Nutrition for Bone Health Calcium and Vitamin D


Calcium and vitamin D,
they do work together. They have this really
great relationship. They work together to form
and maintain strong bones, improve your bone health. It can decrease fractures
or your risk of fractures. And vitamin D is crucial for
calcium absorption, which is why it’s added to milk. It’s a government mandate. It’s not naturally
occurring in there. It’s added. So calcium is important
to really obtain from diet and/or supplements. Our bodies cannot
produce calcium. You need it from
an outside source. Calcium, if your
intake is inadequate, your bones will leach
it, so it will drop it into the bloodstream
to make sure that that level stays normal. It is, again, best
from food sources. Your blood level does
not affect your needs. So I think I hear
this all the time in terms of, oh, my blood
level of vitamin D was this and I’m taking this much,
but my calcium was normal. Then your calcium
always should be normal. And if it’s not,
again, then your body will look to make
sure it’s normal and release some
storage from bone. So calcium
recommendations really are very general for less
than 50 years of age. I have excluded any pre- or
postpartum, breastfeeding, any of that stuff because the
needs are definitely different. This is just for average females
under the age of 50 or 50 without a fracture. You have a little bit of
window after you give birth, after you have a fracture
to re-mineralize bone, and so your needs,
your calcium needs, do jump a little after that. So reading food labels,
just to reiterate, it is based on 1,000
milligrams, the food label. You will always see
calcium on a food label no matter the food
packaging because it is government mandated. Vitamin D will also be on there. So vitamin D is
based on 400 IUs, which is the really low
end of the recommended needs for any age. So this happens to be a
cup of skim milk, which is 80 calories, it has nine
grams of protein, which is actually a little higher,
30% of calcium, which equals 300
milligrams, and it has 25% of the daily amount
of vitamin D, which equals 100 IUs. So again, dairy
foods, I sort of just ranked them in greatest
amount of calcium to least. This is, again, the dairy foods. So the kefir, there
are certain brands that they can
manipulate a little. And if you ultra
pasteurize something, you can actually get a little
bit more calcium out of it. So I won’t say the brand, but
there are certain skin milks that are a little bit
thicker and more palatable and not like kind of
an atypical skin milk. So that has a little
bit more calcium in it. But kefir, if people like it– I know one of the former doctors
that was here sort of told every patient of
hers to have kefir, and every patient was
having so much dairy. And kefir, if you
like it, I mean, I think any of
this stuff, if you can get the stuff from
food, food is medicine, it definitely helps
and it saves you money on having to buy supplements. So again, if you go
down the list here, the one thing I do want
to just kind of point out as I go through all these dairy
foods is prior in my discussion about kind of overall
good diet quality, your whole diet
shouldn’t be dairy. You shouldn’t have
75% of your diet being dairy because there’s
no variation there. So there, again, I just
listed in basic format the calcium-fortified foods. I would say about
five years ago, maybe even a little bit more, I
noticed the marketing trend was more calcium-fortified or
good source of calcium, and so, I mean, I would say
for 15, at least 15, 20 years, there’s a sugar free
hot chocolate mix that has always had 300
milligrams of calcium in it. It’s a little bit
of a supplement. So if you were going
to have that, great. You’re getting a little
bit of calcium from it. But definitely not
necessarily a reason to just start
drinking that as well. Non-dairy foods, so almonds,
these are sort of in least to most. So if you also look down,
so in the non-dairy foods, almond is a non-dairy food. It does naturally have a
smidge of calcium in it. But if you look at how
much calcium is in here, so one ounce of almonds, which is
really a recommended serving, there is only 70
milligrams of calcium. So in order to get a really
good amount of calcium, you would have to have a cup
of almonds, which is really a little bit more than
our recommended estimated intake at one time. And also, it’s
just more calories. So you just have to be
cognizant of calories if you’re trying to up
your dietary calcium. Broccoli as well, kale,
the dark green leafies are really a good source. I’ve had a lot of people
over the years doing kale or the green juices and
liquefying a bunch of stuff. But if you noticed eight
ounces of kale, which is a cup, has 90 milligrams, so you really
have to have a lot of kale. And so if you’re having
that much kale in a day to get a good amount of
calcium in your diet, your GI tract might be a
little bit not so happy, and it makes things
sometimes a little bit tough. So sardines, they have
to have with bone. Same thing with salmon,
any of those fish, if you’re having bones, bones
are where the calcium is. And so then therefore,
you have to make sure you’re getting that
type of fish with bones. Soybeans, edamame, same thing. It does have a little bit
of natural calcium in there. But if you are having a cup of
soybeans, which I’m not sure many people do on
a regular basis because everyone wants
to have soy sparingly, and so 175 milligrams is
in a cup of soy beans. But again, you just have
to be careful with volume. And then non-dairy milks and
yogurts, it really varies. Now there are so many milks. So there’s oat milk, cashew,
walnut, soy, rice, almond, and they are really
just fortified. It’s like taking a liquid
supplement in a way. So your calcium
equivalents, these I just sort of put here to kind
of make it a little easier. Each one of these equals
about 300 milligrams of calcium, which would be
the equivalent of one 8 ounce cup of milk. So when I say also the
milk, it doesn’t matter if you’re having a dairy milk– skim, 1%, 2%, whole
milk– they all have the same amount of
calcium, vitamin D, protein. They just vary in fat,
and therefore, calories. So vitamin D, why
is it important? Where are you going to get it? And what are the
recommendations? So vitamin D, again,
the major role is to really help maintain
normal blood levels of calcium and phosphorus, promotes
calcium absorption in the gut, in your intestines, and it
helps promote brain and muscle health and immune function and
the reduction of inflammation. It’s really helpful
in so many ways. Fat soluble vitamin,
so your body, again, it does really store the excess. And I think that so many people
generally, especially a lot of general practitioners
or internists are recommending just you
may as well take 1,000. I just saw a
patient recently who came in who was taking a
ridiculous amount every day because she’s like, oh,
I have osteoporosis. And her blood level
is 85, which is not above normal, but definitely
at the higher end. And again, it’s not helping her. She still is fracturing. She’s still keeps
fracturing this one hip. So you just have to
really be careful because it is really naturally
occurring in very few foods. Your blood level, that’s
going to be tested as this. And your blood levels,
again, less than 30 it’s really associated
with deficiency. 30 is sort of we consider
the low end of normal. Really specifically
for bone health, if you already know
you have brittle bones, are at risk of
brittle bones, have had a fracture, or your
status post a fracture, then you really should make
sure that your blood level, the goal should be about 50. Research is really
showing us that people in blood levels of about in
the 40s is really optimal, and it always makes me
chuckle because I think, yeah, it’s closest to 50. So the vitamin D
recommendations, again, are very generalized, and 400
to 800 international units a day is recommended. An upper limit of
about 4,000 a day would be recommended unless you
know that you are deficient, and therefore, you might be
told to really do a high dose supplement. There are some
prescriptions that are about 35,000 to
50,000 units a week, but really, you can do
an over-the-counter. The over-the-counters come
in a 4,000, 1,000, 2,000, and a 5,000. So because it’s fat
soluble, sometimes people play with the
numbers and say, oh, if I forget to take it one day,
you can take two the next day. Or if you take a
5,000 pill, then you could just take it
a few times a week. So vitamin D sources,
there are very few of them. These are your food sources. Eggs, so since it’s a fat
soluble vitamin vitamin D, it is really present
in the egg yolk. So for all of you who are
using just egg whites, you’re out of luck. Fatty fish– mackerel,
salmon, sardines, tuna. Again, you might have salmon. A lot of people are, oh,
yes, I’m really healthy, and I eat salmon twice a week. But twice a week isn’t
necessarily every day, and so you do want
some variation. But I don’t know a
ton of people that are eating mackerel regularly
or sardines, to be honest. Fortified foods– again, your
milk, your juice, your cereals, all of those other things. The vitamin D content,
this is sort of listed from greatest to least. The cod liver oil, if any of
you out there actually do this, I still have a handful
of patients that do a tablespoon of cod liver oil. Different cultures do it
for different reasons. Some do it for shiny
hair and nails. Some people do it for digestion. Some people don’t really
know why they do it. It’s just that all
their relatives did. And so you can see sort of
as you go down the list, they’re definitely foods
that you probably are consuming on a regular basis. Orange juice is
definitely on here. I’m never a proponent
of drinking juice, but if people do
drink juice and if you have one that’s
fortified with calcium, at least you’re getting
a little bit of calcium and then you’re getting
some vitamin D as well. So it is always been called
the sunshine vitamin, and I think probably at least
on a weekly basis, if not more, I hear someone
say, oh, I’m going to go out and get
a little vitamin D. And so it always makes me laugh
because, especially now we’re coming out of winter time,
we live in the Northeast, and depending on where
you live, if there’s a lot of cloud
coverage, the pollution, you’re really not necessarily
getting true UVB rays. The other thing, too, is if
you’re using any sort of SPF, whether it’s clothing
or lotions, spray, whatever it is, it really
is filtering out 93% to 98% of those UVB rays, which is
what it’s supposed to do, but it just doesn’t
allow you to synthesize, for your skin to make
vitamin D with sun exposure. So excessive vitamin
D, it is, again, it’s a fat soluble vitamin
and the excess is stored. Toxicity is rare,
but you really want to make sure that
you’re not getting mega doses of supplementation
via the sun and diet. And I listed here
symptoms just in the event that anyone is currently
taking supplementation. A lot of these symptoms
could be related to honestly anything, but
just good information to know. There’s always a consequence. We are Americans and we
think more is better, but it is not true.