What Is The Takeaway
Well, simply, not much has changed. My advice to my healthy patients is still to get calcium from foods, and the best diet for this is a Mediterranean-style diet rich in colorful plants, plenty of legumes, and fish. This plus high-protein, low-fat, and low-sugar dairy can supply plenty of calcium. As far as vitamin D, well, vitamin D supplementation continues to be a topic of lively and livid debate among everyone, including competing guideline-authoring endocrine experts . I hesitate to wander into that minefield again. But here goes
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Relationship Between 25d And Pth Levels And Vitamin D Supplementation
PTH is secreted in response to reduced calcium levels causing an increase in bone resorption and subsequently normalization of calcium levels. In case of vitamin D deficiency, secondary hyperparathyroidism results in increased bone turnover and bone loss and may subsequently increase fracture risk . The relationship between 25D and PTH levels has been described in several cross-sectional studies, indicating a significant negative correlation between PTH and 25D values with only a minimal increase of PTH when serum 25D is above 50 to 75 nmol/L . Recently, Carnevale et al. demonstrated that PTH levels were mainly determined by 25D levels up to 40 nmol/L and to serum ionized calcium at levels greater than 40 nmol/L in healthy volunteers. In a recent study it has been shown that for the same 25-OHD level, PTH levels were comparable across genders but were 1.5- to twofold higher in the elderly compared with adolescents and that elevated PTH is a strong independent predictor for poor outcomes in older patients .
Other Important And Effective Ways To Protect Your Bones
There are other methods that may be more effective at maintaining bone health and reducing fracture risk. One that we can likely all agree on is regular physical activity. Weight-bearing exercise like walking, jogging, tennis, and aerobics definitely strengthens bones. Core exercises like yoga and Pilates can improve balance. All of this can help reduce falls and fracture risk.
And so, in the end, I am recommending what I always end up recommending: a Mediterranean-style diet rich in colorful plants, plenty of legumes, fish, plus low-sugar, low-fat dairy and plenty of varied physical activity throughout your entire life and maybe calcium and/or vitamin D supplementation for certain people, following a discussion with their doctors.
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How Much Vitamin D For Osteoporosis Is Enough
As we age in life its important to understand changes that occur in the body and how we can shield our health for longevity. Osteoporosis affects nearly 20% of women and 5% of men over 50 according to the CDC.1 People who suffer from osteoporosis are more likely to break bones, especially in the hips, forearms, waist and spine. With many treatments available Vitamin D is one of the most reputable but it begs the question. How much Vitamin D for Osteoporosis is enough?
Vitamin D And Osteopenia
Getting at least 10 minutes of daily sunlight helps to prevent osteopenia and fractures, says Torpy. According to the NOF, if you are over 50 years old, you need 800 to 1,000 IU of vitamin D daily to protect your bones from osteopenia. To reach these amounts, you probably need a vitamin D supplement. Ask your doctor to check the vitamin D level in your blood. The Office of Dietary Supplements considers a serum 25-Hydroxyvitamin D level of greater than 50 nmol/L adequate for bone health 2.
- Getting at least 10 minutes of daily sunlight helps to prevent osteopenia and fractures, says Torpy.
- According to the NOF, if you are over 50 years old, you need 800 to 1,000 IU of vitamin D daily to protect your bones from osteopenia.
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What Are Vitamin D And Calcium
Vitamin D and calcium are nutrients that sustain healthy bones. They are also needed for:
Absorption of calcium and phosphorous
Immune system responses
Signaling between cells
Blood vessel flow
Without enough vitamin D or calcium, your parathyroid glands compensate by producing too much of their hormone, a condition called hyperparathyroidism. That can lead to bone weakening and increased fracture risk. Other problems from calcium and vitamin D deficiencies include:
Skeletal deformities in children ages 6-24 months
Muscle weakness in children and the elderly
Given the crucial role of both nutrients in bone health, The Endocrine Society and the Institute of Medicine recommend certain consumption levels based on age and health. They have not yet found, however, that taking vitamin D provides cardiovascular protection.
Vitamin K1 Vs Vitamin K2 For Osteoporosis
Vitamin K1 is processed in the liver and plays a larger role in the coagulation of our blood, whereas Vitamin K2, on the other hand, is processed in the intestine. This makes it more available to different tissues than Vitamin K1.
A large meta-analysis published in 2006 in the Archives of Internal Medicine demonstrated that while both Vitamin K1 and Vitamin K2 were beneficial for osteoporosis and bone health, Vitamin K2 was more effective than Vitamin K1.
The meta-analysis found that high levels of Vitamin K2 were associated with reduced:
- Hip fractures .
- Non-vertebral fractures .
As mentioned before, it has been shown that Vitamin K2 is also beneficial for your cardiovascular system.
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Stop Smoking And Drink Less
Other lifestyle factors that can help prevent osteoporosis include:
- quitting smoking smoking is associated with an increased risk of osteoporosis
- limiting your alcohol intake the NHS recommends not drinking more than 14 units of alcohol a week it’s also important to avoid binge drinking
Read more about looking after your bones on the Royal Osteoporosis Society website.
What Does Research Say About Vitamin D Being Able To Help Manage Osteoporosis
If you already have osteoporosis, the main goal in managing your condition is to avoid breaking a bone. There is a lot of research studying the role of vitamin D in preventing broken bones in people with osteoporosis or osteopenia, but the results are mixed.
For some people, taking vitamin D supplements appears to reduce their risk of breaking a bone, while for other people there is no clear benefit. Some research shows that the people most likely to benefit from taking vitamin D supplements to prevent broken bones due to osteoporosis are frail, older people living in institutions, such as nursing homes and assisted living communities.2,4,5
Because there are differences in the way the research studies were designed and carried out, this makes them difficult to compare. These include differences in:4
- the form of vitamin D people take, for example tablets or injections.
- the amount of vitamin D people take.
- how often people take the vitamin D, for example every day or once a week.
- the people taking part in the research, for example different age groups.
- how researchers measured if the people took their supplements or not.
- whether people took calcium along with their vitamin D or not.
Here is what some more recent research says on preventing a bone from breaking:
- People older than 65 who took vitamin D supplements were less likely to break a bone than those who didnt.
- Vitamin D supplements helped prevent people from breaking a bone whether they lived in an institution or not.
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The Scoop On Vitamin D Deficiency
There is a large group of people who are likely to be deficient in vitamin D. It includes people with eating disorders people who have had gastric bypass surgeries those with malabsorption syndromes like celiac sprue pregnant and lactating women people who have dark skin and those who wear total skin covering . In addition, people with or at risk for low bone density , should discuss whether they need supplements and to have blood levels of vitamin D monitored.
Many New England-dwelling residents are at risk for a dip in vitamin D levels during the long, dark winter months. In my own practice I do consider that a risk factor, and I advise a vitamin D supplement of 1,000 IUs daily. For people who would rather avoid a supplement but may need a boost of vitamin D, it is also found in some common foods, including sardines, salmon, tuna, cheese, egg yolks, and vitamin-fortified milk. I will add that, for those who fall into the healthy community-dwelling adult category, a supplement of anywhere from 400 to 2,000 IUs of vitamin D daily is not likely to cause harm. Yes, vitamin D toxicity is a thing, usually seen at levels above 80 ng/ml, which causes excessive calcium to be released into the bloodstream. This is rare, but I have seen it in patients who took high-dose vitamin D supplementation of 50,000 IUs weekly over a long period of time.
If You Have Osteoporosis
It’s usually recommended you take a supplement all year round, especially if you take an osteoporosis treatment.
Osteoporosis treatments work better if you have good vitamin D levels.
If your healthcare professional thinks you need a vitamin D supplement, they’ll advise you on how big a dose to take.
Be reassured there is no risk of having too much vitamin D if you follow the advice of your healthcare professional.
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Extrarenal Benefits Of Vdra
VDRA in many of the nontraditional tissues may explain beneficial effects independent from decreased synthesis and secretion of PTH. In some instances, calcitriol treatment facilitates local tissue uptake of calcidiol through as yet undefined mechanisms. At least 38 different tissues are known to contain the VDR and often these cells contain 1–hydroxylase enzyme that generate calcitriol locally. This is in an autocrine/paracrine manner rather than as a renal production of calcitriol. These cells respond to exogenous or kidney-generated calcitriol as well as to the internally generated secosteroid. These autocrine/paracrine related VDR rely critically on an adequate source of calcidiol so that calcitriol can be made internally. This helps to explain the essentiality of adequate vitamin D nutrition in patients with constrained levels of circulating calcitriol. Even in the presence of advanced renal failure, peripheral tissue generation of calcitriol can be maintained if an adequate nutritional supply of vitamin D and thus calcidiol is available., The effects of VDRA in peripheral tissues are beyond the scope of this review, though noted to be very important.
How To Use Vitamin E For Acne Scars
It is best to apply a thin layer of vitamin E oil to your face prior to bed. If you have oily skin, we suggest using a thinner Vitamin E serum or toner versus the thick oil. If you have dry skin, many individuals prefer mixing a little bit of vitamin E oil in with their nightly moisturizer and applying together.
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How Do I Know If I Need A Calcium Supplement
Osteoporosis Canada strongly recommends that everyone obtain their calcium through nutrition whenever possible. Even if you take excess calcium from your diet, that is not harmful. However, some individuals just cant seem to get enough calcium in their diet. These persons may need to take a calcium supplement, but this should be discussed with a physician as calcium supplements can have some side effects and have been associated with some risks.
To know whether or not you need to take a calcium supplement, you really need to figure out how much calcium you are getting in your diet. Here is a very simple way to calculate this.
First, give yourself a baseline of 300 mg of calcium simply for eating anything at all. This is because there is a small amount of calcium in a variety of foods such as breads, muffins, oranges, etc. At the end of the day, even without eating any high calcium foods, you cant help but get about 300 mg of calcium in your daily diet.
Now, add another 300 mg for any of the following high calcium foods:
1 cup of cows milk or goats milk
1 cup of fortified soy, almond or rice beverage
1 cup of fortified orange juice
¾ cup of yogurt
2 slices of cheese
one chunk of cheese
salmon, canned with bones or sardines, canned with bones
If you are already getting close to the recommended amount of calcium for your age group, then you are doing great. Your body needs calcium and you are already getting the calcium you need from your diet.
Healthy Eating And Vitamin D Supplements
Eating a healthy, balanced diet is recommended for everyone. It can help prevent many serious health conditions, including heart disease, diabetes and many forms of cancer, as well as osteoporosis.
Calcium is important for maintaining bone health. Adults need 700mg a day, which you should be able to get from your daily diet. Calcium-rich foods include:
- leafy green vegetables
- fortified foods such as most fat spreads and some breakfast cereals
- dietary supplements
However, it can be difficult to get enough vitamin D from foods alone. So, consider taking a daily supplement containing 10 micrograms of vitamin D.
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How Much Vitamin D And Calcium Do You Need
The Endocrine Society and The Institute of Medicine have suggested recommended daily allowances for vitamin D and calcium, as well as maximum daily consumption amounts that you should not exceed for your safety:
The recommendations come with two precautions:
Some people may need more than the RDA if they are:
Taking anticonvulsant medications, glucocorticoids, antifungals such as ketoconazole or medications for AIDS
Taking too much of either nutrient appears to be harmful, with:
Kidney stones associated with too much calcium from supplements
Very high levels of vitamin D potentially causing kidney and tissue damage
How Do You Get Vitamin D And Calcium
Your body makes Vitamin D when your skin is exposed to sun, but several factors limit its creation:
Living anywhere in the country above latitude 33 degrees
Wearing sunscreen to protect against melanoma
Having naturally dark skin
Aging, which changes absorption ability
The amount of sun you would need to achieve normal blood vitamin D levels is probably more than is safe for your skin, so most people may need supplements to achieve a normal vitamin D level.
Either form of vitamin D benefits the body, but very few foods naturally contain the nutrient or are fortified with it. Thats why doctors recommend supplements to make up the difference. Foods containing vitamin D include:
Cod liver oil: 400-1,000 IU per teaspoon
Wild caught salmon: 600-1,000 IU per 3.5 oz
Farmed salmon: 100-250 IU per 3.5 oz
Canned salmon: 300-600 IU per 3.5 oz
Canned sardines: 300 IU per 3.5 oz
Canned mackerel: 250 IU per 3.5 oz
Canned tuna: 236 IU per 3.5 oz
Fresh shitake mushrooms: 100 IU per 3.5 oz
Sundried shitake mushrooms: 1,600 IU per 3.5 oz
Egg yolk: 20 IU per yolk
Milk, orange juice, infant formula, yogurt, margarine, butter, cheese and breakfast cereals are often fortified with vitamin D.
Calcium is found in:
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Too Much Of A Good Thing
Some professional societies encourage people to take as much as 5,000 IU to 10,000 IU of vitamin D each day. This study provides new information that might prompt some to rethink those recommendations.
“This is further evidence that high doses are not advisable,” says Dr. Manson. “In terms of bone health, once you get to a certain level of intake, increasing that amount isn’t going to be beneficial.”
There is also some evidence that people are overdoing vitamin D supplementation on their own. Researchers looking at national survey data gathered from 1999 to 2014 found a 2.8% uptick in the number of people taking potentially unsafe amounts of vitamin D that is, more than 4,000 IU per day, according to a 2017 research letter published in JAMA. And during the same time period, the number of people taking 1,000 IU or more of vitamin D daily increased nearly 18%.
However, while most people should stick to a moderate daily dose of vitamin D, some people do need higher amounts, says Dr. Manson. These include people with conditions that prevent the body from properly absorbing nutrients, such as Crohn’s disease or ulcerative colitis and people who have had gastric bypass surgery. But in most people, high doses are unnecessary, and potentially harmful.
Whats A Good Vitamin D Dosage For Osteoporosis
According to recent studies, it appears less is more when it comes to using vitamin d for safeguarding against osteoporosis.2 In fact adults who took large amounts of this vitamin daily not only didnt see additional gains in bone density, but in some cases ended up worse off. Using a more moderate dose of supplemental vitamin D in the range of 1000-2000IUs will be enough to contribute to adequate bone density levels.
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Experimental Ckd In Dogs And Catspth Calcidiol Calcitriol And Fgf
In another study in dogs with experimental reduction in nephron mass, dietary phosphorus restriction was associated with a reduction of PTH by approximately 70%. This reduction was observed in the absence of a concomitant increase in concentration of iCa or calcitriol. These results support that whenever nephron losses occur and GFR diminishes, phosphate excretion must decrease transiently until increased PTH enhances phosphaturia by decreasing tubular reabsorption of Pi. It is important to note that even though the total phosphorus excretion decreases once the total GFR is below 25%30% of normal, the phosphorus excretion per nephron is greater than normal and this is partially maintained by increased PTH concentration. Hyperphosphatemia can induce tissue mineralization, especially in the kidneys leading to progression of the renal insufficiency. Results from these studies provided support to the trade-off hypothesis in which preservation of phosphorus and calcium homeostasis is maintained at the expense of increased circulating concentration of PTH., This trade-off concept has now been extended to include changes in calcitriol and FGF-23.