Betty is a Registered Dietitian who earned her B.S. degree in Food and Nutrition from Marymount College of Fordham University and her M.S. degree in Clinical Nutrition from New York University. She is the Co-Director and Director of nutrition for the New York Obesity Research Center Weight Loss Program.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Most people know that calcium is needed for strong bones, but it's also needed to help blood vessels and muscles contract and expand, to send messages through the nervous system, and to secrete hormones and enzymes. This is the most abundant mineral in your body and makes up 1%-2% of adult human body weight. Over 99% of it is stored in bones and teeth with the rest stored in blood, muscle, and other tissues.
How much do you need to consume?
There is a great deal of concern over Americans not meeting the recommendations for calcium intake. The recommendations for calcium are listed as an Adequate Intake:
*Breast milk has been shown to have a higher rate of calcium absorption than formula, so calcium requirements are higher for formula-based diets. Calcium needs during pregnancy and lactation do not change from ages 14 to 50.
What are sources of calcium?
Calcium is found in a variety of foods, but the amount that your body absorbs varies. Oxalic acid and phytic acid both interfere with the absorption of calcium. Foods rich in oxalic acid are spinach, rhubarb, sweet potatoes, and beans. Foods rich in phytic acid are unleavened bread, nuts, seeds, and raw beans. You will absorb some of the calcium in these foods, but not as much as you would from foods that do not contain oxalic acid or phytic acid. For example, calcium absorption from dried beans is about half of what you absorb from milk, and calcium absorption from spinach is about one-tenth of that absorbed from milk. There is no need to omit these foods from your diet. Instead, consume a variety of calcium-rich foods throughout the day.
According to the USDA Nutrient Database, the calcium content of some common foods is shown below:
adding nonfat powdered milk to cereals (hot and cold), soups, gravy, baked goods, or casseroles,
using nonfat milk in place of water in recipes (pancakes, pudding, hot cereals, and mashed potatoes), and
having yogurt dips for vegetable and chips.
Do I need to take a calcium supplement?
A well-balanced diet can be enough to reach your recommended intake of calcium. When diet is not enough, a calcium supplement may be necessary. In the case of calcium supplements, more is definitely not better. Calcium absorption is most efficient when the dose is 500 mg or less. This means that taking 1,000 mg at one time is less effective than taking two separate doses of 500 mg.
Calcium exists in nature combined with other chemicals. These compounds are what you will find in supplements and include calcium carbonate, calcium phosphate, calcium lactate, and calcium citrate. Calcium carbonate is the most common one because it is inexpensive and convenient. People who have decreased stomach acid (for
example, older adults and those who take antacids) are better off taking calcium citrate. According to the National Osteoporosis Foundation, "Calcium supplements prepared from unrefined oyster shell, bone meal, or dolomite may contain lead or other toxic metals," so you need to pay attention to the source of calcium in your supplement.
Calcium supplements may cause gas, bloating, and/or constipation. There may be options to help relieve this. You can try spreading out dosages of the supplement throughout the day, try taking it with food, try a different brand, or speak with your doctor or pharmacist for assistance.
What happens if I do not have enough calcium?
Bone is a living tissue that constantly breaks down and builds back up. Up until around the age of 30, consuming an adequate amount of calcium with enough physical activity ensures that your body builds more bone than it breaks down. The majority of adult bone mass is acquired by age 18 in girls and 20 in boys. After that, breakdown typically exceeds the amount of bone being built. For this reason, it's essential to maximize bone stores when it's still possible. The amount that you lose after age 30 will be impacted by genetics, ethnicity, physical activity level, sex hormone levels, diet, and gender. You can replace what you lose with the foods you eat and your activity level, but you can't increase how much you store. When bone mass drops and there is a deterioration of bone tissue, osteoporosis can occur. Osteoporosis causes bones to be susceptible to fractures. Depending on the severity of the damage, bones can break from a minor fall, or in severe cases, from sneezing.
Other factors can put you at risk for low calcium levels.
Amenorrhea: Research has shown that young women who do not get their period due to anorexia nervosa have reduced net calcium absorption, higher urinary calcium excretion, and a lower rate of bone formation in comparison to those who menstruate regularly. Reduced calcium retention and lower bone mass have also been seen in exercise-induced amenorrhea.
Lactose intolerance: Many people find that consuming dairy products causes bloating, gas, cramping, and/or diarrhea. This is often from your body's inability to break down the lactose found in dairy foods. Lactose is the sugar that naturally occurs in these foods. Avoiding dairy foods can put you at risk for calcium deficiency. Fortunately, there are things that you can do to help with these symptoms. The first thing is to try to consume smaller amounts of dairy foods. Studies have shown that people with lactose intolerance can often tolerate 8 oz of milk at once. When this doesn't work, you can purchase dairy products that have the lactose broken down for you. Lactaid products have taken the lactose and broken it up so that your body does not have to.
Is there such a thing as too much calcium?
The Tolerable Upper Limit (UL) for calcium for children and adults ages 1 year and older is 2,500 mg/day. Excessively high intakes would have to come from supplements alone or supplements in combination with dietary sources. The dangers of excessive consumption are impaired kidney function, hypercalcemia, and decreased absorption of other minerals (iron, zinc, magnesium, and phosphorus). Calcium has been shown to interfere with iron absorption. It's best to take the recommended amounts of calcium separate from iron-containing foods or supplements.
Calcium also has the potential to interact with medications by decreasing the absorption of the medication. Some common affected medications are digoxin, fluoroquinolones, levothyroxine, antibiotics in tetracycline family, and phenytoin. Your doctor and pharmacist can provide further information about this.
There are many symptoms involved in the 1st, 2nd and 3rd trimesters of pregnancy. The first early pregnancy symptom is typically a missed period, but others include breast swelling and tenderness, nausea and sometimes vomiting, fatigue and bloating. Second trimester symptoms include backache, weight gain, itching, and possible stretch marks. Third trimester symptoms are additional weight gain, heartburn, hemorrhoids, swelling of the ankles, fingers, and face, breast tenderness, and trouble sleeping. Read more to learn about recommended procedures and tests for each stage of a healthy pregnancy.
There are many causes of scalp hair loss. This featured article covers the common ones such as patchy hair loss (alopecia areata, trichotillomania, and tinea capitis), telogen effluvium, and androgenetic alopecia (male-pattern baldness, female-pattern baldness).
Learn about osteoporosis, a condition characterized by the loss of bone density, which leads to an increased risk of bone fracture. Unless one experiences a fracture, a person may have osteoporosis for decades without knowing it. Treatment for osteoporosis may involve medications that stop bone loss and increase bone strength and bone formation, as well as quitting smoking, regular exercise, cutting back on alcohol intake, and eating a calcium- and vitamin D-rich balanced diet.
Osteopenia is a bone condition characterized by bone loss that is not as severe as in osteoporosis. Bone fracture is the typical symptom of osteopenia, though the condition may be present without symptoms. Treatment involves lifestyle modifications (quitting smoking, not drinking in excess) and ensuring an adequate intake of vitamin D and calcium.
Hypercalcemia is a condition in which calcium levels in the blood are elevated. Hypercalcemia is associated with other conditions such as hyperparathyroidism, lung cancer, breast cancer, kidney failure, and elevated levels of vitamin D. Symptoms of hypercalcemia include constipation, nausea, abdominal pain, kidney stones, to name a few. Treatment depends on the cause of hypercalcemia.
Pregnancy planning is important to help prevent exposure of the mother and fetus to potentially harmful medications and substances during the early days, and throughout the pregnancy. Nutritional planning, prevention of birth defects, conditions such as high blood pressure, heart disease, diabetes, and kidney disease need careful monitoring. Gestational diabetes, preeclampsia, and pregnancy induced hypertension are conditions that may arise during pregnancy. Immunizations, inherited disorders, exercise, air travel, intercourse, and birth control are important factors to consider when planning a pregnancy.
Rickets is caused by a deficiency of vitamin D, calcium or phosphate. Infants and children who are exclusively breastfed, have dark skin, and infants born to mothers who are vitamin D deficient are most at risk for developing rickets. Symptoms and signs of rickets include bone pain, delayed teeth formation, short stature, skeletal deformities (bowlegs, abnormally shaped skull), and decreased muscle strength. Treatment of rickets depends upon the cause, but the first step usually involves correcting any abnormal levels of calcium, phosphate, or vitamin D with supplements.
Vitamin D deficiency has been linked with rickets, cancer, cardiovascular disease, severe asthma in children and cognitive impairment in older adults. Causes include not ingesting enough of the vitamin over time, having limited exposure to sunlight, having dark skin, and obesity. Symptoms include bone pain and muscle weakness. Treatment for vitamin D deficiency involves obtaining more vitamin D through supplements, diet, or exposure to sunlight.
Enjoying a healthy diet helps to prevent diseases. A good diet also helps to control celiac disease, diabetes, and high blood pressure and maintain health by preventing loss of bone mass, muscle strength, and vitamin deficiencies.
Children's health is focused on the well-being of children from conception through adolescence. There are many aspects of children's health, including growth and development, illnesses, injuries, behavior, mental illness, family health and community health.
The importance of a healthy lifestyle in disease prevention is widely understood and most people know that lifestyle changes and choices can be critical to good health. Yet, few practice healthy behaviors that constitute healthy living.
Disease prevention in men includes routine screening tests that are part of basic prevention medicine. Take an active role in your own health care and discuss screening tests with your doctor early in life. Age of screening and timing of screening depends upon the condition being assessed.
Disease prevention in women includes screening tests that are a basic part of prevention medicine. All screening tests
are commonly available through your general doctor. Some specialized tests may be available elsewhere.
Setting a good example for your children when it comes to diet and exercise will help them to make healthy decisions about nutrition and fitness. Eating calcium-rich foods and performing weight-bearing exercise will help your children prevent osteoporosis and fractures later in life.
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