"Coral calcium" is a dietary supplement said to be derived from "remnants of living coral that have fallen from coral reefs, as a result of wave action or other natural processes." It is also said to be mined from the old ocean beds at the base of the coral reefs in Okinawa, Japan [1:120]. Simply put, "coral remnants" are limestone, which coral organisms originally manufacture as a protective shell. Since coral reefs are protected by law, "coral calcium" is made by grinding up limestone that no longer contains live organisms.

Limestone has no unique health properties. It is merely calcium carbonate, with some magnesium and trace amounts of many other minerals. Limestone fertilizer, available at garden centers, costs as little as a dollar for an 80-pound bag. For people who need to consume extra calcium, purified calcium carbonate pills are safer and far less expensive than "coral calcium." But Robert R. Barefoot, of Wickenberg, Arizona, would like you to believe that limestone obtained from Okinawa provides "the scientific secret of health and youth" and can cure cancer. His ideas are promoted through books, lectures, his Web site, an audiotape, a 30-minute infomercial [2], interviews, and thousands of Web sites that sell "coral calcium" products.

Although his sales pitch is preposterous, he has gained a wide audience. During the past two years, all nutritional suppliers have been flooded with inquiries stimulated by his infomercial. His book, The Calcium Factor [1], first published in 1992, has undergone five editions and on January 31, 2003 enjoyed an Amazon Books sales rank of #412, which is extremely high. On the same day, his Death By Diet [3], originally published in 1996 and now in its fourth edition, was ranked #1790; and his other book, Barefoot on Coral Calcium [4], was ranked #8114. Searching Google for "Robert Barefoot" yielded more than 31,000 hits, and searching for "coral calcium found more than 80,000! In January and February, Barefoot's infomercial was among the most frequently shown infomercials and was the most frequent one connected with a dietary supplement. Barefoot's Cure America Web site lists his email address as kingofcalcium@hotmail.com, which, considering his probable sales volume, is probably an apt description.

Dubious Claims

Here is a sampling of Barefoot's claims followed by critical comments. Except as noted, all are from his infomercial.

1. "Over 200 degenerative diseases caused by calcium deficiency. That includes cancer, heart disease, diabetes, Alzheimer's, you name it. These diseases are caused by acidosis -- acidification of the body -- lack of minerals, especially calcium. When you start taking coral calcium, your body alkalizes and drives out the acid."

Comment: All of these statements are incorrect. Calcium deficiency can weaken bones (osteoporosis), but it does not make the body more acidic or cause a wide range of diseases. The idea that calcium supplements (or dietary strategies) can change the acidity of the body is nonsense. The only acid level that diet or supplements can modify is the degree of acidity (pH) of the urine [6]

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2. "There are seven major cultures in the world that never, ever, ever get sick. They never get cancer, they never get heart disease, they never get diabetes. They have no doctors. These people live 30, 40 years longer, and they don't grow old. What's the common denominator? One hundred times the RDA of everything. So they're taking 100 times the RDA. They take so much, they get all they need and the body passes what it doesn't need."

Comment: This statement is preposterous. There is no culture in which nobody gets sick. And nobody ingests 100 times the Recommended Dietary Allowances of everything. That amount of iron, for example, would probably be fatal within a few days.

3. "The body can cure itself of all disease if given the nutrients it needs." [1:142]. Ninety percent of the disease in America can be wiped out if people get on appropriate nutrients."

Comment: Not true. Although nutritional strategies can help prevent and manage many diseases (most notably cardiovascular diseases), there exist many diseases never shown to be related to nutrient levels.

4. Ninety-eight percent of people over age 60 are "totally calcium-deficient." That's why we have all this trouble with heart disease, lupus, and Parkinson's disease.

Comment: Barefoot doesn't say what "totally deficient" means or where he gets this figure. However, U.S. government surveys indicate that at least half the people in this age group are getting at least 900 mg per day, which would hardly make them "totally deficient."

On the other hand, 97% of the population is known to be magnesium deficient, and excess calcium consumption is sure to make this deficiency even worse! Magneisum deficinecy leads to constipation, heart irregularities, msucle cramps and at least 40 other serious ailments.

5. Calcium's relevance to high blood pressure may play a small role in the incidence of heart disease, but lupus and Parkinson's disease are not caused by calcium deficiency. Keep in mind that low calcium intake has very little impact on calcium blood levels. Most of the body's calcium is stored in the bones, which can release whatever amounts are needed to maintain adequate blood levels. Over a period of many years, this can produce osteoporosis, but it has little or no effect on other disease processes.

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6. "Testing the pH level of the saliva is the most reliable test of calcium deficiency and can also tell the state of a person's health."

Comment: Testing saliva has no practical value in evaluating general health. The level is usually similar to blood pH, which the body keeps within a narrow range. When the saliva flow is high, the pH is usually about 7.4 (7 is neutral, low numbers are acid, and higher numbers are alkaline). Calcium intake does not affect the pH of saliva. The most common cause of low (acid) salivary pH is the presence in the mouth of bacteria that cause cavities. In diseases (such as diabetic acidosis) in which blood pH is dangerously low, the level is determined by blood pH testing and calcium pills have no relevance to treatment.

7. "People should not be concerned about their cholesterol levels because abnormal levels are not the cause of heart disease. The real problem is calcium deficiency. Cholesterol problems will correct themselves if your minerals are balanced. (In another TV interview, Barefoot even states "Everyone blames cholesterol, but it absolutely has nothing to do with heart disease."

Comment: Half true. While there are no scientific studies that establish a relationship between abnormal cholesterol levels and calcium deficiency and Barefoot cites no evidence that supports what he says, there is ample research data (Harvard's prestigious Framingham Heart Study) to show elevated homocysteine levels, reversible by adequate B Vitamin intake, is the most critical predictor of cardiovascular disease and Alzheimer's as well..

8. "The most important things people can do to be healthier, live longer, and disease-free are to take coral calcium and get a minimum of two hours of sunlight on their face every day-- without sunscreen."

Comment: Barefoot presents no data to back either of these claims. Even worse, two hours a day of unprotected sun exposure -- particularly in warm climates -- could place the person at high risk of getting skin cancer.

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9. "Experts quoted in the Journal of the American Medical Association say that calcium can prevent and reverse colon cancer."

Comment: Barefoot doesn't cite the article, but a search of the journal site for "calcium" and "colon cancer" found that in 1998, researchers at the Strang Cancer Prevention Center and another prominent medical institution reported that increasing the daily intake of calcium by up to 1,200 mg via low-fat dairy food in subjects at risk for colonic cancer reduced growth characteristics thought to be associated with the development of cancer [8]. The study indicates that increased attention to calcium may find a role in cancer prevention, but the study had nothing to do with either calcium supplements or the "reversal" of an established cancer.

1. Barefoot claims to have seen "millions of testimonials, had a thousand people tell him how they cured their cancer, and witnessed people with multiple sclerosis "get out of wheelchairs just by getting on the coral."

Comment: He doesn't say how he could possibly have received and read millions of testimonials, investigated a thousand cases of alleged cancer cures, or determined that patients with multiple sclerosis were actually helped by coral calcium. Proper evaluation of claimed cancer cures would require (a) checking whether the patient had a biopsy, (b) checking whether or not the patient had standard treatment, (c) checking whether the patient was actually cancer-free, (d) following the patient's course for several years, (e) and compiling detailed statistics. Do you think that Barefoot has done any of these things? The Calcium Factor contains seven brief testimonials from cancer patients, but none contains enough detail either to identify any of the people or to evaluate what they report. Multiple sclerosis testimonials are even more difficult to verify because the disease normally has ups and downs. Controlled studies are needed to determine whether a method is effective.

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2. "All cultures in which people live very long, all the people consume 100,000 milligrams of calcium."

Comment: That would be enough to cause kidney stones, calcium deposits throughout the body, and death within a short period of time [9]. The Institute of Medicine recommends taking no more than 2,500 milligrams a day [7]. Taking twice that amount would be risky [9]. Taking 40 times that amount would be insane. And unless the calcium intake is balanced 2to1 by magnesium in a bioavailable form, you are heading for heart stoppage.

10. "The Calcium Factor contains hundreds of scientific references that back up what it says. "
    
    Comment: If it does, they are well hidden. There are fewer than 100 citations to be found, many of which were to magazine articles and quacky books. The normal way to report journal references is to list the author, journal, volume, page numbers, and year of publication. Despite looking carefully, only a few are to be found that were specified in this way, and some were written by authors known to be untrustworthy. A few passages gave enough information to locate the article to which they referred, and some passages cited standard medical textbooks. However, many of these were outdated, some were quoted out of context, and none appears to be support any of the claims challenged in this article.

11. "About 600 years ago, people in Okinawa began putting coral calcium in their food and discovered that they gradually got healthier. About 100 years later, Spanish explorers came and found virtually no disease. So they filled up their shipholds and brought it to Spain, where they analyzed it and found not only calcium but a perfect balance of magnesium and 70 other trace metals and other minerals."
    
    Comment: That's an amazing story, (as hard to swallow as the product it promotes) considering the fact that 500 years ago the nature and existence of trace minerals was unknown.

12. "Okinawans do not get cancer."

Comment: This claim is easy to explode by doing a Medline search for articles about cancer that mention Okinawa in their title. You will find at least ten that describe the incidence of various cancers. Barefoot's ideas and various coral calcium products have also been promoted by several multilevel companies, one of which, in 1999, was ordered by the FDA to stop making health claims that related its products to blood pressure, arthritic conditions, heart disease, or digestive reflux. [10]

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Questionable Credentials

Thousands of Web sites refer to Barefoot as "Dr. Robert Barefoot" or Robert Barefoot, Ph.D. However, he is not a medical doctor and does not have a Ph.D. degree. In 1999, Barefoot was not permitted to testify as an expert in a case in which the Maryland Attorney General stopped the marketing of T-Up (an aloe vera concentrate) and cesium chloride for the treatment of cancer and AIDS. The case was extremely serious because the regimen had killed several of its users. During hearings in the case, the defendants sought to have Barefoot testify that cesium was effective. The curriculum vitae that Barefoot submitted described his formal education after high school as "1964 Northern Alberta Institute of Technology, Chemistry" and "1967 Graduated with Honors, Chemical Research Technology." [11] This means that his highest educational credential is a diploma (not a university degree) that reflects only three years of coursework. The presiding Administrative Law Judge noted that Barefoot had formal training and experience in inorganic chemistry but had not had any professionally supported or supervised training or done any professionally recognized research in organic chemistry and biochemistry in the human body. Although Barefoot described having many discussions with doctors and patients about using cesium for in treating cancer, the judge concluded that "this experience and study was not scientific." In 2000, a civil court judge ordered the defendants to pay millions of dollars in restitution and $3.7 million in civil penalties [12,13]. In 2001, the Maryland Court of Special Appeals upheld this decision in a ruling that explained why Barefoot's exclusion had been justified [14]. One of the defendants received a 46-month prison sentence in a parallel criminal case [15].

Web sites also describe Barefoot as a "world-renowned chemist" His curriculum vitae states that between 1968 and 1972 he published six scientific research papers on analytical chemistry and diagenesis. Diagenesis refers to the changes that occur in sediments as they are buried under other sediments. This appears to have some relevance to the formation of limestone, but it certainly has nothing to do with human biology or human health. Searching Medline, which is the most comprehensive database of medically-related journals, there are no articles with Barefoot listed as author. His curriculum vitae states that he has patented an ore-extraction process and headed two companies that serviced the petroleum industry. His marketing activities have attracted considerable attention, but I doubt that he deserves to be called a "renowned chemist."

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Carl J. Reich, M.D., who co-authored The Calcium Factor, is a Canadian physician whose license was canceled in 1983. According to Barefoot, Reich had a thriving practice in Calgary, Canada, but the Alberta College of Physicians and Surgeons considered his practices "potentially dangerous." [2:92]. The College's public report states: "A hearing was held before a panel of three peers on March 4, 1986. The allegations were:

1. Between the 3rd day of June, A.D., 1982 and the 3rd day of December, A.D., 1982 provide treatment to patients contrary to the Order of The Council of the College of Physicians and Surgeons of the Province of Alberta dated the 3rd day of June, A.D. 1982.

2. Demonstrate a lack of skill and judgment in the practice of medicine in accordance with an assessment of his medical practice as conducted on December 13, 1983 by an Assessment Committee appointed by the College of Physicians and Surgeons of the Province of Alberta.
   On March 20, 1986 the Council of the College of Physicians and Surgeons of the Province of Alberta advised Dr. C.J. Reich that his name was to be struck from the Register of the College of Physicians and Surgeons of the Province of Alberta.

Kevin Trudeau, who hosts Barefoot's current infomercial, has been the object FTC regulatory action for false advertising. In 1998, in connection with six infomercials that he developed, Trudeau signed a consent agreement to (a) pay $500,000 in consumer redress, (b) be barred from making false claims for products in the future, and (c) establish a $500,000 escrow account or performance bond to assure compliance [16]. In the current infomercial, Trudeau acts skeptical by questioning why listeners should believe various claims that the overwhelming majority of medical doctors would dispute. Barefoot's answer is simple (and incorrect). Doctors, he says, are too busy to read journals and get their information from drug companies; and drug companies don't want them to know that coral calcium is more effective than their drugs. (Doctors actually get most of their information from journals, continuing education courses, and conversations with colleagues, not from drug companies.)

During the early 1990s, according to a report in the Wall Street Journal, Trudeau served nearly two years in prison. In 1990, he pled guilty to larceny in a Cambridge, Massachusetts, state court in connection with $80,000 in worthless checks he had deposited at a bank. The sentencing memorandum said that he had posed as a doctor to increase his credibility with bank officials. In 1991, he pled guilty to credit-card fraud in Boston federal district court. Among his misdeeds in the federal case, he misappropriated for his own use the credit-card numbers of customers of the memory-improvement courses that he offered at the time [17].

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The ostensible purpose of the infomercial is to sell The Calcium Factor and Death By Diet. The infomercial states that listeners can get a special price by calling a toll-free number. One can assume that the product is not mentioned on the program because the cancer claim would make Barefoot and Trudeau sitting ducks for FDA prosecution. But by selling the book, they may be protected by freedom of the press as long as the contents of the book are accurately described. When one calls the number to get the price of the books, it is quoted as $37.97 plus $7.99 for shipping, a total of $45.96. The list prices on Amazon Books total $35.90, but buyers of both pay no shipping charge, and used and nearly new copies are available for less. One can also find a coral calcium suppler who sells both books for $27.40 postpaid.

Cost Considerations

The monthly cost of coral calcium varies with the brand, price charged by the retailer, and the number of capsules taken per day. Barefoot recommends determining the daily dosage by testing the pH of your saliva (a test that is not valid for determining calcium needs).The Calcium Factor states that only 3 are needed for people in the "healthy range" but 6 or 9 are needed for people who are ill or are developing an illness [2:119]. Since most people will test alkaline (7.2 to 7.4), the most likely dosage would be 3 per day.

During the infomercial, Trudeau states that callers to a toll-free number who mention the program's name ("A Closer Look") can take advantage of "special arrangements" he makes with all of his program's guests. When one calls the toll-free number, the operator answers "The Calcium Factor." When asked whether this is a regular business, the operator says it is just an order center. When asked who owns it, he first said he didn't know and then said their names were "Tom" and "Steve." When asked about the "special arrangements, the caller is told that the books, three videotapes, and three audiotapes are available free as part of a package that includes ten 90-capsule bottles of "Coral Calcium Daily" for $299.99 plus $19.98 shipping ($32 per bottle), and that buyers of the package can get additional bottles for life for half that much. The product contains calcium carbonate, 3 other minerals, and vitamins A, C, D, and the operator says the recommended dosage is 3 capsules per day, which would make the monthly cost about $32 for the first ten months and about half that much thereafter. There seems not to be anything "special" about the arrangement, since the same deal is on a Web site for $50 less.

The "Barefoot Calcium Plus" formula, which appears to be a major competitor, contains the same ingredients plus seven more minerals. The Coral Calcium Supplement Center sells twelve 90-capsule bottles for $263.40 plus $17.70 for shipping, which would total about $23 per month. Neither product is rationally formulated. Purified calcium carbonate tablets, which should be chewed to enhance absorption, can be obtained in drugstores and other retail outlets for about $2 per month. Vitamin D can be important, especially for people who have minimal exposure to sunlight. However, people who need supplementary vitamin D can get it combined with calcium carbonate at no additional cost. The other nutrients in these products are readily available in more complete multivitamin/multimineral products that need not cost more than $2 per month [18].

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Using an inexpensive calcium supplement may also be safer. Laboratory analyses have shown that some calcium supplements contain significant amounts of lead and other heavy metals [18]. The UC Berkeley Wellness Letter has warned:

"There has been little or no good research on coral as a source of calcium or as a treatment for disease. But that doesn't stop the marketers from making their claims, since dietary supplements are virtually unregulated. You have no idea what's really in the bottle or if the stuff is safe. Historically, calcium supplements haven't always been safe: years ago calcium carbonate from bone meal or oyster shells, for instance, was used in some supplements -- but was later found to contain high levels of lead. Since then the government and manufacturers took action to reduce lead levels in existing calcium supplements. But new supplements can go untested [19]."

The Bottom Line

Calcium intake is an important factor in bone health and may play some role in the prevention of colon cancer. Barefoot has embellished these simple facts to create an elaborate scheme to promote his publications and coral calcium products. Your best bet is to completely ignore what he says and follow a medically approved program that includes adequate calcium and other measures for preventing osteoporosis. The National Academy of Sciences advises Americans and Canadians at risk for osteoporosis to consume between 1,000 and 1,300 milligrams of calcium per day [7]. This can be done with dairy products, supplements, or both. Readily absorbable supplements need not cost more than a few cents a day.

Coral calcium products are a waste of money, and some are irrationally formulated. For professional advice on calcium intake, ask a registered dietitian (R.D.) or physician to help you. Meanwhile, if you have purchased a coral calcium product and would like to share your feelings about it with us, please send me an e-mail message.

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For Additional Information
a. Acid/Alkaline Theory of Disease is Nonsense
b. Robert Barefoot's Curriculum Vitae
References
1. A Closer Look. Infomercial hosted by Kevin Trudeau, broadcast in January 2003.
2. Barefoot RR, Reich CJ. The Calcium Factor: The Scientific Secret of Health and Youth 5th edition. Southeastern, PA: Triad Marketing, 2002.
3. Barefoot RR. Death By Calcium, 4th Edition. Southeastern, PA: Triad Marketing, 2002.
4. Barefoot RR. Barefoot on Coral Calcium: An Elixir of Life. Newark, NJ: Wellness Publishing, 2001.
5. Robert R. Barefoot Coral Calcium Interview. Audiotape transcript. Coral Calcium Supplement Center Web site, accessed Feb 1, 2003.
6. Mirkin G. Acid/alkaline theory of disease is nonsense. Quackwatch, Feb 6, 2003.
7. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, D.C., 1997, National Academy Press.
8. Holt PR and others. Modulation of abnormal colonic epithelial cell proliferation and differentiation by low-fat dairy foods: a randomized controlled trial. JAMA 280:1074-1079, 1998.
9. Scofield HR. Milk-alkali syndrome. eMedicine Web site, revised Feb 28, 2002.
10. Setterberg SM. Warning letter to Gregg Barna, CEO of Health Thru Nutrition (d.b.a. Health Technologies Network (HTN), Aug 20, 1999.
11. Barefoot, RR. Curriculum vitae. Undated, circa 1999.
12. Curran orders aloe company to stop "miracle cure" claims and to pay restitution and $3.7 million in civil penalties. Maryland Atorney General news release, May 10, 2000.
13. Court affirms order requiring aloe company to cease miracle cure claims, pay restitution & $3.7 million penalty. Maryland Attorney General news release, April 11, 2002
14. Rodowsky J. Opinion in T-Up, Inc, et al. v. Consumer Protection Division, Office of the Attorney General. In the Court of Special Appeals of Maryland, No. 0064, September Term, 2001.
15. Willis L. Man gets term of 46 months in aloe vera case: Concoction distributed as a treatment for cancer. Baltimore Sun, Dec 1, 2001.
16. Infomercial marketers settle various charges: Ad claims for "Hair Farming," "Mega Memory System," "Addiction Breaking System," "Action Reading," "Eden's Secret," and "Mega Reading" were deceptive. FTC news release, Jan 13, 1998.
17. Barrett S. Dietary Supplements: Appropriate Use. Quackwatch, revised May 20, 2002.
18. Emshwiller JR. Nutrition for Life's top recruiter has a criminal past despite convictions, Trudeau gets new distributors to fork out the cash. The Wall Street Journal, Jan 19, 1996.
19. Ross EA and others. Lead content of calcium supplements. JAMA 284:1425-1429, 2000.
20. How to sell a 5¢ supplement for $1. UC Berkeley Wellness Letter, Feb 2003.
 

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