Excellent transcript of radio show on this subject:
(Courtesy of Willner Chemists Radio):

Here is the problem. Josh is a very good soccer player. He is almost 17 years old, and has undergone a big growth spurt this summer. While practicing a couple of weeks ago, he went up for a header, collided with another player, and came down awkwardly on his ankle, resulting in a mild bone fracture.

Well, after the emergency room consultation, the x-rays, and the follow up visit to the orthopedic surgeon, the air cast, and so on, he happened to be scheduled for a regular visit with the family doctor. His Mom, who was naturally concerned about his healing, asked the Doctor whether he should be taking any extra calcium, both because of his recent rapid growth, and to make sure the bone healed properly.

What was the Doctor's response? "Naw, kids don't need supplemental calcium. They get plenty of calcium in their food!"

It's hard to believe that there are still Doctors out there who tell their patients things like this. To advise people that "a well balanced diet" is sufficient to fullfill all your nutrient needs is one thing even though it is not altogether true...

Sam: ...I would say that for most people it is impossible! For one thing, few people really know how to determine what a "well balanced diet" is! Have you looked at this new pyramid thing? And even if you did, how easy is it for most people to avoid the lure of fast foods, junk food, sugar laden and fat soaked snacks, and overly processed foods? ...and if adults have a hard time of it, what about teenagers?

Arnie: I agree Sam. But at least it is a goal. In this case, the Doctor implied that it was not even anything to worry about. His opinion was that "kids eat well enough."

Well, the fact is that few of us "eat well enough."

Major national surveys repeatedly show that diets consumed by many Americans are not at all well balanced! Inadequate intake of vitamins and minerals are frequently reported, including vitamin A, vitamin C, vitamin B1, vitamin B2, folic acid, vitamin B6, calcium, copper, iron, manganese, and zinc. In addition, 9 out of 10 diets are estimated to be low in chromium, and magnesium intake is approximately half the amount recommended in the RDAs.

Dr. Podell: Everything you say is true. And yet here we are, living in the wealthiest country in the world. If anything, we suffer from overabundance. I guess it is hard for some people including some of my medical colleagues to understand how we could be nutrient deficient in the midst of all this abundance.

Sam: It is this abundance that is a major contributor to the problem!

According to Dr. Alan Gaby, in his book Preventing and Reversing Osteoporosis, there are many reasons why our modern diet may not be good for our bones. First, many of us ingest too much sugar, caffeine, salt, and alcohol...

Arnie: ...you know, Sam, at first I was going to interrupt you and point out that we are talking about teenagers here, not adults. But now that I think about it, Dr. Gaby's comment probably applies to kids just as much as for adults. Certainly sugar and salt, given their abundance in convenience and snack foods, is a serious problem with children and teenagers. And, while some of our listeners may think that caffeine is an adult problem, that is not true just think about how much caffeine-rich cola a lot of the young people drink today. And lastly, we have alcohol. I wish we could say that is an adult problem...

Sam: ...I know what you mean, Arnie.

But let me continue on with Dr. Gaby's other two diet related bone problems. We already mentioned sugar, caffeine, salt and alcohol. His second concern is the way food is grown and refined today. He feels that because of that, today's diet probably contains much lower quantities of various vitamins and minerals than it used to. Some of these nutrients are directly involved in maintaining healthy bones.

Third, some of the processing techniques used by the food industry cause chemical changes in our food that may adversely affect the health of the tissues in our bodies, including bone.

Dr. Podell: Maybe we should explain some of this in a little more detail. Let's take sugar, for example. Why is sugar such a bad thing? What is its relationship to bone fractures, childhood growth, and for that matter, osteoporosis in later life?

Arnie: Well, for one thing, back in the early nineteenth century, sugar was a condiment, not a major component of the diet. The average per capita intake at that time was only 10 to 12 pounds per year. Today, the average American ingests close to 140 pounds of refined sugar each year. This can easy translate to about 20% of our total calorie intake. And that is empty calories. So we are reducing our intake of important nutrients, including bone essential nutrients such as magnesium, folic acid, vitamin B6, zinc, copper and manganese by almost 20%!

Dr. Podell: That is only part of the story. Research has actually shown that sugar can actually deplete our bodies of calcium. In one study, giving people 100 grams of sugar caused a significant increase in urinary calcium excretion.

Since most of the body's calcium is stored in the bones, it doesn't take a genius to figure out where that excreted calcium came from.

Another theory connecting high sugar intake with osteoporosis was proposed by Dr. John Yudkin, the well-known British physician. He found that ingesting large amounts of sugar by healthy volunteers caused a significant increase in the fasting serum cortisol level. Cortisol is the primary corticosteroid hormone secreted by the adrenal gland. Cortisone, and cortisoneline hormones have many beneficial actions, of course, but one of the drawbacks, in excess, is that they can cause bone loss.

Sam: I think the concern about refined grains is a very important part of the equation as well. When whole wheat is refined to white flour, you lose 72% of the vitamin B6, 67% of the folic acid, 60% of the calcium, 85% of the magnesium, 86% of the manganese, 68% of the copper, and 78% of the zinc.

It is estimated that grains make up 30% of the American Diet. If you add the 30% of refined grains to 20% refined sugar, you see that nearly 50% of the typical American diet is composed of nutrient depleted sugar and refined grains!

Arnie: Which makes it hard to condone Joshua's Doctor's casual dismissal of questions about diet and bone health!

At the very least, let's try to take away two lessons from this discussion. First, we should accept the fact that the typical child's diet, and teenagers diet, is quite likely to be less nutritious than it should be. Every effort should be make to improve it.

And in addition, it certainly would be prudent for teenagers to take supplemental vitamins and minerals. I like the calcium containing multies for this purpose.

There were two significant questions that had been raised.

• First, do teenagers in general get adequate nutrition from their diet, as our family doctor seemed to think?
• And second, does participation in sports activities necessitate additional nutritional consideration?

The Albany Times Union ran an article titled "Booklet Addresses 'Calcium Crisis' Among Teens."

The article states that, according to health and nutrition experts, there is a "calcium crisis" among teenagers. "Nearly nine out of 10 girls and seven of 10 boys get too little calcium. The National Academy of Sciences recommends 1,300 mg of calcium daily for teens the equivalent of four eight ounce glasses of milk."

This amount of calcium is needed, the article goes on to say, "because 15% of adult height and half of all bone mass are added during the teen years. Blame soda for adolescents' calcium deficit: As teens have double or tripled their soda intake in the past two decades, their milk consumption has fallen by 40%. The Center for Science in the Public Interest pegs boys'soda intake at two and one_half cans daily. For girls, it's two cans."

Let's look, then, at a report from NICHD (National Institute of Child Health and Human Development), a division of NIH.

"Healthy Eating Index Shows Most Children and Adolescents Have a Diet That Is Poor Or Needs Improvement"

"A new indicator of child well-being shows that most children and adolescents have a diet that is poor or needs improvement and that as children get older the quality of their diet declines. In 1996, 76 percent of children ages 2 to 5, 88 percent of children ages 6 to 12, and 94 percent of children ages 13 to 18 had a diet that was poor or needed improvement. "This indicator of diet quality is assessed by the Healthy Eating Index (HEI). The HEI, developed by the U.S. Department of Agriculture's Center for Nutrition Policy and Promotion, consists of 10 components, each representing different aspects of a healthful diet. Components 1 to 5 measure the degree to which a person's diet conforms to the Department of Agriculture's Food Guide Pyramid serving recommendations for the five major food groups: grains, vegetables, fruits, milk products, and meat/meat alternates. Components 6 and 7 measure fat and saturated fat consumption. Components 8 and 9 measure cholesterol intake and sodium intake. And component 10 measures the degree of variety in a person's diet.

"The decline in children's diet as they get older is linked to declines in their fruit and milk component scores of the HEI. The average fruit score falls from 7.0 (out of a maximum score of 10.0), for children ages 2 to 3, to 3.1 for females and 2.8 for males ages 15 to 18. Only 11 to 12 percent of these older children meet the dietary recommendation for fruit. The milk score declines after age 10. Females ages 15 to 18 have a particularly low milk score--4.2. Only 12 percent of these girls meet the dietary recommendation for milk servings.

Secretary of Health and Human Services Donna Shalala issued a statement in November, 1997, supporting an educational program "designed to reverse the trend of dangerously low calcium consumption among teens..."

"In announcing the new program, Secretary Shalala noted that there is a "window of opportunity" during adolescence to increase bone density through calcium intake. Bones grow and incorporate calcium most rapidly during the teen years, and establish approximately 90 percent of adult bone mass by age 17. By the age of 21 or soon after, peak bone density is achieved, and a few years later, a steady loss of calcium from bones begins.

"However, six out of ten teen boys and eight out of ten teen girls don't get enough calcium in their diets at a critical time when nearly half of all bone is formed. Most teens are getting only about 800 mg of the 1,300 mg required each day, setting the stage for osteoporosis. As Secretary Shalala noted, one half of women will have an osteoporosis related fracture at age 50 or older, and doctors believe that inadequate calcium consumption during the teen years is largely to blame.

"Recent NICHD research indicates that supplementing the diets of teenage girls with an extra 350 mg of calcium per day produced a 14 percent increase in bone density.

"If this 14 percent increase in bone density could be maintained, its impact would be striking __ for every five percent increase in bone density, the risk of bone fracture declines by 40 percent," said Gilman Grave, M.D., chief of the NICHD's Endocrinology, Nutrition, and Growth Branch."

So it seems clear that teenagers do not get the levels of calcium, iron and other nutrients that are required. Just how important a problem is this?

According to L. Newman, M.D. and S. Berezin, M.D. in "Quick Reference to Clinical Nutrition, 2nd Ed." (Lippincott, 1987) edited by Seymour Halpern, M.D., "Adolescence is the period of life between childhood and adulthood characterized by a rapid increase in the rate of physical growth and changes involving physiologic development... Adequate nutrition is necessary to provide for increased linear growth, increased body cell mass, and maturation. Because of increased demands in nutrition due to accelerated growth and development, dietary deficiencies are more apt to occur during this period than during other stages when these processes are progressing at a slower rate."

They go on to emphasize that "In adolescents with marked bone growth, calcium needs increase dramatically, paralleling increased caloric intake."

It does make sense, obviously, for parents and physicians to concern themselves with the dietary practices of children and teenagers. The importance of proper nutrition during this period of development is well established. It is also clear that today, perhaps more so than in the past, it is difficult for a teen to obtain the necessary nutrients through diet alone especially if the diet is typical of so many teens today. To many teens subsist on a diet composed primarily of caffeine and phosphorous rich soft drinks, high fat and high sodium convenience foods, and empty calorie sugar laden snack foods and deserts.

The National Osteoporosis Foundation emphasizes the importance of adequate calcium intake, starting with childhood.

"A lifelong intake of adequate calcium is necessary for the acquisition of peak bone mass and maintenance of bone health. The skeleton contains 99% of the body's calcium stores; when the exogenous supply is inadequate, calcium is extracted from the skeleton to maintain serum calcium at a constant level."

"The National Osteoporosis Foundation recommends that all adults receive at least 1200 mg/d of elemental calcium; the typical American diet provides less than 600 mg/d." Thus, even for adults, it is unlikely that most people achieve proper levels of calcium intake. The Foundation goes on to explain: "Increasing dietary calcium is the first line approach, but calcium supplements should be used when an adequate dietary intake cannot be achieved."

Preferred are the multis taken 4-6 per day.  Why are these preferred over many of the typical "one-a-day" type products? Well, even if one does not take the full four per day dose, I feel it is more beneficial to get 250 mg of Calcium and 6 mg of B Vitamins, rather than no calcium, and 50 mg of B Vitamins! (Multigenics is available in the office and on the supplement website)