To those of us who have been encouraged to increase our calcium intake would you please explain the difference between calcium citrate and calcium carbonate and is one better than the other. Also, can you suggest a good multivitamin that the 50+ crowd may want to consider to supplement their diet.   This is such an important issue! Calcium is a mineral essential for life and is involved in several important bodily functions, and still many Americans do not ingest enough on a daily basis. About 99% of calcium is found in our bones and teeth, the remaining 1% is found throughout the body in blood, muscle and the fluid between cells. Calcium is vital to building bones early in life and then maintaining their strength later in life. Usually when we think of calcium, we only think of bone health but, it also plays a role in other functions such as muscle contraction, blood clotting and sending messages through the nervous system.   Our bones are constantly undergoing remodeling. They are always breaking down while at the same time rebuilding and depositing calcium into the new bone. The balance between the bone breakdown and rebuilding shifts as we age. While we are children, the bones are growing so there is more bone formation and less breakdown. As we get older, the shift happens and more breakdown takes place. This can increase the risk for osteoporosis.   Each day, we lose calcium from our hair, sweat, nails, skin, urine and feces. Because the human body cannot make calcium on its own, if there isn’t enough in the diet it will increase bone breakdown and take the calcium from our bones. This is why it’s so important to get enough calcium each day. We need to hang onto that calcium in our bones to ensure they stay strong! The National Institute of Medicine recommends that individuals from 19-50 years get 1000mg calcium each day, while those over 50 should increase to 1300mg of calcium/day.    The most ideal way to get calcium is from food, but most people find this difficult. Calcium is found in many foods, but the main foods that contribute calcium are dairy products such as milk, cheese and yogurt. However, there are some foods such as spinach, kale and broccoli that also provide calcium but in smaller amounts than dairy products. If you are lactose intolerant, there are many calcium-fortified products such as cereals, soy milk, tofu and fruit juices. For a list of calcium-containing foods, please visit http://www.nal.usda.gov/fnic/foodcomp/Data/SR18/nutrlist/sr18w301.pdf to look for your favorite foods!   For those of us who just can’t seem to eat enough dairy products, it’s a good idea to take a calcium supplement. There are a few things to consider when choosing a calcium supplement, you have to choose a type, consider its absorbability, purity, your tolerance and any possible interactions it may have with a medication you are currently taking.   There are a few types of calcium supplements that you may find yourself staring at in the pharmacy or grocery store aisle such as calcium carbonate, calcium citrate, calcium gluconate, and calcium lactate. The main difference is that each one will contain different amounts of calcium. It is important to read the label to see how much calcium is contained as well as how many doses to take to meet your individual needs. Calcium citrate contains about 21% calcium while calcium carbonate contains about 40%. So, you may have to take more doses of calcium citrate to meet your needs than you would of calcium carbonate. However, one advantage of calcium citrate is its better absorption in those who have decreased stomach acid. Another difference is calcium carbonate is better absorbed when taken with food while calcium citrate can be taken at anytime. So, your choice of calcium supplement will be based on personal preference, but as long as you are meeting your needs, they can all work out well.   The body also needs Vitamin D to absorb calcium. There are a few ways we get Vitamin D: through the skin (vitamin D is formed after exposure to sunlight), from the diet and from supplements. Requirements for Vitamin D set by the National Institute of Medicine are 400-800 IU for those from 19-50 years old and 800-1000 IU for those over 50. The preferred form of Vitamin D is Vitamin D3. So, you’ll find that there are some combination products available as well. Vitamin D is also found in fortified milk, egg yolks, saltwater fish and liver.   If you feel like your diet is deficient in many vitamins and minerals, you may choose to take a multivitamin as an “insurance” policy. Many of the same guidelines apply. You want to look on the label and choose a multivitamin that contains around 100% of the recommended daily values. It may be easier to go for a major name brand, but you can choose smaller brands or generics if the container displays the USP symbol. In order to remember to take the multivitamin, bring it to work and take it at the same time everyday.   Please visit the websites of some of the references for more detailed information regarding calcium, vitamin D and multivitamins. It can be overwhelming for anyone as the supplement aisles often contain hundreds of different types of brands and products.   In summation, here are some helpful tips regarding calcium supplements and multivitamins:   *In order to ensure its purity, look for the USP (United State Pharmacopeia) symbol and try and choose familiar brand names. Avoid calcium that comes from unrefined oyster shell, bone meal or dolomite without the USP symbols because they may contain lead or other toxic metals.   *Calcium is best absorbed in amounts of 500mg or less, so spread your supplements throughout the day.   * Some people find that certain calcium supplements can cause gas, bloating or constipation so you may need to switch brands if increasing your fluid or fiber does not help.   *For a multivitamin, try to choose one that contains around 100% of all vitamins/minerals on the food labels and again, look for that USP label.   *And remember to speak with your physician regarding any medications you are taking that may interact with calcium supplements or multi-vitamins.   -Lori   References: http://ods.od.nih.gov/factsheets/calcium.asp   http://www.niams.nih.gov/Health_Info/Bone/Bone_Health/Nutrition/calcium_supp.asp   http://www.mayoclinic.com/health/calcium-supplements/AN00964   http://www.nof.org/   http://www.nof.org/prevention/calcium2.htm   http://www.nlm.nih.gov/medlineplus/osteoporosis.html   http://www.niams.nih.gov/Health_Info/Bone/Bone_Health/Nutrition/default.asp