Vitamin D and Calcium—Good or Bad?

Just a few years ago we were telling every older adult to take vitamin D and calcium to prevent broken bones. Now we're telling them it doesn't matter. Frustrating, isn't it?

The latest change in thinking on these two supplements came just a few weeks ago when the U.S. Preventive Services Task Force announced its finding that normal doses of vitamin D and calcium do not reduce the risk of broken bones in elderly women. (A normal dose is 400 international units of vitamin D and 1,000 milligrams of calcium.) Even in larger doses, the supplements don't help. Another study recently showed that women taking high doses of vitamin D and calcium were more likely to get fractures than those not.

So, now what do we tell older adults about vitamin D?

It's complicated. As a dietitian, I think that if you're getting enough from your food, you don't need a supplement. But that means three servings of fortified milk or yogurt a day. Not many people—myself included—get that much dairy each day.

Then there's the sun. Vitamin D is synthesized in your skin, from cholesterol, when you're out in the sun—a minimum of 20 percent of your skin exposed for at least 20 minutes. So if you get enough time in the sun, you don't have to worry about vitamin D in your diet. The problem is, of course, that the sun doesn't shine much here, and we bundle ourselves up in clothes when we go out. Sunscreen also decreases vitamin D production.

In the Puget Sound region, we have a history of low vitamin D levels. Before the addition of vitamin D to milk, the Pacific Northwest was known as a "rickets area." Rickets is a disease that causes bent and bowed legs in children who don't get enough vitamin D.

If you look closely at photos of white children at the turn of the century in Seattle, they often had rickets. The Native American people who lived in our notoriously cloudy area did not have rickets until they adopted the white settlers' diet. Native diets were rich in vitamin D—not from fortified milk but from fatty fish like salmon and local mushrooms like chanterelles.

So, while I may not be able to endorse taking supplements, I can endorse eating foods high in the sunshine vitamin:

Foods naturally high in vitamin D

Wild salmon
Pacific rockfish
Eel
Catfish
Cod liver oil
Tuna canned in oil
Sardines
Mackerel
Herring or pickled herring
Sole or flounder
Eggs
Beef liver
Ricotta cheese
Portobello mushrooms
Shiitake mushrooms (if dried in the sun)
Chanterelle mushrooms

Try the following salmon recipe this summer. Serve it with some sautéed shiitake or Portobello mushrooms for a burst of sunshine even on a gray day. To help keep your kidneys and heart healthy, be sure to use Grey Poupon honey mustard, which has only 5 mg of sodium per teaspoon, instead of the 50-150 mg per teaspoon found in Dijon mustard.

Sunshine Baked Salmon

2 salmon steaks or salmon fillets (preferably wild-caught salmon)
1/4 cup mayonnaise
1/4 cup Grey Poupon honey mustard
2–3 tablespoons chopped fresh tarragon

Heat the oven or barbecue to 400 degrees. Mix mayonnaise, mustard and tarragon. Cover a baking sheet with foil. Place fish on sheet, spread mayonnaise mixture on top. Bake about 10-20 minutes, until fish is flaky.

Nutritional information:

Calories: 430, Carbohydrates: 4 g, Protein: 30 g, Sodium: 256 mg

—Katy Wilkens, MS, RD


Katy G. Wilkens is a registered dietitian and department head at Northwest Kidney Centers. She has a Master of Science degree in nutritional sciences from the University of Washington. See more of her recipes at www.nwkidney.org.