Calcium Supplementation for Milk-Free Diet

by Kelly Dorfman, M. S.

Many parents are using a milk-protein or casein-free diet to alleviate undesirable symptoms in their children. This can have many benefits including:

Concern over the need for calcium may cause some families to hesitate going milk-free for long periods of time. Even with careful planning, providing sufficient calcium to the bones and nervous system without milk products can certainly be a challenge. With children who have severely limited diets, the task is impossible.

The most practical solution to this problem is the use of calcium supplements. There is a wide array of products available over-the-counter, but which one should you choose? The decision is made easier by considering three factors: dose, form, and delivery method.

Dose

The recommended amount of calcium for children age one to ten is 800-1000 milligrams (mg) per day. Contrary to popular belief, calcium need does not rise dramatically during childhood because the requirements in the early years are already high due to rapid bone growth. Supplementing in this range is preferable if there are no other regular good sources of calcium such as leafy green vegetables or tofu, in the diet. If a child drinks one cup of fortified soy or rice milk per day, 500 mg. of additional calcium should be sufficient.

Form

Look carefully at the label on the supplement to determine the form of calcium it contains. Some forms are easier for the body to use, and, therefore, provide more benefit. The most absorbable forms of calcium are calcium citrate, calcium hydroxyapatite, and protein-bound calcium such as calcium chelate and gluconate. Calcium citrate is arguably absorbed the best, but must be used in small amounts and mixed with other forms of calcium with young children. This is because it is very acidic and in large quantities can cause mouth sores.

Calcium carbonate (oyster shell) is a popular choice because it is dense (creating smaller pills) and inexpensive. This is the main ingredient in "Tums", an over-the-counter digestive remedy. However, medical studies suggest that the bones do not utilize this type of calcium very well. Bone meal, a calcium-phosphorous compound, although a good calcium source, can be risky because of reports of lead contamination.

Delivery

There are four types of supplements: pills, powder, liquids, and chewables. The latter are often rejected because their texture is chalky. If a child will accept ground-up pills or a powder, look for one that contains several forms of calcium mixed together. Divide the 800-1000 mg dose between two meals or snacks for maximum absorption.

Magnesium also improves calcium absorption, but can cause loose stools. A general consideration for ages two to four is 100-200 mg. or magnesium, and for ages five and up, 200-300 mg. along with the calcium.

Liquids are usually the most successful way to supplement calcium in children who have difficulty swallowing. Unfortunately, the best absorbed commercially prepared liquid contains artificial sweeteners. Custom formulas are an option, but must be prepared by a compounding pharmacy. Remember that the pharmacist is not a doctor and cannot advise you about your child‘s individual needs.

Here is a generic liquid formula that you can instruct your pharmacist to make up; It should be given in two divided doses: 300 mg calcium gluconate, 300 mg calcium hydroxyapatite, 300 mg calcium chelate, and 200 international units of Vitamin D per day. 100-300 mg chelated magnesium can also be added, depending upon age. The pharmacy can prepare the mixture in either a 50% maple or sucrose syrup base or in water. If you are using a water-based formula, mix it yourself with maple syrup on the spoon or put it in one to two ounces of juice, making sure the child finishes all of the juice.

Custom formulas have a limited shelf life. Your formula will last up to two months in the refrigerator, and can be shipped without refrigeration. You can reorder indefinitely. If you have specific questions about using this or any other formula, ask your physician or other knowledgeable health care provider. Using calcium supplements is generally a safe "way to provide nutritional insurance when eliminating milk.

[Initially published in New Developments: Volume 2, Number 2 - Summer, 1996]

All material in this web site is given for information purposes only and is not to be substituted for advice from your health care provider.


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Page last modified: February 23, 2009
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