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To absorb calcium, your body needs vitamin D. Vitamin D is added to most fluid milk; it can also be made by your skin when exposed to sunlight. Dietary supplements of vitamin D are usually not necessary. Your doctor or dietitian should advise you on your need for additional vitamin D. If they recommend supplements, they should tell you how much you should take. Generally, vitamin D supplements should not exceed the U.S. Recommended Daily Allowance (U.S. RDA) of 400 International Units (IU) per day, because continued use of high doses is harmful. (U.S. RDA's are nutrient standards developed for food product labels by the U.S. Government.)

In addition to getting adequate calcium and vitamin D, it's important to note that moderate exercise that places weight on your bones, such as walking, helps maintain and may even increase bone density and strength in older adults.

Anyone can get osteoporosis, but women are at greatest risk, especially white women who are thin, fair-skinned, and small in build. Aging itself, extreme immobility, and genetics, as well as smoking and drinking alcoholic beverages, are believed to contribute to risk for osteoporosis. Loss of calcium from the bones increases in women after menopause, when levels of the hormone estrogen decrease. Estrogen replacement therapy can be prescribed by a doctor to help decrease bone loss after menopause. Because estrogens may have negative side effects in some women, the decision to take estrogen should be made by each woman with the help of her doctor.

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How To Get Enough Calcium If You Don't Drink Milk

Should You Take a Vitamin Supplement?

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Milk is the most obvious and popular source of both calcium and vitamin D, but some people don't drink it and need to consider other ways to get calcium.

Some people have trouble digesting lactose, the sugar occurring naturally in milk. If you have trouble digesting milk• Drink milk that has had lactase added or

add it yourself. Lactase is an enzyme that breaks down milk sugar. It can be purchased

at many drug stores. • Drink only a small amount of milk at a time. • Eat yogurt or cheese. Lactose has been

partially broken down in these foods. • Try cooked foods made with milk such as

soups, puddings, or custards. If you don't like milk, eat more of other foods with calcium, such as• foods made with milk or cheese. • tofu, a soy product that is sometimes made

with calcium sulfate (check the label); 1/2 cup (4 ounces) of tofu made with calcium sulfate has about the same amount of cal

cium, protein, and fat as 1 cup of whole milk. • dark-green leafy vegetables, such as

kale, collards, and broccoli. • tortillas made with cornmeal that is

fortified with calcium; label may state that the cornmeal is processed with lime, or may list the cornmeal as “masa harina.” canned or dried fish with edible bones, such as salmon and sardines.

Thirty-seven percent of American adults take a daily multivitamin pill. Some even take extra vitamins and minerals as well, especially vitamin C. Yet most of these supplements are unnecessary for people of any age. A well-balanced diet should provide all of your nutritional needs. High doses of some vitamins, such as A and D, can be harmful. Large amounts of some supplements can upset the natural balance of nutrients normally maintained by the body. Large doses, called megavitamins, containing 10 to 100 times the RDA for a vitamin or mineral, can act like drugs, with potentially serious results.

While researchers continue to learn more about how nutrient requirements change during aging, eating a balanced diet containing foods from each food group (listed on the table on page 17 of this section) is the best approach to getting the nutrients you need. Supplements may be beneficial for people who cannot eat a balanced diet or who do not eat enough food, or people who take medicines that interact with nutrients. Before you decide to take a nutritional supplement, discuss it with your doctor or dietitian. If you have specific health problems, or likes and dislikes that greatly limit your food choices, consult a registered dietitian (R.D.) for help in planning the best diet for you.

Drink Enough Fluids

What About Constipation?

Constipation bothers many older adults. The frequency of bowel movements among healthy people varies from three a day to three a week. Know what is normal for you and avoid relying on laxatives. Drinking enough fluids; eating plenty of fruits, vegetables, and wholegrain products for fiber; and exercising regularly can help with this condition.

The sense of thirst declines with age, so older people may not drink enough water and other fluids. Sometimes people intentionally drink less to avoid going to the bathroom often. But if you aren't getting enough fluids you can become dehydrated, especially during hot weather.

Drinking plenty of fluids is important to. help your body flush out wastes—it's worth a few more trips to the bathroom. Most adults should drink at least eight glasses of water a day. This water can come from any beverage—juice, coffee, tea, milk, or soft drinks—as well as from soup. However, the caffeine in coffee and other drinks may increase your urge to urinate. The sugar in regular soft drinks is an added source of calories you may not need. Plain water, unsweetened fruit juices, and lowfat milk are better choices. Or, for a refreshing carbonated drink, mix fruit juice with club soda or seltzer water. To make plain water more appealing, try it chilled with a twist of lemon or lime.

Prevention of constipation is the

• Eat foods with dietary fiber, such as whole

wheat breads and cereals, fruits, and veg.

etables every day. • Drink plenty of liquids. • Exercise regularly. • Go to the bathroom when you feel the

need. Don't delay.


Facts About Fiber

How Much Fiber
Should You Eat?

Dietary fiber (sometimes called “roughage”) is
the part of plant foods that humans can't di-
gest. The fiber passes through the intestines,
forming bulk for the stool. There are two
major types of fiber-insoluble and soluble.
Each has different health benefits, so both are
needed in the diet. Insoluble fiber is most
often found in whole-grain products, such as
whole-wheat bread and cereals, fruits and veg-
etables with their peels, and dry beans and
peas. Insoluble fiber helps prevent constipa-
tion. Diets high in insoluble fiber and low in
fat may also reduce your risk of colon cancer.

Soluble fiber is found in fruits, vegetables, dry beans and peas, and some cereal products such as oatmeal, oat bran, and rice bran. Some research indicates that diets that are low in fat and saturated fat and rich in soluble fiber may help reduce blood cholesterol levels

It isn't clear yet exactly how much fiber you
should eat each day. Some health experts have
suggested that an increase to a range of 20 to
30 grams is a good idea. That's about twice
what the average adult eats now. Because
plant foods differ in the types and amounts of
fiber they contain, it's a good idea to eat dif-
ferent kinds of foods rich in fiber. You can get
about 20 grams of fiber if you eat three serv-
ings of whole-grain foods, two to three serv-
ings of fruit, and three to four servings of veg-
etables daily. You don't need to take fiber
supplements or sprinkle bran on all your


Hiru Wuh M.D.

Some choices: 3 servings a day

Broccoli spears, corn,

potato, and kidney beans
of vegetables
2 servings a day

Pears, apples, bananas,
of fruit

figs, and oranges
3 servings a day Whole-wheat bread, oatmeal,
Of whole-grain

whole-grain Cereals

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