Health Concerns about Dairy Products

Many Americans, including some vegetarians, still consume substantial amounts of dairy
products—and government policies still promote them—despite scientific evidence that
questions their health benefits and indicates their potential health risks.

Osteoporosis
Milk’s main selling point is calcium, and milk-drinking is touted for building strong
bones in children and preventing osteoporosis in older persons. However, clinical
research shows that dairy products have little or no benefit for bones. A 2005 review
published in Pediatrics showed that milk consumption does not improve bone integrity in
children.1 Similarly, the Harvard Nurses’ Health Study,2which followed more than 72,000
women for 18 years, showed no protective effect of increased milk consumption on
fracture risk. While calcium is important for bone health, studies show that increasing
consumption beyond approximately 600 mg per day—amounts that are easily achieved
without dairy products or calcium supplements—does not improve bone integrity.2

In studies of children and adults, exercise has been found to have a major effect on bone
density.3-5

You can decrease your risk of osteoporosis by reducing sodium and animal protein intake
in the diet,6-9 increasing intake of fruits and vegetables,9,10 exercising,4,11 and ensuring
adequate calcium intake from plant foods such as kale, broccoli, and other leafy green
vegetables and beans. You can also use calcium-fortified products such as breakfast
cereals and juices, although these products provide more concentrated calcium than is
necessary.

Fat Content and Cardiovascular Disease

Dairy products—including cheese, ice cream, milk, butter, and yogurt—contribute
significant amounts of cholesterol and saturated fat to the diet.12 Diets high in fat and
saturated fat can increase the risk of heart disease, among other serious health problems.
A low-fat vegetarian diet that eliminates dairy products, in combination with exercise,
smoking cessation, and stress management, can not only prevent heart disease, but may
also reverse it.13,14 Non-fat dairy products are available; however, they pose other health
risks as noted below.

Cancer
Prostate and breast cancers have been linked to consumption of dairy products,
presumably related to increases in a compound called insulin-like growth factor (IGF-I).15
IGF-I is found in cow’s milk and has been shown to occur in increased levels in the blood
of individuals consuming dairy products on a regular basis.16 Other nutrients that increase
IGF-I are also found in cow’s milk.

Case-control studies in diverse populations have shown a strong and consistent

association between serum IGF-I concentrations and prostate cancer risk.17 One study

1
showed that men who had the highest levels of IGF-I had more than four times the risk of
prostate cancer compared with those who had the lowest levels.18 Other findings show
that prostate cancer risk was elevated with increased consumption of low-fat milk,
suggesting that too much dairy calcium could be a potential threat to prostate health.19,20

Ovarian cancer may also be related to the consumption of dairy products. The milk sugar
lactose is broken down in the body into another sugar, galactose. Research suggests that
the dairy sugar galactose might be toxic to ovarian cells.21 In a study conducted in
Sweden, consumption of lactose and dairy products was positively linked to ovarian
cancer.22 A similar study, the Iowa Women’s Health Study, found that women who
consumed more than one glass of milk per day had a 73 percent greater chance of ovarian
cancer than women who drank less than one glass per day.23

Lactose Intolerance
Lactose intolerance is common among many populations, affecting approximately 95
percent of Asian Americans, 74 percent of Native Americans, 70 percent of African
Americans, 53 percent of Mexican Americans, and 15 percent of Caucasians.24
Symptoms, which include gastrointestinal distress, diarrhea, and flatulence, occur
because these individuals do not have the enzyme lactase that digests the milk sugar
lactose. For those who can digest lactose, its breakdown products are two simple sugars:
glucose and galactose. Nursing children have active enzymes that break down galactose.
As we age, many of us lose much of this capacity.25 Additionally, along with unwanted
symptoms, milk-drinkers also put themselves at risk for development of other chronic
diseases and ailments.

Vitamin D
Individuals often drink milk in order to obtain vitamin D in their diet, unaware that they
can receive vitamin D through other sources. The natural source of vitamin D is sunlight.
Five to fifteen minutes of sun exposure to the arms and legs or the hands, face, and arms
can be enough to meet the body’s requirements for vitamin D, depending on the
individual’s skin tone.26 Darker skin requires longer exposure to the sun in order to obtain
adequate levels of vitamin D. In colder climates during the winter months the sun may
not be able to provide adequate vitamin D. During this time the diet must be able to
provide vitamin D. Fortified cereals, grains, bread, orange juice, and soy- or rice milk are
healthful foods that provide vitamin D. All common multiple vitamins also provide
vitamin D.

Contaminants
Milk contains contaminants that range from pesticides to drugs. Milk naturally contains
hormones and growth factors produced within a cow’s body. In addition, synthetic
hormones such as recombinant bovine growth hormone (rBGH) are commonly used in
dairy cows to increase the production of milk.27 Because treated cows are producing
quantities of milk nature never intended, the end result can be mastitis, or inflammation
of the mammary glands. Treatment of this condition requires the use of antibiotics, and
antibiotic traces have occasionally been found in samples of milk and other dairy
products. Pesticides, polychlorinated biphenyls (PCBs), and dioxins are other examples

2
of contaminants found in milk. These toxins do not readily leave the body and can
eventually build to harmful levels that may affect the immune and reproductive systems.
The central nervous system can also be affected. Moreover, PCBs and dioxins have also
been linked to cancer.28

Milk Proteins and Diabetes

Insulin-dependent (type 1 or childhood-onset) diabetes is linked to consumption of dairy
products.29 A 2001 Finnish study of 3,000 infants with genetically increased risk for
developing diabetes showed that early introduction of cow’s milk increased susceptibility
to type 1 diabetes.30

Health Concerns of Infants and Children

Milk proteins, milk sugar, fat, and saturated fat in dairy products pose health risks for
children and encourage the development of obesity, diabetes, and heart disease.

The American Academy of Pediatrics recommends that infants below one year of age not
be given whole cow’s milk,31 as iron deficiency is more likely on a dairy-rich diet. Cow’s
milk products are very low in iron.32 If dairy products become a major part of one’s diet,
iron deficiency is more likely. Colic is an additional concern with milk consumption. Up
to 28 percent of infants suffer from colic during the first month of life.33 Pediatricians
learned long ago that cow’s milk was often the reason. We now know that breastfeeding
mothers can have colicky babies if the mothers consume cow’s milk. The cow’s
antibodies can pass through the mother’s bloodstream, into her breast milk, and to the
baby.34,35 Additionally, food allergies appear to be common results of cow’s milk
consumption, particularly in children.36,37 Cow’s milk consumption has also been linked
to chronic constipation in children. Researchers suggested that milk consumption resulted
in perianal sores and severe pain on defecation, leading to constipation.38

Milk and dairy products are not necessary in the diet and can, in fact, be harmful to
health. It is best to consume a healthful diet of grains, fruits, vegetables, legumes, and
fortified foods including cereals and juices. These nutrient-dense foods can help you meet
your calcium, potassium, riboflavin, and vitamin D requirements with ease—and without
health risks.

Calcium and Strong Bones

3
Protecting Your Bones

The bone-thinning condition called osteoporosis can lead to small and not-so-small
fractures. Although many people think of calcium in the diet as good protection for their
bones, this is not at all the whole story. In fact, in a 12-year Harvard study of 78,000
women, those who drank milk three times a day actually broke more bones than women
who rarely drank milk. Similarly, a 1994 study of elderly men and women in Sydney,
1

Australia, showed that higher dairy product consumption was associated with increased
fracture risk. Those with the highest dairy product consumption had approximately
double the risk of hip fracture compared to those with the lowest consumption. 2

To protect your bones you do need calcium in your diet, but you also need to keep
calcium in your bones.

How to Get Calcium into Your Bones

1. Get calcium from greens, beans, or fortified foods.

The most healthful calcium sources are green leafy vegetables and legumes, or "greens
and beans" for short. Broccoli, Brussels sprouts, collards, kale, mustard greens, Swiss
chard, and other greens are loaded with highly absorbable calcium and a host of other
healthful nutrients. The exception is spinach, which contains a large amount of calcium
but tends to hold onto it very tenaciously, so that you will absorb less of it.

Beans are humble foods, and you might not know that they are loaded with calcium.
There is more than 100 milligrams of calcium in a plate of baked beans. If you prefer
chickpeas, tofu, or other bean or bean products, you will find plenty of calcium there, as
well. These foods also contain magnesium, which your body uses along with calcium to
build bones.

If you are looking for a very concentrated calcium source, calcium-fortified orange or
apple juices contain 300 milligrams or more of calcium per cup in a highly absorbable
form. Many people prefer calcium supplements, which are now widely available.

Dairy products do contain calcium, but it is accompanied by animal proteins, lactose

sugar, animal growth factors, occasional drugs and contaminants, and a substantial
amount of fat and cholesterol in all but the defatted versions.

2. Exercise, so calcium has somewhere to go.

Exercise is important for many reasons, including keeping bones strong. Active people
tend to keep calcium in their bones, while sedentary people lose calcium.

3. Get vitamin D from the sun, or supplements if you need them.

4
Vitamin D controls your body's use of calcium. About 15 minutes of sunlight on your
skin each day normally produces all the vitamin D you need. If you get little or no sun
exposure, you can get vitamin D from any multiple vitamin. The Recommended Dietary
Allowance is 200 IU (5 micrograms) per day. Vitamin D is often added to milk, but the
amount added is not always well controlled.

How to Keep It There

It's not enough to get calcium into your bones. What is really critical is keeping it there.
Here's how:

1. Reduce calcium losses by avoiding excess salt.

Calcium in bones tends to dissolve into the bloodstream, then pass through the kidneys
into the urine. Sodium (salt) in the foods you eat can greatly increase calcium loss
through the kidneys. If you reduce your sodium intake to one to two grams per day, you
3

will hold onto calcium better. To do that, avoid salty snack foods and canned goods with
added sodium, and keep salt use low on the stove and at the table.

2. Get your protein from plants, not animal products.

Animal protein—in fish, poultry, red meat, eggs, and dairy products—tends to leach
calcium from the bones and encourages its passage into the urine. Plant protein—in
beans, grains, and vegetables—does not appear to have this effect. 4

3. Don't smoke.

Smokers lose calcium, too. A study of identical twins showed that, if one twin had been a
long-term smoker and the other had not, the smoker had more than a 40 percent higher
risk of a fracture.
5

American recommendations for calcium intake are high, partly because the meat, salt,
tobacco, and physical inactivity of American life leads to overly rapid and unnatural loss
of calcium through the kidneys. By controlling these basic factors, you can have an
enormous influence on whether calcium stays in your bones or drains out of your body.

Hormone Supplements Have Serious Risks

Some doctors recommend estrogen supplements for women after menopause as a way to
slow osteoporosis, although the effect is not very great over the long run, and they are
rarely able to stop or reverse bone loss.

Many women find these hormones distasteful because the most commonly prescribed
brand, Premarin, is made from pregnant mares' urine, as its name suggests. What has
many physicians worried is the fact that estrogens increase the risk of breast cancer. The

5
Harvard Nurses' Health Study found that women taking estrogens have 30 to 80 percent
more breast cancer, compared to other women. 6

Moreover, Premarin may aggravate heart problems. In a study of 2,763 postmenopausal

women with coronary disease followed for an average of four years, there were as many
heart attacks and related deaths in women treated with the combined regimen of
estrogens and a progesterone derivative, as with placebo, but the coronary problems
occurred sooner in women taking hormones. Hormone-treated women were also more
likely to develop dangerous blood clots and gallbladder disease. Controlling calcium
7

losses is a much safer strategy.

Reversing Osteoporosis

If you already have osteoporosis, you will want to speak with your doctor about exercises
and perhaps even medications that can reverse it.

Osteoporosis in Men

Osteoporosis is less common in men than in women, and its causes are somewhat
different. In about half the cases, a specific cause can be identified and addressed:
8

• Steroid medications, such as prednisone, are a common cause of bone loss and
fractures. If you are receiving steroids, you will want to work with your doctor to
minimize the dose and to explore other treatments.
• Alcohol can weaken your bones, apparently by reducing the body's ability to
make new bone to replace normal losses. The effect is probably only significant if
you have more than two drinks per day of spirits, beer, or wine.
• A lower than normal amount of testosterone can encourage osteoporosis.
About 40 percent of men over 70 years of age have decreased levels of
testosterone.

In many of the remaining cases, the causes are excessive calcium losses and inadequate
vitamin D. The first part of the solution is to avoid animal protein, excess salt and
caffeine, and tobacco, and to stay physically active in order to reduce calcium losses.
Second, take vitamin D supplements as prescribed by your physician. The usual amount
is 200 IU (5 micrograms) per day, but it may be doubled if you get no sun exposure at all.
If you have trouble absorbing calcium due to reduced stomach acid, your doctor can
recommend hydrochloric acid supplements.

Calcium and Magnesium in Foods (milligrams)

Food Source Calcium Magnesium
Collards (1 cup, boiled) 358 52
Orange juice, calcium-fortified (1
350* --
cup)
Oatmeal, instant (2 packets) 326 70

6
 Figs, dried (10 medium) 269 111
Tofu, calcium-set (1/2 cup) 258 118
Spinach (1 cup, boiled) 244 158
Soybeans (1 cup, boiled) 175 148
White beans (1 cup, boiled) 161 113
Mustard greens (1 cup, boiled) 150 20
Navy beans (1 cup, boiled) 128 107
Vegetarian baked beans (1 cup) 128 82
Great northern beans (1 cup, boiled) 121 88
Black turtle beans (1 cup, boiled) 103 91
Swiss chard (1 cup, boiled) 102 152
Broccoli (1 cup, boiled) 94 38
Kale (1 cup boiled) 94 24
English muffin 92 11
Butternut squash (1 cup, boiled) 84 60
Pinto beans (1 cup, boiled) 82 95
Chick peas (1 cup, canned) 80 78
Sweet potato (1 cup, boiled) 70 32
Green beans (1 cup, boiled) 58 32
Barley (1 cup) 57 158
Brussels sprouts (8 sprouts) 56 32
Navel orange (1 medium) 56 15
Raisins (2/3 cup) 53 35
Source: J.A.T. Pennington, Bowes and Church's Food Values of
Portions Commonly Used. (Philadelphia: J.B. Lippincott, 1994.)
*Information from manufacturer

Parents' Guide to Building Better Bones

Most parents recognize the need to encourage healthy eating habits in their children, and
they have heard that calcium is important for building healthy bones. But did you know
that keeping salt and animal protein intake low and fruit and vegetable intake high is
every bit as important? Did you know that scientists are doubtful that drinking more milk
has any significant benefit for growing bones?

7
In this fact sheet, nutritionists and doctors with the Physicians Committee for
Responsible Medicine (PCRM) aim to set the record straight and help parents sort
through the hype about calcium, milk, and bone health.

For Starters

Most children have no problem developing normal healthy bones. In fact, children in
Japan, China, and other countries consume much lower levels of calcium than their North
American peers and still develop strong, healthy bones. That's because the human body is
an efficient regulator of bone growth.

Just like our hair, skin, and lungs, bone is a living tissue that is constantly being built,
broken down, and made anew. Throughout life, bones are taking up and releasing
calcium and other minerals, a cycle that is influenced by a variety of factors, including
diet, exercise habits, hormones, genetics, and certain diseases. According to two recent
reviews of bone health in childhood, the largest influence on this cycle is genetics,
accounting for 60 to 80 percent of the differences, with hormones related to growth and
puberty second in importance.1,2

Children generally build bone at a slightly higher pace than they break it down. After
adolescence, this cycle begins to shift a little so that bone building and breakdown
generally keep pace with each other. Later in life, this bone-remodeling cycle tends to
head in the reverse direction—with more bone being broken down than is rebuilt. Of
course, the extent of this weakening can range from barely noticeable to a serious
condition called osteoporosis, depending on many lifestyle and dietary habits.

The minerals in a child's skeleton are completely replaced (or recycled) about five times
between childhood and her or his 55th birthday.3 Focusing on those actions that promote
bone building and those that decrease bone breakdown will effectively improve bone
health.

Promoting Bone Building

Bones are a matrix of collagen (the same material used for building joints and other body
tissues), water, calcium, phosphorus, magnesium, and other minerals. Special cells are
responsible for making new bone. Here are the most important steps your child can take
to help keep these bone-building cells busy:

• Get moving! Play and exercise every day.

• Eat a diet rich in fruits and vegetables.
• Get vitamin D from the sun or from supplements.
• Get calcium from plant foods and fortified products.

Exercise
Exercise gives bones a reason to live. When bones are put to work, especially in weight-
bearing activities such as running, soccer, basketball, and weightlifting, they respond by

8
becoming stronger and denser. Engaging in physical activity may be the most influential
thing your child can do to promote adolescent bone health. A recent study published in
the medical journal Pediatrics found that sedentary teens had lower bone density by age
18 than those who engaged in regular physical activity.4

In a study of women 45 years and older, those who exercised four or more times per
week as teenagers were only one-fourth as likely to fracture a hip as those who exercised
once or not at all each week.5 Encouraging your children to get away from the computer
or up off the couch to enjoy more active pursuits is great way to help them build healthy
bones.

Fruits and Vegetables

Will a glass of orange juice, a crunchy salad, or a bowl of vegetarian chili help grow
strong bones? Absolutely. Increasingly, research is pointing to diets rich in fruits and
vegetables for promoting bone health. A study published in the American Journal of
Clinical Nutrition shows that higher intakes of fruits and vegetables throughout the teen
years improve bone density in adulthood.6 An array of nutrients—vitamin C, vitamin K,
potassium, and magnesium—found abundantly in fruits, vegetables, and other plant
foods, have been shown to promote bone health.6-8

Vitamin C from citrus fruits, tomatoes, peppers, and other fruits and vegetables is
essential for making collagen, the connective tissue that minerals cling to when bone is
formed.

Vitamin K is thought to stimulate bone formation. It is found most abundantly in dark

leafy greens like kale and spinach, but is also readily available in beans, soy products,
and some fruits and vegetables.

Potassium decreases the loss of calcium from the body and increases the rate of bone
building. Oranges, bananas, potatoes, and many other fruits, vegetables, and beans are all
rich sources of potassium.

Magnesium, like calcium, is an important bone mineral. Studies have shown higher
magnesium intakes to be associated with stronger bones. “Beans and greens”—legumes
and green leafy vegetables—are excellent sources of magnesium.

Fruits and vegetables are also important for what they don't do. Some foods—especially
cheeses, meats, fish, and some grains—make the blood more acidic when digested and
metabolized.9 These foods add to the body's “acid load.” When this happens, bone
minerals, especially calcium, are often pulled from the bones to neutralize these acids.10
Diets high in fruits and vegetables actually tip the acid-base scales in the opposite
direction and make it easier for bones to hold onto their calcium.9

Vitamin D
Vitamin D is a hormone produced by sunlight on the skin. It controls your body's use of
calcium and is an important player in bone building.11 A lack of adequate vitamin D

9
results in rickets, a serious childhood bone problem. Avoiding rickets is as easy as getting
a short daylight walk on most days or having a bowl of cereal with fortified soy or rice
milk for breakfast. About 15 minutes of sunlight each day normally produces all the
vitamin D your child needs. If your family gets little or no sun exposure, you can include
any common multivitamin or a serving of a vitamin D-fortified food in your daily
routine. Consuming too much causes problems, so be sure not to overdo it.

Calcium from Plant Sources

Children and adults lose calcium from the body every day, so we need to replenish it.
Healthful calcium sources are “beans and greens.” Broccoli, Brussels sprouts, collards,
kale, mustard greens, turnip greens, and others are loaded with highly absorbable calcium
and a host of other important nutrients. While these foods have a smaller amount of
calcium per serving compared to dairy products, they have more calcium per calorie, and
the calcium they contain is absorbed nearly twice as well as the calcium in cow's milk.12

One cup of cooked kale, for example, has the same amount of absorbable calcium (100
milligrams) as one cup of cow's milk with less than half the calories. Beans are a good
source of calcium, too. Choose from baked beans, chickpeas, tofu, or other bean
products, and you will find a taste to please every palate. Just a few ounces of tofu, a
bowl of vegetable chili or creamy Broccoli Potato Soup will provide your child with
another healthful helping of absorbable calcium.

If you are looking for a concentrated calcium source, calcium-fortified orange and apple
juices as well as enriched soy and rice milks contain 300 milligrams or more of calcium
per cup in a highly absorbable form. Your child only needs two-thirds of a cup of
fortified orange juice, one cup of fortified soymilk, or one-third cup of Total Plus cereal
to get the same amount of absorbable calcium as a small carton of cow's milk. Children
readily enjoy tasty and healthy treats made with these calcium-rich foods, such as Orange
Power Pops or cereal topped with berries and rice milk.

Avoiding Excess Bone Loss

A normal part of the bone-recycling process is the breakdown and release of calcium and
other minerals into the bloodstream. These minerals are filtered through the kidneys and
lost through the urine. Minimizing this loss is a smart strategy for protecting bones. Here
are important steps you and your child can take to avoid excess bone loss:

• Limit salty foods.

• Avoid protein from animal sources.
• Keep children away from smoking.
• Avoid caffeine.

Salt
Researchers have known for a long time that higher salt (sodium) intake leaches calcium
from the bones.13 The kidneys have the job of filtering excess salt into the urine. When
they let the sodium pass out of the body, calcium flows out with it. This means the more

10
salt your children consume, the more calcium they lose, and the more they need in their
diets to replace the calcium that is leaving. Lowering salt intake will reduce bone
breakdown and calcium loss. To do this, you may want to eliminate salty snack foods and
canned goods with added sodium, and reduce or eliminate salt use on the stove and at the
table.

Protein from Animal Sources

In 1992, a researcher from Yale University studying animal protein intake and hip
fracture rates in 16 countries around the world found that those with the highest meat,
fish, egg, and dairy product consumption had the most fractures.14 They speculated that
protein from animal products might stimulate bone breakdown and encourage calcium
loss from the body. Since then, other researchers have confirmed this observation.15,16 As
you will recall, animal protein-dense foods make the blood more acidic. The body
responds by pulling calcium and other minerals out of bones to neutralize the acid and
sending it out in the urine. Building your child's diet from fruits, vegetables, grains, and
legumes is a good way to reduce this excess calcium loss and protect bones.

Smoking
You already know that smoking increases susceptibility to colds and other respiratory
illnesses and increases the risk of heart attacks and cancer. But did you know that
smokers excrete more calcium than non-smokers? A study of identical twins showed that
if one twin was a long-time smoker and the other was not, the smoker had a 40-percent
higher risk of a fracture.17

Caffeine
It may surprise you to learn that the caffeine in sodas, coffee, and other beverages and
foods slightly increases the loss of calcium from the body.18 Try to get in the habit of
serving water with meals. You may also want to keep little bottles in the refrigerator for
kids on the go. It makes good parenting sense to offer water first and nutritious juices,
soy, or rice milks second.

Calcium Sources for Building Bones

Calcium and other minerals are the raw materials necessary for building bones. Like
bricks to a bricklayer, calcium is necessary, but is not the only element needed for bone
building. Bricklayers need bricks, mortar, a water source, the right weather, and some
manual assistance to get the job done. In a way, the same holds true in the construction of
bone.

Recommended Calcium-Rich Foods

Food Serving Calcium Per Calcium Amount
Size Serving Absorbed Per Needed to
Serving* Absorb
Approx. 100

11
 mg Calcium
Total Plus cereal 3/4 cup 1,000 301 1/3 cup
Orange juice, calcium-
1 cup 300 108 7/8 cup
fortified
Soymilk, calcium-
1 cup 300 93 1 cup
fortified
Basic Four cereal 1 cup 306 92 1 cup heaping
Sesame seeds, unhulled 1 oz. 280 58 13/4 oz.
Firm tofu, calcium-set 3 oz. 172 53 2/3 cup
Kale, frozen 1/2 cup 90 53 1 cup
Turnip greens, frozen 1/2 cup 99 51 1 cup
Instant oats 1 packet 158 48 2 packets
Mustard greens, frozen 1/2 cup 76 44 1 1/8 cups

Chinese cabbage, bok 1/2 cup 79 43 1 1/8 cups

choy, boiled
White beans, cooked 1 cup 161 35 2 3/4 cups
Broccoli, frozen 1/2 cup 47 29 1 2/3 cups
Brussels sprouts, boiled 1/2 cup 28 18 2 3/4 cups
Spinach, boiled 1/2 cup 122 6 8 cups
*Estimated based on published absorption fractions.

Other Calcium-Rich Foods

Amount
Calcium Needed to
Serving Calcium Per
Food Absorbed Per Absorb
Size Serving
Serving* Approx. 100
mg Calcium
Lowfat yogurt, plain 8 oz. 400 128 3/4 cup

12
2% milk 1 cup 297 95 1 cup
Cheddar cheese 1 oz. 204 66 1 1/2 oz.
Mozzarella cheese, part
1 oz. 183 59 1 3/4 oz.
skim
Processed cheddar
1 oz. 160 51 2 oz.
cheese spread
*Estimated based on published absorption fractions.

It makes sense to choose calcium sources that benefit bones in more ways than one. Good
calcium sources not only contain plenty of calcium, they also must be absorbed
reasonably well by the body. Beyond that, a healthful calcium source also contributes to a
diet that promotes bone building and prevents bone loss. In the table below, foods that
contain at least 30 milligrams of absorbable calcium are given a score based on the
number of attributes the food has for promoting bone building. Foods with scores of 3 or
higher are considered the “best” sources of calcium. To arrive at this “Bone Health
Score,” the foods received one point for each of the following bone-building criteria:

1. Not an acid-forming food

2. Low in salt (low sodium)
3. Rich in potassium (K+)
4. Rich in vitamin C (Vit C)
5. Rich in vitamin K (Vit K)
6. Rich in magnesium (Mg++)
7. Rich in vitamin D (Vit D)

Other Bone-Building Attributes of

Calcium-Rich Foods
Not Acid * Vit * Vit * Vit * Bone
Calcium-Rich Low K+ * Mg+
C K D Health
Food Sodium* Rich +Rich
Forming Rich Rich Rich Score
Kale, frozen (1/2
+ + + + + 5
cup)
Chinese cabbage,
bok choy, boiled + + + + + 5
(1/2 cup)
Orange juice, + + + + 4
calcium-fortified

13
(1 cup)
Mustard greens,
+ + + + 4
frozen (1/2 cup)
Turnip greens,
+ + + + 4
frozen (1/2 cup)
White beans,
+ + + 3
cooked (1 cup)
Soymilk,
calcium-fortified + + + 3
(1 cup)
Firm tofu,
calcium-set (3 + + + 3
oz.)
2% milk (1 cup) + + 2
Sesame seeds,
+ + 2
unhulled (1 oz.)
Lowfat yogurt,
+ 1
plain (8 oz.)
Total Plus cereal
+ 1
(3/4 cup)
Basic Four cereal
0
(1 cup)
Instant oats (1
0
packet)
Cheddar cheese
0
(1 oz.)
Processed
cheddar cheese 0
spread (1 oz.)
Note: These foods are all good sources of calcium and all have nutrients other than the
ones listed. The Bone Health Score represents the number of bone-building attributes
these calcium-rich foods contain. Based on potential renal acid loads of food groups.
Source: Remer T, Manz F. J Am Diet Assoc. 1995;95:719-7.
*Low sodium is less than 35 milligrams per serving; potassium (K+) rich and magnesium
(Mg++) rich is more than 10 percent of Recommended Daily Intake (RDI); vitamin C,

14
vitamin D, and vitamin K rich is more than 25 percent of the RDI.

Why Dairy Products Don't Make the Cut

Dairy products are often cited by the dairy industry as being good sources of calcium
simply because they contain calcium and are “readily available.” But there is more to the
story than that. Concerned parents want more from a calcium-rich food than availability
in the supermarket. They also want to know whether giving the recommended two to
three servings of milk or other dairy products will actually help their children grow strong
bones and whether these foods are likely to promote the long-term health of their
children.

Milk Helps Bones?

There is much debate over whether long-term consumption of dairy products helps bones
at all. A good deal of evidence suggests that it does not. Several studies of teenagers have
found that their adult bone health is related to their physical activity level earlier in life,
but not to the amount of milk or calcium they consumed.4,5 Milk consumption is
apparently no help later in life either. In a 12-year Harvard study of 78,000 women, those
who got the most calcium from dairy products received no benefit and actually broke
more bones than the women who got little or no calcium from dairy.19 Similarly, a 1994
study of elderly men and women in Sydney, Australia, showed that those who consumed
the most dairy products had double the hip fracture rate of those who consumed the
least.20

These findings indicate that despite the amount of calcium in dairy products, other dairy
compounds accelerate calcium loss. Animal proteins and salt are two likely suspects. To
make matters worse, in North America, dairy products are often consumed by people
who already have high-salt, meat-based diets.

Cow's Milk Is Risky

Researchers have linked cow's milk consumption to a number of childhood ailments from
minor to very serious. In children under the age of one, risks include iron deficiency,
colic, and increased risk of Type I diabetes. Naturally, the best beverage for infants and
small toddlers is mother's breast milk. Even after the first year, food allergies to milk and
milk products are common. A recent study also linked cow's milk consumption to chronic
constipation in children.21 Many children and teens with irritable bowel syndrome,
autism, asthma, and allergies improve when they stop drinking cow's milk.

Milk proteins, milk sugar, fat, and saturated fat found in dairy products may pose health
risks for children and lead to chronic diseases such as obesity, diabetes, some types of
cancer, and formation of atherosclerotic plaques that can lead to heart disease. The
consumption of three servings of whole milk each day adds up to a total of 450 calories
and more than 24 grams of fat, most of which is artery-clogging saturated fat.

15
The dairy industry often suggests that drinking milk or chocolate milk instead of soda
will reduce problems with overweight, reduce sugar intake, and improve bone health. But
the nutritional facts say otherwise. Two-percent chocolate milk has 80 percent more
calories and the same amount of sugar as an equivalent serving of cola.

Milk Makes Many Children Sick

Many children by their fourth or fifth birthdays have grown out of their ability to digest
the milk sugar lactose. Drinking milk can cause stomach pain, gas, bloating, diarrhea, and
other uncomfortable symptoms in lactose-intolerant children. There is no need to take
pills or buy special lactose-reduced dairy products. Instead, you might look at this change
as a signal that breast milk is no longer needed, and that cow's milk shouldn't take its
place. It is a time to expand your child's diet to include a wide variety of plant-based
foods.

Dairy Products Edge Out Healthier Foods

Plant foods are chock full of important nutrients that strengthen immune function,
improve bone strength, and protect against cancer and heart disease. For example,
complex carbohydrates, vitamin C, fiber, folate, iron, and antioxidants are not found in
dairy products, but are plentiful in vegetables, fruits, and beans. And plant food sources
of calcium are low in saturated fat and always devoid of cholesterol.

Putting it All Together

As a parent you already have plenty of opportunities for worry. Your child's bone health
need not be one of them. A few simple guidelines will keep children on the right track—a
diet built from grains, legumes, vegetables, and fruit, along with plenty of activity, and
avoiding smoking, severe dieting, salty foods, and excess protein from meats, eggs, and
cheeses is all you need to do. Your child's body will take care of the rest.

Together, these factors, along with your child's hormones and genes, will determine the
strength of his or her bones. When it comes to bone health, it pays to look beyond the
“get more calcium” message and offer your child a diet that both promotes bone building
and reduces bone loss. Because dairy products are high in salt, animal protein, calories,
and fat, plant sources of calcium, along with vitamin D and calcium-fortified products,
are the preferred foods for your child's bones.

What is Lactose Intolerance?

16
Understanding Lactose Intolerance

Lactose intolerance is the inability to digest the milk sugar lactose, causing
gastrointestinal symptoms of flatulence, bloating, cramps, and diarrhea in some
individuals. This results from a shortage of the lactase enzymes which break down
lactose into its simpler forms, glucose and galactose.

Virtually all infants and young children have the lactase enzymes that split lactose into
glucose and galactose, which can then be absorbed into the bloodstream. Prior to the mid-
1960s, most American health professionals believed that these enzymes were present in
nearly all adults as well. When researchers tested various ethnic groups for their ability to
digest lactose, however, their findings proved otherwise. Approximately 70 percent of
African Americans, 90 percent of Asian Americans, 53 percent of Mexican Americans,
and 74 percent of Native Americans were lactose intolerant.1-4 Studies showed that a
substantial reduction in lactase activity is also common among those whose ancestry is
African, Asian, Native American, Arab, Jewish, Hispanic, Italian, or Greek.5

In 1988, the American Journal of Clinical Nutrition reported, "It rapidly became apparent
that this pattern was the genetic norm, and that lactase activity was sustained only in a
majority of adults whose origins were in Northern European or some Mediterranean
populations."6 In other words, Caucasians tolerate milk sugar only because of an inherited
genetic mutation.

Overall, about 75 percent of the world's population, including 25 percent of those in the
U.S., lose their lactase enzymes after weaning.7 The recognition of this fact has resulted
in an important change in terminology: Those who could not digest milk were once called
"lactose intolerant" or "lactase deficient." They are now regarded as normal, while those
adults who retain the enzymes allowing them to digest milk are called "lactase
persistent."

There is no reason for people with lactose intolerance to push themselves to drink milk.
Indeed, milk does not offer any nutrients that cannot be found in a healthier form in other
foods. Surprisingly, milk-drinking does not even appear to prevent osteoporosis, its major
selling point.

Milk Does Not Reliably Prevent Osteoporosis

Milk is primarily advocated as a convenient fluid source of calcium in order to slow

osteoporosis. However, like the ability to digest lactose, susceptibility to osteoporosis
differs dramatically between ethnic groups, and neither milk consumption nor calcium
intake in general are decisive factors with regard to bone health.

The National Health and Nutrition Examination Survey (NHANES III, 1988-1991)
reported that the age-adjusted prevalence of osteoporosis was 21 percent in U.S.
Caucasian women aged 50 years and older, compared with 16 percent in Mexican
Americans and 10 percent in African Americans.8

17
A 1992 review revealed that fracture rates differ widely between various countries and
that calcium intake demonstrated no protective role at all.9 In fact, those populations with
the highest calcium intakes had higher, not lower, fracture rates than those with more
modest calcium intakes.

What appears to be important in bone metabolism is not calcium intake, but calcium
balance. The loss of bone integrity among many postmenopausal white women probably
results from genetics and from diet and lifestyle factors. Research shows that calcium
losses are increased by the use of animal protein, salt, caffeine, and tobacco, and by
physical inactivity.

Animal protein leaches calcium from the bones, leading to its excretion in the urine.
Sodium also tends to encourage calcium to pass through the kidneys, and is even
acknowledged as a contributor to urinary calcium losses in the current Dietary
Guidelines for Americans.10 Smoking is yet another contributor to calcium loss. A twin
study showed that long-term smokers had a 44 percent higher risk of bone fracture,
compared to a non-smoking identical twin.11 Physical activity and vitamin D metabolism
are also important factors in bone integrity.

The balance of these environmental factors, along with genetics, is clearly as important as
calcium intake with regard to the risk of osteoporosis and fracture. For most adults,
regular milk consumption can be expected to cause gastrointestinal symptoms, while
providing no benefit for the bones.

Commercial Lactase Enzymes: Not the Best Choice

Commercial milk products are often depicted as the "solution" to lactose intolerance.
These products are enzymatically modified to cleave lactose into glucose and galactose,
preventing stomach upset and other symptoms of lactose maldigestion. But even the
lactase pills don't solve the problem, as individuals can still experience digestive
symptoms.

Iron deficiency is more likely on a dairy-rich diet since cow's milk products are so low in
iron.12 A recent study linked cow's milk consumption to chronic constipation in
children.13 Epidemiological studies show a strong correlation between the use of dairy
products and the incidence of insulin-dependent diabetes (Type 1 or childhood-onset).14,15
Women consuming dairy products may have higher rates of infertility and ovarian cancer
than those who avoid such products.16 Susceptibility to cataracts17 and food allergies are
also affected by dairy products.

Additionally, samplings of milk have found significant variation in the vitamin D content,
with some samplings having had as much as 500 times the indicated level, while others
had little or none at all.18,19 Too much vitamin D can be toxic and may result in excess
calcium levels in the blood and urine, increased aluminum absorption in the body, and
calcium deposits in soft tissue.

18
Healthier Sources of Calcium

While the focus on calcium intake appears to have resulted from the prevalence of
osteoporosis among Caucasian women (not to mention the influence of the dairy
industry), this is not to say that a certain amount of dietary calcium is not needed by those
in other demographic groups. However, calcium is readily available in sources other than
dairy products. Green leafy vegetables such as broccoli, kale, and collards, are rich in a
form of calcium whose absorption is as good or better than that of milk (Table 1).

Many green vegetables have absorption rates of more than 50 percent, compared with
about 32 percent for milk. In 1994, the American Journal of Clinical Nutrition reported
calcium absorption to be 52.6 percent for broccoli, 63.8 percent for Brussels sprouts, 57.8
percent for mustard greens, and 51.6 percent for turnip greens.20 The fractional calcium
absorption rate from kale is approximately 40 to 59 percent.21 Likewise, beans (e.g., pinto
beans, black-eyed peas, and navy beans) and bean products, such as tofu, are rich in
calcium. Also, about 36 to 38 percent of the calcium in calcium-fortified orange juice is
absorbed (as reported by manufacturer's data).

Green leafy vegetables, beans, calcium-fortified soymilk, and calcium-fortified 100-

percent juices are good calcium sources with advantages that dairy products lack. They
are excellent sources of phytochemicals and antioxidants, while containing little fat, no
cholesterol, and no animal proteins.

Table 1.
Calcium and Magnesium in Foods (milligrams)
Food Source Calcium Magnesium
Barley (1 cup) 57 158 57 158
Black turtle beans (1 cup, boiled) 103 91
Broccoli (1 cup, boiled) 94 38
Brussels sprouts (8 sprouts) 56 32
Butternut squash (1 cup, boiled) 84 60
Chick peas (1 cup, canned) 80 78
Collards (1 cup, boiled) 358 52
Corn bread (1 2-ounce piece) 133 --
English muffin 92 11
Figs, dried (10 medium) 269 111

19
Great northern beans (1 cup, boiled) 121 88
Green beans (1 cup, boiled) 58 32
Kale (1 cup boiled) 94 24
Mustard greens (1 cup, boiled) 150 20
Navel orange (1 medium) 56 15
Navy beans (1 cup, boiled) 128 107
Oatmeal, instant (2 packets) 326 70
Orange juice, calcium-fortified (1 cup) 350* --
Pinto beans (1 cup, boiled) 82 95
Raisins (2/3 cup) 53 35
Soybeans (1 cup, boiled) 175 148
Spinach (1 cup, boiled) 244 158
Sweet potato (1 cup, boiled) 70 32
Swiss chard (1 cup, boiled) 102 152
Tofu (1/2 cup) 258 118
Vegetarian baked beans (1 cup) 128 82
White beans (1 cup, boiled) 161 113
Source: J.A.T. Pennington, Bowes and Church's Food Values of Portions Commonly Used.
(Philadelphia: J.B. Lippincott, 1994.)
*Information from manufacturer

http://www.strongbones.org/

20