Calcium

August 2, 2011. Posted in: Vitamins/ Supplements

By Kelly Bonyata, IBCLC

Do nursing mothers need additional calcium?

No. Pregnant and nursing mothers do not need additional calcium other than that normally required for their age group. The Institute of Medicine recommends that nursing mothers over the age of 18 consume 1,000 mg. of calcium daily — the same as other adults.

See the links below for additional information on calcium and breastfeeding.

What if I am breastfeeding AND pregnant?

Hilary Flower researched this question for Adventures in Tandem Nursing: Breastfeeding during Pregnancy and Beyond. She found three important facts that have come from the research of Dr. Ann Prentice in recent years:

  1. Recovery of bone mineral density occurs BEFORE weaning. The recovery begins after the baby’s diet begins to be supplemented with other foods or liquids (the “partial breastfeeding phase”). By 12 months breastfeeding mothers have fully recovered their bone mineral density.
  2. If a mother becomes pregnant before the recovery is complete, bone mineral density increases during pregnancy, a phenomonon not usually seen.
  3. Mothers who are tandem nursing fare the same as their breastfeeding peers.

Flower comments: “Eventually popular beliefs will catch up to the scientific advances of the last five years, and breastfeeding mothers will no longer have to fend off admonishments that their bones are in jeopardy. For their part, scientists have moved on.” (Adventures in Tandem Nursing, p. 213)

What sort of calcium supplement is best?

Calcium supplements should be combined with magnesium in a 2-1 ratio to allow for adequate assimilation into the body. Since dairy products are one of our major sources of zinc, added zinc is also recommended if you are avoiding dairy. Calcium/magnesium/zinc is a combination that is easily found as a supplement. Adding only a calcium supplement (like Tums) is not the best way to go.

If you’re not getting enough calcium from your diet and are considering using a calcium supplement, it’s recommended that you take a combination calcium/magnesium/zinc supplement of 1500 mg/day. If you’re a vegetarian, then you probably need only 600-700 mg/day. Why the difference? Meat -the phosphorus content, I’ve been told- interferes with calcium absorption, plus vegetarians eat more of the foods that have a high calcium content.

In general, it’s considered safe to take up to 2500 mg of calcium daily, although this is more than needed. If you supplement more than 500 mg calcium per day, then divide the dose so you’re not taking it all at once  – calcium absorption is best when a person consumes no more than 500 mg at one time. Greatly excessive intake of calcium can cause numerous side effects.

How does human milk compare to cow’s milk in calcium content?

Human milk contains less calcium than cow’s milk, but the calcium in human milk has over twice the bioavailability of the calcium in cow’s milk. Increasing mom’s calcium intake does not increase the amount of calcium in her milk – mom’s milk has the right amount of calcium even if mom does not get enough in her diet.

According to the American Academy of Pediatrics Policy Statement on Calcium Requirements of Infants, Children, and Adolescents:

No available evidence shows that exceeding the amount of calcium retained by the exclusively breastfed term infant during the first 6 months of life or the amount retained by the human milk-fed infant supplemented with solid foods during the second 6 months of life is beneficial to achieving long-term increases in bone mineralization… Few data are available about the calcium requirements of children before puberty. Calcium retention is relatively low in toddlers and slowly increases as puberty approaches.

Human milk averages 200-340 mg/liter [Hamosh 1991, Riordan & Auerbach 1999], or 5.9-10.1 mg/oz calcium. 67% of this calcium is absorbed by the body [Riordan & Auerbach 1999].

Infant formulas contain 15.6 mg/oz calcium; toddler formulas contain 24-27 mg/oz calcium. Extra calcium is added to infant formulas because of the lower bioavailability of the calcium from formulas as compared to human milk (they aim for baby to absorb the same amount of calcium as would be absorbed from breastmilk).

Whole milk contains 291 mg/8 oz or 36.4 mg/oz calcium. 25-30% of cow’s milk is absorbed by the body [Calcium Counseling Resources: Absorption / Utilization Issues from the National Dairy Council].

 

List of nondairy foods that are high in calcium

If your baby (or you) is allergic to cow’s milk proteins, make sure you read the labels on any packaged foods to ensure that there are no “hidden dairy” ingredients.

  • breastmilk (studies have shown that breastfed babies get plenty of calcium, even if mom doesn’t eat dairy products)
  • dark greens: broccoli, spinach, collards, kale, turnips, bok choy, parsley, mustard, dandelion
  • tofu and other soy products
  • beans: chickpeas/garbanzo beans, navy beans, pinto beans,
  • nuts & seeds: sesame seeds, sunflower seeds, almonds, filberts/hazelnuts, cashews, nut butters, tahini, walnuts
  • sea vegetables: nori, kombu, wakame, agar-agar
  • grains: tapioca, quinoa, tortillas
  • seafood/fish: shrimp, salmon with bones, mackerel with bones, sardines with bones
  • herbs: borage, lamb’s quarter, wild lettuce, nettles, burdock, yellow dock
  • calcium-fortified orange juice
  • Total cereal (calcium fortified)
  • Gerber Graduate juices (calcium fortified)
  • Sunny Delight Calcium orange drink (calcium fortified)
  • Rice milk (calcium fortified)

 

I really miss things like ice cream and cheese! Are there nondairy substitutes?
  • Goat’s milk and goat’s milk cheese can sometimes be eaten by breastfeeding moms with no problems for their breastfed baby. However, some studies have shown that children with cow’s milk allergy react similarly to the proteins in goat’s milk.
  • Rice Dream makes ice cream products from rice milk (try your local health food store)
  • Try vegan varieties of cheese and yogurt, which are generally made from soy. Just keep in mind that many babies who are sensitive to cow’s milk proteins are also sensitive to soy.

 

Additional information

Calcium and breastfeeding

Vitamins (& other supplements) for Nursing Moms @

Breastfeeding and calcium by Dr. Trisha Macnair

Osteoporosis: Reduced risk with nursing? by Debbi Donovan, IBCLC

Dietary Reference Intakes (DRI) from the US Department of Agriculture’s Food and Nutrition Information Center

Riordan J and Auerbach K. Breastfeeding and Human Lactation, 2nd ed. Boston and London: Jones and Bartlett, 1999.

Hamosh M, Dewey, Garza C, et al: Nutrition During Lactation. Institute of Medicine, Washington, DC, National Academy Press, 1991, pp. 133-140. This book is available free from the HRSA Information Center.

See Journal Articles (below) for more information.

General information

Calcium great general information from askdrsears.com

Milking Your Bones by Linda Folden Palmer, DC. “While the National Osteoporosis Foundation tells us we need more calcium to build stronger bones, especially from cow’s milk, the scientific evidence does not support this.”

Doesn’t my daughter need milk and other dairy products so she can grow strong bones and teeth? by Dr. Jay Gordon

The Science of Feeding Your Children: Where is my child going to get calcium without dairy products? by Dr. Jay Gordon

Allergy related

Dairy and other Food Sensitivities in Breastfed Babies @
(includes more links to info on living without dairy)

Dairy Terminology from DrJayGordon.com – lists what to avoid if you’re avoiding dairy

Allergy Elimination Diet: More calcium info and lists of foods/ingredients to avoid while on an elimination diet (dairy, egg, soy, wheat, peanut, tree nut).

Guide to Vegan Cheese, Yogurt, and Other Non-Dairy Product Alternatives by Reed Mangels, PhD, RD, from Vegetarian Journal Nov/Dec 2000

 Journal Articles

Aloia JF, Cohn SH, Vaswani A, Yeh JK, Yuen K, Ellis K. Risks factors for postmenopausal osteoporosis. Am J Med 1985;78:95-100.

Blaauw R, Albertse EC, Beneke T, Lombard CJ, Laubscher R, Hough FS. Risk factors for the development of osteoporosis in a South African population. S Afr Med J 1994;84:328-32.

Chantry CJ, Auinger P, Byrd RS. Lactation Among Adolescent Mothers and Subsequent Bone Mineral Density. Arch Pediatr Adolesc Med. 2004;158:650-656.

“Lactation was not found to be detrimental and may be protective to the bone health of adolescent mothers.”

Cumming RG, Klineberg RJ. Breastfeeding and other reproductive factors and the risk of hip fractures in elderly women. International J Epidemiol 1993;22:684-91.

Hopkinson JM, Butte NF, Ellis K, Smith EO. Lactation delays postpartum bone mineral accretion and temporarily alters its regional distribution in women. J Nutr. 2000 Apr;130(4):777-83.

Karlsson MK, Ahlborg HG, Karlsson C. Pregnancy and lactation are not risk factors for osteoporosis or fractures [review]. Lakartidningen. 2005 Jan 31-Feb 6;102(5):290-3.

Krieger N, Kelsey JL, Holford TR. O’Connor T. An epidemiologic study of hip fractures in potmenopausal women. Am J Epidemiol 1982;116:141-8.

Kovacs CS, Kronenberg HM. PDF Maternal-Fetal Calcium and Bone Metabolism During Pregnancy, Puerperium, and Lactation. Endocrine Reviews 1997;18(6): 832-872.

Kalkwarf HJ, Specker BL. Bone mineral changes during pregnancy and lactation (Review). Endocrine 2002 Feb;17(1):49-53.

“Additional calcium intake does not prevent bone loss during lactation or enhance the recovery after weaning. The recovery of bone is complete for most women and occurs even with shortly spaced pregnancies. Epidemiologic studies have found that pregnancy and lactation are not associated with an increased risk of osteoporotic fractures.”

Kalkwarf HJ. Hormonal and dietary regulation of changes in bone density during lactation and after weaning in women. J Mammary Gland Biol Neoplasia 1999 Jul;4(3):319-29.

Kalkwarf HJ, Specker BL, Ho M. Effects of calcium supplementation on calcium homeostasis and bone turnover in lactating women. J Clin Endocrinol Metab 1999 Feb;84(2):464-70.

Laskey MA, Prentice A. Bone mineral changes during and after lactation. Obstet Gynecol 1999; 94:608-15.

Laskey MA, Prentice A. Effect of pregnancy on recovery of lactational bone loss. Lancet 1997 May; 349(9064):1518-19.

Melton LJ, Bryant SC, Wahner HW, O’Fallon WM, Malkasian GD, Judd HL, Riggs BL. Influence of breastfeeding and other reproductive factors on bone mass later in life. Osteoporosis Int 1993;3:76-83.

Prentice A. Maternal calcium metabolism and bone mineral status. Am J Clin Nutr 2000 May;71(5 Suppl):1312S-6S.

Prentice A, Jarjou LM, Stirling DM, Buffenstein R, Fairweather-Tait S. Biochemical markers of calcium and bone metabolism during 18 months of lactation in Gambian women accustomed to a low calcium intake and in those consuming a calcium supplement. J Clin Endocrinol Metab 1998 Apr;83(4):1059-66.

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