by Mary Saucier Choate, M.S., R.D., L.D.
Dietitian and Food and Nutrition Educator
Calcium confusion is once again on the rise. We finally seem to understand that you need enough calcium and vitamin D to support strong bones throughout our lifespan and then the U.S. Preventive Services Task Force (USPSTF) publishes the recent Draft Recommendation Statement regarding who should not take calcium and vitamin D supplements to prevent bone fractures. Per usual, media reports have only added to the confusion.
Here’s what they actually found when they looked at the scientific studies on calcium and vitamin D in fracture prevention. For healthy postmenopausal women, living at home, the USPSTF recommended against daily supplementation with less than or equal to 400 IU of vitamin D3 and 1,000 mg of calcium carbonate. This was because of the lack of compelling evidence of fracture prevention benefit, and also because of an increased risk of kidney stones. In the Women’s Health Initiative Study, researchers found that one woman was diagnosed with a urinary tract stone for every 273 women who received supplementation over a 7-year follow-up period (0.3% stone rate). There wasn’t enough evidence, however, to determine if a higher dose of calcium and vitamin D might prevent fractures.
But what didn’t get much press was the fact that for premenopausal women and in men, there was not enough evidence to assess the value of combined vitamin D and calcium supplementation for preventing fractures. No one knows for sure what level of supplementation is most effective for preventing fractures in these groups. The USPSTF stated that further research is needed to fill in the gaps in what we don’t yet know about calcium and vitamin D.
What we do know is that the Institute of Medicine has set daily intake recommendations for calcium and vitamin D as a part of overall health. The levels recommended are not based solely on fracture prevention. The key point is that young men and women still require adequate calcium and vitamin D for general good health, as do older people. Calcium is the main component of bone, but it is also involved in muscle and blood vessel action, nerve transmission and other functions. Vitamin D deficiency results in decreased bone mineralization and in imbalances in certain blood components.
We all need calcium and vitamin D for good health. Exactly how much is needed to prevent fractures is still unknown. What this report did for me, though, was to remind me that as with other nutrients, getting your calcium from foods first and your vitamin D from the sun and foods is the most beneficial way to get the nutrients and the related valuable compounds that are only found in real food.
The list below indicates the amount of calcium you need each day, based on the Institute of Medicine’s latest recommendations.
These foods are rich in calcium:
|Food and Portion Size||Calcium (mg)|
|Fortified ready-to-eat cereals (various), 1 ounce||350-1,000|
|Plain yogurt, nonfat (13g protein/8oz), 8 ounces||452|
|Romano Cheese, 1.5 ounces||452|
|Pasteurized processed Swiss cheese, 2 ounces||438|
|Tofu, raw, regular, prepared with calcium sulfate, 1/2 cup||434|
|Plain yogurt, low fat (12g protein/8 oz), 8 ounces||415|
|Fruit yogurt, lowfat (10g protein/8 oz), 8 ounces||345|
|Swiss cheese, 1.5 ounces||336|
|Ricotta cheese, part skim, 1/2 cup||335|
|Sardines, canned in oil, drained, 3 ounces||325|
|Provolone cheese, 1.5 ounces||321|
|Mozzarella cheese, part skim, 1.5 ounces||311|
|Cheddar cheese, 1.5 ounces||307|
|Skim milk, 1 cup||306|
|Muenster cheese, 1.5 ounces||305|
|1% lowfat milk, 1 cup||290|
|Lowfat chocolate milk (1%), 1 cup||288|
|2% reduced fat milk, 1 cup||285|
|Reduced fat chocolate milk (2%), 1 cup||285|
|Buttermilk, low fat, 1 cup||284|
|Chocolate milk, 1 cup||280|
|Whole sesame seeds, roasted and toasted, 1 ounce||280|
|Whole milk, 1 cup||276|
|Yogurt, plain, whole milk (8g protein/8 oz), 8 ounces||275|
The table below provides a helpful calcium absorption comparison table to help those who avoid dairy to select a variety of foods that will meet their calcium requirement.
Comparison of Calcium Content and Estimated Absorption Efficiency of Various Foods Compared to Milk.
Serving Sizes: Beverages, yogurt 1 cup, Cheese 1.5 oz, Cooked produce, beans, tofu 0.5 cup, Bread, cereal, nuts, seeds 1 oz
|Food||Calcium Content (mg/serving)||Estimated Absorption Efficiency %||Amount to = absorbable calcium in 1 cup of milk|
|Milk, nonfat||306||32.1||1.0 cups|
|Beans, pinto||39||26.7||4.7 cups|
|Beans, red||32||24.4||6.3 cups|
|Beans, white||81||21.8||2.8 cups|
|Bok Choy||79||53.8||1.2 cups|
|Cheddar Cheese||307||32.1||1.5 oz|
|Almonds (24 kernel/oz)||70||21.2||6.6 oz|
|Chinese Cabbage Flower Leaves||239||39.6||0.5 cups|
|Sweet Potatoes||44||22.2||5.0 cups|
|Whole Wheat Bread||20||82||6 slices|
|Yogurt, plain, nonfat||488||32.1||0.6 cups|
|Tofu, calcium set||253||31||0.6 cups|
|OJ w/ calcium citrate malate||300||36.3||0.9 cups|
|Soy milk w/tricalcium phosphate||300||24||1.4 cups|
Daily recommended Dietary Allowances (RDAs) for Vitamin D
|0-12 months||400 IU (10 mcg)||400 IU (10 mcg)|
|1-13 years||600 IU (15 mcg)||600 IU (15 mcg)|
|14-18 years||600 IU (15 mcg)||600 IU (15 mcg)||600 IU (15 mcg)||600 IU (15 mcg)|
|19-50 years||600 IU (15 mcg)||600 IU (15 mcg)||600 IU (15 mcg)||600 IU (15 mcg)|
|51-70 years||600 IU (15 mcg)||600 IU (15 mcg)|
|>70 years||800 IU (20 mcg)||800 IU (20 mcg)|
Very few foods contain vitamin D naturally. Fatty fish (such as salmon, tuna, and mackerel) and fish liver oils contain vitamin D. Small amounts are found in beef liver, cheese, and egg yolks. Mushrooms with enhanced levels of vitamin D, from controlled ultraviolet light conditions, are available in some areas.
An easy way to get vitamin D is to spend a few minutes in the sun, spring through fall. While it’s hard to make specific guidelines, because of all the variables involved, it is suggested that the following plan will usually lead to adequate vitamin D levels:
In Northern New England, from November through March the sun’s rays enter the earth’s atmosphere at an angle that blocks the vitamin D-activating portion of the rays.
|Cod liver oil, 1 tablespoon||1360|
|Swordfish, cooked, 3 ounces||566|
|Salmon (sockeye), cooked, 3 ounces||447|
|Tuna fish, canned in water, drained, 3 ounces||154|
|Orange juice fortified with vitamin D, 1 cup||137|
|Milk, nonfat, reduced fat, and whole, vitamin D-fortified, 1 cup||115-124|
|Yogurt, 6 ounces||80|
|Margarine, fortified, 1 tablespoon||60|
|Sardines, canned in oil, drained, 2 sardines||46|
|Liver, beef, cooked, 3 ounces||42|
|Egg, 1 large (vitamin D is found in yolk)||41|
|Ready-to-eat cereal, fortified with vitamin C, 0.75-1 cup||40-varies|
|Cheese, swiss, 1 ounce||6|
For more information:
U.S. Preventive Services Task Force. Vitamin D and Calcium Supplementation to Prevent Cancer and Osteoporotic Fractures in Adults: Draft Recommendation Statement. AHRQ Publication No. 12-05163-EF-2. http://www.uspreventiveservicestaskforce.org/draftrec3.htm Accessed online 6/18/12