Which calcium supplement is best for you? And how much calcium do you need?

If you are over 50, most physicians recommend 1500 mg to 2500 mg of calcium per day, divided between meals. Younger people can do well with 500 to 1000 mg of calcium or calcium/magnesium per day and if you eat plenty of dairy products and dark green vegetables you may require less.

Forms of Calcium:

• Calcium Citrate is more easily absorbed than Calcium Carbonate

• Vitamin D, phosphorous and zinc enhance absorption of Calcium for example, Calcium Magnesium with vitamin D

• Calcium with Magnesium strengthens bones and supports nerves and muscles.

Be sure to read supplement labels! Aim for 1000 mg of calcium, the side panel of the bottle will tell you if that’s what you’re getting.

Don't Forget! The body will eliminate “excess” calcium, but if you don’t have enough it will be “stolen” from your bones. Osteoporosis, the “silent thief” can cause hip, wrist and shoulder fractures as well as disfigurement. Preventive use of calcium makes good health sense.

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Part VI of Dr. Quinn Hand's Series, Understanding the Vegetarian Diet!

Don't Forget These Other Important Nutrients (see chart below for more information).

Iodine

Iodine is a very important nutrient when it comes to thyroid function.  Iodine is the primary mineral used to make thyroid hormone.  The thyroid is the driving force behind metabolism and without iodine it can become sluggish. 

Calcium/Vitamin D

Some vegans may become concerned that due to lack of dairy, they will become calcium and vitamin D deficient. The good news is, that many vegetarian foods are rich calcium sources – think tofu, almonds, green leafy veggies. Also, there is some evidence to suggest that animal protein may cause calcium loss in the urine. So, by not eating meat, vegetarians and vegans may preserve calcium in the body.  However, this research is inconclusive and other studies suggest protein intake is required to promote calcium absorption. As such, vegetarians/vegans should try to achieve calcium adequacy of 1000mg per day in adults 19-50 years of age and 1200mg in women over the age of 51 and men 70 years and older.

While many products are vitamin D fortified, the reality is that naturally occurring food sources of vitamin D are limited. Fatty fish is the best dietary source of vitamin D and even then it isn’t abundant. Thus, omnivores and vegetarians alike are best to head out in the sun or take a vitamin D supplement. In particular, those of us that live in the northern hemisphere where we don’t get enough sunlight eight months of the year to allow adequate vitamin D production in the skin, can benefit from vitamin D supplementation.

Essential Fatty Acids (EFAs)

Anything labeled “essential” means that the human body can’t make it and it must be obtained via diet. This is true of our EFAs – we require Omega-3 and Omega-6. Sources of Omega-3 include: flax, hemp, canola, soybean, walnut, safflower, sunflower, dark leafy greens and fish oil. Sources of Omega-6 include: safflower, sunflower, hemp, soybean, walnut, pumpkin, flax and sesame. EFAs are critical to cell membrane function, improving cell communication, and they play an important role in the balance of inflammation in the body. They confer cardiovascular, neurological, eye and skin health benefits. Two of the more critical omega-3 fatty acids are docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), found preformed in fish and fish oil. Many of the health benefits attached to EFAs are a result of these two long-chain fatty acids. If humans aren’t ingesting DHA and EPA, preformed in fish or fish oil, the body needs to convert the omega-3 in vegetable sources. Unfortunately, we are not very good converters. However, for vegetarians, it is still critical to use sources of omega-3 such as flax seed oil, evening primrose oil, walnut, hemp, and pumpkin. Vegetarian algae sources of omega-3 can also be purchased. Algae oils provide high amount of naturally occurring DHA (that’s what the fish eat in the first place) and can be converted into EPA in smaller amounts.

Recognizing and Addressing Deficiencies in Vegetarian Diets

Deficiency	Possible Signs of Deficiency	Foods to Eat	Possible Supplements
Protein	Key building block for all cells and tissues, thus can affect entire body.  Symptoms include: fatigue, poor wound healing, brittle hair/nails, decreased immune function, swelling, muscle loss/wasting, difficulty building muscle	Lacto-ovo Eggs, dairy   All (vegans/veggies) Beans, legumes, nuts, seeds	Whey protein isolate powder  (lacto and lacto-ovo) or vegan protein powder,   Vegetarian/vegan friendly protein bars
Vitamin B12	Megaloblastic anemia (big red blood cells), weakness, constipation, loss of appetite, weight loss, numbness and tingling in hands/feet, difficulty maintaining balance, depression, confusion, dementia, poor memory, soreness of mouth/tongue	Lacto-ovo Eggs, dairy   All (vegans/veggies) B12 fortified cereals, soy products, beverages	500mcg per day has been shown to stop depletion and adequately maintain stores in vegetarians   A lower daily dose in a multivitamin or B-complex could also be sufficient   Over deficiency may require higher doses ranging from 1000-5000mcg/d
Iron	Anemia, paleness, fatigue, reduced ability to exercise, shortness of breath, frequent infections, brittle nails, decreased appetite, irritability, sore tongue/mouth, thinning hair/hair loss	Spinach and other leafy greens, tofu, beans, dried fruit, iron-fortified breads/cereals	Based on blood tests by your health care practitioner, recommended doses can be anywhere from 10-100mg, depending on deficiency status.   Vegetarian men should get 14mg/d and women 33mg/d to avoid deficiency
Iodine	Hypothyroidism, symptoms of which are fatigue, weight gain, depression, low body temperature, mental slowing, dry skin, hair and nails, and possibly goiter	Sea vegetables - kelp, hijiki, dulse, nori (seaweed)   Salt (iodized or naturally mineralized salts like Celtic sea salt)	Approximately 150mcg is required daily, but I do not typically recommend supplements unless there is overt deficiency. Sea vegetables are a safer more accessible source
Calcium	Bone density loss, muscle spasm	Lacto-ovo Dairy   All Green leafy veggies, almonds, tofu, tahini, fortified beverages/foods	Adults 19-50: 1000mg/d (including diet)   Women 51+/Men 70+: 1200mg
Vitamin D	Bone disease (rickets/osteomalacia), loss of bone density, muscle pain/weakness, increased risk of certain cancers, autoimmune disease, immune dysfunction	Lacto-ovo Fortified dairy   All SUNSHINE! Fortified beverages (soy/rice/almond)	Minimum: 1000IU/d
EFAs	Fatigue, dry skin/mouth/eyes/hair, depression, hypertension, increase risk of cardiovascular disease and neurodegenerative disease	Nuts, seeds, vegetable oils	1-2 Tbsp (15-30mL) per day of omega-3 rich vegetable oils like flax seed oil OR 1-2 1000mg flax seed oil capsules   Evening Primrose oil can be added as a gamma linoleic acid source – 1000-2000mg (1-2 capsules)
Zinc (not discussed but included for completeness)	Loss of appetite, reduced taste sensation, impaired immune function, mental lethargy	Seeds, beans, legumes, whole grains, mushrooms, spinach, corn	15-50mg per day

Image source: natural-homeremedies.org, joanmorais.com