Calcium

Everybody needs calcium.

From here on all is murky.

How much calcium anyone needs and where best to get the calcium are highly contentious subjects. The National Osteoporosis Foundation recommends 1,000 mg a day of calcium for Americans ages 19 to 50; 1,200 mg for people older than 50; 1,300 mg for ages 9 to 18 and lesser amounts for younger children. But in an article, Got Controversy?, in the Rochester Democrat & Chronicle, Dr. Walter Willett, nutritionist and epidemiologist at Harvard School of Public Health contends that "500 to 700 milligrams of calcium daily is probably plenty."

And he says that dairy isn't necessarily the best source for calcium. Most cultures around the world get their calcium from plant sources.

Willett, who works closely with three of the biggest and longest-running health studies in the country including the Nurses' Health Studies, found that women getting the most calcium from dairy products had more fractures than women who had less dairy — the opposite of conventional wisdom.

The other side of the case is argued by J. Edward Puzas, a research scientist and director of the Osteoporosis Center at the University of Rochester.

It's fine to get calcium from dairy or nondairy sources, including supplements, he says, but the reality is that most Americans don't get enough.

The body needs a certain level of calcium concentration in the blood in order to work properly. When calcium levels run low, the body removes calcium from its bones. If that calcium is not replaced regularly, people end up with weak bones and fractures, he explains.

Here's what most everybody does agree on:

Vitamin D is key because it allows the body to use calcium. "You can have all the calcium you want, but if you don't have enough vitamin D, you just poop it out," says [Dr. Stephanie Siegrist, orthopedic surgeon at Westfall Orthopaedic and Sports Medicine Center in Brighton]. Current research suggests 800 to 1,000 international units a day of vitamin D for a healthy adult, Siegrist says, although the National Osteoporosis Foundation calls for 400 to 800 IU. Both amounts are well above the 200 IU in a typical calcium-plus-D supplement. One cup of fortified cow milk or soy milk provides 100 IU of vitamin D. Your body can make vitamin D when you get 15 to 30 minutes a day of sun on your face and arms (the amount depends on the angle of the sun). Vitamin D levels can be checked with a blood test.

Weight-bearing exercise strengthens your bones.

Smoking and excessive alcohol consumption hurts your bones.

And what if you're lactose intolerant?

Dr. Stephen Cook, a pediatrician/internist and instructor at Golisano Children's Hospital at [the University of Rochester's Strong Memorial Hospital], finds that many people who say they are lactose-intolerant actually can tolerate a glass of milk with a meal. At the Rochester clinic where he works, he sees children too often drinking soft drinks and sugary juice drinks that lack calcium and add excess calories. Worse, the phosphates in soft drinks hinder calcium absorption. Cook, who studies obesity, endorses the three-a-day guideline for dairy. More isn't better because of the extra calories. Chocolate milk — even if low-fat — has excess sugar, he adds.

If you're looking for good information about non-dairy sources of calcium, my LI Links page has a number of links to good pages on the Net that talk about calcium, from dairy, from non-dairy, and from supplements.