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Getting the right amount of calcium and vitamin D

 

What is the problem?

USPSTF FindingsAs new scientific research emerges, recommendations change. We are now rethinking how much calcium and vitamin D is needed for good bone health. There is increasing evidence that too much calcium from supplements is not likely to be a benefit --- and worse, can be harmful. This was underscored in the recent report from the US Preventive Service Task Force (USPSTF) recommending that premenopausal women and men may not benefit from calcium supplements. 

The recommended daily allowances (RDA) are goals established by the Institute of Medicine—the RDA varies with age, gender, and other factors (see table below). These amounts would be sufficient for 97% of the US population.   

Mounting evidence shows that too little calcium in the diet (say less than 500-600 mg a day) is harmful, but too much calcium (say adding calcium supplements when the intake is already 1000 mg) may be harmful.

New recommendations

Life stage group

Calcium
RDA

Vitamin D RDA

Supplement?

Infants 0 to 6 months *

*

**

No

Infants 6 to 12 months *

*

**

No

1–3 years old

700

600

No

4–8 years old

1,000

600

No

9–18 years old

1,300

600

Maybe

19–50 years old

1,000

600

No

14–18 years old, pregnant or nursing

1,300

600

Maybe

19–50 years old, pregnant or nursing

1,000

800

No

19–50 years old

1,000

600

No

MEN: 51–70 years old

1,000

600

Maybe

WOMEN: 51–70 years old

1,200

600

Maybe

71+ years old

1,200

800

Maybe

To find recommended calcium amounts. http://www.americanbonehealth.org/images/stories/Calcium__Vit_D_2010.pdf

Girls age 9-18

The risks of taking calcium and vitamin D supplements are not known in this group, however, during the bone building years girls need extra calcium and might benefit from vitamin D supplements as well.

Premenopausal women

There is not enough scientific evidence to define the risks and benefits of taking calcium and vitamin D supplements in premenopausal women. If a premenopausal woman meets her RDA through food, she should not take a calcium supplement. If a premenopausal woman does not eat any dairy foods, she likely needs to take a calcium supplement — 500mg is probably enough to get her into a reasonable range.

Men

There is not enough scientific evidence to define the risks and benefits of taking calcium and vitamin D supplements in men.

Men or Women at high risk for fracture or osteoporosis:
1200 mg calcium (diet + supplements) and 1000-2000 IU’s of vitamin D

There is evidence of risks (stroke and heart attack) of taking too much calcium supplements. However, postmenopausal women at increased risk for fractures or osteoporosis need more calcium and vitamin D. If a woman with these characteristics is meeting her RDA through food, it is best that she not add a calcium supplement. If she does not eat dairy, she may need a supplement. If she has a balance diet, she may only need an additional 500 mg of calcium and 600 - 1,000 IUs of vitamin D.

What can you do?

The concept “more is better” does not apply to calcium! Too much calcium especially in the form of supplements can be harmful. Before taking a daily calcium supplement, people need to examine their diets to determine if they are getting enough.

Most people who eat dairy products are likely getting enough calcium. As an example, 2 servings of a dairy product (low fat milk, yogurt, cheese) plus a balanced diet of fruits and vegetables provides sufficient calcium for most women over age fifty. If this describes you, you should not be adding calcium supplements.

People who are lactose intolerant may need a calcium + vitamin D supplement. Without the enzyme to digest the lactose in many dairy foods, these people get an upset stomach. Lactose intolerance is reported in up to 75% of adult African Americans and Native Americans and 90% of Asian Americans.

People with other intestinal absorption issues, such as Celiac or Crohn’s Disease, may not absorb calcium. These people may also need a calcium and vitamin D supplement.

 

How can you be sure?

Use the CALCIUM RULE OF 300. Take the number of servings of dairy or calcium fortified juices per day and multiply that by 300. Then add 300 to account for all the calcium you would get from the rest of your diet. The total is your calcium intake from diet. Determine your RDA and add a supplement – if necessary – to avoid calcium deficiency. NOTE: you might be able to reach this goal by simply adding another serving of dairy or fortified juice.