Stephanie Watson

Proposed recommendations question the value of calcium, vitamin D supplements

The U.S. Preventive Services Task Force (USPSTF) has stirred up a maelstrom of debate by proposing that healthy postmenopausal women lay off daily calcium and vitamin D supplements, which the task force says may do more harm than good. If your doctor has recommended these supplements to protect your bones, you might feel like you’re on a see-saw of advice and can’t tell which end is up.

Before tossing your supplements in the trash, you need to understand the USPSTF’s rationale for the advice, and how osteoporosis specialists are advising their patients in light of this recommendation. Three Harvard doctors offer their perspectives on the issue.

The rationale

The USPSTF makes its recommendations by weighing the available evidence on the benefits of any particular preventive practice against its risks. In this case, they examined studies that assessed the ability of calcium and vitamin D supplements to protect against osteoporosis-related bone fractures and cancer, and their odds of causing side effects.

They concluded that, based on the available evidence, supplements containing up to 400 IU of vitamin D and 1,000 milligrams (mg) of calcium don’t reduce fractures in postmenopausal women. Plus, these supplements may slightly increase the risk of kidney stones. (Calcium supplements have also been linked to a higher risk of heart disease.)

As a result, the USPSTF says that postmenopausal women who aren’t at risk for osteoporosis shouldn’t be taking these supplements to prevent fractures. The jury is still out on whether it’s worth it for women and men to take higher doses of calcium and vitamin D to prevent fractures, or to take vitamin D to prevent cancer.

To supplement…or not to supplement?

Before changing your daily supplement regimen, remember that these recommendations are still preliminary. The USPSTF has submitted its recommendation in draft form, hoping to hear from experts in the medical community. The feedback it gets could alter the final recommendations.

Also, the recommendations may not apply to you. “We have to remember that these are draft recommendations and evidence is lacking at this time for many of those recommendations,” explains Dr. Jill Paulson, instructor in medicine at Harvard Medical School. “It is not one-size-fits-all and it is not a blanket statement.”

The recommendations also don’t apply to those who have osteoporosis or who are at risk for it. “I am going to continue to recommend that those patients get adequate calcium and vitamin D,” Dr. Paulson says.

The Institute of Medicine recommends that all women over age 50 need 1,200 mg of calcium a day; those aged 51 to 70 need 600 international units (IU) of vitamin D, while those over age 70 need 800 IU. Men aged 51 to 70 years need 1,000 mg of calcium and 600 IU of vitamin D, while those over age 70 need 1,200 mg of calcium and 800 IU of vitamin D. Our experts say most of those daily requirements should come from your kitchen, not your medicine chest.

“I think calcium and vitamin D are important for bone health, but I recommend that patients get calcium from their diet,” explains Dr. Meryl LeBoff, director of the Skeletal Health and Osteoporosis Center and Bone Density Unit at Brigham and Women’s Hospital and professor of medicine at Harvard Medical School. “In individuals who can’t meet the dietary recommendations, I would recommend supplements.”

“I tell patients to estimate the amount of calcium they are getting from their diet and then supplement it. I don’t want them to take excess calcium,” adds Dr. David Slovik, associate professor of medicine at Harvard Medical School, chief of the Endocrine and Diabetes Unit at Newton-Wellesley Hospital, and endocrinologist at Massachusetts General Hospital.

Getting your daily requirement of calcium is easier than you think—and it doesn’t require chugging gallons of milk. Good sources of calcium include:

  • low-fat yogurt (8 ounces, 400 mg)
  • calcium fortified orange juice (8 ounces, 400 mg)
  • Cheddar cheese (1.5 ounces, 180 mg)
  • canned salmon and sardines (3 ounces, about 300 mg)
  • collard greens and spinach (1 cup, about 250 mg)

Reaching your daily vitamin D requirement with food is challenging, because only a few foods contain large amounts of vitamin D. Good choices include:

  • salmon, trout, halibut, tuna, and sardines (3 ounces, 250 mg to 400 mg)
  • milk, cheese, and other dairy foods (30 IU to 60 IU per serving)
  • fortified orange juice and breakfast cereal (40 IU to 60 IU per serving)

(Extensive lists of good food sources of calcium and vitamin D are available for free from the USDA’s Agricultural Research Service.)

Vitamin D is also activated in sun-exposed skin, but “in the winter in northern climates, there’s very little activation of vitamin D in the skin,” Dr. LeBoff says. That’s why many doctors recommend vitamin D supplements.

So don’t drop your supplement regimen based solely on the USPSTF’s recommendations. You could neglect your bones in the process. “Review the specific recommendations with your doctor, because these are important health decisions,” Dr. LeBoff advises.

Comments:

  1. Christina

    Not even an hour ago, I saw a commercial on TV about how “women do not absorb calcium like they need to” … obviously they were selling some sort of calcium supplement, aimed at women.

    I can even think of a few women who I know who take calcium supplements with added D3. Maybe I’ll have to show them this article! lol

  2. simon

    Hi,
    Diets are hard for some people to stick to, as when we see some nice looking cakes or sweets we just can not refuse. For me I must stay on a low fat diet because of have illness (pancreatitis and gallstone,kidney stone). It changes the way one looks at life and being healthy.

    Having a healthy diets is a must if you want to stay healthy in life, as my bad diet is how I became very ill.

    SO always watch what you are eating.

    Do you know no foods are bad for you – It is just the way you cook them and when to eat them. Some foods must be avoided with some illnesses.

    stay healthy and good luck with your diets..

    warmest regards, simon newcombe…

  3. Fubao

    Some products claimed to have “professional grade” ingredients. Are they better than the normal OTCs?

  4. Brian

    Any extreme “overdose” of supplements can be adversary to your health. In fact any extreme “overdose” of anything is generally not good for you. Important research should be done on what supplements / vitamins you are taking, and a general overview of your diet – so that you can ensure you are not overdoing it!

  5. Paul F Davis

    Wow! A post and discussion on research showing supplements doing more harm than good.

    Much needed! I have for a long time wanted to read something on vitamin supplement toxicity.

    Please write more on this topic.

    • thanh

      I tend to agree that most of us should be getting calcium from the kitchen. Vitamin D3 is another story all together though. The “recommended” dose of 600 IU per day is laughable when you consider that many people taking sometimes twice that dose are still way below the suggested effective level of 40 ng/ml (25(OH)D) in their blood.

      That being said, IMHO it’s most important that those concerned about their Vitamin d3 levels get the 25-hydroxyvitamin D test. That way an effective dose can be accurately sought out and actually begin to have it’s positive effects.

  6. Ern

    Though there is a proliferation of supplements and vitamins today – and many are consuming them, caution really should be observed. Great to know about this study. Ern

  7. nahid naznin

    Nice article.I always think one thing,for dietary suppliment,why should we go for medicine!!!There are so many dietary sources of calcium and vitamin D.Natural sources are always best.

  8. Yerushalmi

    Isn’t it incredible, we are told to give a newborn throughout it’s first year of life 400IU of Vitamin D3 yet the USPSTF recommends only 600IU for an adult weighing about 20 times as much !In my practice adults need to take 4-5 thousand IU of Vitamin D3 just to enter the lower end of the ” normal ” range, perhaps the USPSTF should have lowered the normal range values to fit in with their dosage recommendation ?

  9. anekdotai

    grean leave and vegitables are great For Vitamin B2, B3.

  10. Calcium challenged

    I have looked at your list, and then at the USDA list, and there are discrepancies, such as, you say that canned salmon has 300mgs of Calcium, here is what USDA says:

    15084 Fish, salmon, pink, canned, total can contents 85 3 oz 183 mgs.

    So it’s hard to do this with conflicting information. Can you help?

  11. Just a question.

    Calcium is fairly easy to acquire from a normal diet. Most vitamins and minerals are best acquired that way as the medical profession is quick to point out. There is a blind spot here .The best most natural source of vitamin d is sun exposure it is interesting to note no evidence from randomized trails shows the effect of long term vitamin d deficiency because of sun avoidance across a variety of endpoints :yet the mantra is avoid any sun exposure .Growing evidence indicates UVR may add benefit in certain conditions beyond the D3 produced see the recent study by Dr. Hector Delucca .To draw any conclusions from the 400iu of d3 beyond the fact that that is such a small amount of d3 that it may well have been lost in the noise.

  12. hatiputera

    wow very awesome article regarding the calcium vitamin. Is it 600 IU per day is very high?

  13. CLS88

    600 I.U. of vitamin D is the amount produced (precursor) with less than 1 minute of sun exposure, midday, wearing a bathing suit.

    Does anyone, in any profession, think humans did not regularly produce at least 10 X this, typical daily sun exposure (May-Sept.- Northern Hemisphere), during normal diurnal activity?

    The issue has always been supplemented calcium, with a lack of sufficient vitamin D.

    Light skinned humans will produce at least 10,000 I.U. (up to 20,000 I.U.)in 30 minutes of sunbathing. That’s UV contacting skin, as a species doing work, recreating, or simply enjoying the feeling of the sun.

    Cardiologists have known for at least 15 years that supplementing calcium increased fatal heart attacks by 25%+ in certain demographics.

    Get your calcium from food- it’s everywhere. Think intelligently about the amount of vitamin D produced naturally by even 5 minutes of full sun exposure…in our birthday suits (5,000 I.U.+).

    600 i.u. of vitamin D is essentially meaningless…

    A horse pill of calcium with too few/little cofactors is flushed through our kidneys or sticks to our arteries…

  14. Anonymous

    Thanks for the information. For Vitamin B2, B3, you can eat the vegetables and green leaves those are rich in vitamins.

  15. Vitamin D3 Dosage May Actually Be Too Low

    I tend to agree that most of us should be getting calcium from the kitchen. Vitamin D3 is another story all together though. The “recommended” dose of 600 IU per day is laughable when you consider that many people taking sometimes twice that dose are still way below the suggested effective level of 40 ng/ml (25(OH)D) in their blood.

    That being said, IMHO it’s most important that those concerned about their Vitamin d3 levels get the 25-hydroxyvitamin D test. That way an effective dose can be accurately sought out and actually begin to have it’s positive effects.