“Got milk?” Milk got a boost with this popular and clever marketing campaign 20 years ago, and the question soon became part of the everyday lexicon. Children and adults asked, “Got milk?” every time they took a drink of it. And this question still rings true today…although, “Got calcium?” is perhaps more appropriate. With the range of calcium-fortified products on the market, you can find a variety of milk substitutes that can give you a suitable dose. 
But even with all these products on your kitchen shelf and in your fridge, do you get enough calcium?
What is calcium?
Calcium is one of the most bountiful minerals found in the human body, with almost 100 percent of it positioned in our bones and teeth. The small remaining amount is located in our blood, in our muscles, and within our cell liquids.
Some research suggests that calcium aids in reducing cardiovascular disease risk, lowering blood pressure, and reducing risk of hypertension.
Almost every body tissue uses calcium, making it an essential part in living a healthy, flourishing life. 
“Calcium is required for muscle function and hormone secretion,” Becky Kerkenbush, registered dietitian and member of the Wisconsin Academy of Nutrition and Dietetics, says. “Some research suggests that calcium aids in reducing cardiovascular disease risk, lowering blood pressure, and reducing risk of hypertension.”
How do you know you have a calcium deficiency?
Calcium-deficient individuals might not show any signs or symptoms, especially if it is mild, says Jennifer Wider, MD. But if the deficiency is more severe, she notes that symptoms can include muscle weakness, fatigue, and irritability. Wider recommends scheduling a visit with your health care provider to take a blood test that will check your total calcium levels. This test is the most common diagnostic test to evaluate if you are calcium deficient. It’s usually quite accurate because the balance between free and bound calcium in your bloodstream is generally stable. 
If your results show an atypical total calcium level, your doctor might order additional tests to measure levels of phosophorus, magnesium, vitamin D, and other hormones to determine if you have any type of underlying health issue.
What does calcium affect?
Osteoporosis is a condition in which the bones lose minerals faster than the body can replace them. Most common in older women, osteoporosis makes the bones fragile and brittle. A lack of calcium, according to health resource WebMD, can lead to this condition. 
Consuming calcium, and following a diet rich in calcium-fortified foods, can reduce your risk of high blood pressure. Calcium is “one of the key minerals involved in blood pressure control,” according to Harvard’s Heart Letter, a newsletter about heart health. As far as cancer goes, the National Cancer Institute indicated that calcium can reduce the number of opportunities for colorectal cancer to occur, as well as improving cell-to-cell signaling and possibly causing cancer cells to die off. Cramps and muscle spasms from a lack of calcium typically occur around the thighs, arms, and underarms, typically at night. Calcium is a key part of operating muscle fibers, and a calcium deficiency can result in muscle irregularity. 
Low calcium levels can result in dry skin and weak, brittle nails. As mentioned before, teeth have a high percentage of calcium, so low levels can result in tooth discoloration and weakness. A lack of calcium can also cause insomnia, and even if you can sleep, your body might fail to fall into a deep sleep.
Who does a calcium deficiency most often affect?
According to Julie Upton, a registered dietician, Appetite for Health co-founder, and co-author of 101 Fat Habits & Slim Solutions, those particularly at risk for consuming insufficient calcium intake include the following: 
Anyone who eschews dairy in their diet, like vegans and certain vegetarians, might have a challenging time getting adequate calcium intake, as dairy foods are the best source of calcium. Although it is possible to get adequate calcium on dairy-free and vegan diets, it does take careful planning and generally requires adding some calcium-fortified foods, like a calcium-fortified soy or almond milk, to your diet. Women are often deficient in calcium because of their lower energy requirements, as well as their frequent low dairy intake. This holds especially true with menopausal women and pregnant women. 
Older adults are in similar boat due to their lower total energy intake, and they often consume fewer dairy foods than younger or middle-aged adults. Whenever your energy needs decline, every calorie counts to get all the nutrients you need. In addition, people that are lactose intolerant are also at risk for a calcium deficiency. These individuals cannot completely digest lactose, the natural sugar in milk, avoid dairy products—and therefore miss the calcium they provide.
How much calcium do you need?
The National Institutes of Health provides a table of recommended daily allowances of calcium. A newborn, according to NIH, requires 200 milligrams a day. By the age of 5, they require 1,000 milligrams. Puberty causes the need to ramp up to 1,300 milligrams, but young adults fall back down to 1,000 milligrams by the age of 19. Middle-aged women and elderly men require a bit more, needing 1,200 milligrams. 
To give you an idea of the calcium content typical in most foods, one cup of yogurt contains 450 milligrams, one cup of skim milk has 300 milligrams, and one cup of soy milk has 200 to 400 milligrams. You will also find milk in fruits and vegetables: one cup of raw kiwi has 50 milligrams, one cup of cooked broccoli has 180 milligrams, and one cup of raw kale has 55 milligrams. Additionally, grains, legumes, nuts, seeds, fish, and other foods like molasses have built-in calcium. 
For those looking for other calcium sources, you can purchase calcium-fortified cereals, fruit juices, and oatmeal on the market.
How can we avoid a calcium deficiency?
To maintain a proper calcium balance in your body, Thomas recommends eating a plant-based diet, as well as getting plenty of vitamin D from reasonable exposure to sunshine. 
Vanessa Rissetto, RD, believes you should look to food sources outside of dairy products, as other foods are even more rich in calcium. Examples include salmon and sardines canned with bones, kale, collards, broccoli, mustard greens, turnip greens, bok choy, and sesame seeds. For calcium supplements, she suggests choosing calcium citrate or calcium citrate malate, taking it in at least two divided doses with meals for the best absorption.
Recent Developments in Calcium Deficiency Research
The phosphorus phenomenon: The more phosphorus you have in your diet, the more your need for calcium increases. “As the amount of phosphorus you eat rises, so does the need for calcium,” reads the University of Maryland Medical Center’s overview on phosphorus. “The delicate balance between calcium and phosphorus is necessary for proper bone density and prevention of osteoporosis.”
To increase calcium, lactose-free dairy products are an inexpensive source.
“Phosphorus is indeed found in meat and dairy, but there is also ‘hidden’ phosphorus, which manufacturers add to food and beverages, usually as a preservative or flavor enhancer,” says Priscilla Blevins, RD and dietitian for EduPlated. “It is typically your convenient, ready-to-eat, and processed foods that actually contain a large amount of hidden phosphorus.” She recommends sticking to eating fresh and unprocessed foods instead and watching for words with “phos” or “phosphate” on the food labels. Magnesium relevancy: The calcium and magnesium balance is key, too. As noted in the medical journal BMJ Open, “Magnesium … and calcium … antagonise each other in (re)absorption, inflammation and many other physiological activities.” Barry Sears, PhD, author of the Zone Diet book series and president of the Inflammation Research Foundation, says most Americans are deficient in magnesium. To increase magnesium, he suggests we eat leafy green vegetables and nuts. “To increase calcium,” he says, “lactose-free dairy products are an inexpensive source.” 
“If you use a calcium supplement, then make sure the ratio of calcium to magnesium is always in a 2:1 ratio for optimal results.” The amount of the parathyroid hormone: This hormone makes sure you have the right amount of calcium and phosphorus in your body by helping balance them both out. Without adequate vitamin D, parathyroid hormone levels rise to unhealthy levels. “[Increased intake of] vitamin D—which most Americans are deficient in—helps control the amount of parathyroid hormone in the body,” Blevins says, “thus allowing it to successfully balance calcium and phosphorus.” Like calcium, vitamin D is associated with healthier bones, according to research in the Journal of Nutrition. Nixing calcium supplements: Blevins suggests sticking to eating fresh foods the majority of the time, eating dairy and legumes (also high in calcium), limiting processed foods in your diet, and taking a D3 vitamin with 2000 IU a day. 
As one of the most vital minerals in the body, calcium is necessary for survival, but you do not need to do it with dairy products alone. You can receive a healthy dose of calcium from eating foods outside of cheeses and milk. However, you must stay vigilant in knowing how much calcium is within the foods you consume to ensure you meet the recommended daily allowance for your age group.
