Trip Answers

Question answered:06/11/07 Warning! this question is over two years old.

Unfortunately, we cannot answer this question.

 

We undertook a search in the NLH Library, the TRIP and Medline databases together with the websites of the National Osteoporosis Society, the Scientific Advisory Committee on Nutrition, anthe Food Standards Agency and The Vegan Society but found no guidelines or recommendations on calcium and vitamin D supplementation in lactating women on dairy-free diets. We extended the search to lactating women with no dietary restrictions but, again, found no guidance.

 

The information we did locate is of a very general nature.

 

The National Osteoporosis Society information sheet entitled, ‘Calcium rich foods and bone health’, provides a list of COMA (Committee on the Medical Aspects of Food and Nutrition), and this states pregnant women should consume 700 mg a day of calcium. For breast feeding women, the information sheet recommends adding an additional 500 mg a day. However, there is a note to say that, “COMA notes that the additional increment may not be necessary with more recent evidence.” [1]

 

Unfortunately, the ‘recent evidence’ is not cited. We also checked the COMA website but found no further information confirming or refuting the necessity of additional calcium for lactating women.

 

SCAN, the Scientific Advisory Committee on Nutrition has updated its position statement on vitamin D and in relation to pregnancy and lactation states:

 

“The current Reference Nutrient Intake (RNI) for pregnant and breastfeeding women is 10ìg (400 IU)3 vitamin D per day. In most instances, these intakes cannot be met from the diet and at the present time can only be guaranteed by supplementation. A recommendation of 10ìg (400 IU) a day has been made for pregnant and lactating women and for people over the age of 65 years. Although this has been in place for sometime, there is concern that it is overlooked or not implemented by health professionals and the general public.” [2]

 

The British Nutrition Foundation website considers calcium supplementation on its pages on vegetarian and vegan diets:

 

“…some vegans may have low intakes of calcium as relatively few other foods contain large amounts, and the bioavailability of calcium from some plant sources may be greatly reduced by phytate or oxalate also present in the food. These substances can form complexes with the calcium which are insoluble and cannot be absorbed by the body. Where requirements for calcium are high (for example, during adolescence and during lactation) supplements containing calcium and calcium-fortified foods (such as fortified soya products) may be useful.” [3]

 

Concerning the lactating body’s ability to use calcium more efficiently, we could not trace this information on the National Osteoporosis Society’s website. However, we did locate an article on osteoporosis during pregnancy and lactation which may be of interest. The Medline abstract of the article reads:

 

“During pregnancy and lactation women have to form and maintain fetus and newborn skeleton. These processes require maternal hormonal and metabolic adjustments. During the first weeks of pregnancy, calcium intestinal absorption rise and reach a maximum in the last trimester. Hypercalciuria can be detected until lactation is stopped. During lactation, calcium that is present in maternal milk, results from lowering maternal calcium excretion and increasing bone resorption. Plasma 1,25 (OH)(2) D(3) levels increase two-fold early in pregnancy due to high placental 1-alpha-hydroxilase activity, remain high until delivery and decline to normal values during lactation. Estrogen, prolactin and placental lactogen, which are involved in calcium absorption, increase at the same time. Normal or even low levels of parathyroid hormone (PTH) can be detected during pregnancy. This suggests that their physiological actions could be mimicked by the parathyroid- related-peptide (PTHrP), which increases in late stages of pregnancy and remain high during delivery and lactation. Calcitonin levels increase during pregnancy, decline during lactation and return to normal values after lactation is stopped. The physiological roll of tumor necrosis factor, interleukin 6 and osteoprotegerin has not been elucidated yet. The above mentioned changes can exceptionally lead to generalized or regional osteoporosis.” [4]

 

References
1. National Osteoporosis Society. Calcium rich foods and bone health. December 2005. (http://nos.org.uk/dr_media/nos/Calcium_Rich_Foods_06-Nov-07.pdf)
2. SCAN. Update on Vitamin D. Position statement by the Scientific Advisory Committee on Nutrition. 2007. (http://www.sacn.gov.uk/reports/#)
3. British Nutrition Foundation. Vegan and vegetarian diets. 2003. (http://www.nutrition.org.uk/home.asp?siteId=43&sectionId=651&parentSection=321&which=1)
4. Sarli M, Hakim C, Rey P and Zanchetta J.  [Osteoporosis during pregnancy and lactation]. Medicina (B Aires). 2005;65(6):533-40. (http://www.hubmed.org/display.cgi?uids=16433484).

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