Does what I eat affect my calcium level?
Yes. What you eat does affect your calcium levels. Alfacalcidol, vitamin D3 and magnesium work together to help your body to absorb calcium from your diet. So regular meals with a good calcium content can help to keep levels stable. Food really matters in hypopara.
Is diet important in hypopara?
Very. Along with taking your medication properly, eating regular meals with a good calcium content is the best thing you can do to help keep your calcium levels stable.. Food is a tool you can use to manage your levels better. Read more about diet in hypoparathyroidism here. Eating good fresh food, avoiding processed food and keeping hydrated can make a real difference to how you feel.
How much calcium do I need?
Your daily calcium intake is made up from the food you eat and any calcium supplements you take each day. The total needs to be kept at around 1200mg – 2000mg a day maximum. This is important to help prevent kidney problems.
Should I take my medication with food?
Calcium carbonate supplements should always be taken with food. Calcium is better absorbed if taken with vitamin C and some protein.
Does what I eat affect my calcium level?
Yes, what you eat affects your calcium level in the same way as a calcium tablet.
If you skip meals or leave long gaps between meals your calcium levels may fall. Conversely, if you binge on cheese don’t be surprised when your levels rise. You can boost your calcium level quite quickly if you need to with a glass of milk.
Which foods contain calcium?
Dairy foods are high in calcium so useful in an emergency (especially plain yoghurt) but too much dairy isn’t good for your kidneys. Luckily, there are lots of other foods that contain calcium – a handful of almonds, a helping of kale or a tin of sardines are all high in calcium.
Here’s a list of foods that contain calcium:
This is a useful list of food containing calcium from the Great Western Hospitals NHS Foundation Trust which you can download and print off.
The Association of UK Dieticians provides a good calcium food list and advice here .
Does water contain calcium?
Yes. If you drink bottled water check the label – the calcium content can vary considerably. You can also check the calcium contact of your tap water.
Keeping hydrated is really important. Feeling thirsty is a sign that you are already dehydrated and this makes your calcium level rise. Around 8 glasses of water a day keeps you hydrated and your calcium more stable.
Can any food and drink affect how I absorb calcium?
Alcohol, and to a lesser degree, caffeine and fizzy drinks, can affect calcium absorption. Foods containing oxalates and phytates are best eaten away from food containing calcium as they will affect how much calcium you absorb. For example, spinach will reduce the bioavailability of cheese if eaten at the same meal. There are also other factors which can reduce or improve calcium absorption. Find out about all this in more detail here
What’s in a glass of milk?
Quite a lot, surprisingly. A 200ml glass of milk contains 250mg calcium. That’s over a third of a calcium tablet. Milk also contains phosphorous, potassium, iodine, B2, B12 and is 3.3% protein.
Because of the protein, calcium is absorbed much more effectively so milk can be quite useful in an emergency when you need a quick boost.
To achieve the same amount of calcium as from a 200ml glass of milk taking into account the calcium that is actually available for the body to use, we would have to consume 4 servings of broccoli or 63 brussels sprouts!’ (Dairy Council )
The body needs a small amount of protein every day. However, because the protein in dairy foods is high in fat and because failing kidneys struggle to filter protein dairy foods are best used in moderation or when quick calcium boosts are needed.
In your daily diet there are plenty of alternatives. See the chart below. Plant based milks are a good alternative. Almond milk, for example, contains just as much calcium and vitamin D as cow’s milk but about 1/4 of the protein.
Do I need to be on a low phosphate diet?
In hypopara, phosphate levels are usually high. This is caused by the lack of parathyroid hormone. Because high phosphate levels are part of the condition, following a low phosphate diet is not very effective in hypopara patients. On top of that, low phosphate diets are very difficult to follow so our advisors don’t recommend it unless you are advised to by your renal team.
However, phosphate is toxic. High levels can cause bone disease, calcifications, damage to blood vessels and it can make you very itchy too. Advice on the subject is conflicting and there is no evidence yet on whether we should simply monitor or try to prevent high phosphate levels so, like most things hypopara, it is a question of balance.
A useful guide is this:
- Don’t try to cut out phosphate entirely but keep an eye on how much you eat at any one time. A large load of phosphate at a meal gets dumped on your kidneys causing strain. Smaller meals are better for your kidneys.
- If you do eat a large, phosphate heavy or meaty meal you should take a calcium tablet with your food. (Calcium tablets should always be taken with food anyway.) This will help to bind the phosphate. Be careful you don’t bump up your calcium too high.
- If your phosphate level is not high you probably don’t need to take calcium tablets. Getting your calcium through food is better for your kidneys. Eating smaller meals without a heavy phosphate load will help to keep levels down.
Phosphate food list
If you do need to change your diet, and have been advised to do so by your renal team, this helpful leaflet on diet in Chronic Kidney Disease by the Edinburgh Renal Unit here advises moderation.
Here are two food lists from NHS Hospital Trusts, also intended for renal patients, explaining how to lower or control phosphate levels by using alternative foods.
Remember, that as a hypopara patient you need to watch your dairy intake!
Norfolk & Norwich University Hospitals NHS Trust
Basildon & Thurrock University Hospitals NHS Trust