Milk and Calcium

Here is a question I recently received from FOODPICKER.org

Q: I have type 2 diabetes and cannot tolerate milk.  What may I substitute for my recommended two milk servings per day?  Would I substitute a carbohydrate or a protein?

A: An adequate calcium intake is essential to maintain calcium balance and build strong bones. Dairy products contain large amounts of calcium and are recommended as optimal calcium sources.

My first question to you would be, are you lactose intolerant or do you dislike drinking milk?

Lactose intolerance, also referred to as lactase deficiency, is defined as the inability to fully digest the milk sugar, lactose, in dairy. For some people, the body does not produce, or produces very little of, the enzyme lactase. The most common symptoms of lactase deficiency are diarrhea, bloating and gas.

There are various milk products available that have the enzyme lactase added to the milk such as Lactaid, Horizon lactose free milk, Organic Valley lactose free milk etc. There is also the option of taking a lactase pill or using lactase drops before drinking milk.

Yogurt, another great source of calcium,  may be tolerated more easily since some of the lactose is predigested by the yogurt’s beneficial bacteria.

If you just aren’t a fan of plain milk, try making a milk shake or smoothie. One great product that is tasty and is fortified with lots of vitamins and minerals is Carnation Instant Breakfast No Sugar Added. They even have recipes in the box and on their website to jazz up the drink – like adding peanut butter and a banana or if you like coffee you can make a mocha or cappucino with it. Check out all of their recipes here: Carnation Instant Breakfast Recipes.

Calcium fortified soymilk, rice milk and almond milk have gained popularity in the United States. However, various studies have shown that the body does not absorb the calcium from these fortified sources as well as it does from cow’s milk. Supplements also tend to be absorbed less readily. For example,  each 300 mg Ca provided by supplements or fortified beverages would provide about the same amount of absorbable calcium as 1 glass (240 mL) of milk.

Some plants provide absorbable calcium, but the amount of vegetables needed to be consumed may not be realistic for many.  Additionally,  other ingredients in foods can actually decrease calcium absorption such as: salt, protein, and caffeine.

The American Journal of Clinical Nutrition has listed choices for achieving adequate dietary calcium with other food sources comparable to milk. Take note of servings needed to equal 240 mL of milk.

Food	Serving size1	Calcium content2	Fractional absorption3	Estimated absorbable calcium4	Servings needed to equal 240 mL milk
	g	mg	%	mg	n
Milk	240	300	32.1	96.3	1.0
Beans
Pinto	86	44.7	26.7	11.9	8.1
Red	172	40.5	24.4	9.9	9.7
White	110	113	21.8	24.7	3.9
Bok choy	85	79	53.8	42.5	2.3
Broccoli	71	35	61.3	21.5	4.5
Cheddar cheese	42	303	32.1	97.2	1.0
Cheese food	42	241	32.1	77.4	1.2
Chinese cabbage flower leaves	85	239	39.6	94.7	1.0
Chinese mustard greens	85	212	40.2	85.3	1.1
Chinese spinach	85	347	8.36	29	3.3
Fruit punch with calcium citrate malate	240	300	52.0	156	0.62
Kale	85	61	49.3	30.1	3.2
Spinach	85	115	5.1	5.9	16.3
Sweet potatoes	164	44	22.2	9.8	9.8
Rhubarb	120	174	8.54	10.1	9.5
Tofu with calcium	126	258	31.0	80.0	1.2
Yogurt	240	300	32.1	96.3	1.0
1Based on half-cup serving size (≈85 g for green leafy vegetables) except for milk and fruit punch (1 cup or 240 mL) and cheese (1.5 oz).
2From references 4 and 5 (averaged for beans and broccoli processed in different ways) except for the Chinese vegetables, which were analyzed in our laboratory.
3Adjusted for load by using the equation for milk [fractional absorption = 0.889-0.0964 ln load (6)] then adjusted for the ratio of calcium absorption of the test food relative to milk tested at the same load, the absorptive index. The absorptive index was taken from the literature for beans (7), bok choy (8), broccoli (8), Chinese vegetables (9), fruit punch with calcium citrate malate (10), kale (8), sweet potatoes (9), rhubarb (9), tofu (11), and dairy products (12).