and chemoprophylaxis including NSAIDs, calcium, estrogen, folate, and selenium. CDC, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Colorectal Cancer, A Call to Action, http://www.cdc.gov/cancer/colorctl/calltoaction/slides/slide48.htm.

1. Cancer Risk

• "Several but not all epidemiologic studies have observed an inverse relationship between calcium intake and cancer risk." National Institutes of Health, National Cancer Institute, Prevention of Colorectal Cancer, http://www.cancer.gov/cancerinfo/pdq/prevention/colorectal/healthprofessional.

• "For years, doctors thought a low-calcium diet was the best way to prevent kidney stones, especially in those who already had stones. But recent research has reversed that thinking Researchers now believe that more rather than less calcium is better. Recent studies have shown that a diet with normal amounts of calcium is probably best." NIH News: The NIH Word on Health: November 2002: Kidney Stones Myths, http://www.nih.gov/news/WordonHealth/nov2002/kidneystones.htm.

• "Until recently, osteoporosis has been considered to be a women's problem, said Sherry Sherman, Ph.D., Director, Clinical Endocrinology and Osteoporosis Research, NIA, and project officer for the study. We know that older men do experience considerable bone loss over time. With older people living longer than ever, increasing the intake of calcium and vitamin D can be an important lifelong strategy for both sexes." NIH News Release, National Institutes of Health, National Institute on Aging, Calcium, Vitamin D Combo Reduces Bone Loss, Fracture Rate for Older People (September 3, 1997) http://www.nih.gov/news/pr/sept97/nia-03.htm.

• "Consistent with previous observations, a recent meta-analysis of randomized controlled clinical trials suggests that calcium supplementation results in only a small reduction in blood pressure. This effect has only been observed in those with hypertension." National Institutes of Health, National Heart, Lung, and Blood Institute, Primary Prevention of Hypertension: Clinical and Public Health Advisory from the National High Blood Pressure Education Program at 10 (2002).
• "Randomized trials of calcium supplementation in nulliparous women considered at high risk demonstrated significant reductions in incidence of preeclampsia." National Institutes of Health, National Heart, Lung, and Blood Institute, Working Group Report on High Blood Pressure in Pregnancy at 16 (July 2000).
• Calcium and Magnesium: "These nutrients may help to prevent high blood pressure and improve health in other ways." National Institutes of Health, National Heart, Lung, and Blood Institute, The Healthy Heart Handbook for Women at 61 (2003).

• "Calcium is also important for preventing gum disease." National Institutes for Health, National Institute of Child Health and Human Development, Why Calcium?, http://www.nichd.nih.gov/milk/whycal/calcium.cfm.

II. Academic and Research Institutions

• "Men and women who take calcium supplements may have a lower risk of large bowel adenomas polyps that are considered cancer precursors reports a study let by Dartmouth Medical School researchers Dr. John A. Baron, professor of medicine and of community and family medicine at Dartmouth Medical School, led this multi-centered study, funded by the National Institutes of Health Adenomas or polyps may develop into colorectal cancer. Less than one year into the study, we saw positive results from calcium fewer adenomas and so, less potential for cancer, said Baron." Norris Cotton Cancer Center, New England Journal of Medicine Reports Calcium Supplements Help Prevent Polyp Recurrence; NCCC Led Study, http://cancer.dartmouth.edu/media/release/press14.shtml (1999).

• "In addition, a 14-year study of 86,000 women found that those who had a relatively high intake of calcium, whether through diet or use of supplements, had a reduced risk of stroke." Mayo Clinic, Food and Nutrition Center, Calcium, http://www.mayoclinic.com/invoke.cfm?id=SA00019.

• "Data from the Health Professionals Follow-Up Study suggest that calcium may have a threshold effect on the risk of colon cancer: very low levels appear to increase risk, but once a certain level is reached (about 700 milligrams a day), there is no significant benefit to increased intake, either through diet or supplements." The Source, The Newsletter of the Harvard Center for Cancer Prevention, Activity, Diet, and Colon Cancer: Results from the Health Professionals Follow-Up Study (2002), http://www.hsph.harvard.edu/cancer/publications/source/v9n1/speakers.html.
• "Higher calcium intake is associated with a reduced risk of distal colon cancer." Wu K, et al. Calcium Intake and Risk of Colon Cancer in Women and Men. Journal of the National Cancer Institute 2002;94(6):437-446 (study conducted by researchers at the Harvard School of Public Health, Harvard Medical School, and the Brigham and Women's Hospital, Harvard Medical School).

• "A study published in the newly released Journal of Periodontology found that people who get enough calcium have significantly lower rates of periodontal disease, a leading cause of tooth loss." American Academy of Periodontology, Healthy Gums are Likely to Lie Behind Milk Mustaches (August 2, 2000), http://www.perio.org/consumer/calcium.htm

* Conclusions of a panel convened by the National Institutes of Health at the Consensus Development Conference on Optimal Calcium Intake, held on June 6-8, 1994, are published in the December 28, 1994, issue of the Journal of the American Medical Association (JAMA). The consensus statement was developed by a 15-member independent panel composed of biomedical researchers, health professionals, and representatives of the public. The panel was chaired by Dr. John Bilezikian, chief of endocrinology at Columbia University College of Physicians and Surgeons in New York City.

The consensus panel summarized its conclusions as follows:

• A large percentage of Americans fail to meet currently recommended guidelines for optimal calcium intake.
• On the basis of the most current information available, optimal calcium intake is estimated to be 400 mg/day (birth- 6 months) to 600 mg/day (6-12 months) in infants; 800 mg/day in young children (1-5 years) and 800-1,200 mg/day for older children (6-10 years); 1,200-1,500 mg/day for adolescents and young adults (11-24 years); 1,000 mg/day for women between 25 and 50 years; 1,200-1,500 mg/day for pregnant or lactating women; and 1,000 mg/day for postmenopausal women on estrogen replacement therapy and 1,500 mg/day for postmenopausal women not on estrogen therapy. Recommended daily intake for men is 1,000 mg/day (25-65 years). For all women and men over 65, daily intake is recommended to be 1,500 mg/day, although further research is needed in this age group. These guidelines are based upon calcium from the diet plus any calcium taken in supplemental form.
• Adequate vitamin D is essential for optimal calcium absorption. Dietary constituents, hormones, drugs, age, and genetic factors influence the amount of calcium required for optimal skeletal health.
• Calcium intake, up to a total intake of 2,000 mg/day, appears to be safe in most individuals.
• The preferred source of calcium is through calcium-rich foods such as dairy products. Calcium-fortified foods and calcium supplements are other means by which optimal calcium intake can be reached in those who cannot meet this need by ingesting conventional foods.
• A unified public health strategy is needed to ensure optimal calcium intake in the American population.

Sincerely,

Bob Barefoot - Author, Chemist, Lecturer