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December 27, 2000

Lead in Calcium Supplements

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor

JAMA. 2000;284(24):3126. doi:10.1001/jama.284.24.3123

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.

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