A Paleo Problem: Calcium

paleo diet, Steve Parker MD,calcium, osteoporosis

I worry about her bones 50 years hence

It appears difficult to meet the Recommended Dietary Allowance (RDA) for calcium while eating most versions of the paleo diet.  That’s because they don’t include milk products.  The Linus Pauling Institute at Oregon State University has a review of calcium as related to nutrition and health, last updated in late  2010. They say that few Americans hit their recommended daily calcium goal.

I see lots of little old ladies with hip and other fractures related to osteoporosis. Trust me, you don’t want to go there. It’s difficult to reverse osteoporosis, an insidious process that’s been going on for decades before the fracture.

Osteoporosis may be related to years of inadequate calcium consumption. Adequate vitamin D is  an important part of the equation, too. Blood calcium levels are strictly regulated, and if they’re too low, calcium is pulled from the bones to fill the blood’s tank.

Broccoli and bok choy are fair sources of calcium, but pale in comparison to milk. Bok choy isn’t a part of my diet; I’m not even sure I’ve ever had it. Below is a video on bok choy cooking. Looks simple enough.  I need to look into kale, too.

Many paleophiles promote bone broth, but I haven’t figured out why yet. Is it high in calcium? (Hat tip to Wendy Schwartz for the word “paleophile”.)

A can of sardines looks like a good source of calcium: 350 mg or 35% Daily Value.

Can you help me worry less about calcium deficiency?

17 responses to “A Paleo Problem: Calcium

  1. charles grashow

    What’s wrong with yogurt and/or kefir?

    • Hi, Charles.
      I’m in the paleo purist camp that figures Paleolithic man didn’t have ready access to milk products (other than mother’s milk!) like yogurt, kefir, cheese, butter, and ice cream. The same is true for olive oil and vinegar, which nevertheless are on my version of paleo. So I’m not totally consistent. I’ve nothing against milk products if you can digest them. I realize that many with relative lactose intolerance often tolerate those fermented products.


  2. Its not calcium thats the problem, its collagen. Gelatin has all but evaporated from our diet where a full third of our protein used to be natural gelatins. Bone is a matrix of collagen, calcium and other minerals. No matrix, no amount of calcium is gonna help. Calcium supplements end up in the arteries not the bones as we are finding out.

    Thats my theory and I am sticking to it.

  3. Where did our paleo ancestors get their RDA of calcium? They weren’t doing dairy, yet the anthropologists say they had great strong bones. The answer to strong bones lies somewhere besides calcium intake in my estimation. Perhaps we are missing the synergy between nutrients we no longer get enough of like magnesium, vitamin D, vitamin K2, or maybe even real vitamin A. Calcium supplements are shown to collect in the soft tissues like arteries, Maybe they have the RDA wrong in light of proper nutrition?

    • Thanks for the contributions from all commenters!
      Suzie_B, I think you are onto something. Physical activity is also probably a key to strong bones.
      I just read in the Jaminet book (Perfect Health Diet) that they recommend frequent (daily?) bone broth consumption, for the calcium and other reasons. Making it is a rather lengthy process. I don’t see that catching on with the hoi polloi.


    • Suzie, they never lived long enough to develop osteoporosis.

      • The following is a paper by Gurven and Kaplan which covers longevity of modern day hunter-gatherers:

        Click to access GurvenKaplan2007pdr.pdf

        They don’t all die young and did not in the paleolithic either. The question is, when it comes to calcium, the USA gets more calcium than just about anybody else (diet and supplements), yet has more osteoporosis than most everyone else in the modern world. Do modern day hunter-gatherers have stronger bones and better health than we do? They certainly don’t suffer from the same chronic diseases. Read Good Calories Bad Calories by Taubes.

  4. Agreed with Danny and Suzie. What is the scientific basis for any RDA and calcium in particular? It’s the combo we are missing an affecting some greatly.

  5. I eat small whole fish including bones.

  6. Charles Grashow

    @Dr Parker

    Do you have a problem with dairy or just reject it because it violates your purity paleo concept?

    • Charles, millions of people have ingested milk products without ill effects over many years. They can definitely be part of a healthy diet! I myself have been known to enjoy cheese, milk, yogurt, and ice cream. Never tried kefir. I’m not tempted by raw milk, given its rare but real association with infectious risk (search Science-Based Medicine blog). I think regular consumption of milk products wasn’t possible until domestication of ruminants within the last 10-15,000 thousand years. If so, that leaves hundreds of thousands of years of human evolution during which we didn’t eat or drink milk products. I’m very interested in clinical trials of the paleo diet; such trials probably shouldn’t include milk.


  7. @Dr Parker
    Please read Loren Cordain’s FAQ on calcium. IIRC, the actual dietary requirement for Calcium is actually half of recommended guidelines when you remove all the common factors which tend to promote calcium excretion.

    As far as bone health goes, there are many other factors involved which, collectively, are far more important than calcium intake (though the dairy marketing boards would have you believe otherwise). Protein intake, sun exposure, vitamins A & K, fat intake, magnesium, bone loading, etc., are all requirements for healthy bones. Unfortunately, we live in a society that tells young girls to not eat meat, stay out of the sun, not eat fat, not do anything that might get them “manly” muscles, and we tell them to eat lots of [calcium binding] whole grains. But their bones will be fine if they just drink lots of [low fat] milk.

    If you are concerned about recommending a low calcium paleo diet and lifestyle to people who may become osteoporotic little old ladies in the future, I wouldn’t be.

    • Thanks, Jamie.
      Here’s a link to Dr. Cordain’s website FAQs where he addresses calcium briefly: http://thepaleodiet.com/paleo-diet-faq/
      A quote:

      In the U.S., calcium intake is one of the highest in the world. Yet paradoxically, we also have one of the highest rates of bone de-mineralization (osteoporosis). Bone mineral content is dependent not just upon calcium intake but upon net calcium balance (calcium intake minus calcium excretion). Most nutritionists focus upon the calcium intake side of the calcium balance equation, however few realize that the calcium excretion side of the equation is just as important.

      Cordain also wrote about calcium and vitamin D here: http://thepaleodiet.com/wp-content/uploads/2012/04/The-Nutritional-Characteristics-of-a-Contemporary-Diet-Based-Upon-Paleolithic-Food-Groupsabstract4.pdf

      Cordain also focuses quite a bit on acid-base balance effects on bone. That idea’s not gained much traction with physicians, which doesn’t mean it’s wrong, of course.

      It may well be the case that we don’t need as much calcium as the public health authorities claim, if we’re doing all the other right things for our bones.


  8. Charles Grashow

    Dr Parker – please give me your definition of what a “paleo” diet is?

    • Sure, Charles.
      Briefly: Eat fruit, vegetables, nuts and seeds, meat, eggs, offal, and seafood. Among vegetables, I include tubers/root vegetables. No grains, legumes, dairy. Minimal, if any, alcohol. Relatively little added salt. For condiments, I gotta have olive oil and vinegar, along with pepper and other spices. No artificial sweeteners except possible for occasional honey and stevia (I know, it’s processed). Minimal, if any, industrial seed oils. Cooking is fine.

      Among the popular paleo diet gurus, I am closest to the ideas of Loren Cordain, although I think he’s not very fond of tubers. Nor would I avoid fat as much as he does.

      I realize there may be some logical inconsistencies here. I know that very few of us can replicate intake of our ancestors from 20,000 years ago.


  9. charles grashow

    What are your % of fat. carbs and protein?