Calcium Deficiency

Stored primarily in the bones, calcium is the most abundant mineral in the body. It is also an essential nutrient that the body needs for a variety of other purposes. Bone depends on a ready supply of calcium to stay strong and healthy, but even the circulatory and nervous systems rely on calcium for proper functioning.

The Importance of Calcium

People with Crohn’s disease are susceptible to not getting adequate calcium in their diet. Accordingly, Crohn’s patients must take special care to maintain a sufficient intake of the metallic element.

As a general guideline, adult men and women should aim for at least 1,000 mg calcium per day. Adequate vitamin D is also important, as vitamin D plays a role in both immune system function and bone health. Vitamin D also regulates how much calcium circulates in the bloodstream, and how much will be used by the bones to maintain healthy structure.  

People who do not consume enough calcium, and/or have low vitamin D levels, are at increased risk of developing brittle bones, a condition known as osteoporosis. Worse, some corticosteroid drugs used to treat Crohn’s inflammation may contribute to risk factors for osteoporosis.

Since Crohn’s patients often develop osteoporosis, physicians may prescribe a drug class known as biphosphonates to prevent bone mineral loss. However, a recent study showed that taking one of these drugs was no better at preventing bone mineral loss than taking a daily supplemental vitamin D (1,000 IU) and calcium citrate (800 mg). This finding suggests that getting enough calcium and vitamin D should suffice to keep Crohn’s patients’ bones healthy. If taking daily supplements is feasible, Crohn’s patients may find that this is the best way to ensure adequate intake of these two crucial nutrients.

The Challenge of Lactose Intolerance

Milk and dairy products are among the richest dietary sources of calcium. Unfortunately, Crohn’s patients often fail to consume enough dairy, out of fear (or certainty) that they are lactose intolerant. Lactose intolerance is a condition in which a person is unable to break down the sugars (known as lactose) present in milk, due to the lack of an enzyme called lactase.

Humans are ordinarily born with the ability to produce the enzyme, and thus to digest milk, but many adults lose this ability as they mature. Someone that can’t digest milk will experience symptoms ranging from gas and discomfort to diarrhea and cramping if they consume milk products. While not all people diagnosed with Crohn’s disease are actually lactose intolerant, studies suggest that about 40 percent of Crohn’s patients have some degree of lactose intolerance. Studies have also shown that people whose Crohn’s disease affects the small bowel are especially likely to experience lactose intolerance. Intolerance in this subpopulation of patients may be as high as 100 percent.  

Fortunately, even people who consider themselves lactose intolerant are generally able to tolerate up to two cups of milk per day (supplying about 11 g lactose), with few ill side effects. Even better news for the Crohn’s patient is the exceptionally low amount of lactose in hard cheese. Parmesan, for example, contains less than one gram of lactose per teaspoon, yet it contains a relatively large amount of calcium. 

Patients who are truly intolerant to even small amounts of lactose should be aware that food manufacturers often add lactose to prepared foods—without listing it on product labeling. Examples of foods with this “stealth” lactose include packaged breads and baked goods, processed meats such as sausage and hamburgers, soft drinks, and some breakfast drinks and “slimming” products, among other foods.

Alternatives to Dairy

Crohn’s patients concerned about lactose intolerance can experiment with calcium-fortified substitute foods that may help take the place of dairy in the diet. Soy products, such as soy milk with added calcium, are now widely available. Rarely, some people are allergic to soy. Alternatives to soy milk include rice milk, almond milk, or even coconut milk. As mentioned, hard cheeses, such as parmesan, contain very little lactose, while supplying relatively large amounts of calcium

Mild soft cheeses, such as ricotta or cottage cheese, supply more than 300 mg calcium per half cup. In contrast, one cup of low fat milk supplies about 300 mg calcium. Eight ounces of plain fat-free yogurt supplies more than 450 mg calcium, with the added benefit of probiotics. Greek yogurt provides up to 20 percent of the daily requirement for calcium, in a single 6-ounce serving. Of course, amounts vary by product, so check labels to be sure you’re getting enough calcium throughout the day.