“We treat people, not just problems.”
John L. Pfenninger, M.D.
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Did I ever receive an education today! Because I mentioned my strong family history of bone loss, my physician ordered a bone density study on me. The findings: osteoporosis. Yes, it happens in men, too. 28 million Americans have osteoporosis. Much of this could be prevented with proper amounts of calcium in the diet.
The recommended calcium intake for men and women is 800-1500 mg per day depending on various conditions. The usual American diet has 450-550 mg of calcium and falls markedly short of this essential mineral. It starts in childhood when kids drink pop and “juices” instead of milk. Broccoli and greens are the “yuck” foods. In addition to making bones and teeth strong, calcium may also lower blood pressure, reduce colon cancer and, by taking 1200 mg daily, can limit the symptoms of premenstrual syndrome.
Because of my family history, I knew I was at greater risk for developing osteoporosis and have been taking supplemental calcium for about three years. Not too long ago, my wife came home with a product called Calcium 900. I looked at the back of the bottle. A serving provided 900 mg of calcium. For the last year or so I took one of these pills a day and felt quite smug.
When my bone density study returned as abnormal, my physician suggested that I check to be sure I was indeed taking the 900-1000 mg of calcium that I thought I was. I looked at the bottle more closely. It did read that “calcium provided per serving size was 900 mg”. However, “serving size” was defined in smaller print as 3 pills! In other words, each calcium pill I was taking provided 300 mg of calcium instead of the 900 I was led to believe.
I then talked to Dr. Dave
Nadolski at the Nu Bones Osteoporosis Prevention Center in
Dave also told me I should consider Viactiv. It is a product that has 500 mg of calcium in either butterscotch or chocolate squares. I also found this as Meijer.
I was advised that calcium citrate is better absorbed than calcium carbonate and to consider a product such as Citracal. So, I found the section in the pharmacy with all of the calcium products. I couldn’t believe it. I’m a physician, but it was nearly impossible to decipher the amount and type of calcium in the variety of supplements that were there. I spent at least a half-hour reviewing everything. The most disgusting thing I found was the deception used by the companies to confuse the buyer into thinking they were getting more calcium for less. Just as I had been duped with the 900 mg “serving”, I found one product, which required six pills to receive the “serving size dose of 500 mg!” I decided that a company would probably be more reputable if it listed the contents “per pill” rather than “per serving.” The buyer must truly beware and read the labels closely not only to maximize the cost benefit ratio, but to assure that they are taking the required amount and type of calcium.
Tums® is often recommended as a calcium supplement. It is the chewable antacid pill. It contains calcium carbonate and, although it comes in a 500 mg tablet, the calcium content is only 40% or 200 mg. Therefore it requires 5 Tums® tablets (2500 mg of calcium carbonate) to obtain the appropriate amount of calcium. Calcium from most supplements is well absorbed when taken with meals. It is especially true for calcium carbonate since it must be broken down by stomach acid to be absorbed.
In the past I had always told my patients to take oyster shell calcium – “it’s cheap, it’s easy to take, and it works!” However, I recently attended a conference where the expert cautioned against oyster shell sources of calcium. Apparently with all of the contamination of the water and nutrients consumed by the oysters, this type of supplementation is often tainted with lead, mercury, and other impurities.
I also was reminded that an 8 oz glass of milk has 300 mg. of calcium and that there is calcium-fortified orange juice (Tropicana) which also has 300 mg per glass.
Another important factor
for calcium absorption is vitamin D. Exposure
to the sun provides vitamin D, but if you have looked out the window lately,
there is not much of it here in
Luckily, because osteoporosis is such a major problem in post-menopausal women, new drugs have been developed which will actually replace some of the bone loss. They include a product called alendronate (Fosamax) and Calcitonin. Both are prescription, but can reverse bone loss.
Of course, estrogen is a great medication to prevent osteoporosis, too. But, being male, I do not have that option. Estrogens also reduce Alzheimer’s, colon cancer, strokes and heart attacks. They preserve not only bone, but the vagina, skin and bladder, too.
Who should be tested for osteoporosis? Bone minimal density tests are recommended if you are 65 or older, are post-menopausal with risk factors or have suffered a fracture, if you are female and not taking estrogen replacement, if you are losing height or if you have a family history of the disease.
And so, what lessons did I learn? Never again will I tell a patient to “just pick up some calcium pills” and take 1000 mg of supplements a day. My advice would now be this: (1) Calcium intake should be 1000-1500 mg per day for both men and women. (2) Most diets only provide one-third to one-half of this amount. Subsequently, supplementation is needed. (3) Calcium can be found in many forms. Special K cereal will provide 500 mg per cup. Viactiv will provide 500 mg per cube. Tums® has 200 mg per tablet and should be taken with food. Calcium citrate is probably the best form to take. (4) Bottles must be scrutinized to be sure the appropriate amount of calcium is being taken. Look at the amount of calcium per pill, not “per serving” and be sure to take enough pills. (5) Cow’s milk provides 300 mg of calcium per 8-ounce glass. This is also present in skimmed and low-fat varieties. Some orange juice products can provide the same. (6) Consider adding 500 IU of vitamin D so that the calcium can be absorbed. (7) Get plenty of exercise, do not smoke, limit alcohol intake, reduce protein and salt in the diet and eat lots of green vegetables every day.
Using a variety of the above methods should allow any patient to consume 1000-1500 mg of the calcium needed per day.
(What I also learned was that it is not only patients who need to learn about calcium supplementation but some doctors like me need to go stand at the drug counters and see how difficult it is for most men and women to decide which supplements they should really be taking.)
Copyright, 2011. John L. Pfenninger, M.D. jw 02/11