Calcium & Vitamin D

Calcium is critical to health through all stages of life.

And Vitamin D is critical to maintaining calcium balance.

And yet we do not get enough of either…!

Calcium

Calcium is critical to bone health. Most of us know that. But what other questions might you have?

Q: Do our dietary behaviors in adolescence affect such things as osteoporosis in middle and old age?
A: Yes. Those behaviors are critical. Adequate calcium intake in adolescence directly influence bone health in later life. Taking calcium through life prevents bone loss in later life.

Q: Is calcium important for anything other than "bone health"?
Y: Calcium is critical to heart function, nerve transmission, blood clotting, and the function of virtually every cell in the body. Adequate calcium intake may also prevent high blood pressure, prevent colon cancer, and help people diet successfully. This last fact is being increasingly studied in light of our increasing realization that avoiding obesity is critical to overall health.

Q: How much calcium do I need?
Y: At least 1000 mg/day after age 8. During the critical periods of adolescence and after 50 years old, 1200-1300 mg/day is recommended.

Q: Do I need to take pills?
A: Not necessarily. Dairy products are an excellent source of calcium - - 8 oz of milk/yogurt or 1.5 oz of cheddar cheese each contain about 300mg of calcium. Other calcium-rich foods include green leafy vegetables, broccoli, fish, almonds, oats, and fortified foods such as orange juice or tofu.
If diet doesn't provide adequate calcium, supplementation is simple. Calcium carbonate is the best: one "extra strength" antacid tablet (Tums or generic) contains 750mg. Or take a multi-vitamin. In both cases, be sure to check the label. % Daily Value is based on 1000 mg/day.


Vitamin D

We get vitamin D from two sources:
(1) through diet or
(2) through synthesis in the skin in response to sunlight.
Sun exposure is limited by a number of things including skin pigmentation, latitude, sunscreen use, and air pollution. All this make sun exposure an unreliable source of vitamin D. Diet, therefore, is critical. Older children and adults tend to get enough through supplements, but should be aware of the recommended daily intake for all ages: 400 IU/day.

Infants are not so lucky.

Q: Why is sunlight a particularly poor way for infants to get vitamin D?
A: The American Academy of Pediatrics and all other medical societies is clear on the need to avoid sun exposure in infants and children. Sunscreen is uniformly recommended and therefore precludes sun exposure as a means of getting vitamin D.

Q: Is there a particular challenge associated with dietary vitamin D in infancy?
A: Yes.
· Breast milk does not contain vitamin D meaningful amounts
· Formula is fortified, but intake must be 34 oz/day to meet requirements, an amount rarely reached in infancy
· Baby foods do not provide the needed vitamin D.

Q: Are infants and children at particular risk?
A: Vitamin D deficiency in infancy and childhood affects bone development. In the most severe cases, it can cause softening and weakening of the bones, impair growth, cause developmental delays, and even result in lethargy or seizures.

Q: Is there a solution?
A: Yes. Infants need supplementation with vitamin D. This needs to be part of a daily routine and not seen as a "medicine". Despite recommendations to receive 400 IU/day, physicians continue to not provide this for infants. A recent study (April 2010) showed that in breast fed or combined breast-milk/formula fed infants, less than 15% were receiving the recommended dietary vitamin D. And complete formula fed infants were not much better at less than 35%. Supplementation is not happening!

Q: Why don't physicians supplement infants?
A: Studies show that many physicians think vitamin D deficiency only happens to dark skinned infants or that breast milk contains adequate vitamin D or that infant receive enough sunlight. All these suppositions are wrong!


Parents: you must ask your infant's physician about vitamin D supplementation. Adequate vitamin D is essential to healthy bone development and to normal childhood development!


For more information about calcium and vitamin D supplementation, consult the American Academy of Pediatrics website: www.aap.org

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