DR. BART'S RECOMMENDATIONS FOR OPTIMUM CALCIUM CONSUMPTION

1. The most readily absorbed form of calcium is that which is derived from your diet. Rich sources of dietary calcium include dairy products, calcium-fortified orange juice and dark green vegetables. Other examples include: broccoli, rhubarb, collard greens and tofu.

2. Avoid diets high in protein, sodium and caffeine, since they increase the excretion of calcium by the kidneys.

3. Iron and fiber supplements should not be taken with calcium supplements because they reduce the absorption of calcium.

4. Try to calculate the amount of calcium that you are consuming on a daily basis through diet. When reading the labels of certain foods, you may get information such as, "8 oz. serving provides 30% RDA." The translation is that 8 ounces of the substance in question provides 30% of the recommended daily allowance, as established by the U.S. FDA. Since the FDA recommends 1,000mg of calcium per day for most ages, the food stuff with this label provides 300 mg of calcium in 8 ounces.

5. The term "elemental calcium" refers to that which is absorbed by the body.

6. Not all calcium supplements are alike with regard to absorption. Calcium carbonate (the form found in Tums, OsCal and Caltrate) is 40% absorbed as elemental calcium, meaning that the bottle may state that you are consuming 1,000mg of calcium by only 400mg will be used by the body. Calcium citrate (found as Citracal) is only 21% absorbed. While calcium carbonate is inexpensive and readily absorbed by most people, its absorption is inhibited in those patients with lowered stomach acid levels seen from ingestion of medications such as Prevacid, Prilosec, Protonix, Aciphex, Axid, Pepcid, Tagamet and Zantac. Calcium carbonate is best taken with a meal. With regards to reduction of osteoporotic fractures, there is little evidence that any calcium supplement is more effective than any other.

7. Calcium citrate is the form of supplement recommended for patients with a history of kidney stones. Calcium citrate is best taken in between meals and at bedtime.

8. It is recommended that no more than 500mg of calcium supplements be taken at one time in order to increase optimum absorption.

9. Some oyster shell and bone meal calcium products have been found to have unacceptable levels of lead and arsenic in their preparations.

10. Calcium absorption is enhanced by vitamin D consumption in the range of 200-400 IU per day.

11. Combine calcium with vitamin C to improve the absorption of calcium.