How is nutrition balanced?

Milk and other dairy products are major sources of nutrients in the American diet. The most important of these nutrients is calcium. Calcium is essential for the growth and repair of bones throughout life. In the middle and late years, a shortage of calcium may lead to thin, fragile bones that break easily, a condition called osteoporosis. A concern, for both children and adults with lactose intolerance, is getting enough calcium in a diet that includes little or no milk.

In 1997, the Institute of Medicine released a report recommending new requirements for daily calcium intake. How much calcium a person needs to maintain good health varies by age group. Recommendations from the report are shown in the table

Age Group	Amount of calcium to consume daily, in milligrams (mg)
0-6 months	210 mg
7-12 months	270 mg
1-3 years	500 mg
4-8 years	800 mg
9-18 years	1,300 mg
19-50 years	1,000 mg
51-70+ years	1,200 mg

Also, pregnant and nursing women under 19 need 1,300 mg daily, while pregnant and nursing women over 19 need 1,000 mg. In planning meals, making sure that each day’s diet includes enough calcium is important, even if the diet does not contain dairy products. Many non-dairy foods are high in calcium. Green vegetables, such as broccoli and kale, and fish with soft, edible bones, such as salmon and sardines, are excellent sources of calcium. To help in planning a high-calcium and low-lactose diet, the table below lists some common foods that are good sources of dietary calcium and shows how much lactose they contain.

Recent research shows that yogurt with active cultures may be a good source of calcium for many people with lactose intolerance, even though it is fairly high in lactose. Evidence shows that the bacterial cultures used to make yogurt produce some of the lactose enzyme required for proper digestion. Clearly, many foods can provide the calcium and other nutrients the body needs, even when intake of milk and dairy products is limited. However, factors other then calcium and lactose content should be kept in mind when planning a diet. Some vegetable that are high in calcium (Swiss chard, spinach, and rhubarb, for instance) are not listed in the chart because the body cannot use the calcium they contain. They also contain substances called oxalates, which stop calcium absorption.

Calcium is absorbed and used only when there is enough vitamin D in the body. A balanced diet should provide an adequate supply of vitamin D. Sources of vitamin D include eggs and liver. However, sunlight helps the body naturally absorb or synthesize vitamin D, and with enough exposure to the sun, food sources may not be necessary.

Some people with lactose intolerance may think they are not getting enough calcium and vitamin D. in their diet. Consultation with a doctor or dietitian may be helpful in deciding whether any dietary supplements are needed. Taking vitamins or minerals of the wrong kind or in the wrong amounts can be harmful. A dietitian can help in planning meals that will provide the most nutrients with the least choice of causing discomfort.