There’s always a lot of emphasis on eating dairy products for calcium. I can’t drink milk or eat cheese because I have lactose intolerance. What can I do to get the calcium necessary for my bones?
Lactose intolerance is common. In fact, an estimated 25% of the population of the United States has lactose intolerance. White men and women are affected less often than all other minorities, with 90% of Asians being affected with lactose intolerance.
Lactose intolerance occurs when the small intestine does not make enough lactase, the enzyme required to break down the lactose (milk sugar) in milk products before they enter the large intestine. When the undigested milk products enter the large intestine, you can get bloating, pain, gas, and diarrhea. The symptoms usually appear 30 minutes to 2 hours after eating milk products. Some people can tolerate some milk or milk products if they are eaten in small amounts through the day. The form of lactose intolerance that happens at birth is rare but permanent. Adults can acquire lactose intolerance and sometimes, because of an illness, can have lactose intolerance temporarily.
Don’t be discouraged. You might be intolerant, but sometimes you can recondition your body by eating very small amounts of foods that contain lactose and slowly increase the amount over time. For example, you might start with one teaspoon of yogurt for a few days, then a tablespoon for a few days, increase that to a quarter cup for a few days, and so on. The key is to have lactose-containing foods as a regular part of your diet. What you are trying to do is to train your small intestine to start making lactase again. This is a good example of a “use it or lose it” phenomenon. Yogurt is the best tolerated milk product and will also provide you with 200 to 300 mg of calcium per 6- to 8-ounce serving. Hard cheeses, such as cheddar, Swiss, and parmesan, also tend to be easier to digest than milk.
If you try this reconditioning program and it doesn’t work, you can certainly get calcium from other sources or try over-the-counter tablets that contain lactase, such as Lactaid® tablets, to help with the digestion of milk products. Whatever you do, be sure that you get adequate calcium because in a recent study, lactose intolerance was associated with low bone mass and increased risk of fracture. Table 4 lists foods that are rich in calcium. You will note that there are non-milk products to choose from.
There is some concern among pediatric clinicians that encouraging dairy product intake in children is not necessary. In fact, there is little evidence that intake of dairy products is associated with increased bone density in children. Children (and adults) can get the same amount of calcium that is in 8 ounces of milk if they consume 8 ounces of fortified orange juice, 11/2 cups of calcium-fortified cereal, 2 slices of calcium-fortified bread, or 1/2 cup of tofu (with calcium sulfate).
If you are unable to tolerate any milk products or if you are a strict vegetarian who consumes no dairy products, you should be doubly careful about getting calcium in other foods as well as supplements. Green leafy vegetables do contain calcium, but it is not absorbed as well as the calcium found in milk products, and therefore only very small amounts of calcium actually make it into the bloodstream. You will not be able to determine the amount of elemental calcium you need in supplements based on the formula described in How Do I Know I’m Taking The Right Kind And The Right Amount.
Instead, calculating the amount of calcium you need in the form of supplements might vary somewhat unless you are consistent about the kinds of calcium-rich and calcium-fortified foods you eat. Using Table 4, add up the milligrams of calcium typically found in the foods you eat every day. Subtract that number (you will probably have to average several “typical” days) from the amount of calcium required for your age and sex, found in Table 3. The result is the amount of elemental calcium you need in the form of supplements.