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Special Topic:  Calcium

BONING UP ON CALCIUM: What you need to know

You probably know that one of the unfortunate health consequences of early menopause and premature ovarian failure is an increased risk of osteoporosis -- the weakening and loss of bone. And you also probably know that making sure you get enough calcium is one of the most widely recommended ways of helping to keep your bones strong.

But there are so many different forms of calcium out there -- and so many different opinions, claims, and so can very confusing.

Let’s start with the basics: Getting enough calcium is a definite must where bone-building is concerned. As you know, calcium is vital for strong bones since it is the key ingredient when it comes to bone-building. But many of us don’t get nearly enough calcium. The National Institutes of Health recommends that if you are in menopause, you should get at least 1,000 mg of calcium a day if you are on HRT, and 1500 mg if you aren’t.

But this recommended dosage doesn’t just refer to calcium; it refers to elemental calcium. In plain English, this is the amount of calcium that is available to actually work in your body. This is one reason why, if you opt for calcium supplements, it’s wise to read the labels carefully! Just because the label says the calcium supplement has, say, 1250 mg, doesn’t mean that this is the amount of elemental calcium in it. Often the label will list the elemental calcium; other times it’s not mentioned. So to be sure you're getting the calcium you need, it makes sense to know what percentage of elemental calcium is in the different forms of calcium available.  There's more about this in the explanation of calcium supplements.  But before you get to that step, you first have to determine how much calcium you're currently getting.

Take a look at your daily diet to see if you can and should up your calcium intake through the foods you eat. In general, your best bets for calcium-rich foods are non-fat or low-fat dairy products, salmon, sardines with the bones, green leafy vegetables and tofu.


Dairy Products

Type Serving Size Mg of Calcium
Nonfat yogurt 1 cup 450
Low-fat yogurt 1 cup 415
Ricotta (part skim) 1/2 cup 335
Nonfat or low-fat milk 1 cup 300
Whole milk 1 cup 290
Swiss cheese 1 oz. 270
Cheddar cheese 1 oz. 205
Mozzarella (part skim) 1 oz. 200
Muenster cheese 1 oz. 200
American cheese 1 oz. 180
Feta cheese 1 oz. 140
Cottage cheese 1 cup 135

Other Foods

Type Serving Size Mg of Calcium
Sardines (in oil, with bones) 3 oz. 370
Blackstrap molasses 2 tbsp 300
Calcium-fortified juice 1 cup 300
Figs, dried 10 medium 270
Black beans, dried 1 cup 270
Collard greens 1 cup 270
Salmon (canned, with bones) 3 oz, 200
Broccoli 1 cup 170
Farina, cooked 1 cup 145
Spinach (cooked, drained) 1/2 cup 130
Tofu 1/2 cup 130
Apricots, dried 1 cup 100
Tahini 1 tbs 85
Almonds 1 oz. 70

But what if you’re not getting enough calcium from your diet alone? Or what if you’re a little vague on it...some days, you do get enough; other days, you’re not. Well, when you’re dealing with the possibility of osteoporosis, you can’t afford to be casual about calcium consumption. So if you think you’re not getting enough calcium in your diet each day, you have two choices in this case: either start religiously eating calcium-rich foods like crazy. . . . or take calcium supplements. Because we with early menopause and POF are at such a high risk for bone loss, calcium supplementation usually makes a lot of sense. It’s easy -- and you can be assured that you’re getting a certain level of calcium.

It does get a little confusing, though, when it comes time to choose a calcium supplement. There are so many out there all purporting to do the same thing, but there are differences between the different forms.

  • Calcium citrate is the form of calcium most often recommended by doctors, chiefly because it is the most easily absorbed. This claim to fame may not apply to you since it is older women who tend to have more problems with digestion as their stomach acid production goes down, not women in their 20s and 30s. But if you have any problems with digestion -- or just want a calcium that isn’t hard on your stomach, calcium citrate probably makes sense. There is one drawback to this type of calcium: it contains only about 21% elemental calcium, so to get enough calcium, you usually have to take more tablets. . . . which winds up costing more. In addition, in spite of its stomach-friendly reputation, it may cause stomach upset or diarrhea. If you choose the type of calcium, you should take it between meals or just before bedtime.
  • Calcium Carbonate is the other most widely-used form of calcium. It is not as easily absorbed as calcium citrate, but is the most concentrated form of calcium with 40 percent elemental calcium (which also makes it the cheapest!) In other words, if you take a 1250 mg of calcium carbonate tablet, you’re getting 500 mg of elemental calcium. This is also the form of calcium that has been studied the most -- and there’s another side benefit: It also can act as an antacid. On the negative side, though, it can cause constipation and bloating. If you take this, it’s a good idea to drink more water than usual -- and take it in two or more doses, rather than all at one time. You may also want to chew it to make easily absorbed into your system. Unlike calcium citrate, you should take this with meals.
  • Tribasic Calcium Phosphate contains roughly 39% elemental calcium -- and is another easily digested form of calcium. It’s also the type of calcium used to fortify many foods such as orange juice and soy milk. The only problem? It’s among the most expensive forms of calcium.
  • Like calcium citrate, Calcium Lactate and Calcium Gluconate are less concentrated forms of calcium (containing about 15 percent elemental calcium), and are similar to calcium citrate in terms of absorbability and lack of side effects. But they usually cost more than calcium citrate -- as much as three to ten times more -- so you’re better off avoiding these and opting for another form of calcium.
  • Calcium supplements made of bone meal and dolomite are high in elemental calcium, but are not a good choice as they may contain lead and other toxic metals.
  • Finally, there are calcium-based antacids -- products like Tums and Rolaids Calcium Rich, which are probably one of the cheapest ways of getting calcium. These contain calcium carbonate, so usually offer you about 40% elemental calcium. For example, if you chew a regular Tums tablet (which contains 500 mg of calcium), you’ll get about 200 mg of elemental calcium. Many women like them because you can chew them instead of swallowing. If you opt for this form of calcium, you should take them between meals. And be sure to read the label carefully. You don’t want to get an antacid that includes aluminum because that can leach calcium from your system.

Calcium Supplements Rules of Thumb

  • It is a good idea to take your calcium twice a day, inside of in one dose, because your body can absorb only 600 milligrams of elemental calcium at a time.
  • Do not take calcium with iron, because it interferes with its absorption.
  • Also avoid taking calcium supplements with high-fiber meals or bulk laxatives, as they can cut down on the amount of calcium you absorb.
  • Be sure that your calcium is actually doing what you’re paying for by putting your tablets through this simple absorbability test.. Drop one tablet in a small glass or bowl with white vinegar and stir it every few minutes. After fifteen minutes to half an hour has passed, the pill should have disintegrated. If it hasn’t dissolved in the vinegar, it won’t dissolve in your stomach either -- making it essentially useless. In this case, you should get another brand or try another form.
  • Where calcium is concerned, you can get too much of a good thing. Over 2,000 milligrams a day of elementalcalcium may pose problems for your kidneys. So if you have had kidney stones or have a family history of them, talk to your doctor before taking calcium supplements.

Calcium Helpers

To make calcium work well, you need other vitamins and minerals to help it along. Some of these are available in combination with calcium; others are in multi-vitamins or trace mineral compounds, or you can take them individually -- or, of course, can get them through a well-balanced diet. Where you get them isn’t really the issue; the key is being sure you are getting them to get the most out of your calcium intake. The calcium helpers, then are:

  • Vitamin D -- which is essential for helping your body absorb calcium. While you can get Vitamin D from the sun, it’s not considered the best way since you can’t be sure you’re getting enough (and it’s tough to get if you live in a very cloudy area or use sunscreen.) In fact, according to a recent study, Vitamin D deficiency is much more common then previously thought. Most interestingly, thirty seven percent of the women in the study who had low Vitamin D levels reported that they were consuming at least the minimum requirement of Vitamin D. Since Vitamin D is so vital in the fight against osteoporosis, it’s probably best to take supplementation, then, to be sure you’re getting what you need. Nowadays, most doctors agree that you need at least 1000 to 2000 IU of vitamin D3.  You can get also Vitamin D in your diet from fatty fish (salmon, sardines, herring); fortified milk and other dairy products; egg yolks; and fortified cereals and breads.
  • Magnesium -- which is very commonly found in calcium supplements -- is also crucial for optimum skeletal health. In addition, it appears to hep fight fatigue and boost energy levels, as well as helping protect against heart disease. Generally, you should take a dosage equal to half of the calcium dosage you’re taking. The usual dosage is about 200 to 750 I Us depending on how much calcium you take. Some good natural sources of magnesium include: whole grains; dark-green leafy vegetables; milk and dairy products; nuts; meat and fish; dried cooked beans, especially soy beans.
  • Boron -- another mineral that helps prevent bone loss, it is often included in calcium supplements. It’s generally recommended you get about 3 to 6 mg of boron daily. Good natural sources of boron include fruits (including apples and pears); green and dark-yellow vegetables (including broccoli and carrots); and nuts (including almonds and hazelnuts).
  • Vitamin K -- another key player where bone health is concerned. Most women, however, get enough Vitamin K through their diet -- since it’s found in many vegetables.
  • You also need trace amounts of the following minerals: copper, zinc, manganese, and silicon (all of which are usually included in multi-vitamins or multi-mineral supplement.