One of the most frequent questions that people ask me in my office is "How do I (or my child) get enough calcium if I am lactose intolerant?".  Dairy sources of calcium are so linked in the popular media's mind that many people think that they can't get calcium into their diet if they are lactose intolerant, allergic to milk or have a sensitivity to dairy related products.  So, let's break down this question into two different concepts: first there is the volume of calcium that you are consuming that your body needs and second there is the ability to absorb the calcium that you are consuming. 

Calcium is intimately involved in the structures of bones and teeth where 99% of calcium is stored.  Calcium is necessary for strong bones and teeth as we all know and not getting enough calcium is said to be a big problem.  My contention has always been that whether or not you consume dairy products, most of us get enough calcium in our diets, what we are usually lacking are the co-factors that are required to absorb and utilize the calcium adequately.  Calcium is mostly absorbed early on in the small intestine and is pH dependent.  The more acidic your stomach acid is, the more likely you will be absorbing the calcium you are ingesting.  Many doctors suggest taking a Rolaids or Tums that contains calcium carbonate as a calcium supplement but the antacids make your stomach acid less acidic thus you are unlikely to be getting in as much calcium than you think.  Optimal amounts of calcium intake is between 500 to 1500 mg per day.  Historically, Paleolithic diets probably contained closer to 1500-2000 mg per day. 

The main factors that decrease calcium absorption are decreased HCL (hydrochloric acid in the stomach), oxalates in food, phytates in food, excess magnesium and malabsorption.  Vitamin D, phosphorus, magnesium, boron are all required for absorption of the calcium you consume.  Low calcium consumption can contribute to osteoporosis (fragile bones), elevated cholesterol, high blood pressure, problems with increased blood clotting, periodontal disease, insomnia, restless leg syndrome, anxiety, hyperactivity, depression, lead toxicity and colon cancer.

For all you non-dairy consumers here are some foods that you can consume to help prevent calcium deficiency:

• Cooked turnip greens (492 mg/cup)
• Lamb quarters (400 mg/cup)
• Sardines with bones (372 mg/3 ounces)
• Collard greens, cooked (357 mg/cup)
• Rhubarb (348 mg/cup)
• Spinach (276 mg/ cup)
• Fortified oatmeal (208 mg/cup)
• Canned Salmon with bones (185 mg/3.5 ounces)
• Broccoli, cooked (180 mg/cup)

It looks like cooked turnip greens turns out to be the winner.  Compared to about 3 ounces of gruyere cheese which has 860 mg of calcium or mozzarella which has 621 mg in 3 ounces.  For the lactose intolerant, yogurt is usually fine as the lactose is fermented out.  1 cup of yogurt has 345 mg.  Also try goat or sheep milk cheeses as they have as much or more calcium than cow milk products with less lactose and are usually not allergenic to most people except for the extremely sensitive person. 

If you supplement with calcium choose a citrate, malate, aspartate formula.  Combine it with adequate magnesium.  Make sure you are not taking acid blockers or antacids.  If you have GERD or heartburn, go see a naturopathic doctor who will help you identify food sensitivities and help heal and rebuild your digestive system rather than relying on acid blockers for the rest of your life.  A word of caution is that you should avoid bone meal calcium supplements at all costs as they contain high amounts of lead.  Lead is stored in the bones and thus added into your calcium supplement when they grind up the bone.  Know what source your calcium is coming from if you are supplementing as many different forms of calcium come from bone (thus high lead) containing sources.