We know, don’t we, that calcium is important for bone health, and that resilient bones help reduce our fracture risk. And we really, really want to avoid fractures as we age. Research from Spain published in 2020 found the likelihood of dying within a year of a hip fracture was 27%. I had a wake-up call recently about my own calcium intake when I was researching for my new book on post-menopausal health (now safely delivered to the publisher, yay!)
In the UK, the NRV (Nutrient Reference Value, ie the recommended daily intake) for calcium is 700mg a day. In the US it’s 1200mg for women over 50, and in Australia and New Zealand it’s 1300mg. Nearly twice as much as the UK! Are we being told to take enough? And are we even getting that 700mg? I thought that I was bound to be – I consume plenty of calcium-rich foods – greens daily, kefir/yogurt and beans nearly every day plus tofu and tinned sardines (with bones) weekly. I just assumed I was getting enough, without drilling into how much calcium is in those foods. When I actually looked at dietary calcium levels, I was surprised. This is what I found:
CALCIUM
- 100g canned sardines with bones – 351mg calcium
- 100g tofu – 351mg
- 100g Greek yogurt – 110mg
- 100g cruciferous green vegetables – 99mg
- 200ml semi-skimmed milk – 248mg
- 100g beans – 110mg
- 30g almonds – 72mg
- 100g chickpeas – 105mg
- 1 tbs chia seeds – 100mg
- 1 tbs sesame seeds – 88mg
I’ve done the maths, as they say, and if I have yogurt, chia seeds and greens every day, beans most days plus tofu and sardines every week, that averages out at around 450mg a day. Less than two-thirds of the UK NRV and just one-third of that in the US or Australia/New Zealand.
SHOULD I TAKE A SUPPLEMENT?
I’ve looked at calcium supplements and some of them look like enormous lumps of chalk! But there are powders on the market, which might be easier to swallow. There are two main types available: calcium carbonate, which relies on stomach acid for absorption, so needs to be taken with food; and calcium citrate which is more easily absorbed. I know that many of my clients are prescribed supplements by their doctors following an osteopenia or osteoporosis diagnosis.
I’ve hesitated to buy a supplement because one widely-quoted research paper showed there’s only a tiny increase in bone mineral density – 1-2% – among those who take additional calcium, which is unlikely to impact fracture risk. The research team stated, ‘Evidence that calcium supplements prevent fractures is weak and inconsistent.’ Another study linked high calcium intake to increased dementia risk for women who already had cerebrovascular disease (which affects the blood supply to the brain, like stroke), although the researchers emphasised calcium supplements don’t cause dementia, of course. And consuming too much calcium has been linked to gallstone formation.
WHAT I’M DOING INSTEAD
Rather than take a supplement at the moment, I’m focussing on making sure I’m getting as much calcium as I can from plant sources. The great thing about calcium-rich plants is that they also contain nutrients which help absorption, like magnesium, beta carotene, vitamin C, boron, manganese and zinc. As we’ve written about here, Australian research found that women over 55 who ate more vegetables were less likely to be hospitalised with a fracture. The correlation was particularly strong with consumption of brassicas and alliums (onions, leeks, garlic etc). I’m also making sure I get enough vitamin D (from a supplement at this time of year), with vitamin K2 to move calcium to where we want it to be – our bones – rather than leaving it hanging around in our bloodstream where there’s a danger it may calcify blood vessel walls, which we absolutely don’t want.
I’ll continue to monitor my calcium intake. What do you do? Supplement or dietary sources? Let us know in the comments. And see below for calcium-rich recipes from the archive.
BETTER BRAIN CAMP
Better Brain Camp is focussed on creating habits that reduce dementia risk and building a lifestyle that supports your brain health.
We kick off on Monday February 27th ach at 7pm. Recordings will be available and I’ll be giving you three months of support to embed the behaviours that will make a difference. Each session will be interactive and – I promise – fun! I’ll get you taking action, planning and prepping for better cognition, now and in the future.
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CALCIUM-RICH RECIPES FROM THE ARCHIVE
- Spaghetti with sardines
- Best-ever tofu stir fry
- Lentils in red wine
- Kale shakshuka
- Sardine and watercress pate
- Almond-ginger dipping sauce
- Raspberry almond cake
- Harissa-roasted vegetable salad
Susan
Photo Juan Jose Valencia Antia for Unsplash
I had a surgical menopause at 36 and have been on HRT (oestrogen only, no progesterone needed) ever since. I also take Nutrigold’s Bone Support Formula which includes calcium citrizorb (meaning it’s been processed to be bio-available i.e. easily used by the body) and Vit D3. I also take 800g of Vit D each day. My bone densitometry scans are fine.
Thanks so much for sharing that, Sarah, good to know the protocols are working for you, and to have a supplement recommendation x
What about cheese, Susan? I eat quite a lot of cheddar each week, on oat biscuits with butter or grated over a stir fry.
Hi Lexi, Annabel and I love cheese, but I completely forgot to put it on the list!! It is a good source of calcium: cheddar has over 700mg per 100g, parmesan has the most – 1100mg per 100g. Thanks for the reminder!
You don’t include milk in your list (and I see that someone else has mentioned cheese). Is there a reason for this? Surely milk (or other fortified milk) is a good inclusion in one’s diet?
Milk and yogurt are both on the list already! I did forget cheese but have added it in response to another comment here. Dairy products are a great source of calcium but we need to make sure we’re also getting other nutrients, particularly vitamins D and K2 which help move it to our bones.
I am osteopenic and the only advice from my doctor was to take a calcium supplement. When I looked into them it seemed that low calcium levels weren’t necessarily the reason for getting osteoporosis; the obvious ones were low oestrogen levels and low muscle mass. I eat a healthy diet, take Vitamin D, K and magnesium, and 2 years later my bone density is the same. So I’m now thinking of trying a supplement but it does seem to be the one area where there are such conflicting opinions and advice.
More research is defintely needed.
Have you tried to increase your muscle mass, using dumbbells or resistance bands for instance?
Hi Lexi.
My comment about muscle mass was concerning the reasons bone density reduces in women over 50 which isn’t necessarily to do with calcium deficiency. The research suggests it’s more likely that, and low oestrogen levels. So taking more calcium doesn’t quite make sense. One study says yes, one says no.
I do what I can to increase muscle mass and take oestrogen. Am thinking of joining a gym to really go for it and do weight training!
Go for it!
I love weight training! The benefits are enormous, not just in terms of muscle mass and bone density, but reduced falls, better glucose regulation, better cognition, improved cardiovascular system – the list goes on
We’re all so individual that what works for one person may not work for another. Worth following your doctor’s advice and seeing if it makes a difference?
PS: everyone over 50 should be having regular bone density scans, it goes without saying.
Reading Professor Tim Spector’s book, Food for life and he seems to be suggesting that research isn’t really backing calcium for osteoporosis now?
Oh that’s interesting Sue. I haven’t read his book yet. My concern was really about getting to the NRV rather than having extra, and the huge variants in the recommended amount across the globe.
I am also confused about calcium supplements especially since my cardiologist said I have some minor calcification of blood vessels. I don’t want to make it worse. However, because I am a coeliac and have trouble absorbing vitamins and minerals (how did that calcium get there and would it be worse if I wasn’t a coeliac?) I take a lot of vitamin supplements on doctor’s orders to improve chances of my gut absorbing something useful. I have a bone density reading on the low side. So confusing, but I will just continue to follow doctor’s orders, eat a healthy diet, get exercise, sunshine and sleep. I appreciate this blog and look forward to new posts.
Thanks for your kind words Gaynor. Really important to exercise for strength and balance to support bone health – I might have to do another blog post!
Hi – from the Australian perspective, I’m shocked that the UK RDV is so low. On the upside, you do have some great websites with very reputable advice, for example the Royal Osteoporosis Society! A note on you list above – not all tofu is calcium rich, only the firm set type. It pays to read the labels carefully.
Good to hear the Australian point of view, thanks Anna! Yes the ROS is fantastic and you’re right about firm tofu being best for calcium. Thank you for making that point
You have to be aware that Vitamine D3 – if taken without Calcium supplement – extracts calcium from the bones. That’s why you always have to take them together or eat very calcium rich food together with your Vitamine D3. I learned from a wise Indian doctor and it makes sense. That’s why I stoppen taking Vit D3 as well as Calcium tablets. I make sure I exercise (the best for bones), expose my skin to the sun whenever it’s there and eat calcium rich food. Canned Cod liver is also good to eat once a week (delicate and so cheap).
Note that washing yourself with soap – degreasing the skin – is problematic for the reception of sun light, transforming it to Vit D3 and processing it through your body. I stopped washing my body with soap, only my hair with baby shampoo or Sebamed PH neutral and it works well for my skin and hopefully also for my bones.