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Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor
To the Editor: We are gratified that, in his
Editorial1 accompanying our article,2 Dr Heaney agreed that the labeling of calcium supplements
with their lead levels would be a sound plan. We also share his hope that
calcium intake may attenuate lead absorption; however, this optimism has not
yet been supported by the literature. In the study he cites,3
as well as in the more recent comprehensive findings from the same group,4 the protective effect of calcium was limited to
14-day-old chickens that were calcium deficient. Those authors suggested that
the lead-calcium axis was highly complex and varied with the duration of intake.
Furthermore, the data suggested that some lead absorption may be uncoupled
from calcium transport. Unfortunately, the data that we cited5
failed to confirm the alleged protective effect of dietary calcium in children.
Heaney also correctly pointed out that there are a variety of dietary
foods that may have a relatively high lead content. Nevertheless we view those
"single source" items as being the exception rather than the rule, and US
residents correctly should demand a long-term average exposure of no more
than 6 µg/day. The weight of the evidence indicates that this is a realistic
and attainable goal and that failure to achieve these low levels would be
a public disservice. We would instead challenge manufacturers to improve their
quality control and to label their products accordingly so that consumers
can make informed choices. It is our hope that some of the brands without
detectable levels have already accomplished this goal and thus the manufacturers
have not had the motivation to include this information on their labels.
Ross EA, Szabo NJ, Tebbett IR. Lead in Calcium Supplements. JAMA. 2000;284(24):3126. doi:10.1001/jama.284.24.3123
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