Calcium

What is calcium?

Calcium is a mineral that is very important for:

• bone health
• teeth
• nerves
• muscles
• blood clotting.

If you do not get enough calcium in your diet you may be at risk for losing calcium from your bones, making them thinner and weaker. This condition is called osteoporosis.

How much calcium do I need?

How much calcium you need depends on your age.

The recommendations are:

Group                      Calcium/Day
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Children 1 to 3               500 mg
Children 4 to 8               800 mg
Children 9 to 18             1300 mg
Adults 19 to 50              1000 mg
Women 51 to 70               1200 mg
Men 51 to 70                 1000 mg
Adults over 70               1200 mg
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* mg = milligrams

What are good sources of calcium?

Milk products are one of the best sources of calcium. Calcium is also in a variety of other foods, but if milk products are not a part of your daily diet, it may be hard to get enough calcium from the foods you eat. The following table shows approximate amounts of calcium in various food sources for this nutrient.

Dairy Foods (Milk Products)        Serving Size  mg Calcium
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Plain yogurt, low fat/fat free            1 cup  415 to 450
Fruit yogurt, low fat/fat free            1 cup       350
Milk (fat-free, low-fat, whole)           1 cup       300
Frozen yogurt (fat-free, low-fat, whole)  1 cup       210
Reduced-fat cheddar cheese                1 oz        120
American cheese                           2 oz        323
Swiss cheese                              1.5 oz      336
Cheddar cheese                            1.5 oz      307
Mozzarella, part-skim                     1.5 oz      311
Ricotta cheese, part skim                 1/2 cup     355
Cottage cheese, reduced fat               1/2 cup      75
Calcium-fortified cottage cheese          1/2 cup     300
Cheese pizza                              1 slice     220
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Nondairy Foods                   Serving Size  mg Calcium
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Calcium-fortified orange juice         1 cup       300
Corn tortillas (lime treated)          3           130
Waffle, 7-inch round                   1           180
Pancakes, 4-inch round                 2           115
Beans, dried (cooked)                  1 cup        90
Soybeans (cooked)                      1/2 cup      90
Tofu (processed with calcium sulfate)  1/2 cup     253
Soy drink (calcium-fortified)          1 cup       370
Salmon with small bones                3 oz        180
Broccoli (raw)                         1 cup        90
Almonds                                4 oz         80
Calcium-fortified cereal               1 oz    235 to 1043
Chinese cabbage, raw                   1 cup        74
Turnip greens boiled                   1/2 cup      99
Kale, cooked                           1 cup        94
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Calcium content and availability will vary depending on the type of food, fat content processing, and brand. The calcium in some of the nondairy foods, such as vegetables, beans, and soy, is not absorbed as well as the calcium in milk products. Although foods fortified with calcium make it easier to meet daily calcium needs, it still can be hard for your body to absorb enough calcium if dairy foods are not a part of your diet. If possible, get your calcium from a variety of foods, including milk products.

Do I need a calcium supplement?

If you can get enough calcium in your diet, you do not need to take calcium supplements. If you cannot have milk products in your diet, or they must be limited, ask your healthcare provider or dietitian if you should take a calcium supplement.

You are more likely to need a supplement if you:

• Have digestive problems or other types of reactions if you drink or eat milk products (such as lactose intolerance or milk allergy).
• Have osteoporosis or osteopenia (weakened bones).
• Are pregnant or breast-feeding.
• Are a vegan vegetarian (don't eat any animal products).
• Do not eat a healthy diet.
• Are a postmenopausal woman.

Which calcium supplement should I take?

There are many calcium preparations and strengths. Choosing one can be confusing. The most common products are calcium carbonate and calcium citrate. Look for products that have the USP or Consumer Lab symbol on the label. Products with these labels have been tested for adequate absorption by the body.

Calcium carbonate is best absorbed with a meal. Calcium citrate can be taken on a full or empty stomach. Calcium citrate may be a better choice for older adults or younger people who have low levels of stomach acid.

Look at how much elemental calcium is in the supplement. The less elemental calcium per pill, the more pills you will have to take to meet your needs. If you want to take just 2 calcium pills a day, you need to choose a product that contains 500 to 600 mg of elemental calcium. Calcium, whether in food or supplements, is best absorbed if taken several times a day, in amounts of 500 mg or less.

Calcium phosphate, lactate, and gluconate are also well absorbed. However, the calcium content of these supplements is low per pill, so you need several pills a day to meet your needs.

What happens if I don't get enough calcium?

If you do not get enough calcium, you may have muscle cramps in your hands and feet. You may also develop osteoporosis, which may result in:

• a gradual loss of height
• humping of the back
• bones that break easily
• serious fractures if you fall.

What affects the body's ability to get enough calcium?

Here are some things that can make it harder for your body to get enough calcium:

• Not getting enough vitamin D. Vitamin D increases the amount of calcium absorbed by your body. It’s important to get enough sunlight to help your body make vitamin D and to choose foods that are fortified with or naturally contain vitamin D. Most milk is fortified and now there are some brands of cheese, yogurt, juice, and margarine with added vitamin D. Check labels for this. Fish such as salmon, mackerel, and tuna are good natural sources of vitamin D. You can also buy calcium supplements that include vitamin D.
• Too much fiber in the diet. This is more of a concern for people who have low amounts of calcium in their diet.
• Phosphates (in soft drinks). Negative effects may be from replacing milk with soft drinks.
• Caffeine (found in some soft drinks, energy drinks, tea, and coffee). People who drink these products instead of milk often don't get enough calcium.
• Taking some medicines. Medicines such as tetracycline (an antibiotic), protein pump inhibitors (PPIs) such as Prevacid and Nexium that decrease stomach acid production, and antacids that contain aluminum can make it harder for your body to absorb calcium.

These things can cause you to lose calcium:

• Eating a lot of protein foods, such as meats, poultry, and eggs. The more protein you eat, the more calcium you lose. As long as your diet is balanced and contains enough calcium, this should not be a problem.
• Eating a lot of salt. The more salt in your diet, the more calcium lost. Limit the salt in your diet. Eating a diet rich in fruits and vegetables and getting enough calcium can help to offset the negative effects of a diet high in salt.

Can I get too much calcium?

It is unlikely that you will get too much calcium if you get it from natural food sources and a supplement that provides the recommended daily amount. Taking calcium supplements in combination with too many calcium-fortified foods increases the chance that you will get too much. Too much calcium increases the risk for kidney stones in some people. The upper limit for safety in adults is 2,000 to 2,500 milligrams (mg) a day.

How can I take care of myself?

• Eat more calcium-rich food: milk products, green leafy vegetables, citrus fruit, and sardines. Add cheese to salads and entrees and milk to casseroles and soups. If you are trying to cut back on fat, use only nonfat milk and fat-free and reduced-fat cheese.
• Some people cannot digest most milk products because their bodies lack the enzyme lactase needed to break down milk sugar (lactose). This problem is called lactose intolerance. If you are lactose intolerant, you can buy nonprescription products, such as Lactaid or Dairy Ease. These products come in liquid and pill form and contain lactase, which is a substance that can help you digest milk products.
• Get plenty of exercise. Walk a mile a day if you can and do strength training exercise a few times a week. Your body needs exercise to help it use the calcium in your diet to strengthen your bones.
• Take calcium supplements if your healthcare provider advises you to do so.
• For more information about healthy eating, call the American Dietetic Association at 1-800-366-1655, or visit their Web site at http://www.eatright.org.