- The Washington Times - Sunday, July 23, 2000

One of the most important investments in the future is found in a glass of milk, a dish of ice cream, even the melted cheese on a slice of pizza or a cup of fortified orange juice.
All of those foods contain calcium, a nutrient that America's children are not getting in enough quantity. Experts from health and nutrition organizations are so concerned about children's and teens' lack of calcium they convened at a national calcium summit in Washington in June 1999 to discuss what they call a crisis.
A year later, not much has changed. The National Academy of Sciences recommends that children ages 4 to 8 get 800 milligrams of calcium daily and that children and teens ages 9 to 18 get 1,300 milligrams. However, after age 11, no age group of females achieves even 75 percent of that goal, says Dr. Duane Alexander, director of the National Institute of Child Health and Development.
"About nine out of 10 teen-age girls and seven out of 10 teen-age boys are not meeting the amount of calcium recommended by the [U.S. Department of Agriculture]," Dr. Alexander says. "Some studies show that girls are only getting 61 percent of the daily recommended value. The time they need calcium the most is the time they are not getting it. It is not like you can make it up later."
While adequate calcium intake can have an effect on lowering blood pressure and lowering the risk of colon cancer, it is most crucial for bone development. About 99 percent of total body calcium is found in the skeleton, and more than half of the density of the skeleton is built during the teen years, says Dr. Marc Jacobson, a New York physician and member of the American Academy of Pediatrics' committee on nutrition.
Peak bone mass is reached in the late 20s or early 30s, then starts to decline naturally at about a rate of 1 percent a year.
In other words, the more you deposit earlier, the more you will have later.
Skimping on bone-building calcium could result in osteoporosis, the thinning of the bones that affects more than 28 million Americans, 80 percent of whom are women. Osteoporosis, which typically occurs after age 50, is responsible for 1.5 million bone fractures annually, according to the National Osteoporosis Foundation.
"I think parents and pediatricians need to become aware of this issue," Dr. Jacobson says. "We need to educate kids about eating in general. We are not doing a good job, not just with calcium, but with [the levels of] fat intake and iron intake as well. We need to get kids to understand why this is so important, even for boys."

How a crisis was reached

Having too many choices has led to poor eating habits, Dr. Alexander says. A generation or two ago, children drank milk or water, families ate together, and typically all ate the same thing. With crazy schedules and eating on the run, food is more likely to come from the microwave, a can or a fast-food window.
Most important, a beverage is likely to come from a soda can.
"It is a fact that people are out and about more," says Isabel Maples, a registered dietitian and a spokeswoman for the Dairy Council of the Mid-Atlantic. "People just don't order milk in a restaurant as much as they used to."
Soda consumption has had a direct, negative impact on America's calcium consumption. A 1999 study in the Journal of the American Dietetic Association said that adolescents who consumed 26 ounces of soft drinks daily were about four times more likely to consume less than one cup of milk per day than teens who did not drink soft drinks.
Earlier this year, researchers at the Harvard School of Public Health looked at 460 teen girls and their cola-drinking habits and found girls who drank cola were three times more likely to report having broken a bone than those who did not. The risk increased to five times more likely for physically active girls who drank cola.
The researchers suspect that the problem stems from the phosphoric acid in cola beverages, which can interfere with the body's use of calcium. The study did not, however, look at each girl's calcium or dairy intake.

Putting calcium in

With all the soda consumption going on, why not add calcium to colas the way it is added to orange juice and breakfast cereals? That's only half of the solution, some nutritionists say.
"As a registered dietitian, I would discourage it," Mrs. Maples says. "The caffeine in soda can leech calcium from the body. I want to see ways in which people can get calcium through foods, not supplementation."
Actually, bottling companies have experimented with adding calcium to soda but have been unable to come up with a successful formula, Dr. Alexander says.
"It tastes chalky," he says.
There is no shortage of other foods to which calcium has been added. An 8-ounce glass of calcium-fortified orange juice, for instance, provides about 350 milligrams of calcium or about the same as in an 8-ounce glass of milk.
Total cereal recently introduced a calcium-added variety that provides 1,000 milligrams of calcium nearly a day's daily recommended requirement even milk is added.
Other calcium-enriched cereals offer about 100 milligrams per serving. A calcium-enriched breakfast bar provides about 200 milligrams of calcium. Calcium even is being added to already calcium-rich dairy products such as ice cream and cottage cheese, enabling a person to get a double helping of the nutrient in one sitting.
Calcium supplements found in tablets, chewables and stomach remedies can help adolescents fill in the gaps. A 1999 study at Yale University supported by the National Institutes of Health found that supplementing the diets of 112 girls ages 12 to 16 with 500 milligrams of calcium citrate daily over a period of four years produced a 14 percent increase in bone density in comparison to the bone density for girls whose diets were not supplemented. Researchers found this result important because for every 5 percent increase, the risk of a fracture later in life declines by 40 percent.
While supplements can fill in the gaps, dairy products still are the most nutritionally dense way to get large doses of calcium, says Sheah Rarback, director of nutrition for the Mailman Center for Child Development at the University of Miami and a spokeswoman for the American Dietetic Association.
Dairy products provide other vitamins and minerals, such as protein, vitamin A, potassium and vitamin D, which aids in the absorption of calcium, she says.
Even by eating dairy products and calcium-fortified foods, a person would have to work extremely hard to get too much calcium, Ms. Rarback says.
"I suppose there could be the risk of someone getting too much calcium [about 2,500 milligrams per day] from all the fortified foods, but it would be difficult," she says.
Too much calcium can put a person at risk for kidney stones and reduce the body's absorption of iron and zinc, two minerals that are essential for wound healing and proper immune system function.
Ms. Rarback says she is much more concerned that Americans are getting too little calcium.
"It is a very serious problem with most of the kids that I see," she says. "It just isn't in their mentality to worry about what is going to happen to them when they are 60."
Ms. Rarback says it really isn't such a daunting task to get 1,000 milligrams or more of calcium into a child or teen each day.
"Start with a one glass of milk or fortified orange juice," she says. "If you get three more servings, such a container of yogurt, a piece of cheese and a cup of ice cream, then you are there."

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