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.