Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
4 May

Dear Mark: Calcium for Women

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Dear Mark,

I have been following the PB way of life quite closely now for about five months, and I haven’t felt or looked better!  Well, following it closely except for the dairy part. My question here is “How do I get all my calcium following the PB?” Also, as a female do I need more calcium than a male as we are lead to believe this by normal mainstream information? I guess my problem is I really don’t know how much calcium I should be having as the information ‘out there’ can be misleading and conflicting too. I am worried that I may be doing myself some harm later in life if osteoporosis could stem from not having much dairy.

Thanks to Sonya for this week’s question. I always believe in having a long term vision for your health, and the question is an important one for that plan. The National Academy of Sciences currently recommends 1000 mg/day for women ages 19-50 and 1200 mg/day for women 50+ (post-menopausal women being the real target here). I tend to think that this is probably more than most women need – and definitely higher than most men require. (I’d suggest that pregnant or nursing women maintain these higher levels though.) The fact is, the vast majority of people around the world consume much less calcium than we do in the U.S. (primarily because they eat less dairy), and these populations generally have much lower rates of osteoporosis. On the flip side of this picture is our society’s situation: high calcium intake and sizeable osteoporosis rates.

The fact is calcium recommendations are the subject of ongoing debate. The tide of expert opinion, however, is more recently steering toward lower intake of calcium itself and higher intake of those vitamins and minerals that work in concert with calcium and/or are independently supportive of bone health. Let me tackle both the calcium/other nutrient subject and the dairy issue.

First, the nutrients… Ironically, too much calcium can inhibit the absorption of another mineral that the body needs for bone health: magnesium, which aids in bone formation and helps regulate calcium transfer as well as maintain bone density. (They compete for the same absorption pathways.) Most of us could use more of this mineral. Think leafy greens, seeds, nuts, fish. On the same note, vitamin D is absolutely essential for bone density and may be more important than calcium. As I’ve mentioned time and again, we tend to be sorely lacking in that department. Among the other nutrients crucial for bone health? Add vitamin K and boron (important for bone formation among other regulatory activities) to the list.

And it’s not just about isolated nutrients. As part of the intricate homeostatic mechanisms, the body routinely takes calcium from the bones to counterbalance any increase in acidity. As a result, an alkaline environment is important for calcium absorption. (Diets high in grains are especially problematic in this regard.) An “alkaline” diet includes copious amounts of fresh fruits and vegetables. The potassium in those fruit and vegetables helps regulate acid load. Beyond the questions of acid/alkaline, produce appears to protect in other ways too. A study out earlier this year suggests that the protective antioxidant properties of fruits and veggies (found in their natural pigments) help stave off bone loss in older men and women, presumably by reducing the oxidative stress that contributes to bone breakdown.

As to the dairy, it’s true that dairy products offer among the highest amounts of calcium in any food. However, dairy is acid-forming, which counters the alkaline ideal for absorption. The fact is dairy isn’t necessary for adequate calcium intake and/or bone health. As mentioned, most of the world is testament to that (and let’s not forget Grok’s prior two million years of dairy-free living). On a timely note, research out last month showed that Buddhist nuns who ate a vegan diet and consumed less than 400 mg of calcium daily had the same bone density as non-vegetarian women who consumed 1000 mg of calcium each day. I’m hardly backing a vegan diet by mentioning this study. Nor do I think it’s the best designed research out there, but it’s another illustration of the non-necessity of dairy in a healthy diet.

Ultimately, bone health depends on a number of factors – a constellation of nutrition, activity, and various hormone factors. Here are my nutrient and lifestyle recommendations to maximize calcium absorption and overall bone health…

Get your calcium from alkaline-forming foods like leafy greens, nuts, broccoli, sweet potatoes and calcium-rich fish like wild salmon and sardines.

Eat a diet high in antioxidant fruits and veggies. Go low to moderate on carbs to help maintain hormonal balance, and eliminate grains (phytates in grains can bind to calcium and decrease absorption). Reduce caffeine, which can encourage calcium excretion, and limit alcohol, which can decrease bone density and strength over time.

Ensure adequate vitamin D primarily by spending quality time out in the sun and by taking a supplement containing D3 if need be.

Do plenty of weight-bearing exercise to maintain bone density. I’d recommend a combination of resistance training and some impact interval activities like sprints.

Avoid chronic stress. Excess cortisol messes you up. You know that. It also decreases calcium absorption. In my book (coming soon!), stress is a huge reason we see rampant osteoporosis in our society.

If you’re still concerned about calcium intake, you can always consider a good supplement that includes not just calcium but vitamin D3 and magnesium. In terms of additional therapies for those at risk, research suggests that an aspirin regimen can help treat osteoporosis by balancing bone formation and resorption rates. Of course, talk to a trusted physician about these possibilities in your overall treatment plan.

As always, thanks for your questions and comments, and keep ‘em coming!

Further Reading:

The Definitive Guide to Primal Supplementation

Cranberry Juice and UTIs

Should I Be Taking Vitamin K2 Supplements?

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. Thank you for writing this. Definitely a helpful clarification.

    Holly wrote on May 4th, 2009
  2. I’ve read that goats milk (which is what 70% of the world drinks) is not acid forming like cows milk. Goat milk compares quite favorably to cow milk with dramatically more vitamin A and the B vitamin niacin, a higher amount of calcium, and 20% less cholesterol – all without extra calories! Also much lower in casein and the fat molecules are 5 times smaller. I got some for the first time a couple of days ago (raw of course) and I can’t tell the difference between it and cow milk.

    Dave, RN wrote on May 4th, 2009
  3. I believe this may be the first time I’ve been informed that I don’t need more than the RDA. Good to know!

    Mike T. wrote on May 4th, 2009
  4. Thank you for addressing this topic. What about the calcium : phosphorus ratio? I have heard that because milk is higher in phosphorus, the actual absorption of calcium is not that great. Also, there are phospates added to so many foods… I know this group is not eating a lot of processed foods anyway, but they seem to be everywhere!

    DJ wrote on May 4th, 2009
    • you need as much phosphate as you need calcium to build up calcium phosphates in your bone cells… phosphorous is rarely mentioned only because it is generally more abundant than calcium but a deficiency is just as bad

      mm wrote on July 31st, 2010
  5. “As part of the intricate homeostatic mechanisms, the body routinely takes calcium from the bones to counterbalance any increase in acidity. As a result, an alkaline environment is important for calcium absorption. (Diets high in grains are especially problematic in this regard.)”

    Yes! Yes! Yes!

    Nate wrote on May 4th, 2009
  6. “Avoid chronic stress. Excess cortisol messes you up. You know that. It also decreases calcium absorption.”

    So for those of us already in midstage adrenal fatigue (characterized with lower than average levels of cortisol), what happens to calcium absorption then? Of course, when the adrenals are pooped out, calcium intake is not as high on the priority list as is repairing the adrenals…

    Jennifer wrote on May 4th, 2009
  7. Mark,
    Great article. I think we need to be careful when looking at studies that compare American health with those in other parts of the world. For instance it may be true that Americans eat more dairy and have a higher incidence of osteoporosis than other countries but you also have to factor in that Americans live longer as well. In places such as Africa the life expectancy is very low and medical examination and treatment are non-existent in many areas and so there are probably many many cases that never get diagnosed or never occur due to death at a young age.
    Also I am not sure what is meant by the alkaline and acidic effects of foods. I will quote for Dr Joe Schwarcz’s Book “An Apple a Day”: “Human blood chemistry is a marvellously buffered solution, meaning that it resists change in acidity. It doesn’t matter what we eat or drink; our blood contains substances that can act as acids or bases to maintain our blood pH at 7.4. The only body fluid that responds to diet in terms of pH is urine. Breads, cereals, eggs, fish meat and poultry can make the urine more acidic while most but not all fruits and vegetables make the urine more alkaline.”
    Overall I would have to agree with you though that dairy is non-essential. If you look at the rates of lactose intolerance in the world it clearly shows that after the age of about two years old we just don’t need the ability to digest lactose anymore. A well balanced primal diet is totally sufficient to give us all the calcium we need.

    Jeff wrote on May 4th, 2009
    • So, they don’t autopsy anyone to determine the cause of death/general health in all of those other countries? Not even when making a comparative study of oesteroporosis?

      Also,
      “It doesn’t matter what we eat or drink; our blood contains substances that can act as acids or bases to maintain our blood pH at 7.4.”

      One of those “substances” happens to be at times a calcium hydroxide base to neutralize acidity

      mm wrote on July 31st, 2010
  8. The fact that vegetables like broccoli, spinach, and asparagus are such excellent sources of calcium gets totally obscured by the marketing clout of the National Dairy Council.

    Greg at Live Fit wrote on May 4th, 2009
  9. Try seaweed wraps (sushi style), garlic and watercress, too! Spinach in your eggs. Lots of people can’t digest dairy and still get plenty of calcium. I’ve gone without dairy (other than cream, eggs) for about four years and came out fine on my bone density testing, even with some risk factors. Weight-bearing exercise is important, I think. It’s a good thing to be aware of. Yet another MDA blog of interest and relevance!

    DThalman wrote on May 4th, 2009
  10. Question: is decaf coffee as bad as or worse than regular coffee as it relates to calcium being leeched from the bones to marvelously buffer the blood?

    Meese wrote on May 4th, 2009
    • Coffee (chocolate, etc) are HIGH in phytic acids that bind with nutrients, especially minerals and flush them out of your body.
      Coffee is very very, VERY BAD.

      Primal Palate wrote on June 27th, 2011
  11. As a dairy free family, we drink a lot of homemade bone broths for calcium and other minerals. It’s a delicious way to get calcium in, especially when made into soups.

    By the way, part of the reason that Americans can consume large amounts of diary and still have bone problems is because their milk is pasteurized which adversely effects calcium absorbency. Raw milk is considered PH neutral by many (so it won’t have the acidic effects of pasteurized milk), and it’s calcium is also much easier to absorb.

    But I agree, we don’t need diary for calcium.

    Kimi @ The Nourishing Gourmet wrote on May 5th, 2009
    • No we dont need dairy..but in the old days people ate the marrow from bones in many dishes. Germans use marrow to glue dumplins of all kinds together, marrow and eggs is used. Especially the dumplins that go into all kinds of soups which have been consumed several times per week.

      I know so because my mother and both grandparents made them coming from 2 different countries in europe.

      Humans can’t break down cellulose in plants (or it is extremely difficult)and therefor calcium and many other nutrients are locked away and inaccessible to us. You’d have to graze ALL day long like a cow on vegetables to come up with the daily amount needed for proper bones.

      If you’re dairy free, make sure you eat plenty of bone marrow, blood, liver and glands from animals. (On top of bone broths). And add fermented drinks to your meals for added enzymes, such as fermented beet juice.
      I agree, the dairy from stores that’s pasteurized is quite bad. A toxic soup of puss, blood and grain-garbage fed milk that needed to be pasteurized. This is why many feel ill after drinking store milk.

      Primal Palate wrote on June 27th, 2011
  12. oops! I meant “we don’t need dairy” :-)

    Kimi @ The Nourishing Gourmet wrote on May 5th, 2009
  13. Very informative article. Thank you for writing it.

    Harrie wrote on May 7th, 2009
  14. Calcium is not used to counteract acidity. Ca2+ simply cannot do so in any way. Increased calcium excretion is a byproduct of hydroxylapatite (main mineral in bones and teeth) catabolism. The “active” substance liberated from hydroxylapatite by the body is phosphate which is used as a pH buffer, calcium is only its counterion. You can counteract “acidic foods” by eating more phosphate (dairy, meat, eggs and organs contain a lot of it) or (bi)carbonate (fruits and vegetables). Besides even without phosphate, healthy kidneys can excrete protons indirectly by ammoniogenesis main substrate being glutamine (an aminoacid readily formed from other aminoacids in the liver). The acid-alkaline food theory is mostly useless when it comes to a healthy person with healthy kidneys and liver eating mostly unprocessed foods. Living on fractionated protein powders may cause excessive bone mass loss through this mechanism but this is an extreme example having little in common with normal eating habits.

    Seth wrote on May 9th, 2009
    • Interesting.

      But we still need phosphorous to build bones, so it’s almost like when we take calcium supplements we’re taking the wrong essential mineral.

      I wonder what are the signs of phosphorous deficiency for people whose kidneys can’t take out those hydrogen atoms/protons as easily…

      mm wrote on July 31st, 2010
  15. I remember learning that a large protein consumption leeches calcium from the bones… and that is why americans have such high incidence of osteoporosis…and why certain tribal people (ie who DON’T have high protein) can have strong bones w. a very low calcium intake. Nutrition is still murky.

    Milemom wrote on May 11th, 2009
  16. Great post and thanks for tailoring PB diet info specifically for women. @Jeff, here are a few articles that helped me better understand acid-alkaline balance (in my case, especially how it related to bone health):
    pH and bones: the science

    ACID-FORMING FOODS
    ALKALINE-FORMING FOODS

    Jacqueline wrote on May 28th, 2009
  17. quitting dairy cleared up my allergies and asthma. i’m now asked “where do you get your calcium then?”. i eat a lot of the foods leafy greens, nuts, broccoli and wild salmon… but honestly i’ve never really worried about it.

    this post was awesome.. thanks mark!

    Hart wrote on June 2nd, 2009
  18. But isn’t meat acidic, too? Yet we are supposed to be eating meat!

    Shelly wrote on November 9th, 2010
  19. i’ve read that the calcium in green veggies are hardly even absorbed. You’d have to eat gargantuan-sized amounts to even get a little bit of absorption from veggies .

    Shelly wrote on November 28th, 2010
  20. http://www.ncbi.nlm.nih.gov/pubmed/22081694

    “Recently the lay press has claimed a hypothetical association among dairy product consumption, generation of dietary acid, and harm to human health. This theoretical association is based on the idea that the protein and phosphate in milk and dairy products make them acid-producing foods, which cause our bodies to become acidified, promoting diseases of modern civilization. Some authors have suggested that dairy products are not helpful and perhaps detrimental to bone health because higher osteoporotic fracture incidence is observed in countries with higher dairy product consumption. However, scientific evidence does not support any of these claims. Milk and dairy products neither produce acid upon metabolism nor cause metabolic acidosis, and systemic pH is not influenced by diet. Observations of higher dairy product intake in countries with prevalent osteoporosis do not hold when urban environments are compared, likely due to physical labor in rural locations. Milk and other dairy products continue to be a good source of dietary protein and other nutrients. Key teaching points: Measurement of an acidic pH urine does not reflect metabolic acidosis or an adverse health condition. The modern diet, and dairy product consumption, does not make the body acidic. Alkaline diets alter urine pH but do not change systemic pH. Net acid excretion is not an important influence of calcium metabolism. Milk is not acid producing. Dietary phosphate does not have a negative impact on calcium metabolism, which is contrary to the acid-ash hypothesis.”

    Lorin wrote on March 31st, 2014
  21. I take a calcium-magnesium supplement everyday. 500 mg calcium citrate and 200 mg magnesium citrate plus vitamine c. I started taking this after having severe insomnia and the inability to relax. I was taking magnesium by itself at first but it did not solve the insomnia (it worsened it if anything). The night I took calcium I slept like a baby. Ever since I have been taking calcium however I think it is negatively influencing my health. I have been suffering with depression, mood swings, low blood pressure (calcium linked to blood pressure), brain fog and excessive peeing. I am not saying that calcium is the main assaulter but I wonder if calcium is playing a role in this. However, I am bit afraid of quitting calcium as I am afraid it will bring back the insomnia.

    Groentje wrote on July 28th, 2014

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