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DEAR DR. GOTT: My doctor advised me to take at least 1,500 milligrams of calcium daily to treat advanced osteoporosis. Calcium supplements containing 400 to 600 milligrams of calcium also contain 100 percent of the Recommended Daily Value of vitamin D in each pill. A single multivitamin pill can also contain 100 percent of the RDV of vitamin D. Therefore, it is possible to get 400 percent of the RDV of vitamin D daily. This worries me, so I spoke with my doctor and pharmacist, but each has a different opinion about overdosing. What is your opinion?

DEAR READER: Vitamin D is necessary for the body to absorb calcium. It is present in fish, liver, egg yolks and fortified cereal, margarine and milk. It is also made by the body when skin is exposed to sunlight. It is not necessary for most healthy people with appropriate diets to take vitamin D supplements.

According to the National Institutes of Health Office of Dietary Supplements, the Recommended Daily Value varies according to age. The RDV for birth to 50 years is 5 micrograms or 200 International Units. For ages 51 to 70, it is 10 micrograms or 400 IU, and for those 71 and older it is 15 micrgrams or 600 IU. There is another set of numbers known as the Tolerable Upper Intake Levels, which are the highest levels at which a supplement (in this case, vitamin D) can be taken without risk of overdose. For these levels, children from birth to 12 months can be given up to 25 micrograms or 1,000 IU, and those 1 year and older can take up to 50 micrograms or 2,000 IU.

Overdose of vitamin D can cause nausea, vomiting, weight loss, weakness, poor appetite and constipation. The most serious consequence is that it may raise blood levels of calcium, which can cause heart-rhythm abnormalities and mental changes, such as confusion.

I recommend that you follow your pharmacist’s recommendations. If you want more information, Visit the NIH Office of Dietary Supplement’s vitamin D page at ods.od.nih.gov/factsheets/vitamind.asp. This may be good to bring to your physician for his or her opinion.

Now is also the time to consider prescription medication for your osteoporosis. Advanced osteoporosis may not respond well to the calcium/vitamin D therapy. Fractures of the spine and hip are very real possibilities for anyone with osteoporosis, and these consequences increase as bone loss worsens. You need to take aggressive steps to prevent serious injury because osteoporotic bones do not heal well and may require surgery, hospitalization and months of bed rest and rehab. If your physician is unwilling or unable to help you further, I recommend you be evaluated by a rheumatologist.

To give you related information, I am sending you a copy of my Health Report, “Osteoporosis.” Other readers who would like a copy should send a self-addressed, stamped No. 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Doctor Peter H. Gott is a retired physician and the author of the book, Dr. Gott’s No Flour, No Sugar Diet, available at most chain and independent bookstores, and the recently published, Dr. Gott’s No Flour, No Sugar Cookbook.

If readers would like to contact Dr. Gott, they may write him through your newspaper or send their mail directly to Dr. Gott c/o United Media, 200 Madison Ave., fourth floor, New York, NY 10016. However, if readers want to request a newsletter, they should write to the Ohio address.