what-about-calcium2

What About Calcium?

Any time we mention the whole “we don’t do dairy” thing, we inevitably get The Question:

“But what about calcium?”

The Question is generally coming from the perspective that strong, healthy bones are important, and calcium builds strong healthy bones.

We do not disagree.

But despite what the Got Milk? ads would lead you to believe, the whole “strong bones” thing is a lot more complicated than that. There are three fallacies when it comes to the dairy/calcium/bones triad.

  1. Building strong, healthy bones depends only on calcium
  2. Your calcium intake is the only thing that matters
  3. Dairy is the only good source of calcium

Let’s break these down one at a time.

1. BONES = CALCIUM

Bone development is influenced by a number of factors, including nutrition, exposure to sunlight, hormonal secretions, and physical exercise. Of the nutrition component, calcium is seen as the most critical factor. And there’s no denying that calcium is important for bone health – calcium is the substance that gives bone strength, like bricks do for a building.

But bones need more than just calcium to grow and stay strong. Vitamin C, “vitamin” D3 (which is technically a hormone), and vitamin K, along with minerals like magnesium and phosphorous, all play roles in bone development.

  • Vitamin C helps increases calcium absorption, and helps us form the optimal structure for bone strength.
  • Vitamin D3 is necessary for the proper absorption of calcium in the small intestine. In the absence of adequate amounts of this vitamin, calcium is poorly absorbed, the bone matrix can become deficient in calcium, and the bones are likely to grow weak.
  • Vitamin K has been linked to the cells that generate bone, and produces a specific protein that serves to “fix” calcium in place. It also inhibits other cells from breaking down bones. Observational studies have demonstrated a relationship between vitamin K and age-related bone loss (osteoporosis), such that inadequate vitamin K may increase your risk of fractures.*
  • 60% of the magnesium in our bodies is found in our bones, in combination with calcium and phosphorus. Magnesium improves bone mineral density – and not getting enough magnesium may interfere with our ability to process calcium.
  • Phosphorous supports building bone and other tissue during growth. About 85% of the phosphorus in our bodies is found in our bones, and phosphate makes up more than half of our bone mineral mass.

*There is also evidence that vitamins D and K work synergistically on bone density.

But it’s not just dietary factors that play into strong, healthy bones! Your hormones and inflammatory status also play a role. (That should not surprise you at this point.)

  • Chronically elevated blood sugar (hyperglycemia) enhances the activity of cells that break down bone, and reduces bone density.
  • Chronically elevated cortisol accelerates bone breakdown, and inhibits the activity of bone-building cells.
  • Reduced estrogen levels (especially in post-menopausal women) upsets the normal balance between bone creation and breakdown, making bones more brittle and increasing the risk of fractures.
  • Systemic inflammation and the resultant effects (free radicals, and an inflammatory marker called homocysteine) cause an accelerated breakdown of bone and inhibits the formation of new bone cells.

So it’s clear that strong, healthy bones depend on more than just calcium, and ensuring a diet and lifestyle that included an adequate amount of all of these vitamins and minerals – not just calcium – are necessary for bone growth and maintenance.

2. WE JUST NEED TO TAKE MORE

If first mistake is thinking that bone health is all about calcium, the second is believing our intake of calcium is all that matters. If this was true, then how do you reconcile this?

The United States has one of the highest rates of osteoporosis in the world,
despite having one of the highest calcium intakes.

It makes no sense… unless there’s more to the story than how much calcium we’re taking in. It’s also about how much we’re able to absorb, and retain. And factors like our dietary habits, our lifestyle, and the aging process all contribute to calcium absorption and retention.

  • The phytates in foods like whole grains and legumes form complexes with the calcium and other minerals in the plant. This renders the calcium virtually impossible to absorb, and limits its bioavailability (the amount that can be effectively absorbed and used by the body).
  • Whole grains may also promote a loss of vitamin D, a critical element of bone health. Low vitamin D3 levels (from diet and a lack of daily exposure to sunshine) inhibits calcium absorption.
  • Stress affects HCL production in the stomach (and impacts normal digestion), which can have a negative effect on calcium absorption.
  • Age also negatively impacts calcium absorption – on average, adults absorb about 20% less calcium than children.
  • On the other hand, adequate protein in the diet increases calcium absorption and stimulates the production of hormones that promote new bone formation. This effect is more than sufficient to counter the increased urinary excretion of calcium observed upon increased protein consumption.

Finally, one additional note: vitamin D3 and K are both fat soluble – meaning they require some fat to be absorbed in the bloodstream. So a low fat diet (like the kind we’ve all been advised to eat for the last 20 years) may impair your body’s ability to absorb these two vitamins, which can also diminish bone health.

We told you it was complicated.

THE SUPPLEMENT STORY

These factors are exactly why all the calcium supplementation we’ve been doing just isn’t working to prevent osteoporosis and bone fractures. See, osteoporosis isn’t caused by a lack of calcium. And studies show that calcium intake alone does not prevent fractures due to bone loss. Taking calcium supplements gives you a short-term boost in bone density, but over time, your hormones (again!) will work against the extra calcium, and potentially leave your bones more brittle than before.

Bone density drugs (bisphosphonates) like Fosamax and Boniva aren’t much better. These drugs deposit a long-lasting compound in the bone, giving it the appearance of greater density, but do not build the same type of bone “matrix” that actually makes bones stronger. (Increasing bone density is not synonymous with strengthening bones.) This can result in “dense” bones that are too brittle to withstand everyday activities.

Finally, too much calcium is just as bad as not enough, in terms of our overall health. This excess of calcium generally comes from a combination of dairy plus calcium supplements plus the calcium added to a variety of products, from antacids to orange juice to cereals. Too much calcium increases the risk of developing dangerously high levels of calcium in the blood, which can result in impairment of kidney function, kidney stones, high blood pressure, and may increase your risk of heart disease and heart attack. Furthermore, recent studies suggest that taking calcium supplements actually increases the risk of “cardiovascular events” (translation: risk of heart attack).

3. YOU DON’T NEED MILK

Though we’ve just established that calcium, and your calcium intake, are not the only factors when it comes to bone health, a “just right” calcium balance is still necessary for overall health (bone and otherwise). But it’s high time we correct the “facts” promoted by years of industry-sponsored marketing.

Dairy is not the only good source of calcium.

You can find calcium (in bioavailable forms and significant amounts) in a wide variety of non-dairy, nutrient-dense foods, including vegetables, meat and seafood, nuts and seeds.

  • Vegetable sources of calcium include kale, spinach (cooked), collard greens, mustard greens, turnip greens and bok choy, and sea vegetables like nori.
  • Meat and seafood sources include organ meats, bone broth, small fish (like sardines), shrimp, oysters and canned salmon (with bones).
  • Nut and seed sources include almonds, hazelnuts and walnuts.

THE POWER OF GREEN

It’s not just that you’ll find some calcium in these foods – it’s that the calcium in vegetable sources may prove more bioavailable (useful to the body) than the stuff you get from milk. One study compared the absorption of calcium from kale with the absorption from milk – and found kale the clear winner. (Yay, kale!) And recent studies have shown that plant-sourced calcium in particular increases bone mineral density and reduces the risk of osteoporosis.

This is likely not just due to the calcium content of the plant – the complement of other vitamins, minerals and phytonutrients found in veggies exert work synergistically to promote additional beneficial effects on bones.

Yet another reason to eat your greens.

THE SUMMARY

Your body likes balance. Remember Goldilocks? Not too little, not too much… just right. And calcium doesn’t work in a vacuum, so too much calcium means your body is forced to compensate by adjusting levels of other vitamin and mineral stores, leaving you even more out of balance.

So, how do you build strong, healthy bones without dairy and without supplements? The short answer is, just follow our guidelines! We’ve built a healthy variety of micronutrition and a healthy hormonal balance into our plan. But if you’re looking for the specifics of our strategy, here’s the take-home.

Building strong, healthy bones on a Paleo diet

  • Embrace a diet designed to promote a healthy hormonal response and minimize systemic inflammation.
  • Eat a wide range of nutrient-dense foods (specifically dark, leafy greens and bone broths) to ensure adequate intake of all of the vitamins and minerals necessary for bone health.
  • Avoid foods (like whole grains and legumes) that contain compounds that limit our body’s ability to absorb minerals.
  • Eat a moderate protein diet (from animal sources) to aid in calcium absorption.
  • Ensure a healthy daily dose of vitamin D3, ideally from sunshine, or via supplementation.
  • Consider supplementing with magnesium, an important mineral co-factor in which most Americans are deficient due to dietary habits, depleted soil and fluoridated or filtered water.
  • Include adequate dietary fat, to ensure the absorption of bone-building vitamins D3 and K.

HEAVY STUFF

For all of you overachievers, here’s your special bonus tip for building strong, healthy bones – pick up something heavy. Weight-bearing physical activity and strength training has long been linked to improved bone density. The compression forces of daily activity stress our bones in a healthy way. Our bones respond by building more supportive substances into the bones to structurally bear load.  On the other hand, if we fail to stress our bones in this fashion (with a sedentary lifestyle, or failure to use weights in our exercise routine, our bones will slowly waste away. In other words, as was spoken by Hippocrates, “That which is not used, wastes away.” Or, as we like to say, use it or lose it.

Even if you follow all of our recommendations, however, you’ll find that you’re probably still not getting as much calcium as the powers that be (the US RDA) tells you is necessary.

Know what?

We’re not that concerned.

Remember, it’s not about how much calcium we’re taking in – it’s about all of the other aspects we’ve just discussed. And studies support the fact that you probably don’t need as much calcium as you think, if all of your other factors are in line.

So skip the milk, eat your greens, get some sunshine and exercise regularly and enjoy all of the health benefits of a nutrient-dense, anti-inflammatory, hormone-optimizing diet – including strong, healthy bones.

 


 References

Got Milk? is a registered trademark of the California Milk Processor Board.

More than just calcium: Other Nutrients and Bone Health at a Glance. niams.nih.gov. National Institutes of Health. Dec 2004. Web.

Vitamin K and bone loss: Feskanich D, Weber P, Willett WC, Rockett H, Booth SL, Colditz GA. Vitamin K intake and hip fractures in women: a prospective study. Am J Clin Nutr 1999;69(1):74-79

Bügel S. Vitamin K and bone health in adult humans. Vitam Horm 2008;78:393-416

Magnesium:  Abraham GE, Grewal H. A total dietary program emphasizing magnesium instead of calcium. Effect on the mineral density of calcaneous bone in postmenopausal women on hormonal therapy. J Reprod Med 1990;35(5):503-7

Vitamins D and K work together: Adams J, Pepping J. Vitamin K in the treatment and prevention of osteoporosis and arterial calcification. Am J Health Syst Pharm 2005 Aug; 62 (15): 1574-81

Tanaka, K, Kuwabara, A. Fat soluble vitamins for maintaining bone health. Clin Calcium 2009 Sep; 19(9):1354-60

Schaafsma A, Muskiet FA, Storm H, Hofstede GJ, Pakan I, Van der Veer E. Vitamin D(3) and vitamin K(1) supplementation of Dutch postmenopausal women with normal and low bone mineral densities: effects on serum 25-hydroxyvitamin D and carboxylated osteocalcin. Eur J Clin Nutr 2000 Aug; 54 (8): 626-31

Okano T. Vitamin D, K and bone mineral density. Clin Calcium 2005 Sep; 15(9):1489-94

Weber P. Vitamin K and bone health. Nutrition 2001 Oct;17(10):880-7

Free radicals and bone health: Watkins BA et al, “Importance of Vitamin E in Bone Formation and in Chondrocyte Function” Purdue University, W. Lafayette, IN 47907

Blood sugar and bone health: Burckhardt Peter, Dawson-Hughes Bess, Weaver Connie M. Nutritional Influences on Bone Health. New York: Springer, 2010. Print.

Cortisol and bone health: Talbott Shawn. The Cortisol Connection. Alameda: Hunter House, 2007. Print.

Homocysteine and bone health: Cordain Loren. The Paleo Answer. Hoboken: John Wiley & Sons, 2012. Print.

United States/calcium: Cordain Loren. The Paleo Answer. Hoboken: John Wiley & Sons, 2012. Print.

Whole grains and vitamin D: Cordain Loren. The Paleo Answer. Hoboken: John Wiley & Sons, 2012. Print.

Mellanby, Edward. The Rickets-Producing and Anti-Calcifying Action of Phytate. J. Physiol 1949;109:488-533

Batchelor A J, Compston J E. Reduced plasma halflife of radio-labelled 25-hydroxyvitamin D3 in subjects receiving a high-fibre diet. Brit J Nutr 1983;49:213

Clements Mr, Johnson L, Fraser Dr. A new mechanism for induced vitamin D deficiency in calcium deprivation. Nature 1987;324:62-65

Age and calcium absorption: Heaney Robert P, Recker Robert R, Stegman Mary Ruth, Moy Alan J. Calcium absorption in women: Relationships to Calcium intake, Estrogen status, and age. J Bone Min Res August 1989;4:(4)469–475

Calcium does not prevent bone fractures:  Freskanich D, et al., Milk, dietary calcium, and bone fractures in women: a 12-year prospective study. Am J Pub Health 1997 Jun; 87(6): 992-997

Cumming RG, et al. Case-control study of risk factors for hip fractures in the elderly. Am J Epidem 1994 Mar 1; 139(5): 493-503

Grant AM, et al. Calcium/vitamin D not effective for secondary prevention of fracture. Lancet 2005; 365:1621-1628

Too much calcium: Patel AM, Goldfarb S. Got Calcium? Welcome to the Calcium-Alkali Syndrome. JASN September 1 2010; (21):9,1440-1443

Bolland Mark J, Avenell Alison, Baron John A, Grey Andrew, MacLennan Graeme S, Gamble Greg D, Reid Ian R. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ 2010;341:c3691

Bolland Mark J, Grey Andrew, Avenell Alison, Gamble Greg D, Reid Ian R. Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women’s Health Initiative limited access dataset and meta-analysis. BMJ 2011;342:d2040.

Calcium from kale: Heaney RP, Weaver CM. Calcium absorption from kale. Am J Clin Nutr 1990; 51:656-657

Plant calcium in particular: Park HM, Heo J, Park Y. Calcium from plant sources is beneficial to lowering the risk of osteoporosis in postmenopausal Korean women. Nutr Res Jan 2011;31(1):27-32

“Go Green for Bone Health.” Taste For Life. May 2011:6. Print.

Tucker Katherine L, Hannan Marian T, Chen Honglei, Cupples L Adrienne, Wilson Peter WF, Kiel Douglas P. Potassium, magnesium, and fruit and vegetable intakes are associated with greater bone mineral density in elderly men and women. Am J Clin Nutr April 1999;69(4):727-736

New Susan A, Robins Simon P, Campbell Marion K, Martin James C, Garton Mark J, Bolton-Smith Caroline, Grubb David A, Lee Sue J, Reid David M. Dietary influences on bone mass and bone metabolism: further evidence of a positive link between fruit and vegetable consumption and bone health? Am J Clin Nutr Jan 2000;71(1):142-151

Magnesium: Marier JR. Magnesium Content of the Food Supply in the Modern-Day World. Magnesium 1986;5:1-8

Weight-bearing activity: Kohrt Wendy, Bloomfield Susan, Little Kathleen, Nelson Miriam E, Yingling, Vanessa R. Physical Activity and Bone Health. Strength training:  Medicine & Science in Sports & Exercise November 2004;36(11):1985-1996

Don’t need as much calcium: Prentice Ann, Laskey Ann, Shaw Jacquie, Hudson Geoffrey, Day Kenneth, Jarjou Landing, Dibba Bakary, Paul Alison A. The calcium and phosphorus intakes of rural Gambian women during pregnancy and lactation. Brit J Nutr 1993;(69)885-896

De Souza Genaro P, Martini LA. Effect of Protein Intake on Bone and Muscle Mass in the Elderly. Nutr Rev 2010;68(10):616–623

Sellers EAC, Sharma A, Rodd C. Adaptation of Inuit Children to a Low-Calcium Diet. Can Pub Health J 2003;168(9):1141–1143

 

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Comments

  1. says

    Awesome – perfect.
    Like you I get asked this question ALL the time.
    You have answered it beautifully.

    One thing I point out too is that every animal on the planet manages to avoid osteoporosis and none drink cows milk.

    Thanks

  2. Emily says

    Thank you for this – I just sent the link to my Mom, who is being advised to eat a huge amount of calcium by her docs (seems *really* unhealthy to me!)

  3. Cortney says

    This is another way in which there is a lot of overlap between the Paleo and vegan communities- I used all of these arguments (except the eating meat part) as a vegan trying to tell people that I didn’t need dairy for calcium :) Nice work.

  4. Kendra says

    This is very well written and clearly researched. I have heard all this stuff before via Loren Cordain, and it makes perfect sense. The problem I have lies in my own experiences.
    I haven’t consumed a dairy product in 15 years. This was a hold over from being a vegan as a teenager and I just never went back. I’ve been eating the paleo way for a number of years and it was working for me, until I had my son.
    It’s been three years since he was born, which means three years of trying to get back my old fitness level. I was in excellent shape before I was pregnant and during, but within 6 months or so after he was born, I started experiencing injuries. I was set back a great deal and every time I tried to start over, I found I would have to get back into fitness slower and slower. It got to the point that if I were to take a 20 minute walk pushing my son in the stroller, I’d feel like I had over trained the next 3 days. I wish that was an exaggeration, but that was actually happening. I started to wonder if it was lack of Vitamin D or magnesium because certainly it couldn’t be calcium. I’ve eaten calcium rich veggies practically every day for the last 15 years due to quitting milk. I actually started supplementing D3, magnesium, and K because I knew this information you’ve posted. Nothing seemed to work, until I broke down and started supplementing with calcium. Now, I can work out like I did in the old days – it is a huge difference. I can’t help but think I’ve found the solution, but the solution scares me a little after reading this.
    I put this all out there because I’m wondering if anyone has had the same issue and found a different resolution. I am concerned about too much supplementing, and to be honest I don’t like the idea of downing a bunch of pills everyday to be healthy. It just feels wrong.

  5. says

    Thank you so much for this article! I’m currently doing my first whole30 and calcium is the one nutrient I’ve been worried about lacking, given the no dairy rule. I was taking calcium supplements at the beginning, but I’m on day 21 now and I’ve given that up after reading some things on other paleo blogs, but I was still a bit uneasy about it. This article has convinced me that they’re unnecessary and I’m doing the right thing. Thanks :)

  6. Casey says

    Kendra – I’d say it depends on the person. I started breaking bones at the age of 6 months and have broken about 10 bones in my lifetime (I’m 34). I was diagnosed with Osteopenia at age 12 and with Osteoporosis at age 30. I’ve been studied by all the best Osteo doctors at Creighton and Columbia Universities, and all they can say is I’m idiopathic – they truly don’t know why I have Osteoporosis. Actually, some of the references cited here were written by doctors of mine…

    I’ve been on calcium supplements my whole life and have only seen my bone density continue to go down – until last year. That was the year I started eating meat again after spending 10 years as a vegetarian, because one doctor had told me that eating meat would increase my calcium excretion (he wasn’t a Creighton doc – and I wish I hadn’t listened to him). I wouldn’t say I went Paleo, but my diet has been cleaned up significantly. And I didn’t really have a statistically significant increase in bone density (my doc says it’s within the error of the machine), but it’s the first non-decrease!

    Did your doctor tell you that breastfeeding can reduce bone density? You didn’t say whether you were doing this, but your doctor should have told you. It may be that you need supplementation right now to rebuild what you lost after your son was born, if you were in fact breastfeeding. My doctor said that pregnancy itself is very protective of the body, but breastfeeding is not – that you need to alter your eating and supplementation habits to effectively maintain your own health and your baby’s.

    Melissa and Dallas – thank you for such a well-researched article. Bone health is incredibly complex, and I really appreciate your comment about Fosamax and Boniva. I’m avoiding those drugs as long as I can – primarily because I still want to have children and they’re only FDA-approved for post-menopausal women. But also because I’m hoping that by the time I truly NEED something like that, there will be drugs that don’t have nasty side effects like necrosis of the jaw.

  7. Casey says

    Also, I notice that you specify spinach should be cooked. Does cooking kill off the oxalic acid? I’d been told that while spinach has the highest calcium content of any vegetable, it also has super-high levels of oxalic acid, which inhibits calcium absorption – with the effect that almost none of the calcium in spinach is bioavailable.

    In the meantime, I’m eating kale :) I like it better than spinach anyway.

  8. Carie says

    Do you have an opinion about supplements for children? I am wondering if I should be giving my boys calcium, magnesium, D3 and/or K since one of them refuses to eat anything but beef, chicken and broccoli. No kale for this kid. Thoughts? Thanks!

  9. katie says

    Hi,
    I’m concerned about my son too. He’s 2 1/2, so I’m slowly moving him towards Paleo, as i’m doing Whole30 right now (day 21, yay!) and he doesn’t eat leafy greens yet, so I have been trying to give him milk. However, he has been refusing it completely and only wants to drink water. This is great, except now I’m worried he won’t have enough calcium. He eats lots of eggs and has just started eating almond butter instead of peanut butter, but he only likes meat sometimes and like I said no leafy greens yet. Will this be OK?
    Thanks!

  10. Lisa says

    @ Carie: My 12-year-old daughter would not go near a piece of kale… until I made kale chips. She eats kale chips like you would not believe. Once my three kids ate the equivalent of two large bunches of kale in one sitting. Here is how I make them: I melt a bunch of coconut oil in a large glass bowl. Then I chop the bunches of kale into bite-sized pieces, throw the kale into the glass bowl and toss it until it’s glistening with the coconut oil. Throw some sea salt on the whole thing and bake in a single layer on a cookie sheet at 300 degrees for 36 minutes. (Don’t ask why 36 minutes! Trial and error…) Let them cool off and scrape them into a serving bowl. You can add extra sea salt if you like. When I first made them I did not “force” them on the kids; I just left them out. Eventually they nibbled, and now my adolescent actually exclaims: “Ooh! Kale!”

  11. says

    @Lisa – so funny. My husband made Kale chips for the first time this week, and they are completely addictive. I gave one to my 15 month old son to experiment with. He stuck it in his mouth and his eyes lit up at the salty taste (this kid loves salt), but the leafy texture confused him and he went around blowing raspberries for about 10 minutes. Too cute.

  12. says

    @Morten: Cow’s milk has a completely different nutrient profile in general, compared to human breast milk. For example, cow’s milk has about 7x the casein (building blocks for the cow’s “stuff” – body, muscles, skin, teeth, bones). When you think about it, a calf’s body is growing at a far faster rate than its brain development – and cow’s milk serves to supply the proper nutrients for that function. But does it make sense to give that same fuel source to a child, whose brain is growing at a rate MUCH faster than its body? Thanks, as always, for weighing in.

    @Cortney – we DO have a lot in common! Fabulous observation.

    @Kendra: I’d recommend getting some lab work done to test levels of these things. Just because a calcium supplement is making you feel better doesn’t mean you were lacking calcium. All these minerals work in concert with each other (and with your hormones) in an elegant and complex fashion. Perhaps you really were calcium deficient, or perhaps there is something else going on for which the calcium is providing you with a temporary band-aid. Only some testing will determine the behind-the-scenes.

    @Danny: We don’t in general, unless it’s specifically called for. We’re not big fans of tons of lab work right out the gate, we prefer a specific approach. (And then we refer folks out to a few docs who really know their stuff, for testing and analysis.)

    @Casey: Spinach is not your best leafy-green calcium source, in part because of the amount of calcium per serving, and in part because of the oxalates (which interfere with calcium absorption). Research has shown that the boiling of spinach in large amounts of water helps decrease the oxalic acid content by as much as 50%, which may improve the calcium scenario… but kale is a much better source anyway, so keep on eating.

    @Parents: If your kids aren’t eating any of the foods on our list, then maybe they’re not getting enough calcium. But feeding them milk isn’t the answer! You’ll have to experiment with different veggies and preparation methods (kale chips, soups, stews), or start making homemade bone broths (another excellent source of calcium, and very good for kids’ digestive health) into soups. If you’re still concerned that they’re not getting enough of the right stuff, then you may decide to supplement, but work with a naturopath or functional medical doc instead of adding stuff willy-nilly.

    @Lenny: Grass-fed, pastured dairy fat (like clarified butter or heavy cream) are good sources of K2, but conventionally processed dairy is not. You’ve gotta get it from a high quality source! We love clarified butter or ghee, and recommend it as one of our healthiest fats, in part because of the K2. Heavy cream is up to you – if you tolerate it well, enjoy (as long as it’s pastured/organic).

    Melissa

  13. Dano says

    Kendra,

    Your stress levels and sleep patterns can also play a huge role in recovery and overall health. I’d imagine with a child stress went up and quality sleep went down, just something else to think about.

  14. Ron says

    Given the amount of calcium even in leafy greens/meat it seems very difficult to get anything close to the RDA for calcium. It seems as though your blog is arguing that the RDA is incorrect. Are you?

    If so, I would be curious to see an alternate formulation for the correct amount should be.

  15. says

    Ron, Dr. Loren Cordain (author of The Paleo Diet) postulates if you follow all of the recommendations as outlined, it drops the actual calcium requirement down to about one-half of the US RDA (in the order of 600-700mg vs. 1000-1200mg). However, I’m not sure how he came up with that – you might have to dig deeper into his research to determine his methods.

    We’re not recommending a daily allowance – we’re just saying that, perhaps if you’ve got all your other co-factors in line, you don’t need as much calcium as the RDA outlines to be optimally (bone) healthy. After all, if more calcium was the answer, our rates of osteoporosis wouldn’t be as high as they are right now in this country.

    Best,
    Melissa

  16. Mary Taitt says

    I tried to go on this diet–I eliminated dairy (but I did add calcium!!!)(Hadn’t heard not to,somehow), I eliminated sugar and all other sweeteners, I eliminated legumes, I eliminated refined grains and each step made me feel healtheir. BUT whe I tried eliminating whole grains, I got terribly constipated and got an anal fissure-VERY PAINFUL. I just tried again for a week and had to *quit* when I got constipated again. I am back on whole grains and feel somewhat worse, but I cannot be chrnoically constipated. What do you DO about that?

  17. says

    Constipation isn’t caused by a lack of whole grains – it’s your body adjusting and healing from the damage done by these less healthy foods. Ease into vegetable intake, make sure you’re eating enough healthy fats (especially coconut products) and go easy on nuts and seeds and see if that helps. You could also consider working with a professional to see if you’ve got some specific GI disturbances that may require special care.

    Best,
    Melissa

  18. Mary Taitt says

    I was even cutting up broccoli stems in thin slices trying to provide fiber. :-( I eat lots of veggies. It wasn’t enough. I may have to have a procedure now. :-(

  19. fatchowmein says

    Been Paleo/Primal since July 2011. I do not drink milk (lactose intolerant) and rarely eat cheese (on salads). I only supplement with fish oil, vitamin D3 during the winter, and Natural Calm if I remember to take it (sleep is good so I forget). Since winter is over and I’m in Texas, I stopped taking D3 and I’m tanned from making the time to be outdoors. I lift weights 1-2x week, run and hike a little. Eat plenty of spinach and leafy green veggies with olive oil. Drink Pellegrino by the gallon. Make my own saurkraut for the k2. Just had my physical and blood work and the results were…

    Calcium SerPl-mCnc: 10.8 High
    Is this conventional wisdom high or do I need to stop eating spinach? I’m shocked. With everyone worried of low calcium levels on a Paleo diet, I didn’t think I would be on the high end.

    Potassium: 5.2 mmol/L
    Vit D25: 52 ng/mL

    5’6″ Asian
    132lbs
    Almost 40 years old.
    Good sleep (except for staying up tonight researching).
    Low stress.
    Eliminated seasonal allergies and upper respiratory infection by cutting out grains except for my small and infrequent consumption of white rice.
    No constipation.
    Never felt better.

    I asked Robb Wolf but he’s so hammered by questions I have a better chance of winning the lottery. Thx.

  20. says

    Couldn’t responsibly even guess at what’s going on without a lot more information, and a full consult. Sorry, but these are not quickly-answered questions, and require more time and energy to analyze than we could provide in this setting.

    Melissa

  21. fatchowmein says

    No worries, Melissa. Talked to the Doc and he’s not worried about it. Interesting results. I did wonder about my calcium intake but the arguments from Mark Sisson and Robb Wolf were compelling so I took it on faith and eliminated dairy but I hedged my bets knowing my annual blood work was 8 months away. My version of Sisson’s “2 Minute Big-Ass Salad” really did the trick considering my only supplementation is with fish oil and D3 during the winter. Thx.

  22. says

    Well done & well said!

    Finally, someone is willing to pull back the curtain on “Calcium.” A couple of quick comments:
    1) The white liquid that people think is “milk” is far from “real milk” that cows produce naturally. We’re not comparing the right product. And I totally agree about the societies with the strongest bones don’t drink milk.
    2) It’s refreshing to see an article that has citations — thank you. Another excellent article that I’m sure your readers will enjoy is: Abraham, GE, “The Calcium Controversy,” 1982. A short, to the point 3-pg article that lays out the facts in a very compelling fashion. We have been Misled… and Misfed…
    3) Thank you for mentioning Magnesium! Most writers seem to have a mental block when it comes to the “Orchestra Leader” inside our cells. Some things that you failed to mention about “Maggie”:
    – It activates all 3 hormones that are responsible for controlling Calcium in the body — Parathyroid Hormone, Calcitonin & Vitamin-D (Yup, the storage form can NOT be made “active” w/o Mg!)
    – Vitamin-C is also “activated” by Mg
    – Elevated blood sugars, elevated cortisol & elevated inflammation are ALL brought to you by Mg deficiency in our diet & in our tissues. Paleo is a great diet (I practice it religiously…), but it will NOT reverse a generational deficiency that is raging across America. Somewhere between 80-99.9% of Americans are deficient in Mg.
    – Homocysteine & Mg are on a seesaw — when one is up, the other is down
    – And finally, as you so aptly point out, Osteoporosis is not caused by Calcium loss. It is, in fact, being created by a Mg deficiency which was firmly established by Dr. Dalderup & his Scandanavian research team in 1960. Btw, the “brand name drugs” for Osteoporosis are activated by Fluoride which only drains the body of Mg. Hmmmmm. Interesting strategy for Doctors to take given above…

    Thank you, again for an outstanding article and for the chance to comment on it!

  23. Michelle says

    What about kids? That’s my biggest question. My husband and I have been adhering to a Paleo eating plan and loving the results. I have a 6 month old daughter who is breastfed. The conventional wisdom is to start giving children cow’s milk after they are a year old. I intend to continue nursing her for another year or so, but after she weans, then what? Do children really need cow’s milk? Has there been any research on this?

  24. says

    Is Vitamin K an aid to calcium or can it actually perform the same benefit as calcium? I assume if one eats properly, then maybe just a Vitamin K could be added daily. (I do realize calcium is a mineral and Vitamin K is a vitamin.) My concern is having too much calcium in the blood and kidneys. My nutrionist advised that women do not need 1200 mg of calcium per day. He suggested my taking 700 to 800 mg per day. I am of the opinion that calcium dosages should probably be taken depending on age. What form of calcium would you recommend? For a period of time, a lot of articles were touting coral calcium. However, in an article I read today, it was stated that some coral calcium contains sand. I am now wondering if liquid calcium would be the best choice especially in regard to absorption. Any comments you might have is appreciated.
    This article is very informative. Please know that I have not completely explored this site but
    plan to do so.

  25. says

    @Michelle, we don’t think kids need cow’s milk once they’re weaned – they just need real food. And as we wrote above, real food plus some healthy lifestyle habits means your kids (just like adults) are getting enough calcium and other micronutrients to build strong, healthy bones.

    @Sweety/Carol: Vitamin K2 isn’t a replacement for calcium – it’s a “helper,” directing calcium to the bones where it’s needed. You could supplement with Vitamin K2 (which is not the form found in leafy greens, by the way), or you can get it from your food – specifically, pastured, organic butter and some meats (organ meats in particular).

    We don’t think most people need a calcium supplement at all (as the article stated), if the rest of your dietary and lifestyle factors are in line. If you choose to take a supplement, check with your doctor as to the form and amount he/she recommends.

    Best,
    Melissa

  26. Patricia says

    Hi, Dallas and Melissa,

    I’m a fan of the Whole9 protocol, I think it’s one of the most reasonable eating guidelines I’ve ever seen in a very long time!

    I fully agree with dairy being an overrated source of calcium. My concern with calcium absorption on Whole30, though, is related to animal protein consumption. There are studies reporting that eating protein from animal sources not only impairs proper calcium absorption, but also washes away calcium from bones as it generates excess phosphorus.

    I am not a nutrition expert, but I am an avid reader with a bone condition. I’m really looking forward to reading your opinion on this!

    Thanks,
    Patricia

  27. says

    Patricia,

    You’re talking about the whole “acid/base balance” theory, that suggests if you eat too many acidifying foods (like meat, grains, cheese) and not enough alkalizing foods (vegetables and fruit), your body will leach calcium from your bones in an attempt to buffer the net acid load on your kidneys. Cordain is a big proponent of this theory: http://thepaleodiet.com/acidbase-balance/

    However, we don’t believe this theory has scientific legs. Your body has so many built-in systems to maintain a balanced Ph – respiratory and kidneys, primarily – that it’s just not feasible that the foods you are eating are throwing your body’s Ph off such that calcium is required to buffer. Of course, if you have a kidney disorder, and the kidneys aren’t able to properly regulate the acid load, then that may be a different story… but for those of us with healthy kidney function, I just don’t see this argument for acid/base balance holding up.

    I really like this article for breaking down the science, if you’re interested in reading more: http://sciencebasedpharmacy.wordpress.com/2009/11/13/your-urine-is-not-a-window-to-your-body-ph-balancing-a-failed-hypothesis/

    Finally, just keep doing what you’re doing – eating moderate servings of meat, seafood, and eggs (as we recommend), and copious amounts of plant matter (vegetables and fruit). That’s pretty darn healthy anyway, regardless of acid/base balance, right?

    Best,
    Melissa

  28. Patricia says

    Thanks for the swift reply, Melissa!

    The articles were very interesting, and in the end, it was a useful reminder that the human body is a super efficient machine, as long as we fuel it properly! Truth is that all these supplements on drugstores everywhere and daily allowances numbers get me very anxious and made me forget that important fact.

    Thanks again and congrats on designing such an awesome program. Having shed a few extra pounds and feeling overall better as far as my arthrosis goes, I’m a convert now trying to preach to the family. Your feedback just made it easier!

  29. Tianna says

    Sorry if this was already asked, but I didn’t see this in the comments when I was skimming through them. I was wondering how many servings of the foods per day you would recommend? The enamel on my teeth is really thin and I’ve been having crazy calf and foot cramping at night lately. I’m taking natural calm, eating green veg 3-4 times a week and eating plenty of protein, but I still suspect I’m deficient in a certain mineral. Bone broth is out for me because I can’t find pastured meat where I am. Any suggestions?

  30. says

    @Tianna, you should definitely up your veggie intake and especially your greens. As for bone broth, you can order high bones online at US Wellness meats if there’s nothing near you.

  31. Tianna says

    I think I’ve looked at US Wellness before and they either don’t ship to Canada or it’s crazy expensive. As for the veggies, I do eat tons but it mostly consists of bell peppers, tomato and cucumber. Ill definitely up the greens. Thanks Erin.

  32. Lola says

    What about dairy directly from a cow? Living on a dairy farm, I’ve always drank fresh, whole milk. Is this worse than the stuff you’d get from the store that’s processed and pasteurized (tastes like water to me)? I know it’s high fat content and I don’t drink it on the daily, but I was going to start the whole 30 soon and was just wondering. Hope you can help me out!

  33. Slader says

    One of the biggest shortcomings of paleo-type diets are the lack of calcium they provide. Calcium is heavily implicated in many metabolic processes like cellular energy production and hormonal release. Calcium balances phosphate, so it is important to eat a diet that elicits a good Phosphate:calcium ratio. Ancestral meat-eaters would consume the entire animal-this includes gelatinous cuts and bones which contain sufficient calcium. Paleo diets tend to rely on muscle meats, which are high in phosphate and low in calcium, as a primary source of calories. This leads to a poor ratio, which will inhibit thyroid function, elevate stress hormones and force the body to rely on suboptimal energy processes. Milk is a great way to obtain calcium, as it is low in PUFA, high in protein, and contains pro-metabolic sugars. So long as you aren’t genetically allergic, lactose intolerance is a problem that can be adapted to through repeated consumption of milk. Most allergy symptoms from dairy are actually a result of digesting emulsifiers present in vitamin “fortification” (Polysorbate 80) or industrial enzymes in factory-produced cheeses. Try to consume dairy products without added vitamins and cheese made only with animal rennet, and allergies will disappear. The only viable alternative to consuming milk is eggshell calcium.

  34. Melissa says

    I have hashimoto’s and for thyroid issues like mine, they recommend that we do NOT eat kale, broccoli and other cruciferous vegetables as it interferes with the thyroid. Could you recommend another way to obtain the high amount of calcium needed? OR are the incorrect in their recommendation? (I really miss kale).

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