Out of sight, out of mind
The other day I was cleaning out a kitchen cupboard and unearthed an economy-sized bottle of calcium tablets. Oops! I should be taking one or two of those every day.
Or should I?
Everyone knows calcium is necessary for bone health. Most women have been told by their doctors that they need extra calcium after menopause because without estrogen’s help, bones do not absorb it well. Low calcium leads to osteoporosis, which leads to broken bones, which lead to huge health care costs. Oh no!
Too much of a good thing—or the wrong thing
Calcium supplements have long been linked to the formation of kidney stones, and more recently to heart attacks. With the abundance of supplements available—monster-sized tablets, chocolaty chews, fruity-chalky Tums—it’s easy to get too much.
But calcium from food rather than supplements apparently doesn’t have the same negative effects.
Last month, the United States Preventive Services Task Force (USPSTF) gave combined calcium and vitamin D supplements a D recommendation. That is, it recommended against taking supplemental calcium. After reviewing relevant research, it concluded that “the current evidence is insufficient to assess the balance of the benefits and harms.”
A member of the USPSTF panel, Michael Lefevre, M.D., told the American Academy of Family Physicians that
…we certainly should not be discouraging women from getting an adequate amount of calcium from food. But a calcium supplement is not the same as calcium from food.
Efforts should be made to first meet dietary requirements through food products, before considering supplements. Routine supplementation, in the absence of a dietary deficiency, is not necessary or advisable.
So the current evidence-based recommendation is to get my “recommended dietary allowance” of calcium from my diet alone. But what is an adequate amount?
In 2011, the Institute of Medicine (IOM) revised its daily calcium recommendation, and also added an upper safe limit.
According to the IOM table, I should aim for 1,200 mg of calcium every day, but no more than 2,000 mg. The IOM also recommends 600 IU of vitamin D, but no more than 4,000 IU. Vitamin D is often combined with calcium because it aids absorption, and most calcium-fortified foods include vitamin D. (Vitamin D supplements for other health reasons, such as cancer prevention, is a topic for another post.)
An 8-oz glass of milk has 300 mg of calcium, as does an 8-oz glass of calcium-fortified orange juice or soy milk. A 6-oz container of yogurt also has 300 mg of calcium. Seeds, nuts, canned sardines, dried figs, tofu, dark green and dark yellow vegetables are also good sources of calcium.
If I want to avoid choking on calcium tablets and stop feeling guilty, I need to be mindful of what I eat and have a good idea of how much calcium I am getting in my diet.
I don’t think I’ll have trouble getting enough because these calcium-rich foods are already part of my diet. They are easy to prepare, delicious, and full of other great nutrients, too.