Calcium & Vit. D

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Plenty of talk in the news about Vitamin D has led to more questions than ever.

 

Here’s Matthew’s perspective on the current suggested intake of Vitamin D and of Calcium.  Don’t hesitate to talk with Matthew, Anna or Stan if you would like more information.

 

Terms to keep straight:

  • RDA = Recommended Daily Allowance, set by the Government’s Food and Nutrition Board
  • IU = International Units, used to measure strength of vitamin D and a number of others
  • mg = milligrams, used to measure strength of calcium and many others

 

Vitamin D

For those under 70 years, the new RDA of vitamin D is 600 IU & For those over 70, it is 800 IU

But there are many who feel these numbers are too low.  Because of the safety of vitamin D and several recent studies suggesting extra benefit, I agree that a higher level is a good idea.

There is ongoing research which shows vitamin D can reduce your risk of cancer, heart disease, autoimmune disorders and even accidental falls among the elderly.  It’s important to remember that while it is hard to get too much vitamin D, it is still possible.  I suggest you avoid taking any more than 4000 IU per day, but this is far above what I would recommend.  Vitamin D is found in many foods and is also made in your skin during exposure to sunlight.  It used to be thought that these sources were sufficient, but in the present day, we all get less sun exposure than we used to and the new research is showing that many people are low in vitamin D.

 

Suggested:  1000 – 2000 IU vitamin D per day for adults.

This amount stays well within the safe level (regardless of your diet or sun exposure) and is consistent with most of the current research that shows benefits for vitamin D supplements.  It also matches a common size available: 1000 IU tablets are always in stock at Donlon Pharmacy.  If your combination of supplements yields only 800 IU, that is still just fine.  Likewise, if your intake adds up to 2400 or so, don’t worry about it.

Kids (under 18) should stay down near the 600 IU per day level until more research is done.

 

Calcium Quick Guide

 

  • 1000 mg/day for women up to 50 years old & men up to 70 years.
  • 1200 mg/day for older adults.
  • Adults over 50 should not go beyond 2000 mg/day calcium total (from food & supplements combined.) Excessive calcium can increase the risk of kidney stones or other problems.
  • Best to divide your calcium into 2 doses per day: the body has trouble absorbing more than 500 mg at one time.
  • For adolescents, the RDA is now 1300 mg calcium per day

 

Calcium supplements come in many different forms & brands.  Probably the least expensive kind is generic Tums.  Available in a few different strengths, these are a great source of calcium and they come in several flavors, all chewable.

Don’t get too much.  When calculating your total calcium intake, use this shortcut to estimate how much you’re getting from food:

  • Assume you get 300 mg/day from all NON-dairy foods.
  • Add 300 mg per cup of milk, fortified juice, cheeses, etc. during the day.
  • This will give you a total food-based calcium intake.  So if Jill (age 42) drinks 2 cups of milk, 1 cup calcium-enhanced orange juice, about 1/2 cup of cheese and 1 cup of ice cream, plus all the other foods . . . .   Calculate: that’s about 300 x 4.5 dairies = 1350.  Add 300 for other foods and her dietary intake of calcium for the day is about 1650 mg.  She clearly doesn’t need a calcium supplement!!
  • Good news:  calcium from foods doesn’t lead to “spikes” the way excessive supplements can (spikes can lead to problems), so Jill doesn’t have to worry about getting more than the recommended amount.

Below is a great summary of facts about Calcium, prepared by Dave, our 2011 Pharmacy Rotation Student.  Many thanks to him for working this up.  And if you have questions, feel free to ask a pharmacist: no appointment necessary!

 

 

What’s the Big Deal about Calcium Anyway?

Good for bones

  1. Helps prevent osteoporosis
  2. Most calcium is in bones (99%)

Good for muscles

  1. Helps in muscle contraction

Good for nerve function

  1. Essential for nerve impulses

 

 

So what kinds of products are available?
    1. Calcium Carbonate is the kind of calcium that most of us think of when we hear about calcium supplements. This is a great option for patients because it is effective, yet inexpensive. In order to work, calcium carbonate must be taken with food. Examples of products containing calcium carbonate include the antacid TUMS, OsCal, Viactiv and Caltrate. If you would like to start a calcium supplement, this would be a good place to start.

 

 

    1. Calcium Citrate is another common form of calcium. Products containing this kind of calcium are similar to calcium carbonate, but one usually has to take more to get the same amount of calcium that calcium carbonate provides. One potential advantage to calcium citrate is that it does not require food or stomach acid to be absorbed by the body. Therefore, this product could be advantageous for those “on the go” because it can be taken any time or anywhere. It also, in many cases, has fewer side effects, making it a good alternative therapy for those individuals who do not tolerate calcium carbonate.

 

 

 

 

    1. Calcium Gluconate and Calcium Lactate are alternative forms of calcium that are on the market. These supplements only contain small amounts of calcium and require large doses to achieve a therapeutic effect.

 

 

 

 

 

 

    1. Oyster Shell Calcium, Bone Meal and Dolomite are natural forms of calcium. They were also the first kind of calcium supplements. Although not very common any more, these supplements are still effective. However, they can potentially be harmful because they contain trace amounts of lead and other toxic metals.

 

    1. Coral Calcium is another form of natural calcium that is similar to the calcium found in foods. There seem to be no special advantages to this form of calcium over anything else on the market.

Balicasag Reef Bohol
Creative Commons Licensephoto credit: motnworb

    1. Calcium + Vitamin D are products that contain a certain type of calcium listed above and the fat soluble Vitamin D, a substance that helps calcium be absorbed. There are many combination products on the market. If you are interested in learning more, are interested in this type of product, or need help identifying the best product for you, come visit us at the pharmacy and we would be glad to help you.

 

 

How much calcium do I need?

 

Table 1: Recommended Dietary Allowances (RDAs) for Calcium

Age

Male

Female

Pregnant

Lactating

0–6 months*

200 mg

200 mg

7–12 months*

260 mg

260 mg

1–3 years

700 mg

700 mg

4–8 years

1,000 mg

1,000 mg

9–13 years

1,300 mg

1,300 mg

14–18 years

1,300 mg

1,300 mg

1,300 mg

1,300 mg

19–50 years

1,000 mg

1,000 mg

1,000 mg

1,000 mg

51–70 years

1,000 mg

1,200 mg

71+ years

1,200 mg

1,200 mg

Referenced from the National Institutes of Health’s Office of Dietary Supplements

 

 

What are the potential side effects?

Calcium is usually well tolerated, but common side effects of calcium include the following…

  1. Constipation
  2. Metallic Taste
  3. Nausea
  4. Vomiting
  5. Kidney Stones
  6. Those darned pills are big & hard to swallow!  (Ask at the pharmacy: we have a tasteless powdered calcium that mixes into any beverage or food.)

More serious side effects that require attention of a doctor include:

  1. Heart problems
  2. Hypercalcemia
  3. Muscle weakness
  4. Hypercalciuria
  5. Milk alkali syndrome

 

 

But wait, can’t I get calcium from my diet?

Yes. Calcium is contained in many foods. Here are a few examples:

    1. Yogurt
    2. Salmon and sardines
    3. Milk, cheese, ice cream
    4. Vegetables

Sardine!
Creative Commons Licensephoto credit: brian.gratwicke

When calculating your total calcium intake, use this shortcut to estimate how much you’re getting from food:

  • Assume you get 300 mg/day from all NON-dairy foods.
  • Add 300 mg per cup of dairy foods: milk, fortified juice, cheeses, etc. during the day.
  • This will give you a total food-based calcium intake.  So if Jill (age 42) drinks 2 cups of milk, 1 cup calcium-enhanced orange juice, about 1/2 cup of cheese and 1 cup of ice cream, plus all the other foods . . . .   Calculate: that’s about 300 x 4.5 dairies = 1350.  Add 300 for other foods and her dietary intake of calcium for the day is about 1650 mg.  She clearly doesn’t need a calcium supplement!!
  • Good news:  calcium from foods doesn’t lead to “spikes” the way excessive supplements might(spikes can lead to problems), so Jill doesn’t have to worry about getting more than the recommended amount. And there is no need to worry about dividing the dose: if from food, the body absorbs calcium wonderfully.
That’s a lot to remember!!! So what’s the absolute important stuff I should know?
    1. Find out how much calcium you need and what type of calcium supplement would be best for you based on the information shown above.
    2. For maximum effectiveness and best absorption, divide up your total daily dose of calcium and take it with a full glass of water two or three times during the day. For example, if you require 1000mg per day, take 500mg in the morning and 500mg in the evening.
    3. Calcium can interact with certain medications including various antibiotics (tetracycline and its derivatives, ciprofloxacin, azithromycin and others) and some cancer medications. Therefore, you should avoid taking these medications and calcium at the same time. It is best to administer calcium either two hours before or after other medications you are taking to ensure all medications will be effective. Keep a current medication list at home and discuss any concerns with your pharmacist or physician.
    4. Don’t underestimate the free stuff!!! Exercise helps the body utilize various substances that are important for your health and calcium is no different. Physical fitness that includes weight-bearing exercises along with aerobic exercise such as walking or running will help improve joint strength, build bone density and make you feel better.

 

 

References

  1. Calcium Guide.org Website: Your Complete Calcium Resource. http://www.calciumguide.org/Types_of_Calcium_Supplements.htm. Accessed October 10th, 2011.
  2. Houtkooper, L. and Farrell, V.A. Calcium Supplement Guidelines. The University of Arizona Website: College of Agriculture and Life Sciences. http://ag.arizona.edu/pubs/health/az1042.pdf. Updated January 1st, 2011. Accessed October 10th, 2011.
  3. Mayo Clinic Website. http://www.mayoclinic.com/health/calcium-supplements/AN01428. Accessed October 10th, 2011.
  4. Micromedex 2.0 Healthcare Series Website. http://www-thomsonhc-com.cuhsl.creighton.edu/micromedex2/librarian/ND_T/evidencexpert/ND_PR/evidencexpert/CS/6C7055/ND_AppProduct/evidencexpert/DUPLICATIONSHIELDSYNC/C1D9B4/ND_PG/evidencexpert/ND_B/evidencexpert/ND_P/evidencexpert/PFActionId/evidencexpert.DisplayDrugpointDocument?docId=099520&contentSetId=100&title=Calcium&servicesTitle=Calcium&topicId=adverseEffectsSection&subtopicId=commonSection. Accessed Oct 10th, 2011.
  5. National Institutes of Heatlh Website: Office of Dietary Supplements. http://ods.od.nih.gov/factsheets/calcium. Accessed October 10th, 2011.
  6. Physicians’ Desk Reference for Nonprescription Drugs, Dietary Supplements, and Herbs. 32nd ed. Montvale, NJ: PDR Network, LLC; 2010: 580-582.
  7. United States Food and Drug Administration Website. http://www.fda.gov/Food/LabelingNutrition/ConsumerInformation/ucm078889.htm. Accessed October 10th, 2011.