ARFP

Autumn Road Family Practice

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Calcium and Osteoporosis

This information on the dietary aspects of osteoporosis and calcium is provided as information for general healthy lifestyle and should not be considered a substitute for seeking nutrition advice from your own doctor. Topics covered in this article include:

  1. Using food and supplement labels to assess calcium intake;
  2. Percent Daily Value for calcium in some foods;
  3. Additional dietary concerns;
  4. Help for lactose-intolerant people;
  5. Considerations when taking calcium supplements.

For additional information about diet and osteoporosis as well as other factors influencing bone health, an excellent resources are the National Osterporosis Foundation site.

Using Food and Supplement Labels to Assess Calcium Intake

Calcium, a major component of bones, is one of the dietary factors most frequently mentioned in relation to osteoporosis. You can use the product label to learn how much calcium is in packaged foods. The Food and Drug Administration (FDA) uses the term "Percent Daily Value" (% DV) to describe the amount of calcium a product  provides in relation to the general U.S. population's daily needs.

The 100% DV level for calcium is 1,000 mg.

On the Nutrition panel of a product, the % DV  tells how much calcium one serving provides in relation to 1,000 mg. For example: If a supplement provides 200 mg of calcium per tablet, the label would show a 20% DV for calcium (200/1,000 = 20%).

The serving size on the nutrition label of foods is based on what people typically eat -- it is not a recommended amount. The serving size is given on the panel too.

You can calculate your calcium intake from a specific food or supplement, by using the serving size and the % DV on the label. For example, if the serving size listed on a package of frozen corn is 1/2 cup and this amount provides 3% of the calcium DV. If you eat TWICE this amount (1 cup), you will consume 6% of your daily calcium recommendation.

Percent Daily Value For Calcium In Common Foods

To start you thinking about your dietary calcium intake, here's the approximate % DV for some common foods. Check actual food labels for a more exact amount. These amounts are based, in part, on information provided in: "Calcium! Do You Get It?," by the U.S. Food and Drug Administration/Center for Food Safety and Applied Nutrition.

Grain Products Group

  • Ready-to-eat cereal, calcium, fortified. Serving size varies; check product label.

Vegetable Group

  • Broccoli with cheese; 1/2 cup = 20% DV
  • Collards; 1/2 cup = 20% DV
  • Turnip greens; 2/3 cup = 15% DV
  • Kale; 2/3 cup = 10% DV
  • Bok choy; 1/2 cup = 10% DV
  • Broccoli; 1 stalk = 6% DV

Fruit Group

  • Orange juice, calcium-fortified; 1 cup = 30% DV

Milk Group

  • Yogurt; 8 oz. = 35%
  • Milk, whole, 2%, 1%, skim, chocolate; 1 cup = 30% DV
  • Cheese; 1 oz. = 20% DV
  • Milk pudding; 1/2 cup = 10% DV
  • Frozen yogurt; 1/2 cup = 10% DV
  • Ice cream; 1/2 cup = 6% DV
  • Soy milk, calcium-fortified; 1 cup = 30% DV

Meat & Bean Group

  • Tofu prepared with calcium sulfate; 3 oz. = 60% DV
  • Baked beans with sauce; 1/2 cup = 8% DV
  • Pork & beans with sauce; 1/2 cup = 6% DV

The main dietary sources of vitamin D are fortified milk (400 IU per quart), some fortified cereals, cold saltwater fish (for example: salmon, halibut, herring, tuna, oysters and shrimp) and some calcium and vitamin/mineral supplements. Also, vitamin D can be manufactured in your skin following direct exposure to sunlight. The amount varies according to such factors as time of day, season and latitude.

Additional Dietary Concerns

While dietary calcium and vitamin D are important in helping prevent or treat osteoporosis, the following dietary concerns also come into play.

  1. Food is best calcium source.

  2. Total calcium load at one time. Your body can best handle about 500 mg of calcium at one time, whether from food or supplements. If you take a calcium supplement take one at a time with a meal.

  3. Fiber. High amounts of fiber can interfere with calcium absorption.

  4. Caffeine. Excessive caffeine can increase urinary excretion of calcium.

  5. Excessive sodium. Excessive sodium can increase urinary calcium excretion. Try not to use extra salt at the table. 

  6. Alcohol. More than moderate alcohol use can decrease your calcium.

  7. Soft drinks. When soft drinks or sodas replace milk as a beverage, you are reducing the calcium content of their diets.

  8. Protein. Unbalanced, excessively high protein diets could increase urinary excretion of calcium.

  9. Soy. Soy is a healthy food but not a high source of calcium.

  10. Fruits and vegetables. Medical studies show that a diet high in fruits and vegetables helps maintain bone mineral density. The Food Guide Pyramid recommends 2 to 4 daily servings of fruits and 3 to 5 daily servings of vegetables. Choose from a variety of fruits and vegetables daily. Try many colors and many kinds.

Help For The Lactose-Intolerant people

If you lack the enzyme needed to digest lactose (milk sugar), you still may be able to obtain calcium from dairy products.

These suggestions might work for you:

  1. Eat only small portions of dairy foods.

  2. Combine dairy foods with other foods. Eat dairy foods in combination with a meal or solid foods.

  3. Try non-milk dairy foods. Consider dairy foods other than milk. Many cheeses (e.g. Cheddar, Swiss, Parmesan) contain less lactose than milk.

Considerations When Taking Calcium Supplements

If you're unable to obtain the recommended amount of calcium from your diet, the following tips will help you achieve the most benefit from calcium supplements. Always read the directions carefully. NOTE: Some supplements may require more than one tablet to achieve the amount of calcium listed in the serving size.

  1. Calcium carbonate. This supplement requires acid to dissolve and for efficient absorption. As we age, we may not produce as much stomach acid between meals. It's usually recommended a person take calcium carbonate at mealtime when the stomach produces more acid. It is not as well absorbed if you are on a acid reducing medication.

  2. Calcium citrate. This supplement tends to be more expensive than calcium carbonate but doesn't require stomach acid for absorption.

  3. Vitamin D. Choose a calcium supplement with vitamin D unless you're already getting vitamin D from other sources.

  4. Total calcium load at one time. Your body can best handle about 500 mg of calcium at one time, whether from food or supplements. Consume your calcium supplements and calcium foods throughout the day rather than all at one time.

  5. Food is still important. High calcium foods also contain other nutrients that are important in the diet. You should not try to obtain all your calcium from calcium-fortified orange juice and candies.

In assessing your diet, also consider the other dietary factors and supplement useage guidelines that influence your bones. Before leaving the topic, remember weight-bearing exercise, adopting a healthy lifestyle with no smoking or excessive alcohol use, and getting recommended bone density tests and medications when appropriate are other important steps in preventing osteoporosis.