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Supplements: Helpful or not?

By Ronni Gordon
Beth Israel Deaconess Medical Center Correspondent

Now is a good time to re-evaluate if you’re getting too much, or too little, calcium and Vitamin DFor years, you've heard that you need to take calcium and Vitamin D supplements. But the idea that "more is better" was challenged in new recommendations from the Institute of Medicine, an independent scientific group.

"It can be very confusing," says Elisabeth Moore, registered dietitian at Beth Israel Deaconess Medical Center.

The supplements controversy offers a good chance to re-evaluate if you're getting too much, or too little, calcium and Vitamin D.

"It's important to look at the whole issue, making sure consumers are educated on why they are taking supplements instead of merely just taking them," Moore explains.

The Institute of Medicine's expert committee wrote this past November that:

  • Most people can get enough calcium from food
  • High doses of calcium supplements can lead to kidney stones and even heart disease
  • Too much Vitamin D can raise the risk for fractures

Recommended Daily Intake of Calcium and Vitamin D

The Institute recommends 1,000 milligrams of calcium daily for children 4 to 8, women and men 19 to 50, and men 51 to 70; 1,300 milligrams for children 9 to 18; and 1,200 milligrams for women 51 and older and men 71 and older. Both men and women over 51 should have no more than 2,000 milligrams a day.

Dairy foods such as milk, yogurt and cheese provide the bulk of calcium in our dietMany calcium supplements also contain Vitamin D, which the body needs to absorb calcium. The Institute of Medicine recommends 600 units a day from ages 1 to 70 and 800 units for men and women 71 and older. The upper limit is 4,000 units for everyone over age 9.

According to Moore, "Ideally we should be able to meet all the calcium requirements through food, but due to variability in tastes and other factors, it may be necessary to take a supplement."

In addition, a doctor or dietitian might recommend higher levels for specific reasons.

She advises everyone: " Before starting any new supplement, talk to your doctor or dietitian."

Dairy foods such as milk, yogurt and cheese provide the bulk of calcium in our diet. Almonds and oily fish such as salmon and sardines contain calcium to a lesser degree, and leafy vegetables such as broccoli, kale and spinach have some but not much.

We get most of our Vitamin D from sunlightThere aren't a lot of foods that have Vitamin D in them. We get most of our Vitamin D from sunlight, "But living in the Northeast, we're not getting much of the direct sunlight that helps the body," Moore says. Another problem: Sunscreen blocks absorption of Vitamin D.

Many foods are fortified with vitamins. Soy products and orange juice are fortified with calcium, milk is fortified with Vitamin D, and breakfast cereals with a variety of vitamins and minerals.

Moore suggests checking labels to see how much a product contains. "I wouldn't be as concerned about too much fortification in foods as I would be about taking too many supplements," she says.

When calculating your daily intake, don't forget the calcium and Vitamin D in a multivitamin if you're taking one.

Osteoporosis-related Bone Fractures

Start thinking about the amount of calcium in your child's diet as soon as he or she begins to eat, Moore suggests. "It's important for the elderly as well, because if you have bone loss it can lead to osteoporosis or fracture and falls ." 

Diagram: Healthy bone and bone with osteoporosis 

It is estimated that one in two women and one in four men over 50 will experience an osteoporosis-related bone fracture during their lifetime. Much of the research has been focused on women because loss of estrogen during aging and especially menopause can affect bone density. But according to research published by the American Association of Orthopedics, men lose estrogen and other hormones that affect bone density, although more slowly than women.

"Men are more likely than women to have osteoporosis secondary to an underlying disease or metabolic condition," according to the association. In addition, there is a genetic factor in osteoporosis.

Weight-bearing Exercise

For older adults, weight-bearing exercise, such as walking, is key to bone healthFor both men and women, there's more to bone health than diet.

"Make sure it's not only about the food you eat but also about doing regular exercise, especially weight-bearing exercise," says Moore.

"That means using weights or walking, dancing, running or jogging where our body is the weight," she says.

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted March 2011

Contact Information

Carl J. Shapiro Department of Orthopaedics
Beth Israel Deaconess Medical Center
330 Brookline Avenue
Boston, MA 02215
617-667-3940

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