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Nora Saul, MS, RD, LDN, CDE

Manager, Nutrition Services
Joslin Diabetes Center
Boston, MA

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Calcium Intake and Lactose Intolerance

Ask the Expert
digestive disorders

Q:

I'm lactose intolerant and am concerned about my calcium intake. Are there specific foods that I should eat to compensate for the lack of dairy in my diet?

A:

You are wise to be concerned about getting enough calcium. Inadequate intake of calcium can increase the risk of postmenopausal osteoporosis as well as possibly play a role in weight gain and high blood pressure. The recommended amount of calcium for adults through middle age is 1,000 mg per day. This increases to 1,200 mg for those over age 51. Dairy products such as milk and yogurt, at 300 mg per serving, are a major source of calcium in the diet, but vegans as well as those with lactose intolerance can consume adequate calcium from other dietary sources with a little planning. Fish eaten with bones, such as sardines and canned salmon, provide almost as much calcium as dairy products. Other excellent sources of calcium are soy beverages, juices and cereals that are fortified with calcium and tofu that has been processed with calcium sulfate or nigari (magnesium chloride). Leafy green vegetables, such as collards, bok choy, kale and turnip greens, are also a good source of this important nutrient. Many of the leafy greens provide between 80 and 180 mg of calcium per serving. Although most leafy greens contain calcium, the calcium in some varieties is not readily absorbed during the digestive process. The calcium in vegetables such as spinach, rhubarb, Swiss chard and beet greens is largely unavailable due to the presence of oxalic acid, which binds calcium, reducing its absorption. For those who are don't eat a lot of vegetables, supplements may be the answer. Supplements containing calcium carbonate or calcium citrate are well absorbed and tolerated. It is best to take no more than 500 mg of calcium at a time because absorption declines with greater amounts. Whether you obtain your calcium from dietary sources or from supplements, reducing your sodium intake can help you decrease calcium losses in the urine. And regular weight-bearing exercise such as walking or running helps strengthen bones.

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C. diff is the name of a common, easily transmittable infection caused by the bacterium Clostridioides difficile. The infection causes your colon (bowel) wall to become inflamed, resulting in severe, watery diarrhea. Left untreated, it can cause a serious complication called toxic megacolon.

C. diff affects about 250,000 people in the United States every year. Some people get it only once in their lifetime, but if you have a C. diff infection, there is up to a 1 in 4 chance you might relapse (the same infection returns) or get it again within eight weeks. People at the highest risk for a C. diff infection are those who take or have recently taken antibiotics, especially if they have a weak immune system.

The bacteria live in feces (poop), and in soil and water. They spread easily and can live for a long time on hard and soft surfaces, like linens and clothing. If someone who has C. diff on their hands touches a door handle and you touch it after, the bacteria transfer to your hand. They then can enter your gastrointestinal system if you touch your mouth or handle food before washing your hands.

Protect yourself and others from getting a C. diff infection in a healthcare setting

hand washing in a hospital

If you are a patient in a hospital, skilled nursing facility or rehabilitation center, you are at higher risk of getting a C. diff infection — not just because you likely have a weak immune system from the condition that put you in the facility but also because of the number of people you may encounter while you’re there.

Here are some steps you can take to lower the risk of getting C. diff in a healthcare facility:

  1. Make sure all healthcare workers and visitors wash their hands before they touch you and your things. If you don’t see them wash their hands, ask them to do so.
  2. Wash your hands well with soap and water every time you use the bathroom. If you use a bedside commode, ask to be transported to a sink to wash your hands or use a waterless hand sanitizer.
  3. Wash your hands before eating or drinking. If you can’t get to a sink, ask the staff or a friend to supply you with a waterless hand sanitizer to use while you are in bed or sitting in your chair.
  4. Allow cleaning staff access to your environment. Clear everything off the bedside table or nightstand, and remove clothing or linens from the bedside rails so they can be wiped down.

Patients with a diagnosed C. diff infection should not share a room with someone who does not have the infection. If you do share a room and your roommate contracts C. diff, ask to be moved.

Stop the spread of C. diff at home

household cleaning supplies

C. diff doesn’t just affect people in healthcare facilities. It can happen at home, too.

Here are steps you can take to reduce the risk of spreading C. diff at home:

  1. If your home has a second bathroom, reserve one for the person with the C. diff infection to limit exposure to others.
  2. If your home has only one bathroom, make sure the toilet seat, flusher, faucets, light switches and doorknob are cleaned with a bleach-based cleaner after each use.
  3. If the infected person is immobile, keep waterless hand sanitizer within reach.
  4. Clean common home surfaces (door knobs, light switches, fridge handles, etc.).
  5. Wash clothing (especially underwear), towels and linens separately and in the hottest water possible.
  6. Wear disposable gloves while handling clothing and linens, especially if the person is incontinent (loses control of their bowels). Wash your hands after removing the gloves.
  7. Shower with soap to remove C. diff that may be on the skin.

This educational resource was created with support from Seres Therapeutics and Nestle Health Science.