Best Skin Care Ingredients – The Top Ten

I recently  got an email which chided me for being too negative about too many cosmetic ingredients.   ” If you  don’t  like vitamin E, peptides,  and seaweed, what do you think is worthwhile” she challenged me.

Fair enough.   Truth is  there are  ten ingredients that I love because they truely deliver as promised.  Some are for acne, others for anti-aging and a few for sun proection.  Best of al,l only one needs a perscription.  I also relish the fact that in many of  them, the FDA requires that their concentration by percentage must be listed on the label– so you can see  at a glance  if  it has  what your skin needs.

1.  Glycolic Acid

Derived from sugarcane, glycolic acid is considered the  most effective  form of alpha hydroxy acid.  In a cleanser, toner,moisturizer or mask, glycolic acid takes off dead dry  skin cells, increases cell renewal and stimulates  collagen production.  Its useful for oily skin,  acne prone skin and as an anti-aging tool.  But to be effective most glycolic acid  products need  to have at least 8%  glycolic acid in the formulation.

2. Ceramides

The cells of the top layer of the skin are held together by ceramides, a kind of fatty substance that acts like glue to keep cells in a healthy ordered pattern.   Even better, ceramides are equally important at holding  water molecules in the skin.  Ceramides like so many factors, decline in the body as we get older.  A ceramide moisturizer  definately levels the  playing field. 

3. Vitamin C

Anti-aging properties have been attached to  many vitamins, but vitamin C is the one that has the science to back up  the claims.  Vitamin C ( AKA ascorbic acid) is essential for the growth of  healthy collagen.  In fact  the National Health and Nutrition study of 17,000 Americans found that  those with diets highest in vitamin C had the youngest looking skin and fewest wrinkles.  Even better, vitamin C is one of the few ingredients  that is truely helpful inside and out.  But and its a big but, vitamin C is extremely fragile and not effective in many formulations.  Exposure to light, heat, and moisture quickly  degrade  vitamin C   and steal its anti-aging properties.   When you buy vitamin C serum, make sure its packaged in a dark brown or green glass vial  with at least 5% concentration. 

4. Benzoyl Peroxide

 This skin care work horse is a tried and true acne buster that packs a one-two punch. It  can take off the top layer of dead dry  skin cells that are clogging pores and stale oil that is blocking the pores and  kills the bacterria in the skin that trigger breakouts.  Until recently the FDA alllowed a maximum of 2.5% in over the counter acne preparations.  Now this limit has been lifted and its possible to purchase formulations the have up to 10% benzoyl peroxide. 

But benzoyl peroxide  can be very irritating and its best to start with lower  concentrations, and if well tolorated work  up to stronger formulas.  Like Retin A,  you should wait 10-30 minutes  after washing  your face before applying benzoyl peroxide.  Limit use of alcohol  based toners and glycolic acid products when starting with benzoyl peroxide.   Because it can increase sun sensitivity, always top benzoyl peroxide treated skin with at least a 30SPF  sunscreen.

5.  Zinc Oxide

Zince oxide is a white mineral that has been used for skin care since the time of the Greeks.  Over the centuries, it has been useful for ointments, baby powder, dandruff shampoos and  is  the primary ingredient in calamine lotion.   Currently, zinc oxide ( and its  cousin titanium dioxide) are  the dermatologists favorite sunscreen ingredient.  They are called physical sunscreens because they literally physically  block the rays of the sun.  Zinc oxide  sits on the  skin surface and shields the skin from both UV A and UVB says.  Because they are not absorbed by the skin, physical sunscreens are less irritating and less likely to provoke breakouts.   This means that zinc oxide sunscreens are the best option for sensitive and acne prone  skin.   Look for products that contain  at least 5% zinc oxide ot titanium oxide.

Next week– The final five ingredients  and  a list of  the affordable products that feature them.

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The Beauty of Bok Choy

I love to buy fruits and vegetables at Farmer’s Markets.  I think the food  is fresher, tastes better  and I can pick up  new varieties   not found in supermarkets.  Last week I  scored   what I thought was a gorgeous head of sparkling fresh spinach.   It was 15″ inches across, weighed about 3 pounds and was only $3.  What a buy!  But when I got  home and nibbled on a leaf, I discovered it was bok choy not spinach.  Bok choy is a popular form of  chinese cabbage that is used in soups, stir fried combo’s and  as  side vegetable dish. But from a nutitional  stand point, how does it compare to  the nutrient packed spinach?

Turns out, not too bad.  Bok choy clocks in at just 13 calories in a four ounce serving.  And those 13 calories also deliver 30% of RDA vitamin A and 50% of RDA of Vitamin C.  Since vitamin C is the vitamin  most closely linked to youthful skin, bok choy  can genuinely be considered a beauty food.   Add that to some fiber, iron, and calcium and bok choy  earns  its spot on healthy eating plans.  I love  to serve a double portion of sauteed bok choy with an order of steamed  chicken dumplings– a low fat dinner  plate of flavor and nutrition.

Stir-Fried Bok Choy ( adapted form Foodnetwork.com)

Ingredients:  one  tablespoon corn oil, 2 cloves of garlic, slivered, 1 tablespoon of  chopped  fresh ginger, 8 cups of chopped bok choy ( cut into one inch pieces), 2 tablespoons low sodium soy sauce 

Directions:  Heat the oil in a  large non-stick saute pan.  Toss in garlic and ginger and cook about a minute.  Add bok choy and soy sauce and cook  over medium heat for  5 minutes until leaves are wilted and stalks are crisp but tender. 

You can also serve these over rice  or in a soup.

One last word:  Raw bok choy  can  be difficult to digest and  cause   cramps and bloating– so make certain that the vegetables  are throughly cooked  before serving.

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Budget Beauty- Part 2

Costs seem to explode when daily skin care meets anti-aging.    Brand name tretinoin ( eg Retin A) clocks in  at $300 for a tube that lasts  six months.   Generic Retin A drops to about $200.  Upscale anti-aging  brands with  effective levels of retinol are lower at about $100, but still a  significant bit of change.  And then there are the luxury department store brands  like La Mer and Perricone  that will cost more than $300 a  jar– and thats   just for one product in the recommended routinue.

There are  anti-aging products  that don’t   cost much, but they  don’t do much either.  The challenge is to find affordable   anti-aging  forumlations that  deliver  real results.   I believe that   when a  low cost  cream or mask  doesn’t  deliver,  you are still wasting your  money, albeit less of it.

Glycolic Acid– cheap and effective

The search for  acessible anti-aging skin care starts with  deciding what you want from them.  As the  years go by skin growth slows down, dark spots pop-up  and   our  healthy glow  is replaced with  a sallow, dull skin tone and textrue.  That’s the bad news.  The good news?  Glycolic acid and vitamin C, either singly or in combination  were born to deal with skin aging.  These  two super age busters  are also among the most inexpensive ingredients used in  skin care  products.

Glycolic acid will remove the top layer of dead skin cells and stale  oil and encourage  the growth of healthy hew collagen.   Within a  month of use,  pores will shrink and  rough dull  surface  will be replaced  with a fresh healthy glow.  Think of glycolic acid as “Retin A  light”.   It will  produce real results without irritation– and at about 80% lower cost. Two of my favorite glycolic acid rejuvenation  products are:

Alpha Hydrox Enhanced Lotion ( 10% glycolic) $12- for dry skin

It contains active levels of glycolic acid but forumlated for thin,  dry skin.  Available in pharmacy chains like Duane Reade and online.

Alpha Hydrox AHA wipes ( 14%) $17 for  normal and oily skin

 These wipes are super easy to use  and can be added to  almost any cleansing routinue.   They will  help control breakouts  while stimulating  healthy skin formation. 

Vitamin C– an oldie but goodie

Vitamin C  is  one of the most studied AND effective anti-aging ingredients– and available for literally pennies a day.   Vitamin C  works in three ways– it is essential for  the growth and repair of  healthy collagen, can lighten  dark spots and splotches AND is a powerful antioxidant that protects the skin from UV rays.  But  vitamin A is uber  fragile and takes  careful hadling to avoid oxidation.  When this happens, the vitamin C loses much of its power and potency. 

There are a few  wonderful commercial vitamin C  products  ( eg Cellex C and Ski Ceuticals)  that will deliver  full strength benefits.  But they are expensive and if  you want to stretch your beauty dollar, you can make a  truely effective vitamin C serum without  special ingredients or equipment.

DIY Vitamin C Seum

I tried  six different formulas before  adopting  this  one from Gorgeously Green by  Sophie Uliano.  I could find all the ingredients at a local health food store and  had all the tools I needed in my kitchen.  While DIY  products are so tempting, some formulas  can involve ordering special chemicals and tools, eg scales and thermometers.  These add up and the bottom line here is to save money.

Budget Busting Vitamin C Serum

Ingredients:  2 teaspoons, water (  boiled and cooled), 2 teaspooons vitamin C powder in the form of L-ascorbic acid ( $10 for 4 oz.)  , 2 teaspoons vegetable glycerin ( $10 for 4 oz.), dark brown bottle with eye dropper.  These ingredients  will last three months at the cost of  $1.60 a week.  Seriously.

Directions:  In a little bowl, mix the water and vitamin C until the powder is dissolved. Mix in the glycerin.  Using the eye dropper, transfer  the mixture  to the dark brown bottle. It will stay active for a week.  If you have any leftover, discard it and  mix up a fresh batch.

To  use, shake the bottle well and  put two  drops on fingertips.  Rub in a bit on the  hands then apply to the face.  Repeat  for neck and chest.  And that’s it.  You might feel a  sight tingling that will fade in a moment.  Unlike glycolic acid which  show almost  immediate results, vitamin C takes  time to see benefits.  The changes are  internal but in a few months  you should notice  fewer dark patches and  a radiance that only comes from treating your skin correctly.

In the summer I like to use vitamin C serum under my mineral sunscreen.  In other seasons, I alternate glycolic acid wipes with vitamin C serum  as my bedtime routinue.   Let me know  how you  like to use this home made age buster.

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Its Fashion Flash Monday!

This week the host of Fashion Flash is Mirabai of  Moving Free With Mirabai.  Hands  down, Mirabai is the best credentialed  exercise guru  you will ever meet.   And wherever you are in life, she has developed an exercise program for you.  She has programs to combat childhood obesity,  get moms back in shape, loose weight, improve  heart function, and restore strength and flexibility to both prevent and manage osteoporosis.  In short there is a reason that  she is one of the most  popular exercise  experts on QVC. I am so thrilled that she is part of Fashion FLash.  And if you  have specific questions on  all things exercise email her at mirabai@movingfee.com.   I do and her  advice  is always just what I need.

I was looking for  new books for  my granddaughters last  week when I spotted a pink polka dot  and gingham book  at Strand Bookstore.  But rather than another princess story, it was a small but  very helpful  skin care book by a Miami- based dermatologist.   Six Weeks to Sensational Skin ( Rodale)  by Loretta Ciraldo, MD.  Packed with helpful  tips and info, it  drills down into the basic tools and  really explains  how to care for  our skin on  a daily basis.  She starts out with two very simple  bits of advice that are new to me.  Use  uber mild detergent for your bed  linens ( she recommends All CLear  detergent) and a 400 thread count  pillowcase.  Dr Ciraldo  points  out that  we mash  our faces in  pillows for 8 hours a night and  rough fabric and  harsh detergent  takes it toll  on  our skin. 

Clearly written, Six Weeks to Sensational Skin kept surprising me.  Her  detailed info includes:

* How cholesterol lowering drugs like Lipitor  can  increase skin dryness

*Why  hydrolyzed  proteins stop the over production of  the enzyme  that destroys collagen

*How soy protein blocks  production of enzymes that destroys elastin

* Vitamin C  increases sunscreen effectiveness

I especially likes the emphasis on  affordable daily  skin  care routines that will   result in healthier  skin.  While she touches on  the office  based techniques, the majority of the book  is focused on the totally affordable basics that  will deliver results over the long term.  Her own  daily routinue uses more than 12  products and is daunting, but in  laying out the details she demonstrates  the order of treatments.  This  book earned a spot on my  crowded  beauty bookshlf.

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The Beauty of Butternut Squash

The yellow and rust colors of fall  have  made me hungry  for the sweet, fleshy meat of  winter squash.  Butternut, crook neck, turban and acorn  are shaped differently  but offer very similar  nutritional payloads.  The deep orange color is packed, I mean packed with vitamin A and beta-carotene.   One half cup of  cooked squash   can have 100-200% of  the RDA for  this essential  vitamin as well as 25% of the RDA of vitamin C.  Fat free and salt free, one half cup has 120 calories and 12 grams of carbs.   By comparison, the same amount of a white potato has about 60 calories  and the same amount of carbs.

Given the slightly stringy/gritty texture of winter squash I expected squash to  be a good source of fiber.  I was wrong.  In fact one cup of winter squash  has less than a single gram of fiber.  Squash  also has a Glycemic Index (GI) of 70.  Since   current recommendations are to stay with foods with  a GI below 50, winter squash should not be an everyday  menu item.   To keep the GI from going higher, avoid adding  ingredients like brown sugar,honey or dried fruit to a squash  recipe.

Winter squash is super verrsitile. It  can be roast  in its shell or in peeled cubes, steamed, sauteed, mashed,  or made into soups, ravioli or spreads.  Just keep in mind that it has about twice the calories of a white potato.  Given that squash is not nearly as healthy as it looks, I like to cook it simply to avoid adding calories or carbs.  I’ve found that roasted peeled squash  helps me keep to a healthy portion  size, while a roasted half  has more carbs and calories than an entire meal.  I like  to use  squash to brighten up a meal but serve it only about  twice a month. 

Roast Butternut Squash

Ingredients: 1  whole butternut squash, 1 tablespoon of  olive oil, 1/4 teaspoon of cinnamon,

Steps:  Preheat the oven to 400F.  Peel the squash, take out the seeds and cut the squash into 2 inch cubes.  Toss with cinnamon and oil  and place on a baking sheet. Make sure the cubes are  in a single layer and  not touching.  Roast  for 25 minutes, turning after 10 minutes.

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Question and Answer– Retin A and the Eyes

Question:  If I can’t use Retin A ( aka retinoid) on my eyes,  what  can I use?

Answer:  I answer every email  that I get at  No-Nonsense Beauty Blog, but this one  is so relevant for all of us, I wanted to  put it in my Q& A.  While its  true that you can’t use  straight retinoids around the eyes,  a combination product of retinoids, a steroid and hydroquinone  known as Triluma can  deliver anti-aging benefits.   Triluma’s claim to fame is its ability to erase  dark spots and patches, but the retinoids  also  may build collagen and reduce wrinkling.  For reasons that are not clear, Triluma is  no longer available commercially, but a  full-service pharmacy can compound it specially for you.  I  did just that and uploaded up post about the process on March 28, 2012.

Triluma (  branded or custom made)  can only be used for  three  months at a time.  After a three month holiday, you can use it again.  Some people  don’t react well to Triluma  while others are turned off  by the steroids or hydroquinone, but there are other options.  Vitamin C, growth factors  or peptides  like Matrixyl   have shown to  at least reduce  lines around the eyes, but  its not always clear how much of these effective ingrdients are in a commercial product. Home lasers  like Palovia are approved by  the FDA for smoothing  crows feet and their before and after  pix are impressive.   And then there  always is Botox for instant results.

But whatever treatment you  choose,   prevention is not an option.  The first thing I do every  morning is to put on a sunscreen under and  around my eyes.  I smooth on a concealer fortified with sunscreen  that both hides dark circles and protects against sun damage.  THis is one of my favorite products and my current go-to concealers  is  Revlon Age Defying SPF25.  It’s less than $10, comes in a range of colors and  lasts for hours.   In warm sunny weather I keep one in my purse  for touch-ups. 

One last thought:  Wear   full size shades to both block UV rays and avoid squinting in bright light.  Over time, squinting  can etch deep wrinkles  all around the eyes.  In very sunny areas like Texas, doctors report  crows feet in  girls as  young as 15 due o  squinting in the  strong light.

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Melon Season is Here!

Nothing says the start of summer like the piles of round sweet melons  in supermarkets and farm stand tables.  Melons, including honeydew, watermelon, persian and casaba, are low calorie, affordable and offer a range of vitamins and minerals.

Waterrmelon is mostly water but its red flesh is a great source of   cancer fighting lycopene.  Cantaloupe  is the nutritional  rock star of the melon world.  The sweet rich orange  flesh is packed with  beta carotene, potassium, vitamin A ( 80% of RDA) and vitamin C ( 60% of RDA).  Since  both of these vitamins are closely linked  to  smoother less  wrinkled skin,  cantaloupes   should be part of  beauty diet.

In recent years there have been outbreaks of illness linked to cantoloupe contaminated during storage.  To reduce problems buy whole rather than cut-up melons and rinse throughly before cutting into them.  Most melons including cantaloupe  clocks in at about 30 calories /half cup and less than 8  grams of carbohydrate.  Nice.

What sets melons apart from other fruits is that they are usually served in thir natural state without the addition of  sugar and cream or butter.  Unlike apples, berries or apples that are baked into pies and cakes, melons are used au natural  for shakes  and snacks.   That being said one of my favorite summertime recipes is cold cantaloupe soup.  I first had this at the Ritz Carlton in Naples Florida and I  liked  it so much  I had it again every day  of that trip.   This recipe deliver a payload of calcium, protein and protein  as well the antioxidants in coconut  milk.

Cantaloupe Coconut Soup

Ingredients:  1/2 ripe cantaloupe, peeled and cut into 2  inch pieces, 1  15 oz can of lite  coconut milk, 1/2 cup  plain Greek yogurt, 2 teaspoons of brown sugar or 2 packs of Equal, fresh  mint sprigs

Directions: Drop cubes of peeled, seeded cantaloupe into food processor and blend until  almost smooth; add coconut milk,  yogurt and sweetener of choice  and process briefly to blend. Pour into little cups and top with a few fresh mint leaves.

I love to serve this makes as a cold soup with  tea sandwiches for a real girly lunch.  It also makes a wonderful  gender-free breakfast smoothie.

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Green Beans– An Anti-Aging Veggie with Style and Substance

There is something elegant about green beans.  Sweet and dainty they seem to the perfect companion to a crisp roast chicken or juicy pink  steak.  Green beans are used in a wide range of cuisines including french, chinese, italian, english  and indian–   and I  like all of them.  Restaurants and banquets  love  green beans because they can  be cooked in advance without going limp and grey.

I was psyched to learn that  for such a tastie veggie, green  beans had a very respectable anti-aging  profile.  One cup  clocks in at  just 31 calories .  While they are not high in fiber, the folacin and  skin friendly vitamin C levels are impressive.  Add about 20%  the RDA for vitamin A  and a daily serving of green beans  adds genuine anti-aging nutrition to any  diet.

I was  also intrigued to find out that green beans are actually immature versions of true beans.  In fact,  when they are mature and dry, they are higher in  protein, calories and carbohydrates that young green bean pods.  In the US, green snap beans are the  most popular form.  Italian broad beans, chinese long beans and skinnyFrench haricot vert have similar nutritional profiles, while yellow beans   have much lower levels of beta carotene.

I think of green beans as the chicken of vegetables in that  they can be used in so  many different dishes.  I love this anti-aging Greek style recipe that also contains tomatoes, onions and garlic– all of which add their own nutritional pay-off. Do you have a favorite  way of eating  them?

Greek Style Green Beans ( from the Mediterranean Diet Cookbook by Nancy  Jenkins)

Ingredients: 1 pound cleaned green beans, 1/3 cup chopped onions. small clove of garlic, chopped, 2 tbs. olive oil, 2/3 cup drained, canned whole tomatoes, chopped coarsely, 1 packet Equal or 1 teaspoon sugar, I teasp. lemon juice

Directions: In a saucepan large enough to hold  the beans, saute the onions and garlic on  medium heat until the onion is soft and starting to brown; Rinse the beans and toss into the onions; Stir, cover and cook  on  medium heat for 5 minutes; Uncover  the pan and add tomatoes andEqual ( or sugar).  Cover and cook on low heat for 35-40 minutes; Check every 10 minutes to  stir and make sure that the beans are not too dry;  When they are soft and  the  tomates dissolved into a sauce, add the lemon juice.  These beans can be served hot or room temperature.

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Diet for Beauty– Day One

Its  hard to open up a health or beauty magazine without an article that links diet and beautiful skin.  While its certainly a no-brainer that what we eat affects how we look I want substantive claims that directly link good nutrition  to smooth younger looking skin.   

Some of the best evidence comes from the National Health and Nutrition Examination Survey, aka  the NHANES study.  This  long ( ten year), large  (17K  men and women) study  compared daily food intake with a wide range of health issues including diabetes, heart disease and cancer.  But what makes this a must  keep study for me is the relationship they studied between diet and wrinkles.  To bottom line it, the NHANES found that  people on diets  high in protein, fiber, vitamin C, linoleic acid and omega 3  are linked to FEWER wrinkles.

Good to know, but what  does  this actually mean what  I should eat?   For answers I started  looking at different foods to see what benefits they could offer my skin.  Every other Friday, I’ve been  profiling a popular food item  trying to decide if they belong in my shopping cart or should be left behind on the supermarket shelf. Its actually been eye opening to check out nutritional breakdowns.  I’ve discovered that some favorites  eg artichokes and mussels are beauty diet superstars while others like peaches  are  not that  impressive.

I’ve now put all these posts into a new tab called Beauty Foods.  Looking at this growing list of  beauty diet rock stars, I decided to use them to design menus that could legitimately call themselves an anti-aging beauty diet.

Beauty Diet, Day 1

Breakfast:  2/3 cup of oatmeal ( fiber) with dried cranberries ( vitamin C)

Snack:  1/2 grapefruit ( vitamin C, fiber)

Lunch: Grilled cheese ( calcium) and tomato ( vitamin C) sandwich, carrot sticks( vitamin A, fiber)

Snack:  1/2 cup of  yogurt ( calcium), walnuts ( linoleic acid), an apple ( vitamin C, fiber)

Dinner:  bowl of steamed mussels ( omega-3, protein), spinach ( vitamin C ,vitamin A), sliced tomato ( vitamin C, lutein) and black olive (polyphenols) salad, basmati rice (  I just like it)

I was able to fit in eight foods that I had profiled.   They are widely available and I actually was able to eat this menu  on a weekend trip.  But its just one day.   Can you look at the list of  beauty diet foods and come up  with different menus?

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What supplements should I take for beautiful skin?

I so wish there was a  nutritional supplement  I could take that would make my skin smooth, soft and radiant.   But the links between beautiful  skin and nutrition are more complex than that.  The NHANES study looked at the relationship between health and diet and found that people whose diets were higher in vitamin C, fiber,  protein and linoleic acid  looked  younger and had fewer wrinkles.  But these benefits  were only there  when  the nutrients were from actual food– not where people took supplements.   I know first hand  how hard it is to find healthy food in a world dominated by burgers, tacos, pizza and take-out chinese food.  At lunchtime, I’ve walked for blocks with a rumbling tummy  trying to find a quick bite that wouldn’t shorten my lifespan.   A multi-vitamin supplement can cover  my dietary shortfalls  but won’t really give me the  juice  I need to slow aging.

That being said there are two nutrients which are  vital to good health but are almost impossible to get the amount we need  just from food alone:

Vitamin D-  Repeated studies have shown that low levels of vitamin D are linked  to a wide range of health problems including breast cancer, diabetes and high blood pressure.   For years the recommended daily allowance  (RDA)   has been 800  mg./day, about two servings of dairy products.   We can  create  our own vitamin D when exposed to sunlight, but  our use of sunscreens have actually lowered  vitamin D levels in most Americans.

  A few years ago physicians started  prescribing  vitamin D supplements at a scary 50,000 units/week.  Current recommendations are scaling  back this number to about 3000-6000 units per day.  My recent blood test showed pretty low vitamin D levels but  I hate  BIG pills so I’ve been taking a daily petite gel cap  with 2000 units.  In a few months the  test will be repeated and we’ll see  if these supplements are working.

Calcium– this is arguably  the most important mineral in the body– and we need alot of it. Calcium is essential for strong bones and  teeth. Current recommendations are 1000-12000mg/day for adults and its actually pretty hard to reach that number without  taking in some serously large portions of dairy products.  For example one ounce of cheese has 200 mg, 1/2 cup of  yogurt offers 190mg and 1/2 cup milk clocks in at just 100 mg of calcium.  Reaching  the RDA can be especially difficult for the millions of people who are lactose intolerant.

Calcium supplements usually supply about 1000 mg of  which 400 are actually absorbed.   If you do the math, two ounces of cheese, 1/2 cup milk and a calcium supplement  will get you where you want to go.  However  a single 1000 mg supplement is a pretty big pill to swallow.  Chewable antacids like Tums contain calcium carbonate, one of the most easily absorbed forms of calcium.  Afforadable and convenient,  popping a few Tums during the day  are an easy way to raise your calcium levels to healthy numbers.

Vitamin D helps your body absorb calcium which is why they are often combined  in a single supplement.  I find these large  pills daunting  and  stick to  small  vitamin D gel caps and Tums to  meet my nutritional goals.

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