Dear HEALTHbeat subscriber,

The benefits of a daily multivitamin are looking doubtful these days. Nutritional experts increasingly tout the benefits of getting vitamins and minerals from food sources. But it’s hard to imagine doing so without having to plan incessantly and eat all day long. This issue of HEALTHbeat discusses approaches to getting complete nutrition through your diet, without having to increase your calorie intake. Also in this issue, Dr. Celeste Robb-Nicholson addresses whether calcium supplements are detrimental to those suffering from pseudogout.

Wishing you good health,


Nancy Ferrari
Managing Editor
Harvard Health Publications
HEALTHbeat@hms.harvard.edu

The Challenge

Experts agree that the best way to get the nutrients we need is through food. A balanced diet — one containing plenty of fruits, vegetables, and whole grains — offers a mix of vitamins, minerals, and other nutrients that collectively meet the body’s needs. But many of us doubt whether we can get all the nutrients we need from food alone.

For one thing, the “percent daily values” featured on food labels are based on a 2,000-calories-a-day diet. Many of us can’t eat that much without gaining weight. What if your energy needs are closer to 1,500 calories a day? What if you’re dieting? Can you eat enough to take in the recommended micronutrients without falling back on a multivitamin?

The Good News

It’s not an issue of food quantity, but rather food quality. Even a low-calorie diet can deliver all the vitamins and minerals you need, with one exception — vitamin D. So plan to take a vitamin D supplement. Getting the rest of your nutrients through diet requires some planning and some knowledge about food. The focus should be on nutrient-dense foods such as legumes, Brussels sprouts, kale, eggs, seeds, almonds, and fish, which are packed with vitamins and minerals and have relatively few calories (see examples below).

What you can do

One way to set up a plan that precisely meets your nutritional needs is to work with a registered dietitian, who can take into account your food preferences and allergies or other health issues (such as lactose intolerance). Many dietitians have access to computer programs and databases that ease the most difficult calculations, such as nutrient analyses of menus. You can ask your clinician for a referral (check to see if your insurance covers the cost of nutritional counseling), or ask at a local hospital or medical center. But if you have the time and the inclination to do the work yourself, there are free tools and calculators on the Web that can help. We’ve also provided a 1,200-calorie sample menu below.

Q: I’ve been diagnosed with pseudogout, which I understand is caused by a buildup of calcium crystals in the joints. Should I be concerned about taking a calcium supplement?

A. Pseudogout is a type of inflammatory arthritis characterized by sudden attacks of pain and swelling in the joints. It closely resembles gout, hence the name. But gout usually affects a big toe, and pseudogout usually affects the knee, though both conditions can affect other joints as well. Gout is caused by sodium urate crystals, and pseudogout is caused by crystals of calcium salts — calcium pyrophosphate dihydrate, or CPPD.

CPPD crystals initially form in the cartilage and migrate into synovial fluid, stimulating inflammation in the joint. Most people with x-ray evidence of CPPD crystals never have symptoms, but some develop pseudogout, as well as chronic arthritis. We don’t know why calcium crystals form in joints, but they may result from elevated levels of calcium or pyrophosphate or other factors that lead to supersaturation of calcium pyrophosphate in cartilage and bone.

Risk factors for pseudogout include family history, trauma to the joint, and older age.

As long as your body is metabolizing calcium normally, dietary calcium or a calcium supplement should not increase CPPD formation. Calcium metabolism is a tightly regulated system. Calcium from food or supplements is absorbed in the gut and transported into the blood for use in most cell functions, including bone formation. If we absorb more than we need, our kidneys excrete the excess. However, certain conditions can undermine these controls, causing high blood calcium levels and predisposing a person to forming CPPD crystals.

Conditions associated with pseudogout include causes of excessive calcium in the blood such as an overactive parathyroid gland (hyperparathyroidism); low blood levels of magnesium; an underactive thyroid gland (hypothyroidism); and excess iron in tissues (hemochromatosis). Your doctor can perform blood tests to check for these conditions. If those are normal, you can safely take the calcium (and vitamin D) you need to reduce your risk for osteoporosis.

This Question and Answer first appeared in the July 2009 Harvard Women’s Health Watch, available at www.health.harvard.edu/women.