The
“We treat people, not just problems.”
John L. Pfenninger, M.D.
(989)
631-4545
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|
Calcium
Supplements |
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