Calcium: Fitting it into a Dairy-Free Diet
Are you dairy-free? Make sure you're getting enough calcium.
“I avoid milk and cheese. They make me stuffy,” Susan explains as she hands me her food diary. Jamie, a woman I saw earlier in the week, reports that both gluten and dairy bother her stomach. In Alice’s case, dairy gives her chronic constipation. For these women, symptoms resolve after each eliminates milk, cheese, yogurt and ice cream from her diet. But each now worries about missing critical nutrients without the dairy—and with good reason.
Dairy is one of the foundations of the American diet, providing a significant source of protein, riboflavin, calcium and vitamin D. For vegetarians, dairy can also deliver needed vitamin B12.
Protein is easily obtained from non-dairy sources, such as meat, eggs, nuts, seeds and beans. Riboflavin (vitamin B2) can be found in liver, almonds, soybeans, spinach, beef, asparagus, eggs and mushrooms. Vitamin D is best obtained from sun exposure. There are very few natural food sources of vitamin D but a notable amount is provided in fortified milk, as well as fortified orange juice and almond milk.*
Dairy’s blockbuster nutrient is calcium. A cup of low-fat yogurt can have 400 mg of calcium. The next best non-dairy source is ˝ cup of tofu if it’s made with calcium sulfate. A cup of kale, considered an excellent vegetable source, has 100 mg. Salmon and sardines are good sources of calcium but only if you eat the bones.
The common argument against calcium supplements is that there are plenty of non-dairy sources, especially green vegetables. But the truth is that getting enough calcium without dairy products is a rarely achieved dream. The recommended amount of calcium for ages 4 and up is between 1000 and 1300 mg a day. That would take 2 cups of beans, ˝ cup of tofu and 7 cups of green vegetables per day.
Without dairy, people, especially women, need a calcium supplement.
When choosing a calcium supplement, the three most important considerations are (1) the delivery method, (2) the carrier of calcium and (3) other synergistic nutrients in the supplement.
Delivery method is either liquid, chewable, capsule or tablet. Capsules (either gelatin or vegetarian) are a good choice for calcium because they’re easier to swallow than hard tablets. They also dissolve easily and release their contents once they hit the stomach. Calcium pills tend to be large, reducing the chances that people will take them. In one well-known calcium study, half the participants neglected to take their supplements and ruined the research.
In my experience, there’s poor compliance with liquid calcium supplements unless people are highly motivated. The liquids and the better chewables tend to have a caulky texture but they’re the best choice for people who have trouble swallowing pills.
Many of the chewables are delicious and taste like candy. However, gummy chewables are bad for your teeth (ironic if you’re taking calcium to help your teeth and bones) and they don’t contain sufficient amounts of magnesium. Check the form of calcium in chewables, as many brands use the less desirable calcium carbonate. The better-absorbed calcium citrate is acidic, so have something in your stomach before taking it and brush your teeth afterward.
The carrier denotes the substance tied to the calcium. Mineral nutrients like calcium, magnesium, zinc and copper can’t be consumed as raw elements. They must be bound to a substance that carries the micronutrient into the body and releases it.
When calcium is used with its best carrier, the total percentage of elemental calcium in the supplement is lower. Calcium carbonate, the most concentrated and popular carrier, is 40 percent calcium by weight. It’s also the hardest to absorb. Calcium citrate, which is only 21 percent calcium, is more readily absorbed. One pill can hold 500mg of calcium carbonate but it takes 2 or 3 pills to get the same amount of calcium in the better absorbed, less concentrated calcium citrate.
Choose a supplement that doesn’t use just calcium carbonate but offers some combination of calcium chelate, malate, citrate, hydroxyapatite or other protein binder.
Beyond calcium, other synergistic nutrients aid absorption and are essential for bone health. Strontium, boron, vitamin K and silicon work together for better absorption to benefit your bones, but magnesium and vitamin D are most important.
So look for a calcium supplement that’s balanced with magnesium and contains some vitamin D for maximum utilization. (Vitamin D and magnesium can also be taken separately.) Magnesium helps convert vitamin D to its active form so the body can absorb the calcium. It also stimulates calcitonin, a hormone that takes calcium out of the blood and puts it into the bone.
Magnesium is non-toxic but too much can cause loose stools. (The laxative Milk of Magnesia is a concentrated form of magnesium.) A typical calcium and magnesium supplement is 2 parts calcium to 1 part magnesium. If you’re prone to constipation, consider a calcium/magnesium supplement with a 1 to 1 ratio.
Contact your health care provider if you have any questions about your calcium levels or questions about medication interactions. Calcium supplements are generally safe but as those with food sensitivities know, anything can bother anyone.
Licensed clinical nutritionist/dietitian Kelly Dorfman (kellydorfman.com) is author of Cure Your Child With Food. She practices in the Washington DC area.