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Keep taking vitamin D and calcium separately

Dr. Zorba Paster M.D.

Dear Doc: I need your advice on calcium in the blood and hyperthyroidism. I am taking vitamin D3 for the thyroid and something called colloidal calcium, which is rather expensive. Do I need these? There is so much confusing information out there, I need help. Thanks. — VB

Dear VB: You’re certainly right about confusing information. My friend Dr. Oz is the purveyor of good information and misinformation. I love some of the things he says about balance in your life and taking responsibility for your own health but hate it when he talks about losing a gazillion pounds overnight with five easy steps.

This moves me to one of my favorite topics, health literacy. Study after study shows that people who learn about their health, read articles and listen and watch programs about health have a longer, sweeter life. They have less disability and more fun. In fact, that’s the impetus behind my radio show, lectures, the book I wrote and this column. So I welcome your question with open arms.

Now, on to your good question. You need about 1,000 milligrams of calcium a day. We U.S. doctors have said for years that you need 1,800 milligrams, but many European physicians think that number is way too high. And no study has conclusively shown we need as much as most doctors recommend.

Then there is the study of 24,000 Germans who took daily calcium, showing that it might — and I add the important word “might” — double the risk of heart attacks. The reason behind this is that when you take, for example, a 1,000-milligram calcium tablet, it’s absorbed quickly into your body, suddenly raising your calcium level. It’s that sudden rise in calcium that may be the culprit.

So what to do? Start with food. Food is the first and best source of calcium, with dairy being the most concentrated way to get it. A typical container of yogurt has nearly half of what you will need every day, about 400 milligrams. If you’re a vegan or dairy-intolerant, or you just don’t like dairy products, then try collards, kale, spinach and broccoli.

And I think the middle-road answer to the calcium supplement summary is to take one 500-milligram tablet with food, to slow absorption. That’s one Tums tablet, at a cost of about 10 cents. I’m also for spending your money on food and not on supplements. Go, veggies, go!

As for vitamin D3, it doesn’t do anything for your thyroid. You do need iodine, which you can easily get through iodized salt. Wisconsin was part of the old “goiter” belt. Iodine-rich foods such as fish were not commonly eaten, with the result being goiter. My grandma, aunt and cousin all had goiter operations in their 30s.

Iodized salt solves this problem. In fact, 30 years ago when 30 percent of the world was deficient in iodine, the World Health Organization got the brilliant idea of promoting iodized salt everywhere.

The result has been a dramatic drop in goiter and thyroid deficiency worldwide. Good news.

But D3 is important. For growing children it’s important to prevent rickets.

That’s where vitamin D-fortified milk came in back at the beginning of the last century. I’m proud to say Wisconsin was very important in promoting milk as a vehicle to cure this debilitating problem.

But the role of higher doses of D3 in an adult population has been a topic of interest for more than a decade. I have been a proponent of at least 1,000 milligrams of vitamin D every day because some studies show it might reduce the risk of breast and colon cancers.

The research is early, it’s controversial and it’s contentious, but I don’t see any downside to taking D3, so I do it every day. It also may decrease the risk of osteoporosis, which is why most women and some men take calcium in the first place.

Now, what about calcium and vitamin D pills? I don’t like them because to get 1,000 milligrams of vitamin D, you need to take too much calcium. So I’d stick to keeping them separate — 1,000 milligrams of D, one Tums tablet taken with food, and calcium-rich foods to get the other 500 milligrams you need. Stay well.

Dr. Zorba Paster is a family physician, professor at University of Wisconsin School of Medicine and Public Health, and host of the public radio program “Zorba Paster on Your Health,” which airs at noon Wednesdays on 91.1 FM, and noon Sundays on 91.9 FM. His column will appear twice a month in The Spokesman-Review.

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