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Dear Mark: Calcium for Women

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 [7] 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 [8] 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 [9], 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 [10] 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 [11], which can encourage calcium excretion, and limit alcohol [12], 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 [13].

Avoid chronic stress. Excess cortisol messes you up. You know that. It also decreases calcium absorption. In my book [14] (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 [15] 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 [16]

Cranberry Juice and UTIs [17]

Should I Be Taking Vitamin K2 Supplements? [18]