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Sonja Brownlee, MD.
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Last Updated 7/2011
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Calcium and Vitamin D
Inadequate Calcium and Vitamin D are American children's most common nutritional deficiency.
We need calcium all our lives:
- To build and maintain strong bones and teeth
- To help blood to clot
- For muscles and nerves to function
The need for calcium is especially important during periods of rapid growth and development:
- The first few years of life
- The teen years
- Low calcium is an important risk factor for fractures in teens – a time of rapid growth and participation in athletics with an increased risk of injury
- During pregnancy and breast feeding
Increased calcium is also important after menopause
- Osteoporosis in later adulthood can be prevented by building peak bone mass during the teen years.
Exercise is another very important part of attaining maximum peak bone mass. Weight-bearing exercise is best (walking, running, jumping rope are better than swimming).
Risk Factors for Calcium Deficiency:
- Not drinking milk:
- Unfortunately too many kids and teens chose other beverages such as bottled water, juice, sports drinks, soda, tea, or coffee
- Believing that dairy products will lead to weight gain (especially among adolescent girls)
- 1 cup of 1% milk = 100 calories = 1 cup soda = 1 cup juice = 2 cups gatorade
- Lactose intolerance or milk protein allergy. If you use soy milk or other milk substitutes, check the label for calcium, vitamin D, and protein contents compared to milk
- Too much salt in your diet:
- Besides causing high blood pressure (which increases the risk of heart disease, kidney disease, and stroke) a diet high in salt causes your body to lose calcium through your urine.
- Decrease your use of Convenience or Processed foods and Fast Foods which all contain more salt than “home-cooked” where you control the amount of salt added while cooking.
- Keep salt shakers off the table!
- Watch your intake of high salt snacks and high salt seasonings (soy sauce, bouillon cubes, meat tenderizer, Worcestershire sauce).
- Not enough exercise
- Bones respond to weight-bearing exercise by growing stronger and denser. Any activity that gets your child and teen up and moving will do: jogging, dancing, walking the dog, bowling or jumping jacks.
- Smoking tobacco or drinking alcohol
- Cigarettes and alcohol decrease bone mass, besides all the other detrimental things they do.
Calcium Sources:
- Milk and dishes made from milk: pudding, soups, sauces, baked products
- Use cocoa or strawberry powder to flavor milk so your kids and teens will drink it!
- All milk (whole, 2%, 1%, skim or nonfat) contains the same amount of calcium and Vitamin D
- Cheese: mozzarella, cheddar, swiss, parmesan, cottage cheese
- Yogurt
- Canned fish with soft bones: sardines, anchovies, salmon
- Dark green leafy vegetables: kale, mustard greens, bok choy, turnip greens, spinach
- Tofu, if processed with calcium sulfate.
- Tortillas made from lime-processed corn
- Calcium-fortified juice, bread, cereal, granola bars
- Broccoli
- White beans, red beans, garbanzo beans
Calcium Supplements
- 2/3 of American girls do not consume enough food to obtain adequate Calcium and Vitamin D. Therefore the use of supplements is recommended. See the tables at the end of this page.
- For optimal absorption of calcium, no more than 500 mg should be taken at one time.
- Most 9-18 year olds should take at least 2 calcium supplements each day, once in the morning and once at night.
- The use of a Calcium/Vitamin D combination supplement is recommended.
Vitamin D
- Is essential for the body to utilize calcium and phosphorus.
- Is necessary for building strong bones and teeth.
- Helps prevent diabetes
- Helps fight off infectious diseases.
- Infants with Vitamin D deficiency are more susceptible to RSV (Respiratory Syncytial Virus)
Vitamin D is made in the skin from cholesterol precursors after exposure to ultraviolet radiation in sunlight.
- Sunscreen blocks the body’s production of Vitamin D.
Only a few foods naturally contain significant amounts of vitamin D (as cholecalciferol):
- fatty fish and fish oils (salmon, canned tuna, sardines)
- beef liver
- some cheeses
- egg yolks from hens that have consumed feeds containing vitamin D.
The main dietary sources of vitamin D are fortified dairy products and some fortified breakfast cereals.
Risk factors for Vitamin D deficiency:
- Inadequate intake of milk or milk products
- It takes 32 oz per day of formula to meet Vitamin D requirements in infants (under 1 year old).
- Darkly pigmented skin decreases the production of vitamin D from sun exposure.
- A white man in swim trunks who spends 10-12 minutes out in the sun on a summer day without sunscreen can produce adequate vitamin D for his daily needs. An African-American man in swim trunks would need 120 minutes of summer sun exposure to produce the same amount of vitamin D.
- The use of sunscreen with an SPF of 8 or more completely blocks sunlight from the skin and prevents vitamin D from being made.
- All people living in the northern United States above latitude 40° (which includes Elko, NV) do not get enough sunlight during the winter for adequate Vitamin D production.
- Breast fed babies are at risk for Vitamin D deficiency. They should receive a Vitamin D supplement of 400 IU/day.
- Chronic illness such as Celiac Disease and Cystic Fibrosis
Who should be tested for Vitamin D status? If you have a family history of Diabetes or Osteoporosis, or if your child has Cystic Fibrosis, Celiac Disease, or signs of poor bone health, ask your pediatrician if a test of vitamin D status should be done. Vitamin D status can be determined by a blood test and, if a deficiency is found, supplements can remedy the problem.
Daily Calcium and Vitamin D requirements change with age and stage of life:
|
Adequate intake |
Tolerable upper intake level |
Age |
Calcium |
Vitamin D |
Calcium |
Vitamin D |
Infants from birth to 6 months old |
400 mg/day |
400 IU/day |
NA |
1000 IU/day |
Infants from 7-12 months old |
600 mg/day |
400 IU/day |
NA |
1000 IU/day |
Children from 1-8 years old |
800 mg/day |
600 IU/day |
2,500 mg/day |
2000 IU/day |
Children from 9-18 years old |
1,300 mg/day |
600 IU/day |
2,500 mg/day |
2000 IU/day |
Adults 18-50 |
1,000 mg/day |
600 IU/day |
2,500 mg/day |
2000 IU/day |
During Pregnancy & Lactation |
1,200 mg/day |
600 IU/day |
2,500 mg/day |
2000 IU/day |
Postmenopausal women |
1,500 mg/day |
800 IU/day |
2,500 mg/day |
2000 IU/day |
Calcium and Vitamin D Content in some common Foods:
Food |
Serving size |
Amount of Calcium |
Amount of Vitamin D |
Canned sardines (with bones) |
3 oz |
400 mg |
50 IU |
Salmon (sockeye), cooked |
3 oz |
|
450 IU |
Tuna, canned in water, drained |
3 oz |
|
150 IU |
Nonfat milk powder |
½ cup |
367 mg |
|
Milk (Whole, 2%, 1%, nonfat) |
1 cup (8 oz) |
300 mg |
100 IU |
Calcium-fortified orange juice |
1 cup (8 oz) |
300 mg |
100 IU |
Calcium and Vitamin D fortified cereal |
1 cup |
300 mg |
40 IU |
Swiss cheese |
1 oz |
272 mg |
6 IU |
Yogurt, low fat |
1 cup |
270 mg |
100 IU |
Cheddar cheese |
1 oz |
204 mg |
|
Canned salmon (with bones) |
2 oz |
180 mg |
|
Collards, frozen |
½ cup |
179 mg |
|
Spinach |
½ cup |
122 mg |
|
Bean curd (tofu) |
3 oz |
120 mg |
|
Cheese pizza |
1 slice |
117 mg |
|
Ice cream |
½ cup |
110 mg |
|
White beans |
½ cup |
96 mg |
|
Broccoli (cooked) |
½ cup |
47 mg |
|
Red beans |
½ cup |
40 mg |
|
Meat and poultry |
3 oz |
10-20 mg |
|
Cod liver oil |
1 Tbsp |
|
1360 IU |
Margarine, fortified |
1 Tbsp |
|
60 IU |
Liver, Beef, cooked |
3 ½ oz |
|
50 IU |
Egg, large (vitamin D is in the yolk) |
1 |
|
40 IU |
Commonly used Calcium and Vitamin D supplements:
Calcium carbonate: |
|
|
Tums Regular |
200 mg calcium |
0 IU Vitamin D |
Tums Kids, Extras, +/or Smoothies |
300 mg calcium |
0 IU Vitamin D |
Tums Ultra |
400 mg calcium |
0 IU Vitamin D |
Viactiv Calcium Soft Chews |
500 mg calcium |
500 IU Vitamin D |
Caltrate 600+D Soft Chews |
600 mg calcium |
400 IU Vitamin D |
Calcium citrate: |
|
|
Citracal Regular |
500 mg calcium |
400 IU Vitamin D |
Citracal Calcium Gummies |
500 mg calcium |
500 IU Vitamin D |
Multivitamins: |
|
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Centrum Kids Complete Chewables |
100 mg calcium |
400 IU Vitamin D |
Flintstones Plus Bone Building Support Chewables |
200 mg calcium |
400 IU Vitamin D |
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