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The Medicine Cabinet: Ask the Harvard Experts: Recommendations for calcium and vitamin D intake vary

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Q: I have read different recommendations for how much calcium and vitamin D I should take. What do you recommend?

A: The current recommendation in the United States is 1,000 milligrams (mg) of calcium per day for people ages 19 to 50 and 1,200 mg per day for people over age 50.

However, these amounts are probably more than we need. In the United Kingdom, the recommendation is only 700 mg per day. The World Health Organization says that 500 mg daily is enough.

The English may be correct. Studies have found a calcium intake of 700 mg per day provides as much protection from thin bones and fractures compared to a significantly greater amount of daily calcium.

Over the last few years, some studies have raised concerns about harmful effects of too much calcium. That's especially true when the extra intake comes from calcium supplements. The possible adverse health effects of excess calcium include a higher risk of cardiovascular disease, dementia and a more aggressive type of prostate cancer.

I only recommend calcium supplements for people that are not sure they average 700 mg of dietary calcium daily. For reference, an 8-ounce glass of milk or calcium-fortified orange juice has about 300 mg of calcium.

Some good dietary sources of calcium include fortified cereals; dairy products, such as milk, yogurt and low-fat cheese; fortified soy milk; fish with soft bones, such as sardines and tofu.

While food should be the preferred source of calcium, it's much harder to get enough vitamin D from your diet. There are few good dietary sources of vitamin D. That's why many doctors recommend a vitamin D supplement.

The official recommendation for vitamin D intake is at least 600 International Units (IU) daily for those under age 70. If you are older than 70, the recommendation is 800 IU per day.

Sunlight converts inactive vitamin D in the skin to the active form. But many people rightly avoid the sun to prevent skin damage and certain skin cancers.

A safe amount of vitamin D is up to 4,000 IU per day. However, there is no evidence to suggest a dose that high is more beneficial than a lower dose. So, I recommend a vitamin 1,000 IU vitamin D3 supplement daily for most adults.

(Howard LeWine, M.D., is an internist at Brigham and Women's Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.)

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