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  • Shelley Case, B. Sc., RD
    Shelley Case, B. Sc., RD

    Bone Up on Calcium and Vitamin D

    Reviewed and edited by a celiac disease expert.

    Journal of Gluten Sensitivity Autumn 2002 Issue. NOTE: This article is from a back issue of our popular subscription-only paper newsletter. Some content may be outdated.

    Bone Up on Calcium and Vitamin D - Erawan Waterfalls. Calcium deposits make the water appear bright blue. Image: CC BY 2.0--Todd Huffman
    Caption: Erawan Waterfalls. Calcium deposits make the water appear bright blue. Image: CC BY 2.0--Todd Huffman

    Celiac.com 04/29/2024 - Getting enough calcium in the diet is essential for people of all ages, as this mineral performs many important functions in the body. In addition to bone health, calcium is required for muscle contractions, nerve impulses, normal blood clotting and regulating blood pressure. It may also offer protection from colon cancer.

    Children and adults with celiac disease need to pay particular attention to calcium and other nutrients as many already have or will develop early bone disease such as osteopenia or osteoporosis. Osteopenia is low bone mineral density and osteoporosis is characterized by a significant decrease in bone mass resulting in brittle, easily broken bones. The hip, spine and wrist are most susceptible to fracture. Early diagnosis and treatment of celiac disease is critical for the prevention of bone disease. To maintain good bone health it is important that all people with celiac disease have routine bone density tests done to assess their overall bone health, and to follow the tips outlined below.

    Follow a strict gluten-free diet

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    Healthy villi will result in normal absorption of nutrients.

    Meet your daily calcium requirements

    Table 1: Dietary Reference Intake for Calcium

    Age

    Calcium (mg/day)

    Infants

    0- 6 months

    7-12 months

     

    210

    270

    Children

    1-3 years

    4-8 years

     

    500

    800

    Females and Males

    9-13

    14-18

    19-30

    31-50

    51-70

    71 +

     

    1300

    1300

    1000

    1000

    1200

    1200

    Choose calcium-rich foods

    See Table 2 for a list of gluten-free foods. Remember that not all calcium sources are created equal. Milk (fl uid, powdered or evaporated) and milk products such as cheese and yogurt contain the most readily available source of calcium. Other foods such as salmon and sardines with the bones, calcium-fortifi ed beverages (soy, rice and orange juice), tofu made with calcium sulfate and vegetables (broccoli, collards, kale, mustard greens, turnip greens and bok choy) also contain calcium that is easily absorbed by the body. However, the calcium found in almonds, sesame seeds, dried beans and spinach are absorbed less effi ciently because these foods contain calcium-binding substances called oxalates. Although the calcium content of these foods should not be counted as part of your daily calcium intake; they do provide many other nutrients important for good health.

    Table 2 Calcium Content of Gluten-Free Dairy Foods

    Food

    Serving

    Calcium (mg)

    Buttermilk

    1 cup (250 ml)

    303

    Cheddar cheese

    2 oz. (50 g)

    350

    Cottage cheese, creamed

    ½ cup (125 ml)

    76

    Feta cheese

    2 oz (50 g)

    255

    Ice cream

    ½ cup (125 ml)

    90

    Milk (whole, 2%, 1%, skim)

    1 cup (250 ml)

    315

    Milk (chocolate)

    1 cup (250 ml)

    301

    Milk, powder, dry

    3 Tbsp. (45 ml)

    308

    Mozzarella cheese

    2 oz (50 g)

    287

    Parmesan cheese, grated

    3 Tbsp. (45 ml)

    261

    Processed cheese slices

    2 regular (62 g)

    384

    Swiss cheese

    2 oz (50 g)

    480

    Yogurt, fruit-flavored

    ¾ cup (175 g)

    240

    Yogurt, plain

    ¾ cup (175 g)

    296

     

    Table 2: Calcium Content of Other Gluten-Free Foods

    Food

    Serving

    Calcium (mg)

    Almonds

    ½ cup (125 ml)

    200*

    Baked beans

    1 cup (250 ml)

    163*

    Bok choy, cooked

    ½ cup (125 ml)

    84

    Broccoli, cooked

    ½ cup (125 ml)

    38

    Collards, cooked

    ½ cup (125 ml)

    81

    Orange juice, calcium fortified

    1 cup (250 ml)

    300-350

    Salmon, sockeye, canned with bones

    Half a 7.5 oz (213 g) can

    243

    Sardines, canned with bones

    6 medium (72 g)

    275

    Sesame seeds

    ½ cup (125 ml)

    89*

    Soybeans, cooked

    ½ cup(125 ml)

    93

    Soy beverage, fortified

    1 cup (250 ml)

    312

    Tofu, regular, processed with calcium sulfate**

    1/3 cup (100 g)

    150

    * The calcium from these sources is absorbed less efficiently by the body.
    ** The calcium content of tofu is an approximation based on products available on the market. Calcium content can vary greatly from one brand to another and can be low. Tofu processed with magnesium chloride also contains less calcium.

    Consider calcium supplementation

    If you are unable to consume enough dietary calcium you many to need a gluten-free calcium supplement. Look for the amount of “elemental calcium” on the label. Your body can only absorb 500 mg at one time therefore it is best to divide your dose throughout the day. Calcium carbonate is more slowly absorbed and should be consumed with meals. Calcium citrate is well absorbed with meals or an empty stomach. Bone meal or dolomite calcium supplements are not recommended as some products have been found to contain lead and mercury.

    Limit caffeine intake

    Studies have shown that caffeine increases calcium loss through the urine. Most experts agree that 2-3 cups of coffee/day is probably not harmful provided that calcium intake is adequate, so limit your coffee and cola intake.

    Limit sodium intake

    Sodium also has been shown to increase the loss of calcium through the urine. Therefore it is advisable to limit your intake of processed foods, table salt and salt in cooking.

    Get enough Vitamin D

    Vitamin D helps the body use the calcium in food. It can increase calcium absorption by as much as 30-80 %. See Table 3 for the Dietary Reference Intake for vitamin D. The easiest way to get vitamin D is from exposure to sunlight, which causes the body to make its own vitamin D. All you need is 15 minutes per day; however, aging significantly decreases 1) the ability of the skin to produce vitamin D and 2) kidney function that is involved in converting the inactive to active form of vitamin D. Also, sunscreen blocks the production of vitamin D in the skin. Another concern is that between the months of October and March in Canada and the northern USA, vitamin D synthesis in the skin is very limited. To make up for the lack of sunlight look for other sources of vitamin D listed in Table 4, and remember the points below.

    Table 3: Dietary Reference Intake for Vitamin D

    Age

    Vitamin D (IU)

    Birth – 50 years

    200

    51- 70 years

    400

    Over 70 years

    600

    • Milk is fortified with vitamin D but most other dairy products such as cheese, yogurt and ice cream are not fortified. Recently some companies have been adding vitamin D to other dairy products so be sure to read the ingredient label and nutrition panel.
    • Fatty fish (sardines, salmon and herring) and cod liver oil and halibut liver oil are high in vitamin D.
    • Many soy and rice beverages are fortified with vitamin D. Check the ingredient list carefully as some products may contain barley malt extract/flavoring and must be avoided.
    • Nut beverages (e.g. Blue Diamond Almond Breeze) and potato beverages (e.g. Vances DariFree) are fortified with vitamin D.
    • Multivitamin supplements usually contain 200-400 IU of vitamin D.
    • Some calcium supplements may contain vitamin D. Amounts vary so check the label.

    Table 4: Sources of Vitamin D

    Food

    Serving Size

    Vitamin D (IU)

    Cod liver oil

    Cod liver oil capsule

    1 tsp. (5 ml)

    1 capsule

    450

    100

    Halibut liver oil capsule

    1 capsule

    400

    Sardines, canned

    3.5 oz (100 g.)

    300

    Salmon, canned, with bones

    3.5 oz (100 g.)

    500

    Egg

    1 medium

    25

    Milk

    1 cup (250 ml)

    90

    Soy Beverage (fortified)

    1 cup (250 ml)

    90

    Don’t just sit there…get moving! Regular weight bearing exercises such as walking, stair climbing, dancing and tennis and muscle-strengthening exercises can reduce the risks of falls and fractures. Consult your doctor before beginning a vigorous exercise program.

    So remember the ABC’s…All Bones Need Calcium, Vitamin D and Exercise!



    User Feedback

    Recommended Comments

    Guest marcus

    Posted

    Serum vitamin D levels are important, but usually they are a surrogate measurement For sun exposure. Sun exposure at midday can produce up to 20,000 IU of vitamin D in 20 minutes. Sun exposure is he only natural way to directly obtain vitamin D. Lack of sun exposure can be deadly, and every human being needs some non-burning sunshine every day around noon. Here are some of the beneficial effects of non-burning sun exposure on human health:

    •Influenza diminishes to almost nothing during late spring, summer, and early fall, times of greatest sun exposure and vitamin D production.

    •Seventy-five percent of melanomas occurs on areas of the body seldom or never exposed to sun.

    •Women who sunbathe regularly have half the risk of death during a 20-year period compared to those who stay indoors. A study from Sweden shows that sun avoidance lowers life span as much as smoking.

    •Multiple sclerosis (MS) is highest in areas of little sunlight, and virtually disappears in areas of year-round direct sunlight.

    •A Spanish study shows that women who seek the sun have one-eleventh the hip-fracture risk as sun avoiders.

    •Men who work outdoors have half the risk of melanoma as those who work indoors.

    •Women who avoid the sun have 10-times the risk of breast cancer as those who embrace the sun.

    •Sun exposure decreases heart disease risk.

    •Sun exposure dramatically improves mood.

    •Those persons who spend many hours daily outdoors have only 1/50 the risk of Parkinson's disease!

    •For each death caused by diseases associated with sun exposure, there are 328 deaths caused by diseases associated with sun deprivation.

    •Sun exposure increases the production of BDNF, essential to nerve function.

    •In the U.S., vitamin D deficiency in children has increased by 83 times during a 14-year period. That is likely due to indoor living and sunscreen use:

    More information: sunlightinstitute.org, and read the book, Embrace the Sun.

     

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    Russ H

    It would be nice to have some references for these claims.

    Sunburn in childhood is the greatest risk for skin cancer:

    https://www.nhs.uk/conditions/melanoma-skin-cancer/causes/

    UV exposure is responsible for 80% of skin ageing:

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3790843/

    If you believe that vitamin D levels need to be raised then take a supplement, which is how I maintain my absurdly good looks despite my advanced age.

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    trents

    Links to credible references please, marcus. There are plenty of unqualified "experts" who make a living off of sensational claims that run counter to mainstream scientific opinion.

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  • About Me

    Shelley Case, B. Sc., RD

    Shelley Case, B.Sc., RD, is a consulting dietitian, member of the Medical Advisory Boards of the Celiac Disease Foundation, Gluten Intolerance Group and Canadian Celiac Association and co-author of the celiac section in the Manual of Clinical Dietetics by the American Dietetic Association and Dietitians of Canada. She is also the author of the best selling book Gluten-Free Diet: A Comprehensive Resource Guide.


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