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Calcium and Menopause



Calcium requirements for skeletal maintenance fluctuate throughout a woman's lifetime. This means that your needs for calcium will differ during different times of your life. During a woman's reproductive years, less calcium is required for bone health, and that's because we need just enough to be able to maintain bone turnover. But calcium needs are going to rise at the time of menopause because there's a decreased efficiency in the use of dietary calcium. Research shows that this has a lot to do with the estrogen-related shifts that we are seeing in intestinal calcium absorption. What this means is that if you were to take in the same amount of calcium now as during your reproductive years, your body is absorbing less of it than you would in reproductive years. And if you are Vitamin D deficient on top of that, you are even less likely to be absorbing calcium. So there’s many different factors here that can impact calcium absorption. There’s also an age-related decrease in calcium absorption has been shown in postmenopausal women in addition to the decline that occurs at menopause. Aging also reduces the expression of two key intestinal calcium transporters, to be able to bring calcium into the cell. So just something to keep in mind and why I really focus on this with my menopause and postmenopausal patients.


Both calcium and vitamin D have been shown to reduce bone loss in healthy postmenopausal women and in postmenopausal women with substantial bone loss or previous fracture. So it's just important to keep in mind that we really want to optimize these two nutrients. I just wanted to do a quick slide on actually reading your calcium food labels because I know there are some people that are confused by this. So, the amount of calcium that you see in a label is listed as the percent of daily needs based on 1,000 milligrams of calcium per day. The average person needs about 1,000 milligrams of calcium per day. With post-menopause, we're looking at 1200 mg a day and that's recommended after age 51. So the calcium requirements do increase post-menopause because of the reasons I just mentioned. But just know that the food label is going to list the amount of calcium based on 1000 milligrams a day. So to calculate the milligrams of calcium that you're getting, you essentially just add a zero to the percent of calcium on the label. So you'll see on this label here, it says amount per serving (so per 1 cup), you're getting 30% of calcium. That actually means you're getting 300 milligrams of calcium. So you're getting almost a third of your daily intake, right? 300 out of the 1000 milligrams you need in a day.


Okay, so I hope that makes sense. Again, you just add a zero to the percent on the calcium level. And just remember that it's based on an average person needing 1,000 milligrams of calcium per day. So here are some common food sources and it shows approximately the amount of calcium you're getting per each of these food groups. So as you can see dairy is a big one, right? Typically one cup of cow's milk is going to have 250 milligrams of calcium, so it's a really good source. Cheese and yogurt are also really good sources of calcium.


When it comes to vegetables and fruits you can see again they have some calcium but it does tend to be a little bit less. So like broccoli, kale, mustard greens, you're getting significantly less calcium than you would with dairy sources. With respect to grains, there is some calcium, so about 100 milligrams per serving. With nuts and seeds, it depends on how much you're eating, but you can see here a quarter cup of almonds is about 100 mg of calcium. With protein, you can see that tofu is a really good source of calcium. So, especially in my patients who are not eating dairy, or are dairy free for whatever reason, I will recommend more of those tofu sources if they're open to it, or beans or salmon. I wanted to put this into perspective because like I mentioned, the intake that we're looking for postmenopausal women is 1200 milligrams a day. I can tell you from my clinical experience that a lot of women are not meeting that criteria, especially if you're not eating any dairy. It’s something to keep in mind because we'll talk about calcium testing right now, but maybe you need to consider a supplement if you are not getting to that 1200 milligram dose.


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