Calcium in the Vegan Diet

by Reed Mangels, Ph.D., R.D.

Topics in this article:

• Summary
• The Need for Calcium
• Tofu and Other Sources of Calcium
• How Much Do We Need?
• The Influence of Excessive Protein
• Table 1: Calcium Content of Selected Vegan Foods
• Table 2: Sample Menus Providing More Than 1000 mg of Calcium
• References

The Need for Calcium

Calcium is a very important mineral for humans. Our bones contain large amounts of calcium, which helps to make them firm and rigid. Calcium is also needed for many other tasks including nerve and muscle function and blood clotting. These other tasks are so important for survival, that, when dietary calcium is too low, calcium will be lost from bone and used for other critical functions. The body tightly controls calcium in the blood, so measuring blood calcium levels cannot assess calcium status.

Tofu and Other Sources of Calcium

Because of heavy promotion by the American dairy industry, the public often believes that cow's milk is the sole source of calcium. However, other excellent sources of calcium exist so that vegans eating varied diets that contain these foods need not be concerned about getting adequate calcium. Sources of well-absorbed calcium for vegans include calcium-fortified soy milk and juice, calcium-set tofu, soybeans and soynuts, bok choy, broccoli, collards, Chinese cabbage, kale, mustard greens, and okra ¹. Grains, beans (other than soybeans), fruits, and vegetables (other than those listed) can contribute to calcium intake but cannot replace these key foods. Table 1 shows the amount of calcium in selected foods. When you realize that there is as much or more calcium in 4 ounces of firm tofu or 3/4 cup of collard greens as there is in one cup of cow's milk, it is easy to see why groups of people who do not drink cow's milk still have strong bones and teeth.

How Much Calcium Do We Need?

The recommended level of calcium for adults age 19-50 years and men 51-70 is 1000 mg per day². An intake of 1200 mg of calcium is recommended for women over 51 and for men over 70². Some studies ^3-5, although not all ^3-5, have shown that older adults with a high calcium intake have stronger bones and a lower fracture risk. There are a limited number of studies of vegans, most of which find low bone density as well as low calcium intakes ^7,8. One study ⁹ where vegans had calcium intakes close to recommended levels found that calcium was well absorbed from a vegan diet.

Our Vegan Food Guide (page 198 of Simply Vegan) indicates good sources of calcium from several food groups. By choosing the suggested number of servings of calcium-rich foods daily, vegans should meet calcium needs. Table 2 shows several menus that contain more than 1000 mg of calcium.

Tofu is commonly recommended as a good source of calcium. Actually, the amount of calcium in tofu depends on the coagulating agent used to precipitate the soy protein in the process of making tofu. Calcium sulfate and nigari (magnesium chloride) are two commonly used agents. The agent used will be listed on the label under ingredients. Tofu that is prepared with calcium sulfate will contain more calcium than tofu made with nigari.

The amount of calcium in tofu varies from brand to brand. To calculate how much calcium is in the tofu you buy, look at the label. Calcium content will be listed as percent of the Daily Value. Since the current Daily Value for calcium is 1000 mg, multiply the percent Daily Value by 10 to get the amount of calcium (in milligrams) in one serving. For example, tofu with 10% Daily Value for calcium would have 100 mg of calcium in one serving.

The Influence of Excessive Protein

The area of protein's effect on bones remains uncertain. Some studies show that diets that are high in protein, especially animal protein, do cause increased losses of calcium in the urine ¹⁰ and may even in-crease fracture risk ^11,12. These effects of protein may be especially important in those with low calcium intakes ¹³. Other studies suggest that a higher protein intake is needed to promote calcium absorption ¹⁴, reduce the risk of fracture ¹⁵, and increase bone density ^16,17. Until further evidence is available, vegans should strive to meet calcium recommendations and to have adequate, but not excessive, amounts of protein.

Other factors in bone health include sodium and physical activity. Sodium increases calcium losses with 5 to 10 mg of calcium lost with each gram of salt eaten ¹⁸. Reducing sodium intake can reduce calcium losses. Regular weight-bearing exercise such as walking, running, or aerobic dance is recommended to promote strong, healthy bones. Besides helping strengthen bones, exercise can also improve balance and flexibility, both important factors in preventing and recuperating from falls.

Table 1: Calcium Content of Selected Vegan Foods
Food	Amount	Calcium (mg)
Blackstrap molasses	2 Tbsp	400
Collard greens, cooked	1 cup	357
Tofu, processed with    calcium sulfate*	4 ounces	200-330
Calcium-fortified orange juice	8 ounces	300
Soy or ricemilk, commercial,     calcium-fortified, plain	8 ounces	200-300
Commercial soy yogurt, plain	6 ounces	80-250
Turnip greens, cooked	1 cup	249
Tofu, processed with nigari*	4 ounces	80-230
Tempeh	1 cup	215
Kale, cooked	1 cup	179
Soybeans, cooked	1 cup	175
Okra, cooked	1 cup	172
Bok choy, cooked	1 cup	158
Mustard greens, cooked	1 cup	152
Tahini	2 Tbsp	128
Broccoli, cooked	1 cup	94
Almonds	1/4 cup	89
Almond butter	2 Tbsp	86
Soy milk, commercial, plain	8 ounces	80
*Read the label on your tofu container to see if it is processed with calcium sulfate or nigari. Note: Oxalic acid, which is found in spinach, rhubarb, chard, and beet greens binds with the calcium in those foods and reduces its absorption. These foods should not be considered good sources of calcium. Calcium in other green vegetables, like kale, collard greens, Chinese mustard greens, and Chinese cabbage flower leaves is well absorbed1,19. Fiber appears to have little effect on calcium absorption except for the fiber in wheat bran that does have a small effect20. Sources: Composition of Foods. USDA Nutrient Data Base for Standard Reference, Release 18, 2005 and Manufacturer's information.

Table 2: Sample Menus Providing More Than 1000 milligrams of Calcium
	Calcium (mg)
Breakfast:
1 serving Cindy's Light and Fluffy Pancakes (p. 23)	195
1 cup Calcium-Fortified Soy milk	300
Lunch:
1 serving Hummus on Pita Bread (p. 27)	178
6 Dried Figs	68
1/4 cup Almonds	89
Dinner:
1 serving Scrambled Tofu and Bok Choy over Brown Rice (p. 96)	190
1 serving Green Salad and Tangerine Dressing (p. 39)	30
1 serving Chocolate Pudding (p. 114)	92
TOTAL	1142
Breakfast:
1 serving Tropical Fruit Smoothie (p. 16)	102
1 Toasted Bagel with	89
2 Tbsp Almond Butter	86
Lunch:
1 serving Mini Pizzas (p. 34)	235
1 serving Creamed Spinach (p. 68)	121
Dinner:
1 serving Lemon Rice Soup (p. 46)	82
1 serving Tofu Squash Burgers (p. 102)	135
1 cup Steamed Broccoli	94
1 serving Chocolate Pudding (p. 114)	92
TOTAL	1036
Page numbers refer to recipes in the book Simply Vegan: Quick Vegetarian Meals. Additional foods should be added to these menus to provide adequate calories and to meet requirements for nutrients besides calcium.

There are factors that increase the risk of osteoporosis and that cannot be changed. These include small frame size, female gender, aging, heredity, being Caucasian or of Asian or Latino descent, early menopause, and prolonged immobilization. Other factors like cigarette smoking, excessive alcohol, physical inactivity, and inadequate calcium and vitamin D (see Simply Vegan Chapter on Vitamin D) are under our control. Vegans of all ages can promote bone health by consuming enough calcium and protein, getting adequate vitamin D, limiting use of sodium, and getting regular exercise, especially weight-bearing exercise.

References

1. Weaver CM, Plawecki KL. Dietary calcium: adequacy of a vegetarian diet. Am J Clin Nutr 1994;59 (suppl):1238S-2011S.

2. IOM (Institute of Medicine).Dietary Reference Intakes for Calcium and Vitamin D.. Washington, DC: National Academies Press, 2011.

3. Chevalley T, Rizzoli R, Nydegger V, et al. Effects of calcium supplements on femoral bone mineral density and vertebral fracture rate in vitamin-D-replete elderly patients. Osteoporos Int 1994;4:245-52.

4. Dawson-Hughes B, Harris SS, Krall EA, Dallal GE. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med 1997;337:670-6.

5. Recker R, Hinders S, Davies KM, et al. Correcting calcium nutritional deficiency prevents spine fractures in elderly women. J Bone Miner Res 1996;11:1961-6.

6. Feskanich D, Willett WC, Colditz GA. Calcium, vitamin D, milk consumption, and hip fractures: a prospective study among postmenopausal women. Am J Clin Nutr 2003;77:504-11

7. Marsh AG, Sanchez TV, Michelsen O. Vegetarian lifestyle and bone mineral density. Am J Clin Nutr 1988;48(suppl):837-41.

8. Chiu JF, Lan SJ, Yang CY, et al. Long-term vegetarian diet and bone mineral density in post-menopausal Taiwanese women. Calcif Tissue Int 1997;60:245-9.

9. Kohlenberg-Mueller K, Raschka L. Calcium balance in young adults on a vegan and lactovegetarian diet. J Bone Miner Metab 2003;21:28-33.

10. Kerstetter JE, O'Brien KO, Insogna KL. Low protein intake: the impact on calcium and bone homeostasis in humans. J Nutr 2003;133:855S-61S.

11. Frassetto LA, Todd KM, Morris RC, Jr., et al. Worldwide incidence of hip fracture in elderly women: relation to consumption of animal and vegetable foods. J Gerontol A Biol Sci Med Sci 2000;55:M585-92.

12. Sellmeyer DE, Stone KL, Sebastian A, et al. A high ratio of dietary animal to vegetable protein increases the rate of bone loss and the risk of fracture in postmenopausal women. Am J Clin Nutr 2001;73:118-22.

13. Meyer HE, Pedersen JI, Loken EB, et al. Dietary factors and the incidence of hip fracture in middle-aged Norwegians. A prospective study. Am J Epidemiol 1997;145:117-23.

14. Kerstetter JE, O'Brien KO, Caseria DM, et al. The impact of dietary protein on calcium absorption and kinetic measures of bone turnover in women. J Clin Endocrinol Metab 2005;90:26-31.

15. Munger RG, Cerhan JR, Chiu BC. Prospective study of dietary protein intake and risk of hip fracture in postmenopausal women. Am J Clin Nutr 1999;69:147-52.

16. Kerstetter JE, Looker AC, Insogna KL. Low dietary protein and low bone density. Calcif Tissue Int 2000;66:313.

17. Promislow JH, Goodman-Gruen D, Slymen DJ, et al. Protein consumption and bone mineral density in the elderly: the Rancho Bernardo Study. Am J Epidemiol 2002;155:636-44.

18. Heaney RP. Calcium: How your diet affects requirements. Veg Nutr and Health Letter Feb 1998;1(3):1-2.

19. Weaver CM, Heaney RP, Nickel KP, et al. Calcium bioavailability from high oxalate vegetables: Chinese vegetables, sweet potatoes, and rhubarb. J Food Sci 1997;62:524-525.

20. Weaver CM, Heaney RP, Martin BR, et al. Human calcium absorption from whole-wheat products. J Nutr 1991;121:1769-2011.

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This article originally appeared in the book Simply Vegan: Quick Vegetarian Meals by Debra Wasserman. Nutrition section by Reed Mangels Ph.D., R.D. (ISBN 0-931411-30-0)