by Jackie Hart, MD
Q: I am a female almost 50, taking hormone replacement pills. If I take hormones, do I still need to take vitamins and calcium supplements to stay healthy?
A: This is a great question and the simple answer is "yes." Calcium, along with vitamin D, works in harmony with hormones to strengthen bones and prevent osteoporosis. In medical lingo, we call this "synergy" when the total benefit is greater than the sum of the individual gain of each separate approach.
According to the North American Menopause Society (NAMS), you should try to meet your calcium needs through dietary sources. Both NAMS and the National Institutes of Health (NIH) recommend 1000-1500 mg of calcium per day for menopausal women. Foods rich in calcium include dairy products, leafy green vegetables, almonds, and dried beans. There are also many foods fortified with calcium, such as orange juice and cottage cheese. Many of these, however, have not been tested for how well the added calcium is absorbed and used by the body.
When you are unable to get enough calcium from foods, calcium supplementscan make up the rest. Work with your doctor to calculate the amount of calcium you are getting from your diet on an average day and to determine the amount of calcium you need from supplemental sources. Calcium citrate appears to be the form that is best absorbed. Absorption is also enhanced when supplements are taken with meals and/or at night.
Vitamin D is necessary for calcium to be absorbed by the body. Because levels of vitamin D in the body decrease with age, older people can develop calcium deficiencies. These low levels of calcium increase the risk of a bone fracture. Women between the ages of 51 and 70 need 400 IU per day of vitamin D, and women over 70 need 600 IU per day. Sources of vitamin D include sunlight, fatty fish (such as salmon, mackerel, and herring), and dairy products fortified with vitamin D. If you are not getting enough from the foods that you eat, which is somewhat common, you should consider a supplement>.
Other vitamins and minerals are important after menopause as well. Ask your doctor about the following:
Q: I am a female almost 50, taking hormone replacement pills. If I take hormones, do I still need to take vitamins and calcium supplements to stay healthy?
A: This is a great question and the simple answer is "yes." Calcium, along with vitamin D, works in harmony with hormones to strengthen bones and prevent osteoporosis. In medical lingo, we call this "synergy" when the total benefit is greater than the sum of the individual gain of each separate approach.
According to the North American Menopause Society (NAMS), you should try to meet your calcium needs through dietary sources. Both NAMS and the National Institutes of Health (NIH) recommend 1000-1500 mg of calcium per day for menopausal women. Foods rich in calcium include dairy products, leafy green vegetables, almonds, and dried beans. There are also many foods fortified with calcium, such as orange juice and cottage cheese. Many of these, however, have not been tested for how well the added calcium is absorbed and used by the body.
When you are unable to get enough calcium from foods, calcium supplementscan make up the rest. Work with your doctor to calculate the amount of calcium you are getting from your diet on an average day and to determine the amount of calcium you need from supplemental sources. Calcium citrate appears to be the form that is best absorbed. Absorption is also enhanced when supplements are taken with meals and/or at night.
Vitamin D is necessary for calcium to be absorbed by the body. Because levels of vitamin D in the body decrease with age, older people can develop calcium deficiencies. These low levels of calcium increase the risk of a bone fracture. Women between the ages of 51 and 70 need 400 IU per day of vitamin D, and women over 70 need 600 IU per day. Sources of vitamin D include sunlight, fatty fish (such as salmon, mackerel, and herring), and dairy products fortified with vitamin D. If you are not getting enough from the foods that you eat, which is somewhat common, you should consider a supplement>.
Other vitamins and minerals are important after menopause as well. Ask your doctor about the following:
- Magnesium - helps absorption of calcium. Many experts suggest a ratio of calcium:magnesium of 2:1; for example, calcium 1000 mg and magnesium 500 mg or calcium 1500 mg and magnesium 750 mg per day.
- Boron - helps the body use magnesium and may increase the amount of calcium in the blood. Boron is readily available in foods such as vegetables, nuts, and legumes. If a supplement is necessary, the usual amount is 1 to 3 mg per day.
- Vitamin K - necessary for normal bone health; however, supplements should not be taken if you are using any blood-thinning medication (such as warfarin [coumadin]) . Also, it is unlikely that vitamin K supplementation gives any added benefit above and beyond hormones; so, when taking hormone replacement therapy, addition of this vitamin is unnecessary.
- Antioxidants, such as vitamins E and C - may lower the risk of developing heart disease and stroke after going through menopause. Vitamin C may also help with prevention of bone loss if used for 10 or more years. Vitamin E, when obtained from food sources, may help reduce symptoms such as hot flashes, and lower the risk of other diseases including Alzheimers disease and macular degeneration. The usual dose for vitamin C is 1000 mg per day (this is best taken in two or more small doses throughout the day or in a time-release form), and for vitamin E it is 400-800 IU per day.