Diabetes diet - type 1

Definition

The American Diabetes Association and the American Dietetic Association have developed specific dietary guidelines for people with diabetes.
This article focuses on diet guidelines for people with type 1 diabetes.

Overview & Functions

If you have type 1 diabetes, it is important to know how many carbohydrates you eat at a meal. This information helps you determine how much insulin you should take with your meal to maintain blood sugar (glucose) control.
The other two major nutrients, protein and fat ,also have an effect on blood glucose levels, though it is not as rapid or great as carbohydrates.


A delicate balance of carbohydrate intake, insulin, and physical activity is necessary for the best blood sugar (glucose) levels. Eating carbohydrates increase your blood sugar (glucose) level. Exercise tends to decrease it (although not always). If the three factors are not in balance, you can have wide swings in blood sugar (glucose) levels.
If you have type 1 diabetes and take a fixed dose of insulin, the carbohydrate content of your meals and snacks should be consistent from day to day.
CHILDREN AND DIABETES
Weight and growth patterns can help determine if a child with type 1 diabetes is getting enough nutrition.
Changes in eating habits and more physical activity help improve blood sugar (glucose) control. For children with diabetes, special occasions (like birthdays or Halloween) require additional planning because of the extra sweets. You may allow your child to eat sugary foods, but then have fewer carbohydrates during other parts of that day. For example, if child eats birthday cake, Halloween candy, or other sweets, they should NOT have the usual daily amount of potatoes, pasta, or rice. This substitution helps keep calories and carbohydrates in better balance.
MEAL PLANNING
One of the most challenging aspects of managing diabetes is meal planning. Work closely with your doctor and dietitian to design a meal plan that maintains near-normal blood sugar (glucose) levels. The meal plan should give you or your child the proper amount of calories to maintain a healthy body weight.
The food you eat increases the amount of glucose in your blood. Insulin decreases blood sugar (glucose). By balancing food and insulin together, you can keep your blood sugar (glucose) within a normal range. Keep these points in mind:

• Your doctor or dietitian should review the types of food you or your child usually eats and build a meal plan from there. Insulin use should be a part of the meal plan. Understand how to time meals for when insulin will start to work in your the body.
• Be consistent. Meals and snacks should be eaten at the same times each day. Do not skip meals and snacks. Keep the amount and types of food (carbohydrates, fats, and proteins) consistent from day to day.
• Learn how to read food labels to help plan you or your child’s carbohydrate intake.
• Use insulin at the same time each day, as directed by the doctor.

Monitor blood sugar (glucose) levels. The doctor will tell you if you need to adjust insulin doses based on blood sugar (glucose) levels and the amount of food eaten.
Having diabetes does not mean you or your child must completely give up any specific food, but it does change the kinds of foods one should eat routinely. Choose foods that keep blood sugar (glucose) levels in good control. Foods should also provide enough calories to maintain a healthy weight.

Diabetes food pyramid 

  The Diabetes Food Pyramid divides food into six groups, which vary in size to show relative amounts of servings for each group.
This pyramid differs from the Food Guide Pyramid released by the USDA. In the Diabetes Food Pyramid, the groups are based on protein content and carbohydrates instead of their food classification.

Recommendations

A registered dietitian can help you best decide how to balance your diet with carbohydrates, protein, and fat. Here are some general guidelines:
The amount of each type of food you should eat depends on your diet, your weight, how often you exercise, and other existing health risks. Everyone has individual needs, which is why you should work with your doctor and, possibly, a dietitian to develop a meal plan that works for you.


But there are some reliable general recommendations to guide you. The Diabetes Food Pyramid, which resembles the old USDA food guide pyramid, splits foods into six groups in a range of serving sizes. In the Diabetes Food Pyramid, food groups are based on carbohydrate and protein content instead of their food classification type. A person with diabetes should eat more of the foods in the bottom of the pyramid (grains, beans, vegetables) than those on the top (fats and sweets). This diet will help keep your heart and body systems healthy.
GRAINS, BEANS, AND STARCHY VEGETABLES
(6 or more servings a day)
Foods like bread, grains, beans, rice, pasta, and starchy vegetables are at the bottom of the pyramid because they should serve as the foundation of your diet. As a group, these foods are loaded with vitamins, minerals, fiber, and healthy carbohydrates.
It is important, however, to eat foods with plenty of fiber. Choose whole-grain foods such as whole-grain bread or crackers, tortillas, bran cereal, brown rice, or beans. Use whole-wheat or other whole-grain flours in cooking and baking. Choose low-fat breads, such as bagels, tortillas, English muffins, and pita bread.
VEGETABLES
(3 - 5 servings a day)
Choose fresh or frozen vegetables without added sauces, fats, or salt. You should opt for more dark green and deep yellow vegetables, such as spinach, broccoli, romaine, carrots, and peppers.
FRUITS
(2 - 4 servings a day)
Choose whole fruits more often than juices. Fruits have more fiber. Citrus fruits, such as oranges, grapefruits, and tangerines, are best. Drink fruit juices that do NOT have added sweeteners or syrups.
MILK
(2 - 3 servings a day)
Choose low-fat or nonfat milk or yogurt. Yogurt has natural sugar in it, but it can also contain added sugar or artificial sweeteners. Yogurt with artificial sweeteners has fewer calories than yogurt with added sugar.
MEAT AND FISH
(2 - 3 servings a day)
Eat fish and poultry more often. Remove the skin from chicken and turkey. Select lean cuts of beef, veal, pork, or wild game. Trim all visible fat from meat. Bake, roast, broil, grill, or boil instead of frying.
FATS, ALCOHOL, AND SWEETS
In general, you should limit your intake of fatty foods, especially those high in saturated fat, such as hamburger, cheese, bacon, and butter.
If you choose to drink alcohol, limit the amount and have it with a meal. Check with your health care provider about a safe amount for you.
Sweets are high in fat and sugar, so keep portion sizes small. Other tips to avoid eating too many sweets:

• Ask for extra spoons and forks and split your dessert with others.
• Eat sweets that are sugar-free.
• Always ask for the small serving size.

You should also know how to read food labels, and consult them when making food decisions.

References

American Diabetes Association. Standards of medical care in diabetes -- 2009. Diabetes Care. 2009;32:S13-S61.
Eisenbarth GS, Polonsky KS, Buse JB. Type 1 Diabetes Mellitus. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR. Kronenberg: Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 31.

Age-appropriate diet for children

 

 

Definition

An age-appropriate diet is one that provides adequate nutrition and is appropriate for a child's state of development.

Diet and good health

A well-balanced diet is appropriate for a person of any age. A healthy diet is especially important for children since a variety of food is needed for proper development. Other elements of good health include exercise, rest and avoidance of stimulants such as sugar and caffeine. Recommendations BIRTH TO 4 MONTHS OF AGE During the first 4 - 6 months of life, infants need only breast milk or formula to meet all their nutritional needs. If breastfeeding, a newborn may need to nurse 8 - 12 times per day (every 2 - 4 hours), or on demand. By 4 months, the baby is likely to cut back to 4 - 6 times per day, however, the quantity of breast milk consumed at each feeding will increase. Formula-fed babies may need to eat about 6 - 8 times per day, starting newborns with 2 - 3 ounces of formula per feeding (for a total of 16 - 24 ounces per day). As with breastfeeding, the number of feedings will decrease as the baby gets older, but the amount of formula will increase to approximately 6 - 8 ounces per feeding. Never give honey to an infant, as it may contain the spores that cause botulism. An infant's immune system is not fully developed to fight off this disease. Although an infant may sleep through the night, waking to feed may be necessary if the infant is not eating enough during the day or if they are underweight. Routine check-ups with your physician to monitor your child's growth will ensure they are eating adequately during the day. Your doctor or dietitian will inform you if waking to feed is recommended. 4 - 6 MONTHS OF AGE At 4 - 6 months of age an infant should be consuming 28 - 45 ounces of formula, and is often ready to start the transition to solid foods. Starting solids too soon may cause the infant to choke if they are not physically ready. There are several developmental milestones to indicate an infant is ready to eat solid foods: The birth weight has doubled The baby has good control of head and neck The baby can sit up with some support The baby can show fullness by turning the head away or by not opening the mouth The baby begins showing interest in food when others are eating. Start solid feedings with iron-fortified baby rice cereal mixed with breast milk or formula to a thin consistency. The cereal may be mixed to a thicker consistency as the baby learns to control it in his mouth. Initially, offer cereal 2 times per day in servings of 1 or 2 tablespoons (dry amount, before mixing with formula or breast milk). Gradually increase to 3 or 4 tablespoons of cereal. Cereal should not be given in a bottle unless a doctor or dietitian recommends it, for example, for reflux. Once the baby is eating rice cereal routinely, you may introduce other iron-fortified instant cereals. Only introduce one new cereal per week so you can watch for an intolerance or allergy. Never put a child to bed with a bottle as this can cause bottle mouth, resulting in tooth decay. Use plain water if a bottle is necessary. Discuss use of water with your physician. (In some cases, use of excess water can lead to seizures in children.) 6 - 8 MONTHS Continue to offer breast milk or formula 3 - 5 times per day. Cow's milk is not recommended by the American Academy of Pediatrics for children under 1 year old. The baby will begin drinking less formula or breast milk once solid foods become a source of nutrition. After a baby has tried a variety of different baby cereals, try strained fruits and vegetables. For strained fruits and vegetables, introduce one at a time waiting 2 - 3 days in between to check for any allergic reaction. Start with plain vegetables such as green peas, potatoes, carrots, sweet potatoes, squash, beans, beets; and plain fruits such as bananas, applesauce, apricots, pears, peaches, and melon. Some dietitians recommend introducing a few vegetables before fruits, as the fruit's sweetness may make a less-sweet food such as vegetables less appealing. Give fruits and vegetables in 2 - 3 tablespoon servings and offer about 4 servings per day. Amounts of fruits and vegetables eaten per day will vary between 2 tablespoons and 2 cups depending on the size of your child and how well the child eats fruits and vegetables. The consistency of foods offered may be gradually increased as your child tolerates. Finger foods may be offered in small amounts, but avoid foods such as apple chunks or slices, grapes, hot dogs, sausages, peanut butter, popcorn, nuts, seeds, round candies, and hard chunks of uncooked vegetables that may cause choking. Soft cooked vegetables, washed and peeled fruits, graham crackers, melba toast, noodles are good finger foods. Salty or sugary foods are not recommended. Teething foods, such as toast strips, unsalted crackers, bagels, and teething biscuits may also be introduced at this time. 8 - 12 MONTHS OF AGE Breast milk or formula should be offered three to four times per day at this age. Cow's milk is not recommended by the American Academy of Pediatrics for children under 1 year old. At 8 - 12 months of age, a baby will be ready to try strained or finely chopped meats. For breastfed infants, start meats at 8 months of age (breast milk is not a rich source of iron, but infants have adequate iron stores to last until 8 months of age when iron-rich foods such as meats can be given). As with other foods, offer only 1 new meat per week in 3 - 4 tablespoon servings -- use strained and finely ground meats, frankfurters, or meat sticks. Serving sizes for fruits and vegetables increases to 3 - 4 tablespoons, four times per day. Eggs may be given 3 - 4 times per week, but only the yolk until the baby is 1 year old, as some babies are sensitive to egg whites. By the age of 1, most children are off the bottle. If the child still uses a bottle, it should contain water only. 1 YEAR OF AGE After a baby is 1-year old, whole milk may replace breast milk or formula. Children under the age of 2 should not be given low-fat milk (2%, 1%, or skim) as they need the additional calories from fat to ensure proper growth and development. Children under the age of 1 should not be given whole milk as it has been shown to cause low blood counts. Cheese, cottage cheese, and yogurt, however, may be given in small amounts. The 1-year-old child should be getting much of their nutrition from meats, fruits and vegetables, breads and grains, and the dairy group, especially whole milk. Providing a variety of foods will help to ensure enough vitamins and minerals. Toddlers do not grow as rapidly as babies do, so their nutritional needs relative to their size decrease during the second year of life. Although they continue to gain weight, they no longer double their weight as infants do. Keep in mind, however, that toddlers are becoming more and more active as they learn to crawl and walk. Toddlers and small children will usually eat only small amounts at one time, but will eat frequently (4 - 6 times) throughout the day, so snacking is strongly encouraged. Feeding tips: Feeding solids too early is not recommended and can result in overfeeding. Offer only one new food at a time. Offer the new foods for a few days. Watch for allergic reactions (hives, vomiting, diarrhea). Do not feed solids in a bottle. If your child dislikes the new food, try giving it again later. SAFETY DURING MEALTIMES Feed the baby directly from the jar only if you use the entire jar contents, otherwise use a dish to prevent contamination with food-borne illness. Opened containers of baby's food should be covered and stored in a refrigerator for no longer than 2 days. Use a small spoon to feed the baby. A baby put to bed with a bottle (milk, fruit juice, or sweetened beverage) can develop bottle mouth, resulting in tooth decay. Use plain water if a bottle is necessary. Avoid foods that may cause the baby to choke -- popcorn, nuts, potato chips, whole kernel corn, berries, grapes, hot dogs, raw vegetables, raisins, dry flake cereals. OTHER TIPS Water can be offered between feedings. Feeding sweets or sweetened beverages is not recommended because they will spoil the appetite and contribute to tooth decay. Salt, sugar, and strong spices are not recommended. Caffeine products are not recommended (soft drinks, coffee, tea, chocolate). A fussy baby may need attention, rather than food. OLDER CHILDREN Throughout childhood and adolescence, it is important that the diet include a variety of foods for proper development. The principles of the food guide pyramid apply to a child's diet as well as an adult's, although portions and number of servings per day are obviously less for children. After the age of 2, it is recommended that the diet be moderately low in fat, as diets high in fat may contribute to heart disease, obesity, and other health problems later in life. In areas where water is not fluoridated, fluoride supplementation is recommended. A diet that contains a variety of foods from each of the food groups (breads and grains, meats, fruits and vegetables, and dairy) will help prevent nutrient deficiencies. Both the American Medical Association and the American Dietetic Association recommend that healthy children should get all their nutrients from foods rather than vitamin supplements. The nutrients that are most likely to be deficient in a child's diet are calcium, iron, vitamin C, vitamin A, folic acid, and vitamin B6. The American Academy of Pediatrics does not support routine supplementation for normal, healthy children. However, there is no significant risk if a parent wishes to give their child a standard pediatric multi-vitamin. Children who consume little or no dairy products are at particular risk for calcium deficiency that can interfere with bone growth and development. Foods that are good sources of calcium include low-fat or nonfat milk, yogurt, and cheeses. Other foods such as broccoli, cooked greens, and canned salmon (with bones) will also provide a source of calcium in the diet, however it is often difficult to get children to consume adequate quantities of these foods. Iron requirements vary by age, rate of growth, iron stores, increasing blood volume, and rate of absorption from food sources. Adolescent girls will have increased iron needs due to menstrual losses. Food sources of iron include meat, fish, poultry, iron-fortified cereals, spinach greens, and dried beans and peas.

Carbohydrates

Definition

Carbohydrates are one of the main dietary components. This category of foods includes sugars, starches, and fiber.

Overview & Functions

The primary function of carbohydrates is to provide energy for the body, especially the brain and the nervous system. An enzyme called amylase helps break down carbohydrates into glucose (blood sugar), which is used for energy by the body.

Food Sources

Carbohydrates are classified as simple or complex. The classification depends on the chemical structure of the food, and how quickly the sugar is digested and absorbed. Simple carbohydrates have one (single) or two (double) sugars. Complex carbohydrates have three or more sugars.
Examples of single sugars from foods include:

• Fructose (found in fruits)
• Galactose (found in milk products)

Double sugars include:

• Lactose (found in dairy)
• Maltose (found in certain vegetables and in beer)
• Sucrose (table sugar)

Honey is also a double sugar. But unlike table sugar, it contains a small amount of vitamins and minerals. (NOTE: Honey should not be given to children younger than 1 year old.)
Complex carbohydrates, often referred to as "starchy" foods, include:

• Legumes
• Starchy vegetables
• Whole-grain breads and cereals

Simple carbohydrates that contain vitamins and minerals occur naturally in:

• Fruits
• Milk and milk products
• Vegetables

Simple carbohydrates are also found in processed and refined sugars such as:

• Candy
• Regular (non-diet) carbonated beverages, such as soda
• Syrups (not including natural syrups such as maple)
• Table sugar

Refined sugars provide calories, but lack vitamins, minerals, and fiber. Such simple sugars are often called "empty calories" and can lead to weight gain.
Also, many refined foods, such as white flour, sugar, and polished rice, lack B vitamins and other important nutrients unless they are marked "enriched." It is healthiest to get carbohydrates, vitamins, and other nutrients in as natural a form as possible -- for example, from fruit instead of table sugar.

Complex carbohydrates 

 

Complex carbohydrates are made up of sugar molecules that are strung together in long, complex chains. Complex carbohydrates are found in foods such as peas, beans, whole grains, and vegetables. Both simple and complex carbohydrates are turned to glucose (blood sugar) in the body and are used as energy. Glucose is used in the cells of the body and in the brain. Any unused glucose is stored in the liver and muscles as glycogen for use later. Complex carbohydrate foods provide vitamins, minerals, and fiber that are important to the health of an individual. The majority of carbohydrates should come from complex carbohydrates (starches) and naturally occurring sugars, rather than processed or refined sugars, which do not have the vitamins, minerals, and fiber found in complex and natural carbohydrates. Refined sugars are often called "empty calories" because they have little to no nutritional value. Simple carbohydrates    Simple carbohydrates are broken down quickly by the body to be used as energy. Simple carbohydrates are found naturally in foods such as fruits, milk, and milk products. They are also found in processed and refined sugars such as candy, table sugar, syrups, and soft drinks. The majority of carbohydrate intake should come from complex carbohydrates (starches) and naturally occurring sugars rather than processed or refined sugars. Starchy foods    All food that you eat turns to sugar in your body. Carbohydrate-containing foods alter your sugar levels more than any other type of food. Carbohydrates are found in starchy or sugary foods, such as bread, rice, pasta, cereal, potatoes, peas, corn, fruit, fruit juice, milk, yogurt, cookies, candy, soda, and other sweets. Recommendations Most people should get between 40% and 60% of total calories from carbohydrates, preferably from complex carbohydrates (starches) and natural sugars. Complex carbohydrates provide calories, vitamins, minerals, and fiber. Foods that are high in processed, refined simple sugars provide calories, but very little nutrition. It is wise to limit these sugars. To increase complex carbohydrates and healthy nutrients: Eat more fruits and vegetables. Eat more whole-grain rice, breads, and cereals. Eat more legumes (beans, lentils, and dried peas). Here are recommended serving sizes for foods high in carbohydrates: Vegetables: 1 cup of raw vegetables, or 1/2 cup cooked vegetables, or 3/4 cup of vegetable juice Fruits: 1 medium-size fruit (such as 1 medium apple or 1 medium orange), 1/2 cup of a canned or chopped fruit, or 3/4 cup of fruit juice Breads and cereals: 1 slice of bread; 1 ounce or 2/3 cup of ready-to-eat cereal; 1/2 cup of cooked rice, pasta, or cereal; 1/2 cup of cooked dry beans, lentils, or dried peas Dairy: 1 cup of skim or low-fat milk For information about how many servings are recommended, see the food guide pyramid. Here is a sample 2,000 calorie menu, of which 50% - 60% of the total calories are from carbohydrates. Breakfast Cold cereal 1 cup shredded wheat cereal 1 tbsp raisins 1 cup fat-free milk 1 small banana 1 slice whole-wheat toast 1 tsp soft margarine 1 tsp jelly Lunch Smoked turkey sandwich 2 ounces whole-wheat pita bread 1/4 cup romaine lettuce 2 slices tomato 3 ounces sliced smoked turkey breast 1 tbsp mayo-type salad dressing 1 tsp yellow mustard 1/2 cup apple slices 1 cup tomato juice Dinner Grilled top loin steak 5 ounces grilled top loin steak 3/4 cup mashed potatoes 2 tsp soft margarine 1/2 cup steamed carrots 1 tbsp honey 2 ounces whole-wheat dinner roll 1 tsp soft margarine 1 cup fat-free milk Snacks 1 cup low-fat fruited yogurt Side Effects Getting too many carbohydrates can lead to an increase in total calories, causing obesity. Not getting enough carbohydrates can cause a lack of calories (malnutrition), or excessive intake of fats to make up the calories. References Farrell JJ. Digestion and Absorption of Nutrients and Vitamins. In: Feldman M, Friedman LS, Sleisenger MH, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 8th ed. Philadelphia, Pa: WB Saunders; 2006:chap 97. Dietary Guidelines for Americans 2005. Rockville, MD: US Dept. of Health and Human Services and US Dept. of Agriculture; 2005.

Diet - calories

Definition

The energy stored in food is measured in terms of calories.
Technically, 1 calorie is the amount of energy required to raise the temperature of 1 gram of water 1 degree centigrade. The calorie measure used commonly to discuss the energy content of food is actually a kilocalorie or 1000 real calories. This is the amount of energy required to raise 1 kilogram of water (about 2.2 pounds) 1 degree centigrade.
Different foods contain different amounts of energy -- which is why a small piece of chocolate can have many more calories than a similarly sized piece of lettuce.
However, since calories are a measure of energy, there cannot be, as some diet books claim, different types of calories. A fat calorie has the same amount of energy as a protein or carbohydrate calorie.
A person's caloric need is determined using a variety of mathematical equations. Age, height, current weight, and desired weight are taken into account. Diet is what you eat. Dieting usually refers to eating fewer calories to lose weight.

Overview & Functions

The amount of calories in a diet refers to how much energy the diet can provide for the body. A well-balanced diet is one that delivers an adequate amount of calories while providing the maximum amount of nutrients.
The body breaks down food molecules to release the energy stored within them. This energy is needed for vital functions like movement, thought, growth -- anything that you do requires the use of fuel. The body stores energy it does not need in the form of fat cells for future use.


The process of breaking down food for use as energy is called metabolism. Increased activity results in increased metabolism as the body needs more fuel. The opposite is also true. With decreased activity the body continues to store energy in fat and does not use it up. Therefore, weight gain is the result of increased intake of food, decreased activity, or both.
The nutrition labels on food packages indicate the number of calories contained in the food.

Food Sources

Naturally, different foods provide different amounts of calories. Some foods, such as ice-cream, have many calories; while others, like leafy vegetables, have few.

Recommendations

Recommendations for dieting:

• Do not eat meat more than once a day. Fish and poultry are recommended instead of red or processed meats.
• Avoid frying food because food absorbs the fats from cooking oils and this increases dietary fat intake. Bake or broil food instead. If you do fry, use polyunsaturated oils, such as corn oil.
• Include adequate fiber in your diet. Fiber is found in green leafy vegetables, fruit, beans, bran flakes, nuts, root vegetables, and whole grain foods. Fiber often makes you feel full without having to eat excess calories.
• Do not eat more than 4 eggs per week. Although they are a good source of protein and low in saturated fat, eggs are very high in cholesterol, and should be eaten in moderation for that reason.
• Choose fresh fruit for desserts rather than cookies, cake, or pudding.
• Cut down on salt, whether it is table salt, or flavor intensifiers that contain salt such as monosodium glutamate (MSG).
• Too much of anything has its drawbacks, whether it is calories, or a particular type of food. A well-balanced diet with creativity and variety is best suited to your needs
•  

  Side Effects

  • Inappropriate dieting (fad dieting) can lead to rebound weight gain.
  • Altered body image is associated with anorexia nervosa and bulimia.
  • Diets that are excessively low in calories are considered dangerous and do not result in healthful weight loss. A more desirable method of weight reduction is one that is moderate in calories and that encourages routine exercise.
  • Children and young adults should not limit calories below the Recommended Daily Allowance because they require a certain amount of calories for growth and development. Better eating habits for the entire family often accomplish the caloric decrease that is required for a child or young adult to reach a desirable weight.
  
  

Calories are the basic unit of energy within food. When you eat, your body converts calories into energy and uses what it can and stores the rest in the form of fat. A calorie is a calorie, whether it comes from a brownie or a serving of raw broccoli. The difference between them is the number of calories, nutrients, fat, and other ingredients in a typical serving.

Food	Serving size	Calories	Fat (grams)
Broccoli	1/2 cup	12	0.2
Brownie	1 square	160	3

Calcium in diet

Definition

Calcium is the most plentiful mineral found in the human body. The teeth and bones contain the most calcium (about 99%). Nerve cells, body tissues, blood, and other body fluids contain the remaining calcium.

Overview & Functions

Calcium is one of the most important minerals for the growth, maintenance, and reproduction of the human body. Calcium helps form and maintain healthy teeth and bones. Proper levels of calcium over a lifetime can help prevent osteoporosis.
Calcium helps with blood clotting, nerve signaling, muscle contraction and relaxation, and the release of certain hormones. It is also needed for a normal heartbeat

Food Sources

Many foods contain calcium, but dairy products are the most significant source. Milk and dairy products such as yogurt, cheeses, and buttermilk contain an efficiently absorbed form of calcium.
Whole milk (4% fat) is recommended for children age 1 to 2. The fat content of dairy products is a concern for adults and children over the age of 2. You can easily reduce the fat content while maintaining the calcium content by selecting low-fat (2% or 1%) or skim milk and other diary products.


The calcium is not contained in the fat portion of milk, so removing the fat will not affect the calcium content. In fact, when you replace the fat portion that has been removed with an equal part of skimmed milk, you are actually increasing the calcium content. Therefore, one cup of skim or non-fat milk will have more calcium than one cup of whole milk because almost the entire cup of skim milk is made up of the calcium-containing portion.
Other dairy products such as yogurt, most cheeses, and buttermilk are excellent sources of calcium and are available in low-fat or fat-free versions.
Milk is also a good source of phosphorus and magnesium, which help the body absorb and use the calcium more effectively. Vitamin D is essential for efficient utilization of calcium. Milk is fortified with vitamin D for this reason.

Green leafy vegetables such as broccoli, collards, kale, mustard greens, turnip greens, and bok choy or Chinese cabbage are good sources of calcium.
Other sources of calcium are salmon and sardines canned with their soft bones. Shellfish, almonds, Brazil nuts, and dried beans are also sources of calcium. It is difficult, however, to eat adequate quantities of these foods to achieve optimal calcium intake.
Calcium is added to several food products, such as breads and orange juice, to make them a significant source of calcium for persons who do not eat a lot of dairy products.

Recommendations

The Food and Nutrition Board at the Institute of Medicine recommends the following dietary intake for calcium:
Infants

• 0 - 6 months: 210 milligrams per day (mg/day)
• 7 - 12 months: 270 mg/day

Children

• 1 - 3 years: 500 mg/day
• 4 - 8 years: 800 mg/day
• 9 - 13 years: 1300 mg/day

Adolescents and Adults

• Males age 14 to 18 years: 1300 mg/day
• Males age 19 to 50 years: 1000 mg/day
• Males 51 and over: 1200 mg/day
• Females age 14 to 18 years: 1300 mg/day
• Females age 19 to 50 years: 1000 mg/day
• Females 51 and over: 1200 mg/day

The best way to get the daily requirement of essential vitamins is to eat a balanced diet that contains a variety of foods from the food guide pyramid. Up to 2,000 - 2,500 mg a day of calcium from dietary sources and supplements appears to be safe. The preferred source of calcium is calcium-rich foods such as dairy products.
Up to 2,000 - 2,500 mg a day of calcium from dietary sources and supplements appears to be safe. The preferred source of calcium is calcium-rich foods such as dairy products.
The following list can help you determine how much calcium you are getting from food:

• 8-ounce glass of milk = 300mg of calcium
• 2 ounces of Swiss cheese = 530mg of calcium
• 6 ounces of yogurt = 300 mg of calcium
• 2 ounces of sardines with bones = 240mg of calcium
• 6 ounces of cooked turnip greens = 220mg of calcium
• 3 ounces of almonds = 210mg of calcium

Vitamin D is needed to help the body absorb calcium. When choosing calcium supplements, look for ones that also contain vitamin D.

Side Effects

Increased calcium for a limited periods does not normally cause side effects. However, receiving a large amount of calcium over a long period of time raises the risk of kidney stones in some people.
Those who do not receive enough calcium over a long period of time can develop calcium deficiency. This condition leads to osteoporosis, loss of the jaw bone (osteonecrosis), hypertension, and other disorders.


Persons with lactose intolerance have trouble digesting lactose, the sugar in milk. There are over-the-counter products available that make it easier to digest lactose. You can also buy lactose-free milk at most grocery stores.
In rare instances, some people have a true allergy to the protein in milk. Such persons must avoid all dairy products and may need to take calcium supplements.

References

Hamrick I, Counts SH. Vitamin and mineral supplements. Wellness and Prevention. December 2008:35(4);729-747.
Rakel D, ed. Integrative Medicine. 2nd ed. Philadelphia, Pa: Saunders Elsevier; 2007.
Institute of Medicine. Food and Nutrition Board. Dietary Reference Intakes for Calcium, Phosphorous, Magnesium, Vitamin D, and Fluoride. National Academy Press, Washington, DC, 1997.