Quiz: Getting Calcium When You’re Lactose Intolerant

Most people who are lactose intolerant can have some lactose without symptoms, so you probably don’t need to swear off dairy entirely. This is important since dairy and cow’s milk are a rich source of calcium. Experiment to see what works for you: You may be able to have small amounts of cow’s milk (like half a glass), or drink milk with a meal, without triggering symptoms.

Lactose-free dairy milk offers the same amount of calcium and other nutrients as regular milk. Other calcium-rich drinks include fortified nondairy beverages, such as soy milk and almond milk. Lactase enzyme replacements, sold over the counter in drugstores, can also be taken with cow’s milk or other dairy foods to avoid symptoms.

Eating a diet high in salt may lower the amount of calcium your body keeps. So try to avoid a high-salt diet and high-salt foods. Vitamin D, on the other hand, is needed to help your body absorb calcium. Natural sunlight, in small amounts, is a good source of vitamin D. So are salmon and saltwater fish (such as cod and tuna), liver, egg yolks, and fortified milk.

A glass of skim milk or a cup of nonfat yogurt with fruit delivers about 300 milligrams of calcium, which is about a third of the 1,000 milligrams an adult needs every day. Leave out the fruit and your yogurt packs nearly half of the daily requirement. Lactose-free dairy products have as much calcium as regular ones. Women over 50 and pregnant women need more calcium -- at least 1,200 milligrams a day.

An ounce of almonds, about 20 to 25 nuts, has about 75 milligrams of calcium. While that's a lot for their size, it's only about 8% of what you need each day.

If you're lactose intolerant, you may have better luck avoiding symptoms with small amounts of cheese. Just 1.5 oz. of cheddar cheese or part-skim mozzarella can help you get almost as much calcium as a glass of milk -- with a lot less lactose. An ounce of hard cheese may only contain about 1 gram of lactose, while a glass of regular milk has about 10 grams. Lactose-free cheeses are also available.

If you're lactose intolerant, calcium-fortified foods can also help you get enough calcium in your daily diet. Orange juice, cereals, some breads, and nondairy beverages such as soy and rice milk often have calcium added to them.

Drinking diet sodas, on the other hand, may lower bone density and increase the risk of fracture. Researchers don't know if it's because of soda's phosphorus content or that people who drink a lot of sodas don't get enough calcium to start with.

The more you exercise your bones, the stronger they get. Weight-bearing exercises -- ones like walking that make your bones and muscles work against gravity -- help keep bones strong. Other weight-bearing exercises include tai chi and yoga, tennis, even dancing. Lifting weights also helps build bone strength as well as muscle strength.

Exercises like swimming and biking can help you stay fit but don't build bone (unless you're standing up on the pedals while biking). If you have osteoporosis, check with your doctor before starting an exercise program.

Throughout your life, your body is always losing old bone and making new bone. Young people make new bone faster than they lose old bone, and accumulate up to 90% of "peak bone mass" -- when they have the most bone -- between the ages of 18 and 25. After about age 30, you slowly start to lose more bone than you make, and bone loss increases rapidly for women in the first few years after menopause.

So it's crucial to get enough calcium and vitamin D when you are young so you can build as much bone as possible -- and then work to keep as much bone as you can later in life. Weight-bearing exercises like walking and lifting weights are also good for strengthening your bones, whatever your age.

There are other sources of calcium, but milk and dairy products, including lactose-free dairy, offer the best payload, followed by various calcium-fortified products like orange juice and some cereals. Without them, it can be hard to get enough calcium.

A cup of rhubarb has 348 milligrams of calcium, compared to 302 milligrams in a glass of skim milk. A cup of frozen turnip greens has about 249 milligrams, and a cup of frozen kale has 179 milligrams, while 3 ounces of canned salmon with bones has about 181 milligrams. If you don't eat dairy, ask your doctor about getting more calcium in your diet and whether you should take a calcium supplement.

Some people who are lactose intolerant don't have trouble with yogurt, especially if it contains live cultures or probiotics, which helps them digest lactose. Look for labels that say "active yogurt cultures," "living yogurt cultures," or "contains active cultures." A cup of plain, low-fat yogurt has more calcium than a glass of milk, about 400 milligrams. You may also be able to find lactose-free yogurt.

Your body needs vitamin D so it can absorb calcium and build strong bones. Your body makes vitamin D when it's exposed to sunlight, but most people need other sources to get enough D. Milk, including lactose-free milk, and some orange juices are fortified with vitamin D, but other dairy products (such as cheese) may not be.

Not many foods contain vitamin D, although salmon, sardines, and eggs do.  But many experts think you may need a supplement to get enough D, especially if you are lactose intolerant and don't drink much milk.