Calcium and Vitamin D are still important!

The Institute of Medicine Report was published yesterday and I watched the national news outlets do the report a disservice–those darn sound bites just can’t capture the complexity of the report. (The complete report can be found on the IOM website http://www.iom.edu/).

The report concluded that there is not enough evidence to increase the recommended intakes for vitamin D or calcium but that is far from saying that we don’t need these 2 critical nutrients for bone health. Most people don’t get the recommended amounts of these nutrients in their diets but that message was lost in the reporting. I would not want women of any age to abandon their efforts to get calcium from their diet or supplements. I always recommend food first and there are more foods with added calcium–from orange juice to breakfast cereals–available in the grocery store. A recent study looked at calcium intake in post menopausal women and found that dairy foods were the number one source of calcium for white women but grains contribued the most calcium to the diets of black women.

Older women who don’t get enough calcium should use calcium citrate supplements–they are better absorbed than calcium carbonate supplements as we age. But, more isn’t better and I think that is what the report was trying to stress.

The more controversial part of the report was on Vitamin D; this nutrient is also crucial for bone health–nobody disagrees with that–but there are also claims that this sunshine vitamin also plays a role in diabetes, heart disease, auto-immune diseases and some cancers. It is not surprising to me that the report did not find a strong link with Vitamin D and other disorders because the research is emerging and no conclusions can be reached. Science moves slowly but the media reports every little study as if a cure for every disease was as simple as popping a supplement. The hype is often well ahead of the science.

So, don’t throw away your supplements–make sure to get adequate, not excessive, calcium and vitamin D in your diet and then add what is missing from supplements. Remember that supplements are meant to supplement diet–not replace it.

Cancer Survivors and Lifestyle Changes

October is Breast Cancer Awareness month and I just reached survivor status this month by being cancer-free for 5 years. The American Cancer Society estimates that there are 11 million cancer survivors and by the year 2020 there will be 20 million of us.

Every cancer survivor celebrates beating cancer but also worries about it coming back. The good news is that simple lifestyle changes can stack the odds in your favor. Try these 5 things to help fight your cancer from coming back.

1) Be active every day. Exercise can help control your weight and excess weight increases levels of estrogen and insulin–two hormones that fuel cancer cells. Exercise also fights other chronic diseases like diabetes, high blood pressure, and osteoporosis.

2) Eat and least 5 servings of fruit and vegetables every day. It is easier than it sounds because a small glass of juice, blueberries on your breakfast cereals, a veggie-packed salad at lunch, and an apple gives you the 5 servings needed for good health. One on my favorite quick dinner meals is a saute of veggies (green and red peppers, broccoli, asparagus, and onions) with olive oil and tossed with spaghetti noodles and sprinkled with fresh grated Parmesan cheese. Yummy and a 2 to 3 serving of vegetables meal.

3) Decrease or eliminate processed meats–no more bologna (I grew up on bologna and fried bologna sandwiches were a staple in my family), bacon, sausage or processed luncheon meats.

4) Get more the of the sunshine vitamin–vitamin D. This nutrient is showing promise as a cancer fighting vitamin. Ask your doctor to check your vitamin D level to get a baseline before you start supplementing with vitamin D pills. But eat vitamin-D rich foods every day such as fatty fish and dairy foods fortified with vitamin D. Yogurt is a popular dairy food for its calcium and protein but did you know that not all yogurt has vitamin D? Turn the carton over and look for vitamin D and don’t be surprised if you find zero vitamin D in your yogurt. The exception? Yoplait yogurt has 20% of the daily value of vitamin D in a serving so kudos to Yoplait. And, Yoplait also is a big supporter of breast cancer research–their save the lids campaign benefits Susan G. Koman for the Cure and so far they raised over $1.6 million from this year’s campaign. So dig your spoon into that!

Forty ng/mL? That is the level of vitamin D (also called serum 25(OH)D3) in my blood but what does it mean? Vitamin D is one of the most talked about nutrients and for good reason–along with calcium it is critical for building and maintaining healthy bones, but vitamin D is also one of the most confusing vitamins. We can get vitamin D three different ways:

  • through foods (although very few foods are good, natural sources)
  • through supplements (although it comes in different forms and researchers aren’t always consistent in their advice about which form is best)
  • through sunshine or the ultraviolet rays from the sun to be more precise (but SPF 8 or greater, heavy cloud cover, skin color, aging, and even the angle of the sun in winter blocks vitamin D from being made in sufficient amounts)

So what is an over-50 year old adult to do?

First, choose foods that contain vitamin D or foods that are fortified with vitamin D: salmon, mackerel, tuna and sardines are good sources because fatty fish contain this fat-soluble vitamin. Mushrooms (they are being exposed to ultraviolet light to make them good sources), milk, some but not all yogurts (read the label), many breakfast cereals and orange juice contain vitamin D. A recent study found that half of vitamin D intake comes from milk so that is a good place to start.

Second, consider supplementation; you might be getting some in your multi-vitamin and most contain 400 IU (IU stands for international units, the measure used in supplements). Vitamin D comes in two forms–D2 and D3 and most, but not all, experts recommend the D3 form because early research showed that D3 is more effective at raising vitamin D blood levels than D2. However, some research shows that both forms are effective at improving blood levels.

Third, consider getting some sensible sun–10 to 15 minutes of sun exposure twice a week can improve vitamin D levels. This recommendations is controversial because UV rays from the sun or tanning beds are tied to the million of skin cancer diagnoses each year.

Which leads us back to that 40 ng/mL blood level–is that good or bad? According to the lab report 40 is a healthy level, but trending more toward the insufficient end of the range. A controversial article in an international osteoporosis journal suggests that older adults need 800 to 1000 IU of vitamin D each day to reach the maximal blood levels of vitamin D.

Next time you go to the doctor and have blood drawn, ask for a vitamin D level–in the meantime, increase your intake of vitamin D from foods and if you supplement, look at the supplement label to determine how much vitamin D your supplement provides.

For more information check out Dr. Michael Holick’s website http://www.vitamindhealth.org/ or his new book, The Vitamin D Solution.