Clearing up the confusion over calcium

Q: How can a woman navigate the calcium-bone-density thing? Many calcium supplements in pharmacies are calcium carbonate, which is hard to absorb. You can almost never find calcium citrate.

Also, is dairy good for us? What about other foods? What if you have a tough coffee habit?

Then we're told that it's the amount of calcium you ingested as a teenager, when your bones were being formed, that counts. Of course, I lived on Tab and Red Hots when I was a teenager. Yikes!

A: Your question has a lot of components, so I am going to break it up into parts to make the information easier to digest. Here goes:

Calcium is good for bones, and it may also improve PMS symptoms and drop the risk of colon cancer (though this is less proven). Women before menopause should aim for 1,000 mg of calcium per day and, after menopause, 1,200 mg per day. That includes your diet and supplements. So if you are getting enough calcium in the food you eat, you don't need to take a supplement.

Dairy, like most things in life, has pros and cons. It can be hard to get that much calcium through diet alone, so milk products provide a highly concentrated source and are easy to find.

Yet many people have lactose intolerance (a problem digesting sugar in milk), which can cause gas and cramping. The likelihood of developing it may increase with age. Although you can get around this by using enzymes, such as Lactaid, to digest the milk, it isn't always 100 percent effective.

Even people who don't have lactose intolerance notice they feel better when they avoid dairy. That is why so many holistic providers recommend avoiding dairy products for certain health conditions such as asthma and allergies to see if it helps. Remember, that doesn't necessarily mean you are "allergic" to milk — just that you feel better without it.

There are other foods high in calcium. Kale, collard greens, broccoli, seaweed and dandelion greens are all good sources. But you still have to eat a lot of these foods to get up to the levels needed, and not everyone likes to eat weeds from the backyard.

If you aren't sure you are going to get enough calcium in your diet, then a calcium supplement is a good insurance policy. I usually recommend calcium citrate because you can absorb it even if you don't eat it with a meal (calcium carbonate should be taken with food). It's also the best choice for anyone on an acid blocker. Citracal is a commonly available brand in regular pharmacies, but there are many other brands available in health-food stores.

It's not just about calcium. Remember that in order to build healthy bones, you need to get enough vitamin D and exercise. Also, eating leafy greens helps boost your levels of vitamin K, which helps build bone as well.

The issue around coffee and bone mass is not very clear. Coffee does leach calcium from your body, but if you are making the cutoff for calcium through supplements or diet, then it's probably OK. I would avoid more than three cups of coffee per day.

Even if you lived on Red Hots and soda as a teenager, you can still make a difference. Yes, it's true that you build your bone mass up until about age 35 or so, and then it starts to drop off. That is one of the many reasons it is so important that we model good nutrition for our children. However, even if you didn't do that, taking calcium, vitamin D and exercising still help to slow the rate of bone loss — and some studies suggest it may help it to plateau. So don't give up, even if you didn't make the ideal choices when you were younger.

Dr. Astrid Pujari is a Seattle M.D. with an additional degree as a medical herbalist; she practices at the Pujari Center and teaches as part of the residency programs at Virginia Mason and Swedish/Cherry Hill hospitals. Her column is a weekly feature on Sundays. Send questions to apujari@seattletimes.com for possible use in future columns.