It’s strange but true. People should look into their meds, even if cramps and spasms aren’t listed as a side effect. Also, if I get my vitamin D naturally, why do I need a supplement to help absorb calcium?

DEAR READER: That’s a great question. Calcium is vital for the formation and maintenance of strong bones and for normal bodily functions such as the development and maintenance of strong teeth. It is required for the contraction and expansion of blood vessels, the secretion of enzymes and hormones, and the transmission of impulses of the nervous system. Vitamin D is equally important for the absorption of calcium from the intestines. The combination is most often used to prevent deficiency and to treat it in those who are calcium deficient.

An adequate daily calcium intake is 1,000 milligrams for people between the ages of 19 and 50; and 1,200 for those 50 and older. Food sources include milk, cheese, yogurt, tofu, salmon, fortified cereals and instant breakfast drinks.

An adequate daily intake for vitamin D is 200 IU for people between the ages of 19 and 50; 400 IU for those between the ages of 51 and 70; and 600 IU for those 71 and older. This fat-soluble vitamin is found in fortified milk products and cereals, egg yolks, butter, salmon, sardines, herring and beef liver. Aside from food sources, sunlight exposure for about 15 minutes a day is reported to provide the necessary amount, but don’t get too much sun.

Side effects of too much calcium with D include drowsiness, weakness, dry mouth, irregular heartbeat, difficulty breathing, nausea or vomiting and constipation, but the list goes on and on. If any of these symptoms are experienced, a user should contact his or her physician promptly.

You don’t indicate your age, so I am unsure whether you have issues with such disorders as osteoporosis; however, if your diet is adequate, I don’t believe you require a supplement, but this can be determined by a blood test. You will continue to receive some benefit from the calcium you take, even if you discontinue the D. Perhaps the answer is to take a good one-a-day vitamin. Speak with your doctor regarding his or her views on the subject. In the interim, read labels at your local grocery store when selecting foods. That way, you can determine whether you satisfy the recommended requirements through diet alone. If not, the next step might be to select some of the foods recommended so you can increase your intake naturally.

To provide related information, I am sending you a copy of my Health Report “Vitamins & Minerals.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order made payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR READER: In essence, yes it was. The article should have indicated, “As research unfolds and theories are validated, deficiency is thought to be linked to thyroid disorders …” The word “deficiency” did not appear in print. I spoke of insufficient amounts of D at the beginning of the paragraph, but the way the information appeared would lead a person to think just as you did.

Thank you for pointing this out. It’s readers like you who keep me on my toes, and I’m grateful you took the time to write.

DEAR READER: Vitamin D is a fat-soluble vitamin essential for the growth and development of teeth and bones and for the absorption of calcium and phosphorous from the intestines. Without sufficient vitamin D, bones can become thin, brittle and misshapen. It prevents softening of bones in children, a condition known as rickets. When combined with calcium, it helps protect older adults from osteoporosis. As research unfolds and theories are validated, it is thought to be linked to thyroid disorders, hypertension, stroke, diabetes, heart failure, colon, prostate and breast cancer, multiple sclerosis, chronic pain, infection and other disorders.

The average vitamin D intake of American adults is about 230 IU daily. Some researchers are recommending that the dose be increased to between 1,500 and 2,000 IU daily, while others believe 5,000 is appropriate. According to the Office of Dietary Supplements, a division of the National Institutes of Health, people between infancy and 50 should take 200 IU; between 51 and 70, 400 IU; 71 and over, 600 IU. Research remains ongoing, and new studies were to have been completed in May 2010 and reported later this fall that may modify these recommendations.

Vitamin D comes from three sources — supplements, exposure to the sun’s ultraviolet rays that penetrate the skin and foods such as fatty fish, fortified milk products, egg yolks and butter. It is said that 20 minutes in the sun at solar noon provides 200 times more vitamin D than one glass of milk.

To provide related information, I am sending you a copy of my Health Report “Vitamins & Minerals.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order payable to Newsletter. Mail it to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR READER: Osteoporosis occurs when the normal buildup and breakdown of minerals in healthy bones falls out of balance. The condition is difficult to detect in its early stages, but the first clue is often a bone fracture, loss of height, back pain, stooped shoulders or through a routine bone density (X-ray) study.

There are a number of prescription medications; however, as you may be aware, several can lead to osteonecrosis of the jaw and other serious complications.

The recommendation for people 51 and older is 1,200 milligrams of calcium per day. Vitamin D is of equal importance in order to utilize the calcium and should not exceed 2,000 IU daily for healthy people. Therefore, in answer to your question, it all depends on how much calcium and D is present in the vitamin regimen you are taking. Read the ingredient label. If necessary, switch to combinations of calcium and D available at your local pharmacy in single-tablet form.

Beyond that, don’t smoke, avoid alcohol, maintain good posture, eat well, and exercise.

To provide related information, I am sending you a copy of my Health Report “Osteoporosis.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

Can you tell me what could be causing my low vitamin D level? Do you believe that this is the issue, or are the low levels caused by something else?

DEAR READER: Vitamin D is a fat-soluble vitamin that is essential for promoting calcium absorption, maintaining adequate serum calcium and phosphate levels, bone growth and remodeling, reduction of inflammation, and neuromuscular and immune function.

If your levels are low, you are at risk of developing weak, brittle and/or deformed bones. This could also affect your immune system, making you more susceptible to infection, allergens and more. Your low vitamin D level may indeed be the cause of your allergies, which are causing your cold and flu-like symptoms; however, this does not explain why you have a low D level to begin with.

In healthy people, vitamin D deficiency can typically be avoided by adequate sun exposure and a well-balanced diet. Because there are very few foods that naturally contain D, fortified cereals and dairy products are the best way to achieve sufficient dietary amounts.

Older adults, breastfed infants and those with limited sun exposure, dark skin or fat malabsorption are at increased risk of developing deficiency. Obese individuals may have difficulty absorbing vitamin D from sun exposure because the subcutaneous fat essentially blocks part of the D from entering the bloodstream. Those who have undergone gastric bypass may also have difficulty because most forms of this surgery bypass the upper small intestine where D is absorbed.

Symptoms of vitamin D deficiency typically go unnoticed. The most common consequence is weakened bones, also known as rickets in children, osteomalacia in pre-menopausal women and men, and osteoporosis is post-menopausal women. There may be an increased risk of developing cancer, especially that of the digestive tract. There is also research suggesting deficiency may play a role in the prevention and treatment of diabetes types 1 and 2, hypertension, glucose intolerance, multiple sclerosis and more. However, because these studies have not been randomized clinical trials, the implications will continue to be debated until definitive proof is found.

According to the Food and Nutrition Board (FNB) at the Institute of Medicine of the National Academies, adequate intakes (AIs) for healthy people between birth and age 50 should be 200 IU of vitamin D daily. Those aged 51 and over should double that. Recently, the American Academy of Pediatrics issued its own recommended intakes that exceed those of the FNB. This led to an expert committee formation by the FNB, which decided that recommended intakes be re-evaluated. To the best of my knowledge, the decision of this committee should be made public later in 2010. Tolerable upper-intake levels (ULs) for those between birth and 12 months is 1,000 IUs; age 1 and older is 2,000 IUs daily. This, too, was challenged and is currently under review.

I suggest that you speak to your physician to request that the underlying cause be found. It may be as simple as not getting enough sun exposure and may be helped by exposure without sunblock for 15 or 20 minutes each day. Longer unprotected exposure is not recommended because of the increased risk of developing skin cancer.

If the cause cannot be found, follow your physician’s advice regarding supplementation and including more vitamin D-enriched foods into your diet.

You should also be watchful for signs of excess intake. Most commonly, these symptoms are nonspecific and include nausea, weakness, constipation, weight loss, vomiting and poor appetite. If healthy people continually take levels above the UL, it may result in elevated blood levels of calcium, which may cause confusion and other mental-status changes, as well as heart-rhythm abnormalities. There is also an increased risk of developing kidney stones, especially when used in conjunction with calcium; however, because you are deficient and under the care of a physician, these are not likely to result.

To provide related information, I am sending you a copy of my Health Report “Vitamins and Minerals.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title. Order forms are also available for printing on my Web site at www.AskDrGottMD.com.

I have enclosed some article from different sources on the importance of vitamin D and hope that you will re-evaluate your position on the necessary amount of the essential vitamin.

DEAR READER:
Thank you for including the back-up information. My position on the amount of necessary vitamin D in the daily diet is directly related to various government sources that indicate 400 IU is adequate for healthy individuals. However, this does not mean that current research is incorrect.

As more studies are done, several sources have found that vitamin D deficiency is on the rise among infants, children, teens, adults and seniors. Further studies need to be done to determine why this is happening and what steps we can take to prevent future generations from developing this deficiency.

Interestingly, the body stores vitamin D but it cannot be activated for use until exposed to ultraviolet B. Simply being outside for 15 minutes in the sun everyday can provide dramatic results.

I do not recommend that patients increase their vitamin D intake but I can encourage them to see their physicians to discuss the issue. A simple blood test may be all that is needed to determine if a deficiency is present. If it is, simple supplementation may be all that is required but a referral to an endocrinologist or other specialist may be advised to determine if there is a more serious underlying cause.

Vitamin D deficiency can lead to several problems, the most common of which is weak, brittle bones. This can lead to fractures which can take extended periods of time to heal because unhealthy bone does not heal as quickly or as well as normal bone. It has also been linked with thyroid disease, cancer, diabetes, stroke, asthma, heart failure and more.

Several physicians who specialize in bone health have begun recommending the recommended daily intake be increased to about 1000 IU, which is currently more than double the standard. Until further studies have shown that this will benefit a majority of the population without serious side effects, I must stick to the old guidelines but am willing to change my opinion when more definitive results are available.

To give you related information I am sending you copies of my Health Reports “Osteoporosis” and “Vitamins and Minerals”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 per report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

DEAR READER:
You are one of many people who have written to me asking the same question. Calcium (or calcium plus D) supplements DO NOT cause hardening of the arteries. The way that the media portrayed the issue caused near panic for thousands of individuals taking these supplements.

The information reported was that arterial plaque caused by excess calcium could lead to heart attack and stroke. While this is true, the problem does not lie in how much calcium in ingested but rather with the body itself. As we age, our bodies become less able to absorb calcium properly. Most of it is excreted but a minimal amount can be carried to other areas of the body, such as the arteries, where it is deposited. Overtime this can lead to large patches of hardened arterial lining which can become cracked or break off, leading to clot formation. If the clot then breaks off, it can be carried to the heart, brain or lungs leading to an emergency situation.

Calcium is necessary for many bodily functions such as bone health, heart action, normal blood clotting, muscle contraction, and nervous system maintenance.

If you are truly concerned, I recommend you speak with your primary care physician or gynecologist. Since they know you best, they can give you the best explanation specific to you.

To give you related information, I am sending you a copy of my Health Report “Osteoporosis”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

DEAR READER:
You are referring to a small study reported in The Journal of Orthopaedic Trauma, disclosing patients with low-to-no-trauma fractures. A large portion of those in the study had been on long-term Fosamax therapy for an average of 6.9 years. Of particular interest is that all of the breaks occurred straight across the bone and some were preceded by weeks or even months of unexplained aches and pains.

In the past Fosamax has been associated with osteonecrosis of the mandible (destruction of the jaw bone) in some users. When this information was made public, I recommended all my patients on the drug switch to something else for control of their osteoporosis. With this newest report, I can only state my personal opinion which is to stay away from Fosamax and consider other options.

While research is ongoing and positive strides are being made, it often takes years before we know the full story on any medication. For example, biphosphonates are available in weekly and monthly doses through oral tablets, or annually by injection. Personally, I feel it is too soon to know of any possible long-term consequences that could develop while on these drugs. To compound the issue, by the time complaints are made and stories are correlated for similarity, years may have passed and the damage to bones might already be done. It’s a difficult dilemma.

Calcium supplements for men and pre-menopausal women should be 1000 mg with a vitamin D supplement of 400 IU daily. For post-menopausal women, the appropriate dosing is 1500 mg of calcium and 600 IU of vitamin D daily. The easiest way to accomplish this is to purchase a calcium supplement that also contains D, such as Citracal + D or Caltrate + D.

I want to include a quick note about vitamin D, since overload can cause poor appetite, constipation, confusion, mental changes, vomiting, and heart rhythm abnormalities. While too much D is unlikely for the average individual, normal ranges are 200 IU daily for individuals up to 50 years of age, 400 IU for those from 52-70 and 600 IU for those over 70. The tolerable upper limit for individuals over one year of age is 50 mcg or 2000 IU. Be sure to read the recommended serving size on labels, since you may have to consume two or more pills daily to get the proper supplement amount.

If you are concerned about taking too much vitamin D, you can easily take a plain calcium supplement with a separate vitamin D supplement to ensure you are not getting too much or too little of either.

Eating well-balanced meals that include broccoli, kale, mustard greens, legumes, and shellfish will help maintain strong bones. Healthful foods should be a part of everyone’s lifestyle.

Take your concerns to your primary care physician. If you haven’t had a bone density X-ray (DEXA) in the last two years, requests your physician’s office set up an appointment. Determine how severe your osteoporosis is and work out a plan together as to which control might be best for you.

To give you related information, I am sending you a copy of my Health Report “Osteoporosis”. Other readers who would like a copy should send a self-addressed, stamped, number 120 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

DEAR READER:
Vitamin D is necessary for the body to absorb calcium. It is present in fish, liver, egg yolks and fortified cereal, margarine and milk. It is also made by the body when skin is exposed to sunlight. Therefore, it is not necessary for most healthy individuals who consume an appropriate diet to take a vitamin D supplement.

According to the National Institutes of Health Office of Dietary Supplements, the recommended Daily Value varies according to age. The rDV for birth to 50 years is 5 micrograms (mcg) or 200 International Units (IU). For ages 51-70 it is 10 mcg or 400 IU and for those 71 and older it is 15 mcg or 600 IU. That being said there is another set of numbers known as the Tolerable Upper Intake Levels which are the highest levels at which a supplement (in this case vitamin D) can be taken without risk of overdose. For these levels, birth to 12 months can be given up to 25 mcg or 1000 IU and those one year and older can take up to 50 mcg or 2000 IU.

Overdose of vitamin D can cause nausea, vomiting, weight loss, weakness, poor appetite, and constipation. The most serious consequence is that it may raise blood levels of calcium which can cause heart rhythm abnormalities and mental status changes such as confusion.

I recommend that you follow the pharmacist’s recommendations. If you want more information, I suggest that you visit the NIH Office of Dietary Supplement’s vitamin D page at http://ods.od.nih.gov/factsheets/vitamind.asp. This may be good to bring to your physician also for his opinion.

Now is also the time to consider prescription medication for your osteoporosis. Advanced osteoporosis may not respond well to the calcium/vitamin D therapy. Fractures of the spine and hip are very real possibilities for anyone with osteoporosis and these consequences increase as the severity of bone loss worsens. You need to take aggressive steps to prevent serious injury because osteoporotic bones do not heal well and may require surgery, hospitalization and months of bed rest and rehab. If your physician is unwilling or unable to help you further, I recommend you be evaluated by a rheumatologist.

To give you related information, I am sending you a copy of my Health Report “Osteoporosis”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Is it possible for me to get enough calcium from my diet without taking the over-the-counter kind? I enjoy all kinds of vegetables and dairy products. I run and take aerobics classes (which includes weights) about three times per week.

DEAR READER: I recommend that you have a bone density exam. This test will let your doctor know how well your bones are absorbing calcium. If you have minor deficiencies (osteopenia) but not osteoporosis, increasing your calcium intake with calcium and vitamin D supplements may stop or slow bone loss. If you have osteoporosis, you should start one of the medications available on the market as well as including extra dietary calcium and vitamin D.

Whether or not you need calcium/vitamin D supplements, they are relatively inexpensive and won’t hurt you. (Incidentally, just because you are slim is not reason enough to assume that you are a candidate for osteoporosis.) As a preventive you may wish to start taking supplements even if you have no problem.

If you decide to take calcium supplements, be sure that you take one that includes vitamin D. The vitamin D works with the calcium in your body and aids absorption. Without it the amount of calcium used by the body is minimal.

To give you related information, I am sending you a copy of my Health Report “Osteoporosis”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.