1

Running head: THE RELATIONSHIP BETWEEN MILK AND CALCIUM INTAKE

The Relationship Between Milk and Calcium Bioavailability:

Research of Human Bones and Their Intake of Calcium in Milk

2
Running head: THE RELATIONSHIP BETWEEN MILK AND CALCIUM INTAKE
Introduction

Calcium intake from milk and other dairy products can be a controversial subject with the

rise of diets and healthy fads around the world. Many people claim dairy is bad for health and

that people are better off using other substitutes. Furthermore, some people claim that bones have

trouble absorbing calcium from dairy products, so there is no healthy reason for eating dairy.

Other people claim that people need to consume dairy daily in order to gather enough calcium to

strengthen bones.

Though the research collected in this paper has been done before with better resources

and more time, this research is still significant to educate myself and therefore, those around me.

I have grown up hearing different theories about the health effects of dairy without knowing

what is true and what is not true. Hopefully, through research, a greater understanding of how

calcium is consumed in the body can be found.

With proper research, I hope to find several articles with data supporting or opposing the

use of milk as a supplement for calcium, and therefore, stronger bones in the human body.

Materials and Methods

I used Taylor University’s Zondervan Library website to find journal articles and news

articles. This website uses EBSCOhost and has several databases, including academic medical

databases with. The terms I used to search for journal articles here were: “effects,” “dairy,”

“consumption,” “calcium,” “bone,” “intake,” “vitamin d,” “absorption,” “cow,” “children”

“adults” and “milk.”

With those terms, I found many articles in the database claiming that dairy is good, but I

still did not have that many terms claiming dairy is bad. I did a quick google search and came up

with the name of a Harvard professor, Walter Willet, M.D., Ph.D. Through that, I found articles
3
Running head: THE RELATIONSHIP BETWEEN MILK AND CALCIUM INTAKE
by him supporting the opposite side. With this information, I then sifted through to find articles

relevant to my topic.

Results

The first article used, titled “Effects of Two Marine Dietary Supplements with High

Calcium Content on Calcium Metabolism and Biochemical Marker of Bone Resorption” was

written by Dr. Jean-Michel Lecerf, Dr. Christophe Lamotte, B. Boukandoura, Dr. Amélie

Cayzeele, Dr. Charles Delannoy, and B. Borgiès (2008). This group of researchers looked at fish

bone powder and a ray cartilage hydrolysate and compared it with milk and a placebo in order to

measure the calcium intake of human bodies. While the results showed varying differences with

the tests, overall, the two marine dietary supplements are valid substitutes for milk when

considering calcium intake. The study used the oral calcium tolerance test on 20 men who were

chosen by the Lille Clinical Investigation Centre. They followed a strict diet and at least one

week apart took 200 mL of either the placebo, the milk, the fishbone powder, or the ray cartilage

hydrolysate powder. After each session, blood samples would be taken and measured: “Serum

calcium concentrations and other parameters of the calcium metabolism, such as serum intact

parathyroid hormone (iPTH) and serum C telopeptides (s-CTX), were measured after an acute

oral calcium load based on the Pak protocol” (Lecerf et al., 2008, p. 879). According to this

work, most people do not receive an adequate amount of calcium in their diet and choose to take

calcium supplements instead just like the ray cartilage hydrolysate and the fish bone powder, but

it is important to know whether these supplements actually work before taking them (Lecerf et

al., 2008).

Secondly, the “Effects of Consumption of Oat Milk, Soya Milk, or Cow’s Milk on

Plasma Lipids and Antioxidative Capacity in Healthy Subjects” was written by G. Önning, B.
4
Running head: THE RELATIONSHIP BETWEEN MILK AND CALCIUM INTAKE
Åkesson, R. Öste, and I. Lundquist of the University of Lund, Sweden, and published in 1998. It

concluded that oat milk is a valuable milk alternative for people who will benefit from lower

LDL cholesterol. This study tested 24 men and women. The study looked at plasma lipid,

glucose, insulin, and antioxidant status. Half the subjects drank daily 0.75-1 liters of oat and soya

milk for two four-week periods, and the other half drank the same amount of out milk and cow’s

milk for the same periods of time. The results were, “the oat milk regimen resulted in decreased

plasma cholesterol (4%) and low-density lipoprotein (LDL) cholesterol (9%) levels as compared

with baseline, but no changes in high- density lipoprotein cholesterol (HDL) and triglyceride

values were observed. Also soya milk consumption resulted in de- creased LDL cholesterol

concentrations” (Önning et al., 1998, p. 211). Also, the only a significant plasma change with

the cow’s milk consumption was the HDL cholesterol. “No consistent changes in body weight,

fasting blood glucose, serum insulin, and antioxidant status occurred after consumption of any

milk regimen” (Önning et al., 1998, p. 211).

The article “Effects of Two Years’ Milk Supplementation on Size-Corrected Bone

Mineral Density of Chinese girls” was written by Zhu Kun, H. Greenfield, Du Xueqin, Zhang

Qian, Ma Guansheng, Hu Xiaoqi, C.T. Cowell, and D. R. Fraser in 2008. They found that milk

supplementation of ten-year-old girls showed positive effects on bone mineral while accounting

for changing in skeletal size during growth. The difference could be seen mainly in the legs.

Many studies in the past did not account for changing bone during growth periods for children.

The study looks at the bone mineral density (BMD) of 345 ten-year-old Chinese girls, those of

whom have relatively low calcium consumption. 260 girls received 330 ml of milk every school

day, while the remaining girls ate their regular diets. The study was done over a 2-year period

with a size-corrected BMD: “Sizecorrected total body and regional BMD was calculated as:
5
Running head: THE RELATIONSHIP BETWEEN MILK AND CALCIUM INTAKE
BMDsc = BMC/BApc, where pc was the regression coefficient of the natural logarithm

transformed total body BMC and bone area. After 2 years, both supplemented groups had

significantly greater gain in BMDsc of total body (3.5-5.8%, p < 0.05) and legs (3.0-5.9%, p <

0.05) than did the control group” (Kun et al., 2008, p. 149).

Diane Feskanich, Walter C Willet, and Graham A Colditz wrote an article titled

“Calcium, Vitamin D, Milk Consumption, and Hip Fractures: a Prospective Study Among

Postmenopausal Women” in 2003 found that consumption of vitamin D can reduce hip fractures

in menopausal women, but milk, or high-calcium diets did not reduce hip fractures in this sample

for the population. In the past, short trials had shown to diminish loss of bone in postmenopausal

women, and not many of the studies focused on the vitamin D factor. The researchers looked at

72,337 postmenopausal women over an eighteen-year period. There were 603 hip fractures.

Women consuming “≥ 12.5 μg vitamin D/d from food plus supplements had a 37% lower risk of

hip fracture (RR = 0.63; 95% CI: 0.42, 0.94) than did women consuming < 3.5 μg/d. Total

calcium intake was not associated with hip fracture risk (RR = 0.96; 95% CI: 0.68, 1.34 for ≥

1200 compared with < 600 mg/d). Milk consumption was also not associated with a lower risk of

hip fracture (P for trend = 0.21)” (Feskanich et al., 2003).

Y.Sato, M.Iki,Y.Fujita, J.Tamaki, K.Kouda, A.Yura, J.-S. Moon, R. Winzenrieth, H.

Iwaki, R. Ishizuka, N. Amano, K. Tomioka, N. Okamoto, and N. Kurumatani wrote an article in

2015 titled “Greater Milk Intake is Associated With Lower Bone Turnover, Higher Bone

Density, and Higher Bone Microarchitecture Index in a Population of Elderly Japanese Men

With Relatively Low Dietary Calcium Intake” in-which they found what their title states: more

intake of milk was associated with better bone development, higher areal bone mineral density

(aBMD), and greater trabecular bone score in these elderly Japanese men. The effects of milk
6
Running head: THE RELATIONSHIP BETWEEN MILK AND CALCIUM INTAKE
intake on elderly Japanese men with low dietary calcium intake is not widely studied. This study

looked at bone turnover, bone density, and bone microarchitecture. They used interviews to

gather information about medical and family history including milk consumption with a one-

week food diary and measurements of bones at the “lumbar spine (LS), total hip (TH), and

femoral neck (FN) by dual-energy x-ray absorptiometry (DXA), trabecular bone score (TBS)

using DXA images at LS, and biochemical markers of bone turnover in sera” (Sato et al., 2015,

p. 1585). They excluded patients with abnormalities and ended up with 1479 participants.

An article titled “Milk Intake and Risk of Mortality and Fractures in Women and Men:

Cohort Studies” by Karl Michaëlsson, professor, Alicja Wolk, professor, Sophie Langenskiöld,

senior lecturer, Samar Basu, professor, Eva Warensjö Lemming, researcher, Håkan Melhus,

professor, and Liisa Byberg, associate professor in 2014 found that more consumption of milk

resulted in a higher death rate with one group of women, another group of men, and more hip

fractures in all groups of women. The article looked at 61433 women and 45339 men in three

separate countries in Sweden. The methods used to examine the cohorts were questionnaires and

the models used were, “Cox proportional hazards regression for estimation of age adjusted and

multivariable adjusted hazard ratios and their 95% confidence intervals for prespecified

categories of milk intake (<200, 200-399, 400-599, and ≥600 g/d) and for continuous milk intake

for each 200 g/d, corresponding to one glass of milk” (Michaëlsson et al., 2014). The results

were that, after 20 years, 15541 women had died, and 17252 had fractures on any part of their

body. Out of that 17252, 4259 were hip fractures. In men, after 11 years, 10112 had died with

5066 fractures, 1166 being hip fractures: “In women the adjusted mortality hazard ratio for three

or more glasses of milk a day compared with less than one glass a day was 1.93 (95% confidence

interval 1.80 to 2.06). For every glass of milk, the adjusted hazard ratio of all cause mortality
7
Running head: THE RELATIONSHIP BETWEEN MILK AND CALCIUM INTAKE
was 1.15 (1.13 to 1.17) in women and 1.03 (1.01 to 1.04) in men. For every glass of milk in

women no reduction was observed in fracture risk with higher milk consumption for any fracture

(1.02, 1.00 to 1.04) or for hip fracture (1.09, 1.05 to 1.13). The corresponding adjusted hazard

ratios in men were 1.01 (0.99 to 1.03) and 1.03 (0.99 to 1.07)” (Michaëlsson et al., 2014).

In an article titled “Effect of Age on Calcium Absorption in Postmenopausal Women,”

the authors, BE Christopher Nordin, Allan G Need, Howard A Morris, Peter D O’Loughlin, and

Michael Horowitz, found that there is an age-related decrease in calcium intake which could be

because of declining active calcium transport, or declining diffusion component of the calcium

absorption system. The goal of this study was to find the particular age and extent of change in

calcium absorption for post-menopausal women. They looked at 262 women between the ages of

40 and 87 years and examined their health closely, measuring for other biochemical variables

such as “serum vitamin D metabolites, parathyroid hormone” and other relevant things (Nordin

et al., 2004, p. 998). The study showed that radio calcium decreased with age, as it was 28%

lower in women 75 years old than the rest. There was some relation to one type of vitamin D, but

no relation to any of the other measured variables. Furthermore, “On multivariate analysis, the

serum 1,25(OH)2D concentration was a positive function of 25(OH)D (P 0.001), albumin (P

0.010), and PTH (P 0.012) and a negative function of serum creatinine (P 0.003). PTH was a

negative function of calculated ionized calcium (P 0.004) and 25(OH)D (P 0.009) and a positive

function of weight (P 0.011) and age (P 0.028)” (Nordin et al., 2004, p. 998).

Lastly, “The Good, the Bad, and the Ugly of Calcium Supplementation: a Review of

Calcium Intake on Human Health” written in 2018 by Kelvin Li,Xia-Fang Wang, Ding-You Li,

Yuan-Cheng Chen, Lan-Juan Zhao, XiaoGang Liu, Yan-Fang Guo, Jie Shen, Xu Lin, Jeffrey

Deng, Rou Zhou, and Hong-Wen Deng, found that calcium implementation should be prescribed
8
Running head: THE RELATIONSHIP BETWEEN MILK AND CALCIUM INTAKE
cautiously, accounting for the patient. They say that the idea that calcium supplementation is

necessary for the prevention of diseases such as osteoporosis has been one of the most

detrimental public health problems across the world right now. Awareness of over-consumption

of calcium needs to be spread. Some serious side effects includes cardiovascular diseases. The

results on kidney stones, and gastrointestinal diseases were inconsistent. The article shows there

are not serious evidence to support calcium supplementation for premenopausal women,

pregnant women, and there is an increase in bone mineral density in men. There is an

improvement for postmenopausal women and children when taking calcium supplementation (Li

et al., 2018).

Discussion

Firstly, many articles I found were extremely contradictory with a wide variety of

findings. and I do not know how to account for this other than to blame different research

methods, bias, or possible demographic differences.

One interesting finding that was not explicitly stated in any of the articles is that there is a

difference of over-calcium supplementation and simply implementing something in the diet that

was not there before. For example, the two most recent studies, Li et al., (2018) and Sato et al.,

(2015). One showed only one possible benefit—higher bone density in men—while also

showing the many risks of over-supplementing such as cardiovascular diseases (Li et al., 2018).

Sato et at. (2015) solely looked at a demographic of elderly Japanese men who had previously

not had very much calcium supplementation and found that bone mineral density increased.

These two examples show that the amount of calcium or milk supplementation may be a factor in

the differences of the studies.

9
Running head: THE RELATIONSHIP BETWEEN MILK AND CALCIUM INTAKE
Also, after reading the articles, I came to another discussion point not highly advertised in

any of the articles: there could be a difference between milk and other calcium supplementary

items. Some of the other articles did measure other vitamins such as vitamin D when monitoring

the effects of calcium in milk, but perhaps milk has other things in it that are not being measured

that affect a body differently. Surely there is a difference between drinking the milk of an animal

versus ingesting a capsule or eating a vegetable to receive calcium. This could account for the

differences in conclusions of many articles, as some used calcium supplements, and others used

milk.

Lastly, though my question was never fully answered, as I wanted to see whether calcium

from milk was actually absorbed, there could be a connection between vitamin D and calcium

intake. It seems that, as many studies monitored vitamin D, and one even stated that it helped in

hip fractures, (Feskanich et al., 2003), the intake of vitamin D might be just as important in

calcium absorption, as it is what aids in absorption.

Conclusion

In conclusion, milk and calcium can be absorbed by young children and it should be

given in healthy amounts (Kun et al., 2008; li et al., 2018), there are varying and effective milk

substitutes such as broccoli, soya milk, and supplements that can be taken instead of milk and are

just as bioavailable (Lecerf et al., 2008; Önning et al., 1998), yet there is no good conclusion on

whether adults should be drinking milk or intaking amounts of calcium. In fact, the information

found was extremely contradictory, ranging from possible higher mortality, higher risk of

cardiovascular disease, to building stronger bones. one article even suggested that as age

increases, the human body’s ability to intake calcium decreases (Nordin et al., 2004).
10
Running head: THE RELATIONSHIP BETWEEN MILK AND CALCIUM INTAKE
More research would need to be done to analyze calcium for adults. Furthermore, I would

love to look more into the differences between milk and other calcium options, and the amount

of milk that the body actually needs to do its job and whether or not humans are over-

supplementing or under-supplementing.

For my next steps, I will begin engaging with the people who have opinions about milk,

ask them to cite their information, instead of taking their word for it. Also, I will research in

different areas and search engines, and perhaps engage one-on-one with people who are

knowledgeable in this field to find more information about calcium absorption from milk.
11
Running head: THE RELATIONSHIP BETWEEN MILK AND CALCIUM INTAKE
References

Feskanich, D., Willett, W. C., & Colditz, G. A. (2003). Calcium, vitamin D, milk consumption,

and hip fractures: a prospective study among postmenopausal women. The American

Journal of Clinical Nutrition, 77(2), 504–511. doi: 10.1093/ajcn/77.2.504 Kun Zhu,

Greenfield, H., Xueqin Du, Qian Zhang, Guansheng Ma, Xiaoqi Hu, … Fraser, D. R.

(2008). Effects of two years’ milk supplementation on size-corrected bone mineral

density of Chinese girls. Asia Pacific Journal of Clinical Nutrition, 17, 147–150.

Retrieved from http://search.ebscohost.com.ezproxy.taylor.edu/login.aspx?

direct=true&db=aph&AN=31268793&site=ehost-live

Lecerf, J.-M., Lamotte, C., Boukandoura, B., Cayzeele, A., Libersa, C., Delannoy, C., &

Borgiès, B. (2008). Effects of two marine dietary supplements with high calcium content

on calcium metabolism and biochemical marker of bone resorption. European Journal Of

Clinical Nutrition, 62(7), 879–884. Retrieved from

http://search.ebscohost.com.ezproxy.taylor.edu/login.aspx?

direct=true&db=mnh&AN=17522607&site=ehost-live

Li, K., Wang, X.-F., Li, D.-Y., Chen, Y.-C., Zhao, L.-J., Liu, X.-G., … Deng, H.-W. (2018). The

good, the bad, and the ugly of calcium supplementation: a review of calcium intake on

human health. Clinical Interventions in Aging, Volume 13, 2443–2452. doi:

10.2147/cia.s157523

Merritt, M. A., Cramer, D. W., Vitonis, A. F., Titus L. J., & Terry K. L. (2012). Dairy foods and

nutrients in relation to risk of ovarian cancer and major histological subtypes. Int. J.

Cancer 132 (5) (July 24): 1114–1124. doi:10.1002/ijc.2770

12
Running head: THE RELATIONSHIP BETWEEN MILK AND CALCIUM INTAKE
Michaëlsson, K., Wolk, A., Langenskiöld, S., Basu, S., Lemming, E. W., Melhus, H., & Byberg,

L. (2014). Milk intake and risk of mortality and fractures in women and men: cohort

studies. BMJ: British Medical Journal, 349(7981), g6015. https://doi-

org.ezproxy.taylor.edu/10.1136/bmj.g6015

Nordin, B. C., Need, A. G., Morris, H. A., Oloughlin, P. D., & Horowitz, M. (2004). Effect of

age on calcium absorption in postmenopausal women. The American Journal of Clinical

Nutrition, 80(4), 998–1002. doi: 10.1093/ajcn/80.4.998

Önning, Åkesson, Öste, & Lundquist. (1998). Effects of consumption of oat milk, soya milk,

or cow’s milk on plasma lipids and antioxidative capacity in healthy subjects. Annals of

Nutrition & Metabolism, 42(4), 211–220. https://doi-

org.ezproxy.taylor.edu/10.1159/000012736NOTES:

Sato, Y., Iki, M., Fujita, Y., Tamaki, J., Kouda, K., Yura, A., … Kurumatani, N. (2015). Greater

milk intake is associated with lower bone turnover, higher bone density, and higher bone

microarchitecture index in a population of elderly Japanese men with relatively low

dietary calcium intake: Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) Study.

Osteoporosis International, 26(5), 1585–1594. https://doi-

org.ezproxy.taylor.edu/10.1007/s00198-015-3032-2