Dietary calcium and bioavailability

[JCB56]

I was diagnosed with osteoporosis last year. I had the DEXA scan at the suggestion of an osteopath who thought I might be at risk, due to my small stature. I am a 63 year old woman. I sustained an endplate fracture at L1 a few years ago which was never treated, partly due to Covid and partly to do with the fact that I thought I'd just 'strained' my back badly. I had been trying to do some very inadvisable lifting. I don't necessarily believe that this injury was anything to do with osteoporosis, as I've not broken any other bones, despite tripping over in the park several times when walking our dog. I've sprained ankles and wrists but never broken anything. I was told by my GP that I'm under the threshold for treatment and that I should try to eat more calcium as part of my diet, rather than rely on supplements.

Apologies if some of this post is a repetition of my post from a couple of weeks' ago but I thought the background may be helpful. Back to the calcium - I am doing my best to increase my dietary calcium, whilst trying not to eat too much fat (due to high cholesterol) and trying not to eat too much of anything which aggravates my digestive system (due to IBS). This was covered in my previous post but I'm very curious as to why so many healthcare professionals and 'medical' articles online etc. still recommend increasing the amount of leafy greens, nuts, seeds etc. when research has shown that the amount of bioavailable calcium is extremely low. Obviously there are other dietary benefits to these foods but it doesn't seem that calcium is one of them. I also read an article about a study on calcium fortified milk-substitutes which said that up to 40% of the calcium isn't ingested because it sinks to the bottom of the carton. The study said that shaking the carton didn't make much difference. Again, these are regularly recommended if you can't tolerate too many dairy products. Also they are usually supplemented with calcium carbonate, which I understand is the least digestible form of calcium.

Interested to hear others' thoughts on this. I really want to do the best I can!

[Graceissufficient]

Celiac been excluded? I just ask because IBS can be a mistaken diagnosis. D checked?

[JCB56 in reply to Graceissufficient]

I had this tested recently, at my request. My scores were 'very negative' and I had been eating some food containing gluten beforehand. Sorry but not sure what 'D checked' means?

[Gala123 in reply to JCB56]

I imagine they mean your vitamin D levels

[Graceissufficient in reply to JCB56]

Some food, so not on a full gluten intake when u took tests? Already largely off gluten?

[JCB56 in reply to Graceissufficient]

Not really sure what a 'full gluten intake' would be. I'd certainly been eating gluten-containing foods on most days for some weeks but not large quantities. I can't eat large quantities of anything. My inability to digest things has got worse as I've got older. I used to eat lots of bread, cake and whatever else I fancied! I know coeliac disease can develop later in life but I think it's pretty unlikely I have it. I will check my previous blood tests but I don't think they've ever included vitamin D. I'll ask about this next time.

[Graceissufficient in reply to JCB56]

Yeah... the incidence of celiac in the general population is c 1 in 100 as you probably know, but must be much higher in the osteoporotic population esp with gastric symptoms. Haven't found a figure for that though.

Sounds as though u were eating enough gluten for the test to work though.

[Ergendl]

Avoid wheat bran when you are having cereal as it leaches out the calcium in the food. I make my own high fibre muesli with oat bran which does not have the same properties.

I did take dolomite tablets when I was younger to increase my calcium levels, but now I've been prescribed calcichew which are easy enough to take.

Just found out that 15 years of taking omeprazole has depleted my bones, so stopped taking it yesterday. The effects are a lot easier to manage than the alendronic acid prescribed to remedy the iatrogenic problem.

[Gala123 in reply to Ergendl]

Can I ask how you are now managing your gastric issue after stopping PPIs? I am in the same boat. I am still taking omeprazole though a tiny amount. I spoke to the ROS specialist and they said to keep taking on balance (risk/benefit). But I'd rather not.

[Graceissufficient in reply to Gala123]

I have had reflux for 30 years when I was first pregnant - blew the valve. I found dramatic diet changes help control it - coffee gone, peppermint T gone, alcohol reduced, watching all the time for triggers and trying slowly to reduce or remove them. Not easy but slowly possible.

[Ergendl in reply to Gala123]

Someone I knew tapered off with slippery elm powder.

I have just stopped taking them. The symptoms are far less severe than the acute delayed stomach pains with alendronic acid: just a slight stomach grumble that something is different - at least that doesn't stop me sleeping.

I was prescribed omeprazole after changing NSAIDs from Naproxen to Etodolac. Naproxen gave me severe bruising and mouth ulcers after several years of use. Etodolac is receptor specific, so wouldn't have needed cover from a PPI.

[Gala123 in reply to Ergendl]

Thank you for sharing this. I really need to address the PPIs and it’s a minefield. So, other people‘s experience helps.

[Nadjio in reply to Ergendl]

I took stopped taking omeperazole just over a month ago, I started taking tumeric, it has taken a full month to kick in, but definitely my heartburn has improved. I have a friend who has been taking it for years and swears by it. The one I take is also fortified with vitamin D, I'm already taking 10mg bit D Adcal, but I read between 10-20 is recommended.

[allofaquandry in reply to Ergendl]

NB I believe that after taking omeprazole long term you need to taper rather than suddenly stop otherwise you may end up with bad reflux. Please check.

[Ergendl in reply to allofaquandry]

My symptoms this time are far less severe than the acute delayed stomach pains with alendronic acid: just a slight stomach grumble that something is different - at least that doesn't stop me sleeping.

When I tried to come off omeprazole previously, I did have a return of reflux, but no problems this time. I just take care not to eat highly fatty or spicy foods.

[Gingertea3]

I have often wondered this too. It seems you'd have to eat an awful lot of greens/nuts or seeds to get much calcium and as people get older digestive systems can't always tolerate this.I asked a nurse once and I seem to remember that she recommended having a glass of milk or a pot of yoghurt (or other calcium rich food if you are intolerant) as a snack between meals, (when you aren't combining them with other foods), as well as incorporating calcium into your main meals. Apparently skimmed milk/low fat yoghurt actually has more calcium.

In this way, while you may not absorb all the available calcium from meals, you will get enough over the day.

I've also read that your body can't absorb too much calcium at once (can't remember the exact amount), so it's better to spread your intake over the day.

And finally, if you take a supplement to top up, I believe Calcium Citrate is better absorbed. I'm not sure why GPs still routinely prescribe calcium carbonate supplements as they are supposed to be less well absorbed and cause constipation or other digestive issues for so many, which add to the effects of the bone meds.

It would be really helpful to have a fact sheet from ROS on how people with IBS/sensitive digestive systems can get calcium via diet - maybe simple meal or snack ideas.

[JCB56 in reply to Gingertea3]

I believe it's over 500mg calcium which the body can't deal with well, so I split my doses in two. Then there's other info about not taking it at the same time as other foods/supplements ... I'm trying to get a good routine without getting too obsessed! I've not drunk milk for years (apart from a small amount in tea) due to digestive issues but I've never had anything properly tested or diagnosed. It's all trial and error - I don't want any more tests! I'm trialling lactose-free milk at present and will get some skimmed lactose free, as I am a little concerned I'm getting too much fat (not good for cholesterol, allegedly, and not great for my digestion either). I keep filling my face with almonds and brazils (which are supposed to add extra calcium to the diet) but now I'm wondering whether it's worth it for a tiny bit extra. Nuts are very filling and I'm only small - I simply can't eat enough of all the recommended things! I think I may be worrying too much about all this. I won't know whether any of it has done any good until I have another bone scan mid-2026 ...

[petabyte in reply to JCB56]

If you take calcium carbonate, food helps bioavailability since stomach acid is needed. Calcium citrate can be taken anytime but is more expensive.

[petabyte in reply to JCB56]

Brazils contain a lot of selenium which is needed but you should not get too much of it either.

One nut contains the RDA of selenium.

verywellhealth.com/brazil-n...

I love them but restrict how many I eat

[Capan24 in reply to petabyte]

I love Brazil nuts too. I usually eat only one or two a day.

[JCB56 in reply to petabyte]

Everything in moderation I suppose. I think I'd better hold off the brazil nuts for a bit then! I believe almonds have the most calcium of all nuts, so I'll eat them for now. I buy 1kg bags of calcium citrate powder because we also cook our own dog food and dogs need a lot of calcium compared to humans. I measure mine out in the morning and then spread the doses - at least I can take it when I remember and don't have to remember to always take it with a meal. I'm getting some capsules as well, so they're more convenient to take if I go out.

[petabyte in reply to JCB56]

I still eat Brazils. A great source of selenium and many soils are deficient.

[Graceissufficient in reply to JCB56]

Cheese? I read that lactose intolerance for some can cause OP.

[springcross in reply to Graceissufficient]

Arla make a lacto free mature Cheddar cheese and it's really nice, albeit a bit expensive! I've been buying it for the last couple of years and prefer it to the ordinary cheddar.

[JCB56 in reply to springcross]

That's good to know, thank you. We are so spoilt really. I sometimes forget to be grateful that we have so much choice.

[Smithie49]

Hi. I eat a lot of fat free natural yoghurt for Ca. Also, from advice on this forum, now take vit D3 and K2 and Mg in the form of Mg glucinate. I am waiting for the results of a DEXA scan done on 18th Feb!!!

[JCB56 in reply to Smithie49]

I forgot to add that I also take Magnesium Glycinate. I'm eating as much as I possibly can at the moment. Sometimes I start to feel that I've 'failed' when I have a meal which doesn't contain enough calcium! When you say 'a lot' of yoghurt, roughly how much each day? Some days I feel constantly full - I just can't eat any more and I don't want to disrupt my digestion any further ... I've just ordered some 0% lactose-free Greek yoghurt - sounds revolting but it's a reputable brand and had good reviews! Really hope you get the results you want from your scan. Let us know how you get on.

[Gingertea3 in reply to JCB56]

I totally sympathise with the 'trying to eat as much as you can ' thing. I am small too (49.5 kg), have OP and took AA for a few months. During the time I took the treatment I tried really hard to get enough calcium through diet but felt like I was stuffing myself to the point of feeling very uncomfortable. I got a bit obsessed with counting how much calcium was in everything. I wish GPs could give a bit of individual guidance on this.

[JCB56 in reply to Gingertea3]

Did you not get on with AA and how do you manage to get enough calcium now? I'm glad I'm not the only one feeling like this! I was given very little guidance. GP was a bit impatient when I tried to explain about my IBS etc. It just sounded like she was repeating the 'standard' guidance and didn't want too many questions. I told her was already taking calcium anyway, so I wasn't offered anything on prescription. Having researched the options, I'd rather stick with my own regime. I used to see a lovely GP until last year but I think she's left. The one I spoke to about my OP may have been a locum. I don't even know the names of the GPs at my surgery any more. That said, they are pretty good overall and compared with some stories I hear from others in my area. We went out for dinner last night and I'm still feeling full! Don't think I can really face much in the way of diary products today. Trying very hard not to get too obsessive about the counting ...

[Gingertea3 in reply to JCB56]

My GP (experienced and generally good) said OP was not her area of expertise and that I knew more than she did! She was also unable to explain my DEXA results. I didn't get the usual side effects with AA but had 3 episodes of choking (I think they were 'laryngospasms' while I was taking it), which were terrifying, as I couldn't breathe in or out for a minute or so. I have now been given Risedronate but haven't started it as I'm worried it might happen again. For balance, I know someone else who has taken AA for 2 years with no problems.

I probably don't get enough calcium at the moment but I can eat some dairy so I am strict about having 300ml milk with breakfast, yoghurt mid morning and cheese in some form each day. I also use the ROS calcium rich food lists to choose other things for meals/snacks e.g. muesli, broccoli, kidney beans, easy peelers, bread - and hope it all adds up.

I'm going to invest in some calcium citrate to top up as well.

Is there any evidence that K2 helps and should it be taken with vit D or separately?

[JCB56 in reply to Gingertea3]

That all sounds very scary for you. I am very averse to taking prescription drugs because of the possible side-effects but I know not everyone gets them. I also know of people who've taken AA with no bad side effects. I think the jury is out on whether K2 is of benefit but there are some studies which say it is. I thought I read K2 and D3 should be taken separately but now I don't know where I read it! They are fat soluble, so it's recommended you take them with a meal containing some fat. I eat oranges/easy peelers on most days and I've started sprinkling grated parmesan on salads - it tastes good and has quite a bit of calcium but less fat than some cheeses.

[Graceissufficient in reply to Gingertea3]

Guidance on taking K2 and D3 varies. I take them separately because those 4 fat soluble vitamins/prehormones seem to fight for absorption.

[Smithie49 in reply to JCB56]

I eat at least 500ml fat free yoghurt a day. It used to be a lot more but I was advised by ROS that that might not be healthy as the excess Ca could go into the blood rather than the bones 😞. I like Lidl's brand and at 35p a pot I'm a happy woman!!! It does fill me up so if you have trouble eating enough maybe eat it in small amounts throughout the day? I will let you know the results if I ever get them 😀

[JCB56 in reply to Smithie49]

That is a lot of yoghurt! I don't think I could stomach it! I guess the fat-free version won't be as filling, so perhaps that's the way to go. I'll give it a try but I just can't eat large quantities and I don't want all my meals and snacks ending up being mainly yoghurt 😅

[Nessie87 in reply to JCB56]

Goats milk yoghourt is much lighter to digest. Full fat is better for you than fat free too.

[JCB56 in reply to Nessie87]

I like full-fat goats milk yoghurt and it seems to like me but doubtless I'd be told by my GP and the heart consultant that I should avoid full-fat due to my high cholesterol. The conventional opinion is still that 'saturated fat is bad' but there is also research to say that this is not the case. There is so much conflicting information and it's hard to know whether you're doing the right thing but I am trying!

[Nessie87 in reply to JCB56]

You could look the ‘Freshwell’ App, two doctors run it. It’s dietary advice. They advocate full fat milk/dairy or you could follow Dr. Unwin he’s reversed lots of patients diabetes by them following low carb diet but full fat dairy.

Take a look. Proper qualified GP

[JCB56 in reply to Nessie87]

Interesting, thank you. I will have a look at that. I've started reading a book by a Scottish GP, Dr Malcolm Kendrick, who also disputes the link between full fat food, high cholesterol, heart attacks etc. He references all the studies but it doesn't suit the big drug companies to publicise all the research. It will be interesting to see whether advice does start to change. I've got nothing against medication if it really improves a person's health but so many drugs seem to end up causing additional problems, which also need medicating ...

[Nessie87 in reply to JCB56]

My views are the same actually, your last comments are so true!

[JCB56 in reply to Nessie87]

I just hope we turn out to be right! 😆

[Gala123]

I think that it is actually quite difficult to eat the daily calcium recommended amount of 1200 mg. I tracked and calculated my intake and realised that I still need to supplement, though not for the whole amount of 1200 that my Calci-D prescription contains. If you can't tolerate dairy, it will be harder. Most of my calcium comes from milk (skimmed), kefir, yogurt and cheese. The thing with fortified products is that it is the same calcium carbonate supplement you get in supplements. You will be better off to take supplements rather that eating/drinking calcium-fortified food. I do have osteoporosis and also take alendronic acid, due to being on long-term steroids for my autoimmune condition. I have been taking half of Calci-D tablet that was prescribed to me (600 mg), as by my calculation I can only reliably manage about 900 mg. 600 extra mills take me over the required dose, but then I can't always know for sure how much I have eaten. It is worth tracking from time to time and adjust the dose accordingly. I now decided to buy a different, more digestible calcium over the counter rhather than taking Calci-D, just ordered one that was recommended on this forum. Will see how it goes. Good luck finding the best solution for you!

[JCB56 in reply to Gala123]

Thank you. My diet is a work in progress! I can eat a certain amount of dairy products but am constantly aware of my cholesterol level and not aggravating my IBS. I'm trialling some lactose free products and looking at the fat free versions but I don't find them enjoyable to eat. I suppose I have to treat them like 'medication'. I've never been diagnosed as lactose intolerant and I don't really want any more tests, so it's all trial and error at present. I don't think the standard dietary advice is always very helpful, especially for people who have other dietary needs.

[JCB56]

I'd never heard of dolomite tablets but I'm taking calcium citrate, vitamin D and vitamin K. I am learning a lot here! I usually have some form of oats for breakfast too, sometimes including oat bran but I hadn't heard that oats were better with regards to the calcium, so that's good to know. I was actually a bit concerned about adding too much oat bran. I usually add ground seeds to my breakfast but I'm a little concerned that they don't help the calcium uptake. I need the extra fibre and seeds are supposed to contain so many other nutritional benefits. At the moment I'm adding about 15g (a mix of chia, flaxseed and sesame) which allegedly add calcium but now I'm not really sure if they help! Sorry to hear of your problems with the omeprazole. I am really trying to resist being put on prescription medications and was actually quite pleased when the GP told me I didn't meet the threshold for treatment. Due to my high cholesterol, I am now on the radar for being given statins, which I also want to avoid. I dread going to the doctor these days! 😅

[petabyte in reply to JCB56]

What form of vitamin k do you take?

There is K1, and K2 in 2 forms, MK-7 (the most common in supplements) and MK-4 (short half life means 3 daily doses needed).

There is not definitive evidence that it works but some studies indicate that vitamin k (along with adequate vitamin d) directs calcium to the bones rather than to arterial plaque.

What is your vitamin d level? If you don't know, the next time you get a blood test ask to include it.

[PoppyPaddler in reply to petabyte]

I take a Vit D3/K2 Mk-7spray which can be adjusted as 1, 2 or 3 sprays, dosage given on the box (from Bare Biology - am I allowed to say that?) Just goes under tongue.

[JCB56 in reply to petabyte]

I've got the K2 in the MK-7 form. I was advised not to bother but I decided it was worth a go, as I couldn't find any risks associated with it. I've read it has benefits to the heart as well. I'm not sure I've ever had my vitamin d checked but doubtless I'll be having another blood test at some point, so I'll to ask. I have been taking vit d supplements for a long time.

[Rooruby in reply to JCB56]

I too have high cholesterol and just started statins. It is very hard to get enough calcium with high cholesterol and the nurse said I need at least 1000 a day if not more as I'm also taking daily teriparatide injection as my osteoporosis is severe with a fracture to t12 which is progressive since late 2023.I am also not sure if the statins interfere with the teriparatide as my back has been so bad last few weeks.

TBH this is all so confusing 1 doctor states 1 thing and another somthing different. I try to eat weetabix daily with semi skimmed milk a smoothie of natural yoghurt ground walnuts banana and Berries. I also eat a few slices of GOUDA cheese every other day and l9ts of veg such as kale Brussels green beans. Now I have extra belly fat as well as more pain so not sure what next lol.

[JCB56 in reply to Rooruby]

It is hard and I'm very sorry to hear you're suffering with your back and hope you get some relief soon. Every time I see the nurse about my cholesterol, she exlaims 'oh that is high!' which isn't very reassuring. However, they said I was low-risk because I'm not overweight, don't smoke, blood pressure is reasonable etc. So they've not been pushing me to take statins. However, I'm now in the clutches of the cardiologist because it was found I have a leaky heart valve (this all came about because I asked about some loud tinnitus I was having and the GP said it might be heart related - it wasn't but they found something else instead!) So the cardiologist said I should consider statins. I am trying to take it all in my stride because I know I am quite well off - none of my conditions are serious at present and I'm still mostly able to do what I want. I suppose it's to be expected as you get older. I just want to give myself the best chance of staying healthy as long as possible, which I'm sure is what everyone on here is trying to do.

[Graceissufficient in reply to JCB56]

Statins gave me acute depression, so that I found myself while driving suddenly overcome with the urge to accelerate into the back of a lorry.

Prob don't do that to all women, but be aware. Also brought on immediate menopause.

[JCB56 in reply to Graceissufficient]

How awful for you. So sorry to hear that. I'm hearing more and more about them causing mental health issues. I hope I don't get persuaded to take them. Some people have said 'well you can always try them'. Still doesn't sound like a good argument to me!

[Caradoc1a]

I have at least desertpoon of tahini a day. Sesame seed paste. I mix into yogurt with muesli or use instead of butter on toast with jam. 30g is 42mg calcium. A jar is 270g.

[JCB56 in reply to Caradoc1a]

I usually blend up some kind of 'shake' for breakfast and have been including sesame and chia seeds, which both apparently have respectable amounts of calcium. However, these are precisely the type of foods I've been questioning because although they contain calcium, our bodies do not metabolise much of it due to the other substances which inhibit the calcium. I will continue to take them for their other nutritional benefits but I'm not sure they are valuable source of calcium.

[Caradoc1a in reply to JCB56]

Could you point to the evidence for the non absorption of calcium from sesame seeds. Thanks. I haven't come across this before.

[JCB56 in reply to Caradoc1a]

It's to do with a high content of oxalate and/or phytate in some foods. This is a rather academic article. It states that despite high gross calcium contents many plant-based foods have little bioavailable calcium. I need to read the whole article properly myself!

sciencedirect.com/science/a...

Just found this very useful table as well, which involves a lot less reading:

ese-hormones.org/media/2iwc...

[Rooruby in reply to Caradoc1a]

I also heard Brussels and Spinach did not absorb

[HeronNS in reply to Rooruby]

I don't actually know if it's true, but I've always thought that food like oranges helped with calcium absorption. We make a nice dish which includes both oranges and Brussels sprouts! Calcium citrate as a supplement is more readily absorbed than calcium carbonate.

[Rooruby in reply to HeronNS]

Oh that's good I try to eat a orange everyday and also lots of green veg and dairy lol

[petabyte]

If you still have a link to that article or study about calcium precipitation and sedimentation, I'd be interested to see it? The only thing I found was a milk producer's web site which wasn't that convincing 😉.

[JCB56 in reply to petabyte]

I think this was the article I read and the second link is for the full study (which I need to look at in more detail!) The original study is from 2007, so I don't know if there's anything more up-to-date.

dairynutrition.ca/en/nutrie...

ift.onlinelibrary.wiley.com...

[petabyte in reply to JCB56]

Thanks!

I haven't noticed any sediment in my fortified soy milk but will cut open the next one.

The relevant text from the study:

Related to this matter of bioavailability is another quality-related issue. In beverages, such as soy “milk” and some fortified orange juices, it has been shown that the fortificant tends to settle to the bottom of the carton (Heaney and others 2005a, Heaney and Rafferty 2006). Even vigorous shaking was not sufficient to resuspend the calcium salt in some products. Here bioavailability is moot, as it is ingestion itself that is compromised. In all such instances, the labeled content, while technically accurate, is irrelevant and will likely be misleading to consumers.

I looked at the paper and I was bothered by the lack of references, and when they were there they linked to the author's own papers.

I asked perplexity.ai to evaluate it:

• Limited Referencing of Specific Studies: The paper often makes broad statements about calcium absorption without citing specific studies to back them up. While it mentions a literature search was performed, the results aren’t presented in a way that allows easy verification of the claims. You can’t easily track down the original data.

• Reliance on Authors’ Own Work: The paper relies heavily on studies performed in the authors’ own laboratory. While there’s nothing inherently wrong with this, it introduces a potential for bias. It also makes it harder to assess the generalizability of the findings.

• Age of the Paper: Given that it was published in 2007, some of the information may be outdated. New calcium fortificants and fortification strategies may have emerged since then.

[JCB56 in reply to petabyte]

Interesting AI evaluation. I'm still a bit suspicious of AI, as I know some software literally makes stuff up 😆. Just found this table about the bioavailability of calcium in different foods. It has a list of references, although many of those are pretty old studies. Seems like some new research is needed! Anyway, I think I'm done with dietary research today. I need a cup of tea (with cow's milk, of course!)

ese-hormones.org/media/2iwc...

[Capan24]

I was using a food app to help me track calcium in my diet, since I eat a plant-based diet and do not consume too much dairy having a little bit of lactose intolerance. I have to take the lactaid enzyme pills to help digest any dairy. I'm 65 years old and it is recommended that I get 1200 mg of calcium from food and supplements. When I tracked my calcium, I was getting on average around 800 mg with food. I do take citrical maximum plus which has vitamin D and the two caplets have 600 mg of calcium citrate. I have read that calcium citrate is better absorbed by the body and you can take it with her without food. When I did a little research on calcium supplements, I found that typically, only about 20-30% of the calcium from a supplement is absorbed by your body. Which means that I might absorb 120 to 180 mg from the supplement I take. I also read that the body absorbs calcium best in doses of 500–600 mg or less at a time. Vitamin D: Essential for calcium absorption (goal: 600–800 IU/day).Magnesium & K2: Help direct calcium to bones and prevent artery calcification. I do also take vitamin K2 100 micrograms daily. So taking this into consideration, I'm still on most days probably not getting my daily requirement of calcium. I think when you're including fortified foods with calcium in your diet, it's probably similar to taking supplements with how your body absorbs it. I'm still working on trying to boost my calcium intake with food and will continue to take the supplement for now. It's a work in progress.

[JCB56 in reply to Capan24]

Sounds like you're doing well to get that much calcium with a plant based diet. 'Work in progress' is exactly the phrase I used earlier! I am doing all the 'right' things with the vit D, K2, magnesium, as far as I can tell. We are all doing our best and I suppose that's all we can do. I've avoided much in the way of dairy produce for many years, due to my IBS. We'll see how I get on with the lactose-free stuff. I was taking a calcium carbonate supplement for along time to try to make up for my lack of dietary calcium, long before OP was even mentioned. It either wasn't enough or it wasn't going to the right place ...

[Capan24 in reply to JCB56]

I only eat about a half cup of the Good Culture 2% milk fat cottage cheese. I take the lactaid enzyme pill also. I think I can tolerate this cottage cheese better because it has probiotics in it. So far I haven't had any issues eating this.

[JCB56 in reply to Capan24]

I'll look out for that brand, thanks. I often take digestive enzymes, although not specifically for lactose - absolutely no idea if they make things better. I think my digestive system has a mind of its own!

[Graceissufficient in reply to JCB56]

Sorry, you've prob had enough of the whole discussion, but have u tried a Fodmap (?) diet for the IBS?

[JCB56 in reply to Graceissufficient]

Yes, thank you. I started the discussion in the first place, so I can't complain and I am still learning! It's great that everyone here wants to help each other. I have known about the Fodmap diet for a long time and have loosely followed it at times. I have a pretty good idea of what upsets me but having to add in all this calcium (and dairy) has made me entirely rethink what I eat! I was thinking of downloading the Fodmap app but at the moment I feel that focussing on calcium is probably more important. I realise I'm in danger of becoming too diet-obsessed and it does somewhat take the pleasure out of eating ... At present I think low-fat dairy products, mostly lactose-free or made from goat milk, are the way to go. I realise we are very fortunate to have the luxury of being able to choose.

[PoppyPaddler]

On the RoS there's a really easy calcium checker which gives more of a weekly score. I found that by using it, it gives an overall score over a week so you can see that daily adjustments average out over a week. I felt I was less hung up then over my daily intake. The last thing we need is more stress!

[Capan24 in reply to PoppyPaddler]

osteoporosis.ca/nutrient-ca...

I have used this calcium calculator to get a general idea of calcium intake.

[JCB56 in reply to Capan24]

Many thanks. I don't think I've seen that one, so I'll have a look.

[JCB56]

I have used the calcium checker online but I've made myself a simple chart of the foods I usually eat, so I can do a quick check. Overall, I think I'm much less stressed about it than I was initially. The diagnosis was very unexpected for me! I just thought the DEXA scan was 'precautionary', like a lot of tests. This group is really helpful too.