SPOTLIGHT ON CALCIUM AND VITAMIN D. Presenter Name. Presenter Title Presenter Organization

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1 SPOTLIGHT ON CALCIUM AND VITAMIN D Presenter Name Presenter Title Presenter Organization

2 OUTLINE Calcium Recommendations - How are we doing? Calcium and Bones More Than Strong Bones Sources, Absorption, Fortification, and Supplementation Vitamin D A New Appreciation for the Sunshine Vitamin Recommendations Vitamin D-ficiency The Role of Vitamin D The Iceberg below the Surface Sources, Fortification and Supplementation 2 Calcium and Vitamin D, Bringing It Home

3 Structural role in bones and teeth 99% of calcium in the body is found in the skeleton Most abundant mineral in your body CALCIUM Part of every cell

4 CALCIUM RECOMMENDATIONS FROM THE NATIONAL ACADEMY OF SCIENCES, 2010 You Are You Need Life-Stage Group 1-3 Years 700 mg 4-8 Years 1,000mg 9-18 Years 1,300 mg Years 1,000 mg Years (Men) 1,000 mg Years (Women) 1,200 mg 71+ 1,200 mg **NOTE: The recommendations for pregnant and lactating women are the same as for other women their age 4

5 NUTRIENTS OF CONCERN Calcium Potassium Fiber Vitamin D 5

6 HOW ARE WE DOING? NOT SO GOOD. Mean Daily Calcium Intake (mg) from Food RDA Males Females Ages 2-5 Ages 6-11 Ages Ages Ages Ages Ages 70 & Over 6 What we Eat in America: NHANES

7 THE CALCIUM GAP Dietary Guidelines for Americans

8 THE CALCIUM BONE BANK Deposits are made early in life 85-90% of bone mass is formed by age When calcium is lacking in the diet, withdrawals are made from BONES Frequent withdrawals = fragile bones 8

9 DAIRY: MORE THAN STRONG BONES Cardiovascular Disease Full fat dairy foods have not been associated with CVD; in fact, some studies show possible protective role of dairy foods Type 2 Diabetes risk of Type 2 Diabetes with adequate (3 daily servings) dairy intake unclear if relation is strongest for low-fat, full-fat, or all types of dairy Blood Pressure Regulation risk of high blood pressure with daily calcium intake of 1,000-1,500 mg/daily 9

10 A NOTE ON CALCIUM AND YOUR HEART 2010 meta-analysis Increased risk of heart attack among women taking calcium supplements Calcium from supplements, rather than calcium from food may be the most suspect The jury is still out The American Heart Association supports national calcium intake recommendations Fat-free milk & low-fat dairy products encouraged 10

11 FOOD SOURCES OF CALCIUM Food Calcium (mg) Yogurt, plain, low-fat, 1 Cup 415 Yogurt, fruit-flavored, low-fat, 1 Cup 345 Sardines, canned in oil, with bones, 3 ounces 324 Milk, plain, flavored or lactose free, 1 Cup 300 Orange Juice, calcium-fortified, 8 ounces 300 Cheddar Cheese, 1 ounce 204 Cottage Cheese, low-fat, 1 Cup 138 Kale, cooked, 1 Cup 94 Broccoli, raw, ½ Cup 21 11

12 CALCIUM BIOAVAILABILITY Calcium absorption and renal excretion may be affected by: Age Estrogen status Some diseases of the small intestine, liver and pancreas Alcoholism Pregnancy Use of certain medications Vitamin D status Fiber and its components (oxalic acid or phytic acid) High-sodium diets Caffeine Lactose 12

13 NOT ALL CALCIUM SOURCES ARE CREATED EQUAL To absorb the same amount of calcium as you get from ONE cup of milk, you would have to eat one of the following: 13

14 WHY CAN T I JUST TAKE A SUPPLEMENT TO GET THE CALCIUM I NEED? More than just calcium The Academy, NIH, and AAP recommend we meet nutritional needs through food first A fundamental premise of the Dietary Guidelines is that nutrients should come primarily from foods. ~ 2010 Dietary Guidelines for Americans 14

15 QUESTIONS? 15

16 Widespread vitamin D deficiency Expanding role of vitamin D in human health VITAMIN D New dietary recommendations

17 VITAMIN D IN THE NEWS 17

18 VITAMIN D THE SUNSHINE VITAMIN Considered a hormone, vitamin, and essential nutrient Synthesized in the skin as a result of exposure to sunlight Most known for role in enhancing calcium absorption and increasing bone resorption Vitamin D receptors present in most body cells and tissues 18

19 VITAMIN D SYNTHESIS Skin exposure to sunlight Vitamin D 3 Liver Calcidiol Kidney Calcitriol (active form) 19

20 A NEW APPRECIATION FOR THE SUNSHINE VITAMIN 1920s vitamin D deficiency identified as the cause of rickets in infants and young children 1930s fortification of milk with vitamin D Today Renewed interest: Re-appearance of vitamin D deficiency rickets New findings of an epidemic of poor vitamin D status Research demonstrating adverse affects of deficiency beyond bones New vitamin D recommendations 20

21 VITAMIN D RECOMMENDATIONS Age Adequate Intake RDA 0-12 mo 400 IU/day years IU/day >70 years IU/day **NOTE: The recommendations for pregnant and lactating women are the same as for other women their age Assumptions: -Minimal sun exposure -Adequate calcium intake 21 National Academy of Sciences, Institute of Medicine, 2010

22 NUTRIENTS OF CONCERN Calcium Potassium Fiber Vitamin D 22

23 VITAMIN D-FICIENCY Who s at Risk? Breastfed Infants Older Adults Those Receiving Limited Sun Exposure Individuals with Dark Skin Fat Malabsorbers Obese Individuals Or, those who have undergone bariatric surgery 23

24 VITAMIN D AND BONE HEALTH Helps maintain healthy blood levels of calcium and phosphorus Aids in absorption of the key bone minerals Plays a role in the prevention of rickets and severe bone loss Studies show that people with low levels of vitamin D have lower bone density or bone mass. They are also more likely to break bones when they are older. - National Osteoporosis Foundation 24

25 THE ROLE OF VITAMIN D: THE ICEBERG BELOW THE SURFACE Bone Health Metabolic syndrome Hypertension Muscle weakness/wasting Certain Cancers Heart Disease Type 1 Diabetes Falls Chronic pain/fibromyalgia Autoimmune disorders AND MORE 25

26 VITAMIN D AND Auto-immune disorders D-deficient individuals have an increased prevalence of various infectious and autoimmune diseases Cancer Inverse associations between vitamin D status and certain cancers Cardiovascular Disease Inverse associations between vitamin D status and CVD risk, blood pressure, metabolic syndrome, type 2 diabetes 26

27 Humans make thousands of units of vitamin D within minutes of whole body exposure to sunlight. From what we know of nature, it is unlikely such a system evolved by chance. ~ Dr. John Cannell, Executive Director, Vitamin D Council. 27

28 BEST SOURCES OF THIS NUTRIENT? Food Vitamin D (IU) Salmon, 3 ½ ounces, cooked 360 Tuna, light, canned, drained, 3 ounces 200 Fortified Milk, all types, 8 ounces 120 Orange Juice, fortified, 8 ounces 100 Yogurt, fortified, 6 to 8 ounces Cereal, ready-to-eat, fortified, ¾ to 1 Cup Egg, 1 large, whole, cooked any way 20 Mushrooms, ½ Cup, cooked 11 Sensible Sun Exposure 28

29 VITAMIN D FORTIFICATION Vitamin D fortification in milk 1932 Optional, however Nearly all milk sold in the U.S. is fortified with vitamin D Fluid milk is the single largest source of vitamin D in the American diet Some cheeses and yogurts are also being fortified 29

30 SUPPLEMENTATION: D 2 OR D 3? Vitamin D 3 (cholecalciferol) Produced in the skin upon exposure to UVB irradiation Vitamin D 2 (ergocalciferol) Manufactured by yeast upon exposure to UV irradiation Vitamin D 3 is the preferred, and most common form Both D 3 & D 2 are effective in raising serum vitamin D levels 30

31 QUESTIONS? 31

32 VITAMIN D & CALCIUM, BRINGING IT HOME

33 VITAMIN D & CALCIUM, BRINGING IT HOME Milk is the #1 dietary source of Vitamin D & Calcium in the American Diet What do we do? 33 NHANES , ages 2 years and older

34 TIPS FOR INCREASING CALCIUM & START AT BREAKFAST VITAMIN D Use low-fat milk in place of water when making oatmeal Pair low-fat cottage cheese with fresh fruit for a nutrient-rich breakfast Make scrambled eggs with low-fat milk and top with shredded cheese Top a whole-grain waffle with low-fat yogurt and mixed berries instead of syrup Top off breakfast with a glass of calcium and vitamin D fortified orange juice 34

35 TIPS FOR INCREASING CALCIUM & VITAMIN D SNACK SMART Mix low-fat milk or vitamin D-fortified yogurt with fruit in a blender to make a fruit smoothie or licuado When a craving strikes, enjoy a cup of steaming hot chocolate mix fat-free milk with a little chocolate syrup For a nutrient-rich snack, enjoy fruit and cheese kabobs, or skip the cheese and dip fruit kabobs in low-fat yogurt 35

36 TIPS FOR INCREASING CALCIUM & VITAMIN D IN CHILDREN Dairy foods supply 83% of the calcium in the diets of young children Dairy s unique nutrient package is an important source of nutrition for growing bodies WHAT ABOUT FLAVORED MILK? Greater total milk intake Greater nutrient intake No relationship with obesity 36

37 TIPS FOR INCREASING CALCIUM AND VITAMIN D IN CHILDREN EATING TOGETHER IS IMPORTANT Meals eaten as a family increase likelihood of milk intake More family meals means increased intake of encouraged food groups Moms who drink milk have daughters who drink more milk, less soft drinks 37

38 3 EVERY DAY OF DAIRY One serving: Milk 8 ounces = 1 cup Cheese 1 1 ½ ounces Yogurt 8 ounces = 1 cup 38

39 DO PEOPLE WITH LACTOSE INTOLERANCE NEED TO AVOID DAIRY? D Drink milk with food. A Add natural cheeses to your diet, such as Cheddar, Colby and Swiss, which are low in lactose. I Introduce dairy slowly. Gradually increase the amount. R Reduce it. Enjoy lactose-free milk and milk products. Y Yogurt with active cultures helps digest lactose. 39

40 Easiest Moderately Easy More Difficult Ease of digestion Natural cheeses: Cheddar, Colby and Swiss Yogurt with live and active cultures Kefir Lactose-free milk Chocolate milk Ice cream and frozen yogurt Soft cheeses: Cottage, Feta, Ricotta Whole milk Reduced fat milk Lowfat milk Fat-free milk 40

41 For More Information: Western Dairy Association: westerndairyassociation.org National Dairy Council: nationaldairycouncil.org 2010 Dietary Guidelines for Americans and MyPlate: dietaryguidelines.gov, choosemyplate.gov Office of Dietary Supplements: ods.od.nih.gov NIH Osteoporosis and Related Bone Diseases National Resource Center: osteo.org American Academy of Pediatrics: aap.org Today s presentation provided by: 41

42 QUESTIONS? 42