Calcium: Intake versus Recommendations
Dietary guidelines and government agency reports clearly support the need for attaining adequate calcium intakes throughout the lifecycle. In 1997 the Food and Nutrition Board of the National Academy of Sciences revealed national recommendations for calcium, which increased for most age groups. These recommendations show that calcium intakes need to be higher to optimize bone formation in the younger years and minimize loss in the older years.

Dietary intake surveys repeatedly show that many people fail to meet these calcium recommendations. In the nationwide 1994-95 Continuing Survey of Food Intake by Individuals (CSFII), the median calcium intake for boys aged 14-18 years was 1094 mg/day, and for girls was 713 mg/day, well below the current recommendation of 1300 mg/day. The graphs show the gap between intake and recommendations across the lifespan for both men and women. This calcium "deficit" has severe consequences for the health of Americans.

As shown in Table 1, milk produced under California standards provides up to 33% more calcium than that produced under the federal standards. Because dairy products contribute about three-quarters of the calcium in the American diet, several age groups are more likely to meet their needs for this important nutrient by drinking California milk.

Bone Health
Osteoporosis currently afflicts more than 25 million Americans. It causes an estimated 1.3 million fractures per year, with an associated enormous financial and personal burden. The two important factors that affect the occurrence of osteoporosis are an individual's peak bone mass, which is reached by about age 30, and the rate of bone loss in later years. Research shows that adequate calcium intake is critical for achieving peak bone mass and modifies the rate of bone loss associated with aging. Calcium intake in early life may account for as much as a 5-10% difference in peak adult bone mass, which may contribute to a 50% difference in the hip fracture rate later in life. A recent review of clinical research also shows that high calcium diets also potentiate the effect of estrogens on bone mass in post-menopausal women.(1) The increased calcium content of fortified fluid milk promotes optimal bone density and decreases the risk of osteoporosis later in life.

Hypertension
Recent research shows that calcium plays an integral role in modulating blood pressure. The 1996 "DASH" study (Dietary Approaches to Stop Hypertension) indicated that people with mild hypertension could decrease their blood pressure significantly by including 8-10 servings of fruits and vegetables and 2-3 servings of low-fat dairy foods in their diets every day.(2)

Other studies have also shown inverse relationships between blood pressure and calcium intakes. An excerpt from Nutrition Reviews states: "Within the last 15 yrs, numerous observational epidemiologic studies have found a statistically significant inverse relationship between calcium intake and higher blood pressure. Associations have been reported for total calcium intake from foods, including those from dairy products it is clear from the epidemiologic literature that dietary calcium plays an integral role in the maintenance of normal blood pressure, and adequate calcium intake may help reduce the risk of high blood pressure."(3)

The higher calcium content provided under California fluid milk standards benefits not only those with mild hypertension but may also play a preventative role against the disease.

Cancer
Epidemiological studies have repeatedly shown an inverse relationship between consumption of dairy products and colorectal cancer.(4-6) A recent clinical study indicated that a diet high in low-fat dairy products (equivalent to 1500 mg calcium/day) may decrease the risk of colon cancer.(7) Other studies indicate an inverse relationship between milk and dairy intake and the incidence of breast cancer.(8-10) "There is a protective effect, dietary or habitual, associated with consumption of milk that overwhelms the associations between different other factors and risk of breast cancer."(8)

Milk consumption has also been associated with a reduced risk of cervical cancer(11) and endometrial cancer.(12) It is not clear what factor in milk and dairy products is responsible for a protective effect against cancer. There is some evidence it may be calcium(7,12) or a component of milk protein(13) or milk fat: "Recent research shows that milk fat contains a number of potentially anticarcinogenic components including conjugated linoleic acid, sphingomyelin, butyric acid and ether lipids."(14)

Kidney Stones
New research provides evidence for an inverse association between dietary calcium intake and risk of kidney stone formation.(15,16)

Other Nutrients
Table 2 shows that milk produced under California standards contains up to 33% more protein than that produced under federal standards. Other nutrients are only minimally affected by the fortification of fluid milks. The positive impact on calcium content discussed above is achieved with minimal increases in sodium and calories.

Following is a summary of recent nutrition recommendations for dietary calcium and calcium-rich foods such as fortified fluid milk.

National Osteoporosis Foundation
"Calcium plays an important role in maintaining bone. Calcium alone cannot prevent or cure osteoporosis, but it is an important part of an overall prevention or treatment program. Yet, national surveys have shown that many Americans are not consuming enough calcium. Many women, in fact, consume less than half of the daily recommended amount of calcium. One way to increase the amount of calcium in your diet is to eat calcium-rich foods like low-fat milk, cheese, broccoli, and others. Getting enough calcium… is essential to maintaining bone strength and can play a vital role in preventing osteoporosis-related fractures."

National Institutes of Health
"Calcium is an essential nutrient for developing and maintaining strong bones throughout life. Optimal calcium intake is most important from childhood through the mid-twenties, when bones are growing at their fastest rate, and during late life, when bone loss occurs, often leading to osteoporosis."

"The National Institutes of Health recommends that children 6-10 years of age get 800-1200 mg of calcium per day, or the equivalent of about 3-4 glasses of low-fat milk. Adolescents and young adults, ages 11-24, whose bones are growing very fast, need more calcium, between 1200-1500 mg, or about 4-5 glasses of low-fat milk per day."

National Institute of Child Health and Human Development (NICHD)
"While calcium can be found in a variety of foods, including vegetables and dairy products, the NICHD believes low-fat milk or low-fat milk products are the best sources of calcium. The are the most widely available source of calcium and are already part of most American diets. Along with calcium, milk provides eight other essential nutrients, including vitamin D, potassium, and magnesium, all essential for optimal bone health and human development. Green leafy vegetables are healthy sources of calcium too, but it takes 7-9 servings of broccoli a day to get the same amount of calcium that is in 3-4 glasses of milk."

2005 Dietary Guidelines for Americans
"Diseases caused by vitamin deficiencies are rare in this country. But some people do not get recommended amounts of a few nutrients, especially calcium and iron."

"Many women and adolescent girls need to eat more calcium-rich foods, such as milk products, to get the calcium they need for healthy bones throughout life."

All values are in milligrams of calcium, for 8 oz. (244 g) of milk.
Values are based on nutrient content of NFDM and extrapolated to appropriate level of fortification. NFDM values from Handbook 8-1, 1976. Minimum nonfat solids content standards for California are as follows: whole milk=8.7%, 2% milk=10%, 1% milk=11%, nonfat milk=9%.
NFDM = non-fat dry milk solids.

*These are the minimum California and federal standards.

Table 2:
Protein Content of Milk under California vs. Fluid Milk Standards*

All values are in grams of protein, for 8 oz. milk.
Values are based on nutrient content of NFDM and extrapolated to appropriate level of fortification. NFDM values from Handbook 8-1, 1976. Minimum nonfat solids content standards for California are as follows: whole milk=8.7%, 2% milk=10%, 1% milk=11%, nonfat milk=9%.
NFDM = non-fat dry milk solids.

*These are the minimum California and federal minimum standards.