It's no secret that many women with endometriosis struggle with digestive issues like bloating, constipation, and food intolerances. As a result, many have turned to eliminating dairy from their diets to alleviate symptoms. While these dietary changes can be beneficial for some, it's essential to consider the potential nutritional implications, particularly when it comes to calcium.

Dairy and Endometriosis: A Complex Relationship

A meta-analysis involving 120,706 participants explored the connection between dairy intake and endometriosis. Interestingly, the study found that higher consumption of dairy products, especially high-fat dairy and cheese, was associated with a reduced risk of endometriosis. This study suggests that the nutrients found in dairy may play a protective role in the body.

However, it's important to note that not all dairy products are created equal. For instance, high butter intake was linked to an increased risk of endometriosis.

The Lactose Factor

One of the main reasons people with endometriosis may avoid dairy is lactose intolerance. Lactose is a sugar naturally found in milk and dairy products. When people with lactose intolerance consume dairy, their bodies struggle to digest the lactose, leading to symptoms like bloating, gas, and diarrhea.

For those with endometriosis and lactose intolerance, it's essential to find ways to incorporate calcium-rich foods into their diet without triggering digestive discomfort. Fortunately, many lactose-free dairy alternatives are available, such as lactose-free milk, yogurt, and cheese. Additionally, lactose-digesting enzymes can be taken with dairy products to help improve digestion.

The Role of Calcium in Women's Health

Calcium is a crucial mineral that supports various bodily functions, including:

Bone health: Calcium is essential for maintaining strong bones and teeth, especially in women. Osteoporosis—a condition characterized by weak and brittle bones—can develop over time with insufficient calcium intake.

Muscle function: Calcium is required for proper muscle contraction and function. Low levels of calcium can lead to muscle cramps and spasms.

Nerve signaling: Calcium helps regulate nerve impulses, ensuring proper communication between the brain and other parts of the body.

Hormonal balance: Adequate calcium levels support the secretion of hormones, which is particularly important for women's reproductive health.

For women who are struggling with fertility and conditions like endometriosis, meeting calcium requirements is especially important. Calcium not only supports reproductive health but also plays a role in maintaining overall well-being.

Risks of Low Calcium Intake

Eliminating dairy requires finding appropriate calcium-rich alternatives to avoid calcium deficiency. The risks associated with low calcium intake include:

Osteopenia and Osteoporosis: Without sufficient calcium, bones lose density over time, making them fragile and more susceptible to fractures.

Muscle Weakness: Low calcium can impair muscle function, leading to fatigue, weakness, and, in severe cases, muscle cramps.

Hormonal Imbalance: Calcium is crucial for hormone regulation. A deficiency may exacerbate symptoms of hormonal imbalance, which can be particularly concerning for women with endometriosis or those trying to conceive.

Given these risks, ensuring adequate calcium intake is critical for women who eliminate dairy from their diets.

How Much Calcium Do Women Need?

For women aged 18-50, the recommended daily calcium intake is 1,000 mg. Women over 50, due to the increased risk of osteoporosis, should aim for 1,200 mg of calcium per day.

It's vital to spread calcium intake throughout the day for optimal absorption. The body absorbs calcium best in smaller doses, ideally no more than 500 mg at a time. This means that women should consume calcium-rich foods or supplements in divided doses across meals.

How to Calculate Calcium in Your Diet

Understanding the nutrition labels and portion sizes is key when evaluating food for calcium content. Most nutrition labels list calcium as a percentage of the recommended daily intake. To convert this percentage into milligrams, multiply the percentage by 10. For example, if a food item provides 20% of the daily value of calcium, that equates to 200 mg of calcium.

Calcium-Rich Foods: Dairy and Non-Dairy Sources for Endometriosis

Dairy products are well-known for being high in calcium. However, there are plenty of non-dairy calcium-rich foods for those who are lactose intolerant or avoid dairy due to endometriosis. Here's a list of calcium-rich options, both dairy and non-dairy:

Dairy Sources of Calcium:

Milk (1 cup): 305 mg

Yogurt (1 cup): 400-500 mg

Cheese (1.5 oz, cheddar): 115-485 mg

Cottage cheese (1 cup): 187 mg

Non-Dairy Sources of Calcium:

Fortified plant-based milk (almond, soy, oat) (1 cup): 200-300 mg

Tofu (with calcium sulfate, 1/2 cup): 434 mg

Chia seeds (1 oz): 179 mg

Almonds (1/2 cup): 120 mg

Sardines (with bones, 3 oz): 325 mg

Kale (1 cup, cooked): 177 mg

Broccoli (1 cup, cooked): 60 mg

Here’s a comprehensive list of dietary sources of calcium: USDA

Calcium Supplements

Supplements may be necessary for those who struggle to meet their calcium needs through diet alone. Two common types of calcium supplements are:

Calcium carbonate: This type contains the highest amount of elemental calcium and is best taken with food to ensure proper absorption.

Calcium citrate: Easier to digest and absorb calcium citrate can be taken with or without food. It's a good option for those with digestive sensitivities.

Avoid exceeding the recommended daily intake, as excess calcium can lead to kidney stones and other health issues. Aim to take no more than 500 mg of supplemental calcium at one time and spread doses throughout the day.

Blood Tests for Calcium: Not a Reliable Indicator of Dietary Intake

While blood tests can measure calcium levels in your blood, they aren't a reliable indicator of whether you're consuming enough calcium through your diet. Your body tightly regulates calcium levels in the blood. Even if you're not getting enough calcium from your food, your body will often draw calcium from your bones to maintain blood levels within a normal range.

Low calcium intake can lead to a situation where your blood calcium levels appear normal, even though your bones may lose calcium. Over time, this can contribute to weakened bones and an increased risk of osteoporosis.

Bone Density Scans: A More Accurate Assessment

If you've been eliminating dairy for a long time or are at risk of calcium deficiency, your doctor may recommend a bone density test (also known as a DEXA scan). This test provides a more accurate picture of your bone health by measuring bone mineral density. It can help detect early signs of osteopenia or osteoporosis, characterized by reduced bone mass and increased risk of fractures.

The DEXA scan is a non-invasive and painless procedure that typically focuses on areas prone to bone loss, such as the spine, hips, and wrists.

Conclusion

While eliminating dairy may help reduce symptoms of bloating, constipation, and diarrhea in women with endometriosis, it can also result in calcium deficiency if appropriate dietary changes aren't made. Calcium is crucial for bone health, muscle function, nerve signaling, and hormone regulation, so finding alternative sources of calcium is essential for maintaining long-term health. For women managing endometriosis, meeting daily calcium needs can be achieved through a combination of non-dairy foods and, if necessary, supplements. Women can support their overall health and well-being while managing their endometriosis symptoms by understanding the importance of calcium and making informed choices with diet and supplements.

Sources:

U.S. Department of Agriculture and U.S. Department of Health and Human Services. Food Sources of Calcium. Dietary Guidelines for Americans, 2020-2025. Available at: https://www.dietaryguidelines.gov/food-sources-calcium.

Qi X, Zhang W, Ge M, Sun Q, Peng L, Cheng W, Li X. Relationship Between Dairy Products Intake and Risk of Endometriosis: A Systematic Review and Dose-Response Meta-Analysis. Front Nutr. 2021 Jul 22;8:701860. doi: 10.3389/fnut.2021.701860. PMID: 34368211; PMCID: PMC8339299.

National Osteoporosis Foundation. A Guide to Calcium-Rich Foods. Available at: https://www.bonehealthandosteoporosis.org/patients/treatment/calciumvitamin-d/a-guide-to-calcium-rich-foods/.

National Institutes of Health, Office of Dietary Supplements. Calcium - Consumer Fact Sheet. Available at: https://ods.od.nih.gov/factsheets/Calcium-Consumer/.