Epilepsy Talk

Calcium — Friend or Foe? | June 16, 2013

After talking to a famous epileptologist, I learned that calcium is really a two-edged sword. Which surprised (and scared) me.

I’ve always read that calcium was imperative if you were taking antiepilepsy drugs — especially Dilantin. Even if your doc “forgot” to tell you!

Speaking of which, a survey found that fewer than one-third of neurologists routinely evaluated AED patients for bone disease. And fewer than 10% prescribed calcium and Vitamin D.  

But, at least, most doctors do recommend DEXA scanning at one-to-two-year intervals to monitor changes in bone density during treatment.

Unfortunately, monitoring osteoporosis treatment using DEXA scans is highly controversial. Because bone density changes so slowly that the changes may be smaller than the measurement error of the machine.

However, right now, it’s all we’ve got. So until something better comes along, at least this will give us a clue about what’s going on with our bones.

WHY YOU NEED CALCIUM

Believe it or not, reduced bone mineral density (BMD) has been reported in 20-75% of people taking AEDs.

Most importantly, the risk for skeletal fractures if you have epilepsy, is two to six times greater than in the general population.

These fractures may be caused by seizures themselves or by falls, as we know all too well.

The following drugs have the clearest association with decreased bone mineral density and bone disease:

Dilantin, Mysoline, Phenobarbital, Tegretol, and Valproate.

And antacids may interfere with your absorption of those meds, decreasing the acidity of your stomach and also forming insoluble complexes that cannot be absorbed.

HOW MUCH IS ENOUGH?

The Office of Dietary Supplements suggests children and teenagers nine to eighteen years old consume 1,300 milligrams of calcium.

Healthy adults 19 to 50 should have 1,000 milligrams of calcium. Adults over 50 should consume 1,200 milligrams.

Consuming calcium-containing foods and/or calcium-containing supplements is so safe that although calcium can react with some AEDs, over-dosage hasn’t been reported.

Some of the top calcium-rich foods are:

Cheese, yogurt and milk

Sardines

Dark leafy greens like spinach, kale, turnips, and collard greens

Fortified cereals such as Total, Raisin Bran, Corn Flakes. (They have a lot of calcium in one serving.)

Fortified orange juice

Soybeans

Fortified soymilk (Not all soymilk is a good source of calcium, so it’s best to check the label.)

Enriched breads, grains, and waffles

The two most common calcium supplements are calcium carbonate and calcium citrate.

However, your combined calcium intake from the dietary sources and vitamin supplements should not exceed 1,500 mg per day. Because, your body can only absorb so much calcium at a time.

Your calcium supplements should be divided into two doses daily with food, in doses of 500 mg to 600 mg — to increase absorption.

Also calcium supplements should be taken one to two hours apart from other supplements or medications. When taken at the same time, calcium can bind those products and pass them unabsorbed from the body.

But, there’s a potential catch to correcting such “nutrient depletions.”

In some cases, taking the nutrient can impair the absorption or alter the metabolism of anticonvulsant drugs.

In other cases, it’s possible that nutrient depletion is part of how the anticonvulsant operates! (Catch-22?)

So physician or nutritional supervision is important when taking any supplements.

THE SURPRISING NEWS

While the majority of calcium in your body is stored within your bones, the rest is in your bloodstream and other body fluids.

Abnormalities in your body’s calcium level can result in significant health problems.

Both low calcium levels (hypocalcemia) and high calcium levels (hypercalcemia) can cause seizures.

According to Epilepsy.com, hypocalcemic seizures can cause generalized tonic-clonic seizures, focal muscle seizures and absence seizures.

Although, hypercalcemic seizures are relatively rare, 20-25% of people who have this calcium deficit require emergency medical attention.

However, chances are that you only have a mild blood calcium deficiency, especially before a seizure.

The good news is that when your blood calcium levels get low, your bones release calcium to bring it back to a good blood level.

(Hmmmm. Is that where osteopenia and osteoporosis come in?  You’re between the devil and the deep blue sea!)

Interestingly, a study found that those who were on long-term AEDs, had higher levels of calcium than non-medicated controls.

This might suggest that one of the reasons that some of these medications are continued long-term is that for some people, they somehow increase the retention of calcium, which may account for some of their anticonvulsant effects! (Wow.)

THE CONTROVERSY

There are also scattered reports that the anti-epilepsy medications Phenobarbital, Tegretol, Valproate, Lamictal, Neurontin and Sabril can cause or contribute to myoclonic seizures in those who previously hadn’t been having those types of seizures.

Why? Because some AEDs can reduce Vitamin D levels which is needed to efficiently absorb the calcium efficiently. (I know, it’s confusing.)

Milk is the best dietary source of Vitamin D. The recommended Vitamin D levels for those up to 70 years old is 600 IU or 15 mcg.

Foods such as spinach and rhubarb can decrease calcium absorption.

And calcium itself can interfere with the absorption of iron, zinc, bisphosphonates and tetracycline.

Now for the really sticky part…

A newly recognized worrisome concern on higher dosages of calcium is an increased risk for hardening of the arteries and heart attacks.

The Women’s Health Initiative (WHI), one of the largest studies evaluating the female population and including some 36,000 women, addressed this concern.

In one subgroup analysis, there was an increased risk for heart disease for women who had taken calcium supplements (with or without vitamin D).

And conversely, in another, there was not.

So now for the $64,000 question: What are we supposed to believe?

The theory is that sudden peaks in blood calcium may increase the risk for plaque progression (hardening of the arteries).

When we eat calcium in our diet, we introduce our bodies to small amounts of calcium at a time.

Taking a supplement, exposes our bodies to much higher amounts of calcium. So the calcium levels in our blood spike.

Our bodies may not be able to absorb or process that amount of calcium as easily (remember the 500mg to 600mg maximum), and the extra calcium may then stick to plaque in the arteries.

Obviously the goal should be to minimize any unnecessary spikes in blood calcium to reduce possible heart risk.

But, there’s no one-size-fits-all.

The first choice (which few of us can adhere to), is to increase your dietary intake of calcium. But the key is consistency.

And since most of us are inconsistent in our diets, a calcium supplement is recommended.

Once again, it’s important to take your supplement with food — divided into two doses daily of 500 mg to 600 mg.

And calcium supplements should be taken one to two hours apart from other supplements or medications.

Ideally, the supplement should also include 600 IU or 15 mcg. of Vitamin D which aids your body’s absorption of calcium.

The object is to switch more supplemental calcium to our bones — where we want it — and less calcium goes towards the plaques where we don’t want it.

Do the benefits of calcium outweigh the possible dangers?

If you’re not in danger of heart disease, or don’t already have it, I’d definitely say “YES.”

Especially when you factor in the effects and potential dangers of AEDs.

In medicine, we often have to look at the risk vs. benefit of any given situation. And then make our own decisions.

I guess that’s why they call it the “practice” of medicine. Because no one has all the answers.

Other articles that may be of interest:

Brain Food for Your Health…  https://epilepsytalk.com/2011/06/21/brain-food-for-your-health%E2%80%A6/

Fighting Seizures Nutritionally  https://epilepsytalk.com/2009/11/26/fighting-seizures-nutritionally/

Foods That Fight Stress…  https://epilepsytalk.com/2010/06/20/foods-that-fight-stress%E2%80%A6/

Zinc Can Help You Think!   https://epilepsytalk.com/2012/06/19/zinc-can-help-you-think/

To subscribe to Epilepsytalk.com and get the latest articles by email, go to the bottom box of the right column and click on “Sign me up!”

Resources:

http://www.webmd.com/a-to-z-guides/calcium-ca-in-blood

http://www.webmd.com/vitamins-and-supplements/lifestyle-guide-11/supplement-guide-calcium?page=2

http://www.livestrong.com/article/365302-calcium-seizures/

http://www.livestrong.com/article/210436-what-are-the-dangers-of-too-much-calcium/

http://professionals.epilepsy.com/page/electroab_hypocalcemia.html

http://www.healthresearch.com/myoclonic.htm

http://www.netdoctor.co.uk/ate/heartandblood/203185.html

http://www.tanyafeke.com/?tag=epilepsy

http://www.raysahelian.com/calcium.html

http://www.mcppnet.org/publications/issue15-5.pdf

http://www.bidmc.org/YourHealth/Holistic-Health/Conditions.aspx?ChunkID=38390

http://www.sciencedirect.com/science/article/pii/S1525505003003871

http://www.sciencedirect.com/science/journal/15255050/5/supp/S2

http://www.webmd.com/food-recipes/features/10-calcium-rich-foods

http://www.medicinenet.com/bone_density_scan/page5.htm

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2673405/


33 Comments »

  1. Holy cow! Maybe this is why I have CRAVED dairy products so often since I was a kid. In high school I used to get leg cramps and taking a calcium supplement helped almost instantly. Thanks for the information, Phylis. I never even knew calcium had these interactions with epilepsy drugs. My epileptologist never mentioned it and I don’t remember reading it on the paper that came with the Depakote (the double-sided tiny print that took an hour to read).

    Like

    Comment by Laura M — June 16, 2013 @ 8:37 PM

  2. I’m an ice cream junkie myself! 🙂

    And I don’t understand why docs “forget” to warn you about calcium depletion, etc…

    As for the drug warnings — you need a magnifying glass and a lot of persistence to get through them.

    Good for you, for being so diligent!!!

    Like

    Comment by Phylis Feiner Johnson — June 16, 2013 @ 8:54 PM

  3. I didn’t know about this either. Thank you for the report.

    Like

    Comment by Lee Ann Steinmetz — June 16, 2013 @ 9:21 PM

  4. I’ve heard from a couple of nutritionists and my doctor that calcium should be taken w magnesium in order for the full effects to take place. Calcium alone can have a detrimental effect,causing issues w cardiovascular & bone spurs. Also, mag is good for neurological health. the recommended ratio of cal:mag is 2:1. Carolyn Dean, MD wrote an excellent book on the topic:

    http://drcarolyndean.com/magnesium_miracle/

    Like

    Comment by urbangirl — June 17, 2013 @ 2:00 PM

  5. Right you are and thanks lots for pointing that out. I appreciate it.

    You might be interested in the article:

    Brain Food for Your Health…

    https://epilepsytalk.com/2011/06/21/brain-food-for-your-health%e2%80%a6/

    Again, thank you so very much!

    Like

    Comment by Phylis Feiner Johnson — June 17, 2013 @ 2:33 PM

  6. I take a product called Bone Up to fight bone loss. It contains other vitamins and minerals such as Vitamin k and magnesium.. Here is a link with ingredients..
    http://www.jarrow.com/product/551/Bone-Up

    Like

    Comment by Doug — July 10, 2013 @ 12:57 AM

  7. Phylis, have you ever heard of a product called MBP Bone Renew? My vitamin person says this is supposed to help build bone along with the normal supplements. Wondered if it was safe and safe for those with epilepsy.

    http://www.sourcenaturals.com/products/GP2406/

    Like

    Comment by Doug — July 10, 2013 @ 12:59 AM

  8. I’ve never heard of MBP but why would it be better than Bone Up? (Which at least I’ve heard off.)

    I will tell you that Dr. Whitaker’s Osteo Essentials from Healthy Directions is what I’d recommend.

    http://www.healthydirections.com/index.cfm/fuseaction/product.detail/categoryID/376F990A-4B95-49BC-A14B-45F7E46DB312/productID/0DC45AE1-3EAA-46AE-8010-4CC06862BD0A/?HD=&key=209564&mr:trackingCode=08D465D3-F816-E211-8AE9-001517B1882A&mr:referralID=NA&mr:adType=pla&mr:ad=18045800217&mr:keyword=&mr:match=&mr:filter=21201823497&gclid=CN3Hl-fipLgCFYmk4Aod-wUAoQ

    I’ve written for Dr. Whitaker (who’s amazing). And I’ve written about the product. Which is the real deal. Even my 92 year-old mother-in-law takes it!

    And if you’re interested, you can subscribe to Dr. Whitaker’s monthly newsletter.

    It’s expensive, but packed with the latest and best natural wellness info. Plus, he shoots straight from the hip.

    (He’s an MD and a naturopath. The best of both worlds!)

    Like

    Comment by Phylis Feiner Johnson — July 10, 2013 @ 7:12 AM

    • MBP is not a calcium supplement (like Bone up is), they claim its supposed to help the body better absorb and use the calcium you provide either through diet or supplement.

      Like

      Comment by Doug — July 10, 2013 @ 12:32 PM

      • Doug, did you take the time to READ about Osteo Essentials?

        It’s “a natural bone solution that helps you preserve bone mass and build new bone!”

        Like

        Comment by Phylis Feiner Johnson — July 10, 2013 @ 3:49 PM

  9. According to my Internalist/family DR, Calcium Citrate is the Best Calcium Supplement to use. Or at least it is after Bone Density tests detect problems. 🙂 He also told me Tums was my Cheapest source for Calcium. I think he forgets I have Ep. Another Tip. Your body only absorbs 500mg of calcium per consumption/dose. So, anyone who takes full dose of 1000/1500, is just ‘pissing/eliminating the Extra, 500 mg. My doc Wants me to take Fosamax, but, I refuse. 😦 What’s the point of taking a med that Mite cause Femur to break. Rare??? So What? My System Likes Rare. 😦 I realize my Pheno’s are a part of my problem. But, I had No Problems till After the DR placed me on Advair for COPD. Advair is Another Calcium Stealing product. 5 yrs later, the 2 combined was too much. I went off the Advair & test showed improvement. But, I wasn’t taking Calcium properly so next test showed advancement. 😦 Can’t wait to get another test. Yeah Rite! 😉 Hugs Everyone! Thank You Phylis! HUGS to you too! 🙂

    Like

    Comment by Jeanne Phelps — July 29, 2013 @ 12:53 PM

  10. Fosamax is poison. It causes necrosis and all kinds of side-effects. And the jury on it’s success rate is still out.

    Candi, thanks for your advice on the Calcium Citrate.

    I’m always learning something new from you!

    Like

    Comment by Phylis Feiner Johnson — July 29, 2013 @ 1:18 PM

  11. Anybody know if the calcium citrate is better than the microcrystalline hydroxyapatite (MCHA) formula used in other supplements? I know citrate is better calcium carbonate, but hadn’t heard if citrate was better than microcrystalline hydroxyapatite (MCHA).

    Like

    Comment by Doug — August 30, 2013 @ 2:41 AM

  12. Calcium

    “The easiest forms of calcium to absorb are:

    Calcium Microcrystalline Hydroxyapatite (calcium MCHA).

    Calcium MCHA is made from cow bone. It is prepared using a special process of re-suspending bone matrix into an easily absorbable crystalline structure.

    Calcium MCHA is bone so it has the appropriate ratio of minerals such as magnesium, boron and silica.

    It may be necessary for those who are deficient to supplement more magnesium.

    Signs of magnesium deficiency are restless leg, leg cramps, muscle tension and muscle spasm.

    Use additional magnesium with all of you calcium sources if you have these symptoms.

    You can use up to 1000 milligrams of magnesium per day, with your calcium.

    Protein and Vitamin D should also be used additionally when using MCHA.

    Calcium MCHA is bulky, so it is often necessary to take 4-6 capsules to achieve a dose of 1000mg/day-1500mg/day.

    The normal Calcium MCHA dose is 1000mg/day of calcium (which is about 3-4 grams of the entire MCHA complex)

    Note: Not all Calcium MCHA is created equal!

    It is easy to make a bad batch of calcium MCHA, and quality matters!

    Do not find the cheapest version of Calcium MCHA, because you are most likely buying bone meal with very low absorption potential.

    Bone meal is not the same as Calcium MCHA!

    Calcium Citrate is another version of easily absorbed calcium.

    Calcium citrate is not dependant on stomach acid for absorption.

    Those on acid blockers can still use this form of calcium.

    Calcium citrate is not a complete mineral supplementation for bone density.

    Supplementation should also include magnesium, trace minerals, vitamin D & C and protein.

    Calcium citrate is an excellent choice for those with constipation, because one of the side effects is to loosen stools.

    Find a calcium citrate that doesn’t have propylene glycol.

    Calcium citrate dose per day is 1500mg/day

    Chelated calcium such as calcium glycinate, calcium aspartate or calcium malate are also easily absorbed versions of calcium.

    These forms of calcium supply the body with amino acids or nutrients that are used to create energy, as well as calcium.

    They do not cause loose stools normally.

    These forms of calcium are not complete mineral supplementation for bone density.

    Supplementation should also include magnesium, trace minerals, Vitamin D & C and protein.

    The dose of calcium glycinate/aspartate or malate is 1500mg/day

    Calcium carbonate is difficult to absorb in individuals with low stomach acid, a common problem in post-menopausal women and those on acid blockers due to reflux or ulcers.

    Calcium carbonate blocks stomach acid. Stomach acid helps acidify calcium and improve its absorption.

    Stomach acid is also necessary for digestion, especially digestion of protein.

    Protein is also necessary for bone density.

    All calcium supplementation should be divided throughout the day, to increase absorption.

    I do not recommend calcium carbonate to anyone because of the long-term risk of damaging digestion.

    Calcium carbonate is the cheapest and smallest version of calcium, so it is most often used and recommended by MDs.

    I do not believe the convenience of “one pill” can outweigh the fact that “one pill” doesn’t give you anywhere near the benefit of the other calcium types mentioned.

    Calcium carbonate also is not a complete bone food.

    If you are taking calcium carbonate, you still need to use protein, vitamin D, Vitamin C, magnesium and trace minerals.

    Calcium Oxide is also used commonly. It is not easily absorbed but not as poorly absorbed as calcium carbonate.

    Oxides are small and difficult molecules to digest. I do not recommend this type of calcium either.”

    http://steveclarknd.com/?page_id=215

    Like

    Comment by Phylis Feiner Johnson — August 30, 2013 @ 1:25 PM

    • That’s great info Phylis! I take a version of the MCHA calcium daily. I know you mentioned the need to take other vitamins and nutrients like magnesium, D, C, and protein. Can these other things, like protein, be taken with the calcium? Or does this need to be divided up too? At some point, I run out of hours in the day to space out my AEDs with my B vitamins, my calcium, and everything else!

      Like

      Comment by Doug — December 8, 2013 @ 11:20 PM

  13. Also, I’ve heard you mention the dangers of the bisphosphonates. Are there any new osteoperosis (or old ones for that matter) that are effective for those that may already have osteoperosis. I know many docs still say to go with the bisphosphonates if you already have full blown osteoperosis, but I agree with you, in that I’ve heard they can have nasty side effects.

    Curious what might be other options or something new coming down the pike?

    Like

    Comment by Doug — December 8, 2013 @ 11:26 PM

    • To get the low-down on which supplements go together and which should be taken alone go to:

      Brain Food for Your Health…

      https://epilepsytalk.com/2011/06/21/brain-food-for-your-health%E2%80%A6/

      Basically, the most important vitamin to keep in mind is B Complex. When and what it should be taken with. (I take the combos at breakfast and then the second B Complex at dinner.)

      But I tell you, between sorting through your med times and your supplement times, it’s quite challenging.

      Arthur has my vitamins and then meds divided in pill packs with labels saying which should be taken when. It makes me crazy.

      Thank heavens for a guy who gets it all. But of course, his field is vitamins and supplements.

      And now that I’m titrated up on my Lamitcal (hopefully, I get more blood work tomorrow,) it won’t be so confusing.

      Like

      Comment by Phylis Feiner Johnson — December 9, 2013 @ 10:15 AM

  14. As for bisphosphonates like Fosamax, Boniva, Actonel, Atelvia and Reclast, there doesn’t seem to be much in the works.

    However, there are Anabolic Drugs — speaking specifically about Teriparatide.

    Teriparatide is a form of parathyroid hormone, and it increases the rate of bone formation and is in a distinct category of osteoporosis medicines called anabolic drugs.

    This is currently the only osteoporosis medicine approved by the FDA that rebuilds bone.

    The goal of treatment with Teriparatide is to build bone and lower the risk of breaking bones.

    http://nof.org/articles/22

    Like

    Comment by Phylis Feiner Johnson — December 9, 2013 @ 10:40 AM

    • Anabolic? That almost sounds like a steroid of some kind… Which maybe it is, as I know that increases in some naturally occurring body steroids can increase bone mass along with muscle mass. Are they related?

      Like

      Comment by Doug — February 15, 2014 @ 3:40 PM

  15. “Anabolic steroids are man-made substances related to male sex hormones. Doctors use anabolic steroids to treat some hormone problems in men, delayed puberty, and muscle loss from some diseases.

    Bodybuilders and athletes often use anabolic steroids to build muscles and improve athletic performance. Using them this way is not legal or safe. Abuse of anabolic steroids has been linked with many health problems. They include

    Acne
    Breast growth and shrinking of testicles in men
    Voice deepening and growth of facial hair in women
    High blood pressure
    Heart problems, including heart attack
    Liver disease, including cancer
    Kidney damage
    Aggressive behavior”

    http://www.nlm.nih.gov/medlineplus/anabolicsteroids.html

    Like

    Comment by Phylis Feiner Johnson — February 15, 2014 @ 4:54 PM

  16. My vitamin person recently told of a product by New Chapter that claims it is plant sourced calcium that is supposed to be easily absorbed.

    Here is a link to see it.
    http://www.allhealthtrends.com/new-chapter-bone-strength-take-care-120tabs.html?gdftrk=gdfV2281_a_7c328_a_7c916_a_7c

    Like

    Comment by Doug — July 2, 2014 @ 12:17 AM

  17. Also, I spoke with a chiro (who is also a naturopath) and he wanted me to take beteine HCL to increase stomach acid to break down supplements and supposedly increase their absorption.

    I found this advice strange since I thought calcium supplements like citrate and others weren’t dependent on stomach acid to be absorbed.

    Like

    Comment by Doug — July 2, 2014 @ 12:20 AM

  18. Take a look at this link: Probiotics — Food For Thought

    https://epilepsytalk.com/2013/11/24/probiotics-food-for-thought/

    I think you may find it helpful.

    Like

    Comment by Phylis Feiner Johnson — July 2, 2014 @ 10:31 AM

  19. I only use non-fat yogurt daily. When I was on Tegretol, I had a clotting problem after 20 years of taking it. I had to find a medication to take to control my seizures. I started with none breaks and was told I had osteoporosis.
    It was serious in neck and hip. They gave me medication for 5 years. Now taking 5 drugs to control seizures . Yuck! It’s helping but taking Folic Acid, vid D 2000. Eating plenty of fruits and veg. Daily! exercise is necessity! Do not need med. for osteoporosis now. Exercise and change of medications did the trick!

    Like

    Comment by red2robi — October 24, 2017 @ 10:22 AM

  20. Hi there, excellent topic. It has now been mentioned to me( by my int. med doc) that my labwork was showing that I have increased blood calcium levels. That have consistently stay high. He took me off the Calcium supplement. I do have osteopenia (DEXA scan results). I am considered a high risk heart disease person. I had heard something about epi meds pulling out Calcium and putting it in the blood. My epi doc said something about increased blood Calcium being a sign of malignancy. Does any of this make sense? I do take a 50+ women multi vit, vit c and vit d3 should these help re: the Calcium stuff?

    Like

    Comment by Cindy Fiser — October 24, 2017 @ 11:35 AM

    • Increased blood Calcium being a sign of malignancy? That’s a new one on me. (Not that I’m a doc and/or know everything!)

      One proactive thing you could do is take other supplements to help. Like the Vitamin D you’re taking.

      10g. Vitamin D — a recent study showed that 44.5% of epilepsy patients — men and women — were vitamin D deficient, putting these people at potential increased risk for a wide variety of conditions, including osteoporosis, autoimmune disease, cancer, cardiovascular disease, and infectious disease, among others.

      In addition, people with epilepsy, memory problems, dementia and Alzheimer’s are often deficient in vitamin D.

      Brain Food for Your Health…

      https://epilepsytalk.com/2017/07/28/brain-food-for-your-health/

      I hope this helps.

      Like

      Comment by Phylis Feiner Johnson — October 24, 2017 @ 12:22 PM

  21. Thanks for the info. I used the converter to check on my Vit D and I came up with only 5mg. I will check with my epi doc(I see him in a couple of weeks) to see what he says. Don’t sell yourself short. You are a great resource of info that I trust! Have a good seizure free day!!

    Like

    Comment by Cindy Fiser — October 26, 2017 @ 9:00 AM

  22. I have a 22 year old son on 3 different seizure meds he is on topamax,lamictal, and oxtellar all of them are xr, he has been on meds from age 2 no Dr ever said anything about calcium levels. So can take supplement if needed.

    Like

    Comment by Lisa Williams — November 17, 2017 @ 12:13 AM


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    About the author

    Phylis Feiner Johnson

    Phylis Feiner Johnson

    I've been a professional copywriter for over 35 years. I also had epilepsy for decades. My mission is advocacy; to increase education, awareness and funding for epilepsy research. Together, we can make a huge difference. If not changing the world, at least helping each other, with wisdom, compassion and sharing.

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