Do You Really Need a Supplement to Protect Your Bones?

Popping a pill seems like an easy route to meeting calcium and vitamin D needs, but it's not as simple as it sounds



You know that calcium and vitamin D are vital to building and maintaining strong bones, and that what you don’t get from your diet you can get by swallowing a daily supplement. Simple, right? Don’t be so sure. Late last fall, a committee assembled by the Institute of Medicine (IOM) reviewed the most recent research and came up with new guidelines for how much calcium and vitamin D are necessary for optimal health and how much of these nutrients can be detrimental – both of which have an impact on the wisdom of taking supplements. The new recommendations:

·      For calcium: Although the dietary reference intake, or DRI, the most recent set of dietary recommendations established by the IOM, remains the same -- 1000 mg per day for women up to age 50, 1200 mg per day for women 51and over -- the IOM committee lowered the tolerable (safe) upper limit for calcium intake at 2000 mg/day, down from 2500 mg/day. This means that taking more calcium than you need may not be healthy. 

·      For vitamin D: The new DRI for people ages 1 to 70 is now 600 IU per day (up from 200 to 400 per day), and 800 IU per day for folks 71and older. And the tolerable upper limit for vitamin D has increased -- from 2000 IU per day to 4000 per day for ages 9 and up.

What are the implications of these new guidelines?  If you’re like most women, they mean...

You may not need a calcium supplement at all… especially if you regularly consume dairy products. “Many women think that if their DRI for calcium is 1200 mg per day then they need to take a 1200 mg supplement,” says Jeri Nieves, Ph.D., associate professor of clinical epidemiology at Columbia University in New York City, and a scientific advisor to the National Osteoporosis Foundation. Not true! “In fact it may be unsafe to add a 1200 mg supplement to a diet already sufficient in calcium; more is not better when it comes to calcium.” Too much calcium may increase the risk of kidney stones, and recent evidence suggests it may increase the risk of heart attack.  So before you start popping pills, calculate how much calcium you get each day. For example, if your typical breakfast consists of calcium-fortified orange juice, cereal with milk and coffee with milk, you’ve consumed around 600 milligrams of calcium before you’ve even left the house. Now factor in the trace amounts of calcium you likely get during the course of the day from vegetables, fruits and nuts: For most women, that’s 200 to 300 milligrams, bringing your total to 800 to 900 milligrams. Now all you need to meet your calcium requirement for the day is to eat a low-fat yogurt or 1 to 2 ounces of cheese – and you don’t need a supplement at all.

You probably shouldn’t take calcium alone… If you discover that you’re not meeting your daily requirement for calcium through food and you decide to boost your intake with a supplement, be sure to take a vitamin D supplement as well. It improves calcium absorption, and some studies show that through a different mechanism it may improve balance, and, as a result, reduce the risk of falls and fractures. Taking vitamin D with calcium may also reduce the health risks associated with taking calcium supplements alone. In a large analysis of 15 studies published in the British Medical Journal last year, women who took calcium supplements alone had a 30 percent increased risk of heart attack. “However, studies have shown no increased risk of heart attack in women who take vitamin D along with calcium,” says JoAnn Manson, M.D., chief of the division of preventive medicine at Harvard’s Brigham and Women’s Hospital in Boston, and a member of the IOM committee. “There’s even some evidence that moderate doses of vitamin D may reduce calcification in the arteries, which is linked to lower risk of heart disease.” One thing to note: Consuming calcium-rich foods does not appear to raise heart attack risks. “In fact, high intakes of low-fat/non-fat dairy products and other natural sources of calcium have been linked to a reduced risk of type 2 diabetes, hypertension and cardiovascular disease,” says Dr. Manson. 

You may still need a vitamin D supplement… even if you don’t take calcium supplements. Vitamin D is not as abundant in the diet as calcium is. For example, three to four cups of low-fat milk are enough to meet your daily calcium needs, but you’d need to drink nearly twice that -- six cups – to get enough vitamin D. And even though vitamin D is manufactured by the skin when it’s exposed to sunlight, making a simple walk in the park a viable source of D (unless you’re slathered in sunscreen), not every region enjoys enough natural sun to guarantee adequate exposure. If you live in the northern United States, roughly above an imaginary line drawn between Boston and the northern border of California, you probably don’t see enough sun for most of the year to maintain your D levels, no matter how much time you spend outside.

Best advice?  Consult your doctor about your own needs for calcium and vitamin D. The new DRIs are recommendations for people who are healthy overall.  If you have any preexisting conditions, such as osteoporosis, Crohn’s disease or another illness that might affect your ability to absorb nutrients from food, or if you take certain medications, your vitamin D and calcium needs may be higher than the DRI for the general population. Good health habits are also vital to strong bones: Exercise regularly [LINK TO OUR WORKOUT HERE], stop smoking (if you do), keep alcohol and diet sodas to a minimum and eat a well-balanced diet, and you’ll keep your bones strong and healthy well into the future.






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