Calcium-rich foods: Pakistani sources, daily need and deficiency signs
The richest calcium foods in a Pakistani kitchen are milk, dahi, paneer and cheese: one glass of buffalo milk gives about 400 mg. Small fish with bones, whole til, sarson ka saag, bhindi and chana help too. Adults need about 1,000 mg a day, women over 50 about 1,200 mg. Calcium works only with enough vitamin D, which most Pakistanis lack.
Calcium in common Pakistani foods
| Food | Portion | Calcium (mg, approx.) | Note |
|---|---|---|---|
| Buffalo milk | 1 glass (250 ml) | 400 to 450 | Most common milk in Pakistan; higher in fat too |
| Cow milk or packet milk | 1 glass (250 ml) | about 300 | Low-fat milk has the same calcium |
| Dahi (plain yoghurt) | 1 katori (200 g) | 240 to 300 | Easier to digest if milk causes gas |
| Lassi (plain, salted) | 1 glass | 150 to 200 | Depends on how much dahi is used |
| Paneer | 50 g (a few cubes) | about 200 | |
| Cheese (cheddar or slice) | 1 slice (20 g) | 100 to 140 | Salty; count it in your salt |
| Choti machli or canned sardines, with soft bones | 100 g | about 350 | One of the best non-dairy sources |
| Til (sesame seeds), whole | 1 tablespoon (9 g) | about 90 | Hulled white til has much less |
| Sarson ka saag, cooked | 1 katori | 150 to 200 | Well absorbed |
| Bhindi, cooked | 1 katori | 120 to 150 | |
| Chana or chickpeas, cooked | 1 katori | about 100 | Also gives protein and fibre |
| Anjeer (dried figs) | 3 to 4 pieces | about 65 | Also high in sugar |
| Badam (almonds) | 10 almonds | about 35 | |
| Palak, cooked | 1 katori | about 240 on paper | Only about 5% is absorbed because of oxalate |
| Chapati (whole-wheat atta) | 1 medium | 15 to 20 | Small, but adds up over 3 to 4 a day |
| Egg | 1 whole | about 25 | Low; eggs give vitamin D instead |
Values vary with the brand, the animal and the recipe. Calcium in dairy and in sarson or bhindi is well absorbed; calcium in palak is mostly locked up by oxalate.
How much calcium you need a day
| Age group | Calcium per day |
|---|---|
| Children 1 to 3 years | 700 mg |
| Children 4 to 8 years | 1,000 mg |
| Children and teens 9 to 18 years | 1,300 mg |
| Adults 19 to 50 years | 1,000 mg |
| Men 51 to 70 years | 1,000 mg |
| Women over 50, and everyone over 70 | 1,200 mg |
| Pregnancy and breastfeeding (adults) | 1,000 mg (1,300 mg under 19) |
Teenagers need the most, because almost all bone is built before about age 25. A girl who drinks little milk in her teens starts adult life with weaker bones. More is not better: for adults, total calcium from food and tablets should stay below 2,500 mg a day (2,000 mg after 50).
A day with about 1,000 mg of calcium
- Nashta: 1 glass of milk or a milky chai plus a small glass of milk (about 300 mg), 1 chapati with egg
- Lunch: 1 katori dahi or raita (about 240 mg), sabzi such as bhindi or sarson ka saag (about 150 mg), 1 to 2 chapatis
- Evening: doodh patti chai (about 100 mg) with 10 almonds and a tablespoon of whole til, for example in a til ladoo or on roasted chanay (about 120 mg together)
- Dinner: daal or chana with chapati (about 100 mg together)
This reaches roughly 1,000 mg without a tablet. Women over 50 can add one more katori of dahi or a glass of lassi.
Getting the most out of calcium
- Vitamin D first. Without it, only a small part of the calcium you eat is absorbed. Vitamin D deficiency is very common in Pakistan, even in sunny cities, because of indoor life and covered skin. See vitamin D deficiency.
- Spread it out. The body absorbs calcium best in amounts of about 500 mg or less at a time, so dairy at two or three meals works better than one large serving.
- Keep salt moderate. High salt intake increases the calcium lost in urine.
- Move. Walking, stairs and strength exercise tell bones to keep their calcium; bed rest and inactivity weaken bones fast.
- Space it from iron and thyroid tablets. Calcium (in food or tablets) reduces absorption of iron tablets and levothyroxine. Keep a gap of about 4 hours from thyroid tablets.
Calcium deficiency: who is at risk
- Teenage girls and women who drink little milk or avoid dairy
- Women after menopause, when bone loss speeds up
- People with vitamin D deficiency, coeliac disease or other gut conditions that reduce absorption
- Long-term users of steroid tablets or some anti-epilepsy medicines
- People with lactose intolerance who have not replaced milk with dahi or other sources
- Pregnant women with low intake: the WHO advises calcium supplements in pregnancy where diets are low in calcium, to lower the risk of pre-eclampsia. Your gynaecologist decides this. See the pregnancy diet chart.
Calcium tablets: food first, tablets when needed
Pharmacies in Pakistan sell many calcium tablets, sachets and effervescent tablets, often combined with vitamin D. They are useful when diet cannot reach your target, in osteoporosis treatment, or when a doctor finds a deficiency. They are not a general tonic for weakness or body aches.
- Calcium carbonate: take with a meal. Can cause constipation and gas.
- Calcium citrate: can be taken with or without food; better for people on acid-reducing medicines.
- Effervescent tablets: often high in sodium; not ideal with high blood pressure or kidney disease.
- With vitamin D: helpful if your vitamin D is low, but count the vitamin D you already take from other products.
Calcium from food is preferred because tablets have been linked with kidney stones and constipation, and with heart concerns in some studies. Count the calcium you eat first; often a tablet is not needed at all, or a smaller one is enough. Ask your doctor before starting one if you have kidney disease or stones.
See a doctor first if
- You have tingling around the mouth or in the fingers, or muscle spasms (check blood calcium the same day)
- You have had a fracture from a minor fall, or lost height
- You have kidney disease, kidney stones or a parathyroid problem before taking any calcium tablet
- You are over 50 (especially after menopause), on long-term steroids, or underweight: ask about a bone density scan
- A child has bowed legs, delayed walking or poor growth (possible rickets)
Common questions
Which food is highest in calcium?
Milk, dahi, paneer and cheese are the richest and best-absorbed sources in a Pakistani kitchen: one glass of buffalo milk gives about 400 mg, close to half of an adult's daily need. Without dairy, the best sources are small fish eaten with their bones, whole til, sarson ka saag, bhindi and chana.
What are the symptoms of calcium deficiency?
Low calcium intake usually causes no symptoms for years, because the body takes calcium from the bones to keep blood levels normal. The result shows up later as thin bones (osteoporosis) and fractures, or rickets in children. A low blood calcium, which is different, causes tingling around the mouth and in the fingers, muscle cramps and spasms, and in severe cases fits or heart rhythm problems.
What is the normal calcium range in blood?
Total blood calcium is normally about 8.5 to 10.2 mg/dL (2.1 to 2.6 mmol/L); ionised calcium is about 4.6 to 5.3 mg/dL. A low result is often due to low albumin, vitamin D deficiency, kidney disease or a parathyroid problem, not to diet. A normal blood calcium does not prove that you eat enough calcium, because the bones keep the blood level steady.
Do joint pain and body aches mean calcium deficiency?
Usually not. Joint and body pain is far more often due to vitamin D deficiency, osteoarthritis, muscle strain, low activity or other conditions. Taking calcium tablets for body aches without tests rarely helps. Check vitamin D, and see a doctor for pain that does not settle.
Which calcium tablet is best?
There is no single best brand. Calcium carbonate is cheaper and must be taken with food; calcium citrate can be taken at any time and suits people on acid-reducing medicines. Many tablets also contain vitamin D. Effervescent (fizzy) tablets often contain a lot of sodium, which matters with high blood pressure or kidney disease. Your doctor decides whether you need one and how much.
Does calcium cause kidney stones?
Calcium from food does not; people who eat enough dietary calcium actually form fewer stones, because calcium binds oxalate in the gut. Calcium tablets taken on an empty stomach may slightly raise the risk. If you have had stones, get calcium from food spread through the day and take any tablet with meals.
Does chai reduce calcium?
Not in a meaningful way. Doodh patti chai actually adds calcium from the milk. Caffeine causes a small calcium loss, which a little milk more than covers. Chai does block iron absorption, so keep it an hour away from iron-rich meals.
What are calcium-rich foods if I cannot digest milk?
Many people who get gas from milk can manage dahi, lassi and cheese, which contain less lactose. Small portions of milk with meals are often fine too. Non-dairy sources include small fish with bones, whole til, sarson ka saag, bhindi, chana and almonds; you need several of these a day to reach your target.
Keep reading
Talk to a qualified dietitian
Tell us your goal on WhatsApp. We reply with the next step, the fee and a time that suits you.
Sources
- NIH Office of Dietary Supplements. Calcium: fact sheet for health professionals
- NHS. Vitamins and minerals: calcium
- World Health Organization. Calcium supplementation during pregnancy for the prevention of pre-eclampsia and its complications, 2018
- MedlinePlus. Calcium blood test
- Curhan GC et al. A prospective study of dietary calcium and other nutrients and the risk of symptomatic kidney stones. N Engl J Med, 1993
- USDA FoodData Central (calcium content of foods)