Dairy Free Diets and Calcium
Calcium by Rae
Let’s get some clarity on calcium. Although there may be challenges to getting enough calcium without dairy, it’s very attainable. Knowing what your typical diet usually looks like and what your needs are, you can get the calcium you need with some planning.
The RDA for calcium for adults up to 70 years old is 1,000mg per day, then 1,200mg after that (NIH, 2022).
Lactose intolerance, menopause, veganism, lack of knowledge, lack of availability, and digestive problems are all common reasons people don’t get enough calcium. Typically, not all the calcium in foods is absorbed (Traverso, 2004). Keep reading for tips on what you can do to help optimize calcium absorption.
Bones
Calcium is the most plentiful mineral in the body. Almost all of it is in bones and teeth with a small amount in body fluids. Our bodies are constantly keeping body fluid calcium levels balanced for important body processes, like muscle contraction (NIH, 2018). Because calcium balance is very important, it’s under strict control. To regulate calcium, absorption can increase in the intestines, calcium loss can be reduced in kidneys, and calcium can be taken from bones (Sizer & Whitney, 2017, cited in Stanford University, 2019). Bones act as a reservoir of calcium for the body to be used when needed. Bone is dynamic tissue and continually forming and resorbing. Childhood is when the process of bone formation is fastest. The calcium in bone is resorbed, as needed, starting in later adulthood, which can lead to weakened bone structure, osteopenia, osteoporosis, and bone fractures usually during senior years if not getting enough calcium. Nutrition and appropriate calcium intake are key for quality of life over time (Hodges, 2019).
Lactose Intolerance
Lactose intolerance symptoms include gas, bloating, abdominal discomfort or pain. Other symptoms, like headaches, itching, breathing problems, could indicate an allergy or sensitivity to dairy, but not necessarily lactose intolerance. Lactose intolerant symptoms are a sign the small intestine isn’t making enough lactase, an enzyme that breaks down lactose. Most people with lactose intolerance can handle small amounts of dairy, often yogurt and hard cheeses, but it depends on the person. Calcium is still absorbed despite the symptoms (NIDDK, n.d.), (Institute of Medicine, 2006). You can have your bone density checked and talk with your doctor about lactose intolerance to find out if your symptoms are lactose intolerance or maybe an allergy. If you are lactose intolerant, you could try lactase supplements.
Other issues and nutrients
It’s natural for us to be interested in one nutrient at a time, like calcium but I encourage people to think about an overall diet. Bone health involves more than calcium alone.
Most people have a lot of salt in their diet, especially people who eat a lot of prepared foods. Restaurants usually use extra salt. Foods like frozen dinners, canned foods and ready-made meals from the grocery store usually use a lot of salt for flavor and as a preservative. The Upper Intake Limit for sodium for most adults is 2.3 grams per day (Institute of Medicine, 2006). A healthy diet will usually have enough sodium without having to add salt. Additional sodium can cause problems, especially over time. It’s a good idea to do our best to lower sodium intake. The body gets rid of excess sodium through urine, and it takes calcium with it. Studies have shown high sodium can increases calcium excretion (through urine) which can lead to bone loss (Teucher, 2008).
Magnesium also plays a role in how calcium is used and managed. Magnesium helps maintain balanced calcium levels (Teucher, 2008). A diet of a variety of healthy foods provides the nutrition we need, like calcium and magnesium. Good calcium balance is another reason why eating a diet of whole foods, mostly vegetables, with plenty of beans and whole grains is the best way to stay healthy through the years.
Calcium, magnesium and potassium interact together for maintaining blood pressure. Calcium levels in blood, in bone formation, and its absorption from foods, is managed by vitamin D. To optimize the use and absorption of calcium, it's important to get the right amount of all these nutrients (Lewis, 2018).
Non-dairy calcium foods are lower in saturated fat than dairy and often have fiber and other nutrients.
Foods to consider for calcium:
- Non-dairy substitutes like fortified soy milk, almond milk. Nut yogurt, coconut yogurt, checking the label because not all dairy substitutes have calcium.
- Milk without the lactose.
- Calcium set tofu. Check the label for calcium.
- Lactase supplements to help with dairy digestion.
- Vegetables like broccoli, bok choi, kale have a lot of calcium.
- Golden Delicious apple, with skin has about 10mg calcium.
- Seasonings high in calcium (to use instead of salt), like basil. 2 tablespoons have 9.4mg (nutritionalvalue.org, n.d.).
- For non-vegans, canned salmon or sardines with bones and look for low sodium.
- Chia seeds. 1 tablespoon has about 76mg calcium.
- Whole grain breads. Whole grain cereal like oat groats. Grains don’t provide as much as dairy, but they provide some along with other nutrients. 1 slice whole wheat bread has 30mg calcium (NIH, 2022).
Optimizing calcium
- If lactose intolerant, experiment with different ways to have dairy, or trying small amounts of different dairy products that tend to be more tolerable, like low fat yogurt and hard cheeses. Yogurt has bacteria that can help digest lactose and hard cheeses have less lactose. Parmesan with vegetables may be a good option (IOF, n.d.).
- Medications may interfere with calcium, so check with your doctor.
- Reduce sodium. A high sodium diet can cause calcium loss (Higdon, 2017), (Teucher, 2008).
- Exercise for healthier bones (IOF, n.d.). This is very important. A healthy diet is great, but exercise strengthens bones too. Bones are not built on calcium alone.
- Variety is important. Antinutrients can interfere with calcium absorption. Some foods have a lot of oxalic acid or phytic acid which can reduce the absorption, bioavailability, of calcium. Spinach, rhubarb, sweet potatoes, seeds, nuts, and unleavened bread are higher in them (NIH, 2022). Antinutrients are another reason vegans are at risk for low calcium. Variety helps. Smaller amounts of these foods mixed into meals can minimize the effects and improve calcium absorption.
- If you decide to take a calcium supplement, absorption is optimal taken with a meal at 500mg or less (Institute of Medicine, 2006). A higher dose doesn’t mean it’s better for you and supplements aren’t for everyone.
Excess calcium
The Tolerable Upper Intake level for calcium for most adults is 2,500mg per day up to age 50, then 2,000mg per day over 50 (NIH, 2022). Excess calcium can increase the risk of hardening of arteries with deficient magnesium, so make sure you have a diet with a variety of nutritious foods. High levels of calcium can interfere with the absorption of other minerals like zinc and iron. Excess calcium can also lead to hypercalcemia and renal insufficiency, and kidney stones (Institute of Medicine, 2006).
There are many studies regarding calcium supplements and cardiovascular disease with conflicting results. Age, gender, predisposition to heart disease, lack of exercise, diet, and other factors should be taken into consideration. Many of the studies have focused on older people, particularly women (Kittithaworn, 2023). Much of the data suggests that calcium supplements may increase the risks of heart disease for people who are predisposed to heart conditions (Myung, 2021). For the average healthy person there isn’t clear evidence of increased risk of heart disease with calcium supplements at low doses. The total of dietary and supplemental calcium intake should stay under the RDA (Kittithaworn, 2023), (Kopecky, 2016). In practice, this may not be simple to do. If you have a good idea of how much calcium you usually get in the foods you typically eat, you will have a better idea if and how often you could take a calcium supplement.
However, even if there aren’t any direct negative effects from a daily supplement dose of 400mg to 500mg, they could be missing out on all the other benefits from eating calcium rich foods. Overall, it’s best to try to get nutrition from foods rather than supplements for macro and micronutrients, and the pleasure of eating healthy food (DGA, 2020), (Harvard, 2020).
Dairy is a common source of ample calcium and people who don’t eat dairy have to be more engaged with nutrition care for calcium. The key is to know what healthy, delicious foods work best for you and your situation, and eat an overall healthy diet.
Sources
(DGA) Dietary Guidelines for Americans. 2020. https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf
Harvard Medical School. February 28, 2020. Could too much calcium cause heart disease? Harvard Health Publishing. Online article. Harvard https://www.health.harvard.edu/blog/study-links-too-much-calcium-to-heart-disease-20100812204
Higdon, J. 2017. Calcium. https://lpi.oregonstate.edu/mic/minerals/calcium
Hodges, J. K., Cao, S., Cladis, D. P., & Weaver, C. M. 2019. Lactose Intolerance and Bone Health: The Challenge of Ensuring Adequate Calcium Intake. Nutrients, 11(4), 718. https://doi.org/10.3390/nu11040718
Institute of Medicine. 2006. Dietary Reference Intakes: The Essential Guide to Nutrient Requirements. Washington, DC: The National Academies Press. https://doi.org/10.17226/11537.
(IOF) International Osteoporosis Foundation n.d. Fact Sheet. https://www.osteoporosis.foundation/sites/iofbonehealth/files/2019-03/2015_ServeUpDairyProducts_FactSheet_English_0.pdf
Kittithaworn, A., Toro-Tobon, D., & Sfeir, J. G. 2023. Cardiovascular benefits and risks associated with calcium, vitamin D, and antiresorptive therapy in the management of skeletal fragility. Women's health (London, England), 19, 17455057231170059. https://doi.org/10.1177/17455057231170059
Kopecky, S. L., Bauer, D. C., Gulati, M., et. al. 2016. Lack of Evidence Linking Calcium With or Without Vitamin D Supplementation to Cardiovascular Disease in Generally Healthy Adults: A Clinical Guideline From the National Osteoporosis Foundation and the American Society for Preventive Cardiology. Annals of internal medicine, 165(12), 867–868. https://doi.org/10.7326/M16-1743
Lewis, J.L. III. 2018. Overview of electrolytes. https://www.msdmanuals.com/home/hormonal-and-metabolic-disorders/electrolyte-balance/overview-of-electrolytes
Myung, S. K., Kim, H. B., Lee, Y. J., et. al. 2021. Calcium Supplements and Risk of Cardiovascular Disease: A Meta-Analysis of Clinical Trials. Nutrients, 13(2), 368. https://doi.org/10.3390/nu13020368
(NIDDK) National Institute of Diabetes and Digestive and Kidney Diseases n.d. Lactose Intolerance. https://www.niddk.nih.gov/health-information/digestive-diseases/lactose-intolerance
(NIH) National Institutes of Health, Office of Dietary Supplements. 2022. Calcium. Fact Sheet for Health Professionals. https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/
nutritionvalue.org n.d. Basil. https://www.nutritionvalue.org/Basil%2C_fresh_nutritional_value.html?size=2+tbsp%2C+chopped+%3D+5.3+g
Sizer, F.S. & Whitney, E. 2017. Nutrition: concepts and controversies. 14th ed. US: Cengage.
Stanford University. 2019. Course materials. Stanford University Center for Health Education.
Traverso, M. August 8, 2004. Calcium in the body. http://www.chemistry.wustl.edu/~edudev/LabTutorials/CourseTutorials/Tutorials/Vitamins/calcium.htm
Teucher, B., Dainty, J.R., Spinks, C.A., et. al. 2008. Sodium and Bone Health: Impact of Moderately High and Low Salt Intakes on Calcium Metabolism in Postmenopausal Women. J Bone Miner Res, 23: 1477-1485. https://doi.org/10.1359/jbmr.080408
