How do I choose the best calcium for me?

Calcium carbonate and calcium citrate are the two most commonly available and clinically studied forms of calcium. Both offer benefits for bone health, but one form may be better for you depending on your supplement habit. Read on to learn more about these two forms of calcium, guidelines for maximizing the bone-building benefits of this mineral — whether from supplements or food — and recommended daily intakes.

The meal effect on absorption of calcium supplements

Some researchers report calcium citrate is absorbed better than calcium carbonate;^1,2 however, when taken with a meal, both calcium salts have similar absorption profiles.^3,4 Researchers call this the meal effect. When food is being digested, the stomach’s acidic environment becomes more acidic, which helps to increase calcium absorption. For optimal absorption, calcium carbonate should be taken with a meal. On the other hand, calcium citrate is efficiently absorbed without food and can be taken between meals.

More calcium with fewer pills

Another important difference between calcium preparations is the amount of calcium per pill. Calcium carbonate is nature’s most concentrated form of calcium. In fact, some health experts recommend calcium carbonate as the calcium supplement of choice for bone health because it delivers the highest percentage of calcium. It’s usually the least expensive as well. So, in practical terms, choosing calcium carbonate means you’ll take fewer pills to get the same amount of elemental calcium as you would from other forms with some cost savings.^†

Getting the most from your calcium intake – food and supplements

Consider the following guidelines to maximize the bone-building benefits of this essential mineral from your foods and supplements:

• Whether you supplement with calcium carbonate or calcium citrate, take no more than 500 mg of elemental calcium at one time. Above this amount, absorption tends to decline.
• If you choose calcium carbonate, take your calcium supplements with meals.
• Ensure an adequate intake of other nutrients critical for calcium absorption and healthy bones, including magnesium, vitamin D, vitamin K, vitamin C and potassium.^5†
• Consistently consume an adequate amount of calcium throughout your lifetime.
• Choose calcium-rich foods every day. Good dietary sources of calcium include: dairy products, calcium-fortified products (e.g., orange juice, soy milk, tofu), greens, broccoli, sardines/salmon with bones, almonds, and dried figs.

 

Recommended dietary intake for calcium

For optimal bone health, it is important to consume an adequate amount of calcium each day. With busy schedules and less-than-healthy food choices, a habit of daily supplementation can help fill any potential nutrient gap between what you’re consuming and what your body really needs for optimal bone health.^†
Recommended intakes for calcium by age group are:

Children and teens (9-18 years): 1,300 mg/day
Adults (19-50 years): 1,000 mg/day
Adults (over 50 years): 1,200 mg/day

 

References

1. Sakhaee K, Bhuket T, Adams-Huet B, Rao DS. Meta-analysis of calcium bioavailability: a comparison of calcium citrate with calcium carbonate. Am J Ther. 1999;6:313-321. PMID: 11329115
2. Heller HJ, Stewart A, Haynes S, Pak CY. Pharmacokinetics of calcium absorption from two commercial calcium supplements. J Clin Pharmacol. 1999;39:1151-1154. PMID: 10579145
3. Heaney RP, Dowell MS, Barger-Lux MJ. Absorption of calcium as the carbonate and citrate salts, with some observations on method. Osteoporos Int. 1999;9:19-23. PMID: 10367025
4. Heaney RP, Dowell MS, Bierman J, Hale CA, Bendich A: Absorbability and cost effectiveness in calcium supplementation. J Am Coll Nutr. 2001;20:239-246. PMID: 11444420
5. Nieves JW. Osteoporosis: the role of micronutrients. Am J Clin Nutr. 2005;81:1232S-1239S. PMID: 15883457

† These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

Does vitamin D offer benefits beyond bone health?

Researchers continue to report on a growing body of evidence that indicates vitamin D plays a much larger role in regulating health than simply helping build strong bones. Vitamin D appears to help regulate cell growth, immunity, musculoskeletal health and various other biological functions that play a role in keeping us healthy.^1,2,3 Scientists are currently working to better understand all the benefits that vitamin D has to offer. ^4,5† Read on to learn more about dietary recommendations for vitamin D, current dietary intakes and ways to improve your vitamin D status.

Dietary recommendations for vitamin D

Researchers have yet to agree on the amount of vitamin D needed for optimal health. However, experts at the National Academy of Sciences recently established a new set of dietary recommendations for vitamin D, including Adequate Intake (AI) levels that serve as a goal for the nutrient intake of individuals. The AI levels for vitamin D are:

Children and adults up to age 50: 200 IU per day
Adults 51-70 years: 400 IU per day
Adults above 70 years: 600 IU per day

The Tolerable Upper Intake Levels (ULs) for vitamin D are set at 2,000 IU per day for children and adults, which is the maximum level of daily nutrient intake that is likely to pose no risk of adverse effects. The UL represents total intake from food, water and supplements.

Current dietary intake of vitamin D

Some researchers have reported that vitamin D intake is often too low to sustain healthy circulating levels of the active form of this nutrient. This is mostly due to unique dietary patterns, such as low milk consumption, vegetarian diet, limited use of dietary supplements or low fish intake.⁶

Furthermore, nutrition surveys suggest that the majority of Americans fail to consume enough vitamin D from food sources and dietary supplements combined. Based on these findings, some researchers have proposed that additional food fortification as well as dietary and supplement guidance are needed for the general population.⁷

Ways to improve your vitamin D intake

Vitamin D is obtained from two sources: sunlight and diet. The skin manufactures the majority of the body's vitamin D after direct exposure to sunlight, but as adults age the ability to make vitamin D through the skin diminishes. Avoiding sun exposure or using sunscreen can also limit a person's production of vitamin D. Good dietary sources include salmon and other fatty fish, shrimp, and vitamin D fortified foods such as milk, orange juice and cereals. However, for many people, dietary sources alone may not be enough.

Until public health officials make further recommendations, some researchers advise regular sun exposure, consumption of foods rich in vitamin D and a daily vitamin D supplement. Others propose that, in the absence of adequate sun exposure, 1,000 IU of vitamin D per day for children and adults is required to achieve adequate circulating levels of the active form of vitamin D.^{4 †}

Adequate sun exposure is 4-10 minutes for people with pale skin in the summer noonday sun in the southern United States; for African Americans and others with darker skin tones, the corresponding time is 60-80 minutes.⁴ Since the length of time for sun exposure varies with geographical location, skin pigmentation, percent body fat and age, careful attention to obtaining dietary sources of vitamin D and daily supplementation is prudent.

References

1. Raiten DJ, Picciano MF. Vitamin D and health in the 21st century: bone and beyond. Executive summary. Am J Clin Nutr. 2004;80:1673S-1677S. PMID: 15585787
2. Cantorna MT, Zhu Y, Froicu M, Wittke A Vitamin D status, 1,25-dihydroxyvitamin D3, and the immune system. Am J Clin Nutr. 2004;80:1717S-1720S. PMID: 15585793
3. Montero-Odasso M, Duque G. Vitamin D in the aging musculoskeletal system: an authentic strength preserving hormone. Mol Aspects Med. 2005;26:203-319. PMID: 15811435
4. Grant WB, Holick MF Benefits and requirements of vitamin D for optimal health: a review. Altern Med Rev. 2005;10:94-111. PMID: 15989379
5. Holick MF. Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis. Am J Clin Nutr. 2004;79:362-371. PMID: 15585788
6. Calvo MS, Whiting SJ, Barton CN. Vitamin D intake: a global perspective of current status. J Nutr. 2005;135:310-316. PMID: 15671233
7. Moore C, Murphy MM, Keast DR, Holick MF. Vitamin D intake in the United States. J Am Diet Assoc. 2004;104:980-983. PMID: 15175600

† These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

How do I choose the best multivitamin for me?

A good diet is the foundation for better health, but even the most knowledgeable consumers don’t always eat the way they should. With today’s hectic lifestyle, taking a daily multivitamin is more important than ever to help bridge the gap between an inadequate nutrient intake and what your body needs for optimal health. Picking the best multivitamin depends on your gender, age, and general state of health.

Read on to learn more about what nutrients Americans are lacking and key guidelines for choosing a multivitamin to suit your needs.

Inadequate nutrient intake is widespread

According to the 2005 Dietary Guidelines, several target groups fail to consume an adequate intake of essential nutrients and may benefit from supplementation.¹ Children, adolescents and adults often fall short in their intake of vitamin E, magnesium and potassium. Adults frequently fail to get enough vitamin C, and many people need extra vitamin D.^†

Furthermore, the 2005 guidelines indicate that practically everybody — children, teens and adults alike — fail to consume enough calcium from their diet. Although multivitamins often supply some calcium, a separate calcium supplement, in combination with dairy products or calcium-fortified foods, is usually needed by most people to meet the recommended daily allowance for their age group. Everyone over the age of 8 needs at least 1,000 mg of calcium per day, and teens and seniors need even more — 1,200 to 1,300 mg.^†

Choosing the best multivitamin for your needs

Women

Adolescents and younger women, especially those with heavy menstrual periods, may require iron in supplement form (9-18 mg per day). Menopausal women should opt for an “iron free” formula. Women considering pregnancy should be sure their daily multivitamin provides 400-800 mcg of folic acid to support a healthy pregnancy, but limits the amount of preformed vitamin A such as retinyl palmitate or retinyl acetate to no more than 5,000 IU. A high amount of preformed vitamin A is considered unsafe for a developing fetus.^†

Men

Men should choose an “iron free” formula to avoid iron build-up in the body. Most men consume plenty of iron from their diet. Unlike women of childbearing years, men don’t lose this mineral every month through menses; therefore, iron in supplement form is not needed.^†

Vegetarians

Vegetarians who exclude all animal products from their diet including eggs and dairy products (i.e., vegans) should take a multivitamin with extra vitamin B12. Other important nutrients for vegans include vitamin D, calcium and zinc.^2†

Over 50

All persons over age 50 should choose an “iron free” multivitamin unless directed otherwise by their physician. Vitamin B12 in supplement form is especially important for older individuals since the ability to absorb this nutrient declines with age. Vitamin D is needed in higher amounts as a person ages, and many older people don’t synthesize enough of this nutrient due to inadequate sun exposure, so a multivitamin with 400-600 IU of vitamin D is important.^†

Health Concerns

If you’ve been diagnosed with an illness, or are a smoker or heavy drinker, talk to your physician before taking any supplement, including a multivitamin. Many illnesses and lifestyle habits such as heavy drinking or smoking can lead to poor nutrient intake or deplete certain nutrients. Your doctor can help you decide which products would best meet your specific nutrient needs.^†

References

1. United States Department of Agriculture. Dietary Guidelines for Americans 2005. Available at: http://www.health.gov/dietaryguidelines/dga2005/document/pdf/Chapter2.pdf.
2. American Dietetic Association. Position Paper on Vegetarian Diets. Available at: http://www.eatright.org/Public/GovernmentAffairs/92_17084.cfm.

† These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

How can I ensure an adequate intake of B vitamins?

Practically everyone has heard about B vitamins, but most people don’t know which vitamins officially belong to the B complex family. Check your favorite cereal box or other packaged foods. You’ll find these need-to-have nutrients prominently displayed in the Nutrition Facts panel, but you may not recognize them as B vitamins because they are disguised by their chemical names such as thiamin, riboflavin, niacin, pyridoxine and folic acid. Read on to learn more about the official members of the B vitamin family and how you can fuel your body to ensure an optimal intake.

The official B vitamin family

Eight water-soluble vitamins are official members of the B vitamin family, including thiamin (B1), riboflavin (B2), niacin (B3), pyridoxine (B6), folic acid (B9), cobalamin (B12), pantothenic acid and biotin. Choline joined the list in 1998 when the Food and Nutrition Board of the National Academy of Sciences designated choline essential for human health.

Inositol and para-aminobenzoic acid (PABA) are often referred to as B vitamins and are sometimes included in B vitamin complex or multivitamin supplements; however, they are not considered essential nutrients or officially designated as B vitamins.

The benefits of supplementing with B vitamins

B vitamins are widespread in the food supply; therefore, a deficiency in these nutrients is uncommon. However, supplementing may be especially helpful for certain people. If you tend to limit your food choices — eating the same few foods day in and day out, then consider supplementing. If you are trying to lose excess weight by following a strict low-calorie diet, supplement with a daily multi with B’s. Or, if you are interested in extra nutritional support for heart or cognitive health, make sure the B’s are included in your supplement program.† The good news is most multivitamins provide all the members of the B vitamin family and supply at least 50-100% of the recommended daily intake of these essential nutrients.

Fuel your body with foods rich in B vitamins

Supplementing is ideal to help bridge any potential nutrient gaps between your food choices and your body’s needs, but don’t forget to include a wide variety of foods in your diet that are good sources of B vitamins. Find your favorites below and include them in your diet regularly:

• B1 (Thiamin): Spinach, green peas, tomato juice, watermelon, sunflower seeds, lean ham, lean pork chops, soy milk and fortified grains
• B2 (Riboflavin): Milk, fortified milk products, liver, fortified grains, oysters and clams
• B3 (Niacin): Potatoes, tomato juice, lean ground beef, chicken breast, tuna, liver, shrimp and fortified grains
• B6 (Pyridoxine): Bananas, watermelon, turkey, potatoes, sweet potatoes, chicken breast and fortified grains
• Biotin & Pantothenic acid: Widespread in foods such as eggs, milk & milk products, potatoes, whole grain cereals, vegetables, beans and beef
• Folic acid: Leafy green vegetables such as spinach, oranges, orange juice, beans, fortified grains, green beans, peas and cabbage
• B12 (Cobalamin): Meats, poultry, fish, shellfish, milk and eggs
• Choline: Milk, liver, eggs and peanuts

Whatever your nutritional goals, combining healthy food choices with sensible supplementation is a great way to help you fuel your body for high energy and optimal health.

† These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

Should I take a vitamin D supplement for breast health?

Emerging research suggests that vitamin D may be an important nutrient for breast health. Yet many women may fail to get enough vitamin D in their diets to reap this benefit. Here’s a perfect example of how sensible supplementation can help bridge the gap between what you eat and what your body needs.† Read on to learn more about the role of vitamin D in breast health and how you can ensure an adequate intake of this essential nutrient.

Role of vitamin D in breast health: research update

A growing body of research continues to support a link between breast health and an adequate intake of vitamin D with or without regular sun exposure. Key research findings include the following:^†

• Women with higher vitamin D intakes and more sun exposure over a period of 20 years are more likely to experience normal breast health.¹
• Premenopausal women with a higher vitamin D intakes have significantly better breast health.²
• Postmenopausal women with a daily intake of at least 800 IU of vitamin D are more likely to experience better breast health.³
• Premenopausal women consuming higher intakes of both vitamin D and calcium from food and supplements are more likely to have healthy breasts.⁴

Researchers have yet to uncover how vitamin D positively influences breast health. But, they do know that vitamin D is one of the most potent regulators of cellular growth,^5,6 suggesting an adequate level of this vitamin is important for maintaining normal cell growth.^†

Are you getting enough vitamin D?

Nutrition surveys report most Americans fail to consume enough vitamin D.⁷ You may be particularly at risk if you don’t take a dietary supplement, if you don’t regularly drink milk or eat fish or if you’re vegetarian.⁸ What’s more, some researchers believe that regular sunscreen use is leading to an inadequate vitamin D status in a growing number of young, healthy people.⁹

How much is enough?

For optimal breast health, the research suggests you should consume at least 800 IU of vitamin D per day. This is consistent with the amount health experts recommend for the typical adult -- at least 800 IU to 1,000 IU -- for bone and muscle health, particularly as they age.^{9,10,11,12†} In addition, the Canadian Cancer Society recently released recommended intake levels of vitamin D for adults living in Canada, which include a daily intake of 1,000 IU during the fall and winter. This amount should be taken year round by people who are at risk for low vitamin D levels such as adults with dark skin or who usually wear clothing that covers most of their skin, older adults and those who don't go outside often.^13†

Choosing vitamin D-rich foods

Start boosting your intake by choosing more vitamin D-rich foods. Fish such as salmon, mackerel or sardines are naturally rich in vitamin D and the variety of fortified foods continues to grow. See the table below for foods to focus on.

Foods to Boost Your Vitamin D Intake
Food	Serving Size	Vitamin D Per Serving
Salmon, cooked	3½ ounces	360 IU
Mackerel, cooked	3½ ounces	345 IU
Tuna fish, canned in oil	3 ounces	200 IU
Sardines, canned in oil, drained	1¾ ounces	250 IU
Milk, all varieties, vitamin D fortified	1 cup	100 IU
Orange juice, vitamin D fortified	1 cup	100 IU
Margarine, fortified	1 Tablespoon	60 IU
Cereal, ready-to-eat, fortified*	¾ to 1 cup	40 IU
Egg	1 each**	20 IU
* Fortified with 10% of the Daily Value for vitamin D ** Vitamin D is found only in the egg yolk. Source: USDA National Nutrient Database available at: http://www.nal.usda.gov/fnic/foodcomp/search.

Choosing a vitamin D supplement

Add a daily supplement to ensure your vitamin D needs are met. Vitamin D supplements are available in two forms: vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol). Both forms are well absorbed, but cholecalciferol appears to be more efficient in raising blood levels of 25-hydroxyvitamin D. This vitamin D metabolite is the best measure of vitamin D status in the body.^14†

Adding it all up

Ideally, your diet should provide at least 200 IU to 400 IU of vitamin D per day. Your daily supplement should supply the rest. Consider Natrol® My Favorite Multiple® Original, which provides 400 IU of vitamin D per recommended daily intake or Natrol® My Favorite Multiple® Prime, which provides 600 IU of vitamin D per recommended daily intake.

By focusing on your food choices and taking your daily multi, you can ensure an adequate intake of vitamin D for overall health, including breast health.^†

To learn more about vitamin D and calcium go to:
Does vitamin D offer benefits beyond bone health?
How do I choose the best calcium for me?

References

1. John EM, Schwartz GG, Dreon DM, et al. Vitamin D and breast cancer risk: the NHANES I Epidemiologic follow-up study, 1971-1975 to 1992. National Health and Nutrition Examination Survey. Cancer Epidemiol Biomarkers Prev. 1999;8:399-406.
2. Shin MH, Holmes MD, Hankinson SE, et al. Intake of dairy products, calcium, and vitamin d and risk of breast cancer. J Natl Cancer Inst. 2002;94:1301-1311.
3. Robien K, Cutler GJ, Lazovich D. Vitamin D intake and breast cancer risk in postmenopausal women: the Iowa Women's Health Study. Cancer Causes Control. 2007;18:775-782.
4. Bérubé S, Diorio C, Mâsse B, et al. Vitamin D and calcium intakes from food or supplements and mammographic breast density. Cancer Epidemiol Biomarkers Prev. 2005;14:1653-1659.
5. Holick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr. 2004;80:1678S-1688S.
6. Office of Dietary Supplements. Vitamin D Fact Sheet. Available at: http://ods.od.nih.gov/factsheets/vitamind.asp.
7. Moore C, Murphy MM, Keast DR, Holick MF. Vitamin D intake in the United States. J Am Diet Assoc. 2004;104:980-983.
8. Calvo MS, Whiting SJ, Barton CN. Vitamin D intake: a global perspective of current status. J Nutr. 2005;135:310-316.
9. Hanley DA, Davison KS. Vitamin D insufficiency in North America. J Nutr. 2005;135:332-337.
10. Dawson-Hughes B, Heaney RP, Holick MF, et al. Estimates of optimal vitamin D status. Osteoporos Int. 2005;16:713-716.
11. Bischoff-Ferrari HA, Willett WC, Wong JB, et al. Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA 2005;293:2257-2264.
12. Vieth, R.Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. Am J Clin Nutr. 1999;69:842-856.
13. Canadian Cancer Society. Vitamin D Recommendation. Available at: http://www.cancer.ca/ccs/internet/standard/0,3182,3172_1176359459__langId-en,00.html.
14. Trang HM, Cole DE, Rubin LA, et al. Evidence that vitamin D3 increases serum 25-hydroxyvitamin D more efficiently than does vitamin D2. Am J Clin Nutr. 1998;68:854-858.