No excitement or helicopter rides to report, just back-to-basics articles,– although I may let it slip that Dr. Bob has been dumpster diving at the pharmacy. I had a Vitamin D and calcium article written and ready for the November Health Matters column. Boy was I surprised when I saw his article on Vitamin D in the October issue! However, Vitamin D is still a hot topic; so I’ll try to build on Dr. Bob’s excellent article.
It appears that the FDA has underestimated our Vitamin D requirement for quite some time. The old RDA (Recommended Dietary Allowance) limit of 400 IU per day for adults was set in 1968. Now many physicians are suggesting that adults take from 1000 to 2000 IU per day. The recommended amount for children has been raised to 400 IU per day. What amount you need depends on several things. A simple blood test will tell you what your Vitamin D level is. Those who may be at risk for Vitamin D deficiency include:
• Older adults
• People with limited sun exposure.
• People who may go out in the sun but wear sunscreen when they do.
• People with darker skin pigmentation.
• People with fat malabsorption disorders (e.g., Celiac disease, Crohn’s disease, pancreatic insufficiency, liver disease, or cystic fibrosis)
• Pregnant women
• Breast-fed infants
• Obese individuals
• People taking any of the following medications: prednisone, rifampin, Xenical®, Alli®, Questran®, Cholestyramine, Prevalite®, phenobarbital, phenytoin, Tegretol®, or carbamazepine.
Since we live in the wonderful, albeit cloudy, Northwest, most of us will need some extra Vitamin D. You can get Vitamin D in one of three ways:
1) Regularly spend time in the sun with your skin exposed (not fun in a December Nor’easter).
2) Eat foods that are rich in Vitamin D (eel, herring, sardines, cod liver oil – yum!) or drink fortified milk (whole, 2% or skim) that contains 100 IU of D per 8 oz. glass. We’re talking lots of milk.
3) Take a Vitamin D supplement. Be sure to buy cholecalciferol (D3) and not ergocalciferol (D2). D3 is the more active form of Vitamin D. Personally, I think I’ll skip the eel and reach for the supplement.
The next order of business for bone health is calcium. The most recent recommended DRI (Dietary Reference Intake) for calcium is 1300 mg per day for adults. Daily recommendations vary by age range, health conditions, etc. Space doesn’t allow me to cover these variations in detail; feel free to stop by the pharmacy with any questions you may have.
Dietary Calcium: there are many good sources. Consider milk (approx. 300 mg/serving), low-fat yogurt (340-450 mg/serving), collard greens (300-350 mg/serving), soy milk (80-300 mg/serving), cereal (up to 1000 mg/serving) or fortified fruit juice (225-300 mg/serving). Also consider supplementing with cheese, canned salmon or sardines with bones, beans, broccoli, cabbage, figs, tofu and almonds. Become a label-reader to find out the calcium content of your packaged and processed foods.
Buying calcium supplements is a bit more complicated. Here are some points to remember:
Note the serving size on the label. Not all calcium types/tablets are created equal. Look for the amount of ELEMENTAL calcium in each tablet.
There are different types of calcium (i.e. calcium carbonate, calcium citrate, oyster shell calcium, chelated calcium).
Calcium carbonate: Usually contains the most elemental calcium per tablet and is the least expensive to buy. However, it can give some folks gas or stomach-bloating problems. Additionally, since calcium carbonate requires an acid environment to dissolve, people taking a proton pump inhibitor or PPI (Prilosec®, omeprazole, pantoprazole, Aciphex®, Prevacid®) need to choose calcium citrate instead.
Calcium citrate: Works better for patients taking a PPI because it does not require an acid environment for absorption. It is also recommended for those who experience stomach upset with calcium carbonate. The downside is that people who take calcium citrate usually require more tablets every day to get the recommended amount of calcium. (Remember the mantra: “Read the label.”)
Oyster shell calcium: Avoid supplements containing unrefined oyster shell, bone meal or dolomite, since they may be tainted with toxic substances such as lead, mercury or arsenic.
Chelated calcium: Should be avoided altogether, since it simply separates you from your money without providing any added benefit.
Other calcium salts are available: These include calcium gluconate, dibasic calcium phosphate, and calcium lactate among others, but are less commonly used due to increased cost and/or decreased amount of elemental calcium per tablet requiring more tablets per dose.
Consider getting a calcium supplement with Vitamin D added, that way you cover two needs with one bottle on your medicine shelf. Note: with the current revised recommendations, you may still need additional Vitamin D.
Make sure that your calcium dissolves. For a simple test place your calcium tablet in a glass of clear vinegar, stirring it occasionally. If the calcium dissolves within 30 minutes it should dissolve in your stomach too. The ones we recommend dissolve within 30 minutes.
For better absorption, take your calcium supplementation in divided doses (e.g., 500 mg twice daily instead of 1000 mg once daily).
I’m out of my allotted space; so I’m glad the technical explanations of the brain biopsies and nude sun-bathing were covered by Dr. Bob last month.
P.S. With Thanksgiving around the corner, I’d like you to know that I am thankful for my readers. Happy Thanksgiving!
