Women aged 20 to 49 need 1,000 mg of calcium a day, and 1,200 mg from age 50, under Malaysia's Recommended Nutrient Intakes (RNI) 2017, yet Malaysian women eat a median of only 333 mg a day. The best food sources (makanan tinggi kalsium) include milk, yoghurt and cheese, ikan bilis and sardines eaten with their bones, tauhu, tempeh, dhal, almonds, and green vegetables such as kailan, sawi and watercress. Food is the preferred source. If you cannot get enough from your diet, a calcium supplement such as calcium carbonate can help, taken with food in doses of 500 mg or less at a time and with enough vitamin D.
Ringkasan: Kalsium untuk wanita
- Wanita berumur 20 hingga 49 tahun memerlukan 1,000 mg kalsium sehari, dan 1,200 mg mulai umur 50 tahun (RNI 2017). Ibu mengandung dan menyusu juga memerlukan 1,000 mg.
- Wanita Malaysia hanya mengambil kira-kira 333 mg sehari, iaitu kurang daripada separuh keperluan.
- Makanan tinggi kalsium: susu, yogurt, keju, ikan bilis, sardin bertulang, tauhu, tempeh, dal, badam, kailan, sawi dan selada air.
- Sumber selain susu: ikan bilis, sardin, tauhu, susu soya berkalsium dan sayur hijau. Bayam bukan sumber yang baik kerana kalsiumnya sukar diserap.
- Jika perlu pil kalsium, makan calcium carbonate bersama makanan, tidak lebih daripada 500 mg sekali makan, dan pastikan cukup vitamin D.
- Jangan ambil lebih daripada 2,500 mg sehari daripada makanan dan suplemen. Tanya doktor jika anda pernah ada batu karang.
RNI Malaysia 2017; MedlinePlus; NHS
Fungsi kalsium (what calcium does)
Calcium is the most plentiful mineral in the body, and more than 99% of it is in the skeleton (Malaysian RNI 2017). According to the NHS, calcium:
- helps build bones and keep teeth healthy;
- controls muscle contractions, including the heartbeat;
- makes sure blood clots normally.
Your blood calcium level is tightly controlled. If you do not eat enough calcium, the body takes it from your bones to keep the blood level steady, which slowly weakens the bones (Cleveland Clinic). Over a lifetime, this can lead to osteoporosis, where bones become thin and break easily (MedlinePlus). Bone mass is relatively stable between ages 20 and 50, and bone loss starts earlier in women than in men because of menopause (RNI 2017).
Berapa kalsium sehari? (how much calcium you need)
Malaysia's Recommended Nutrient Intakes (RNI) 2017, published by the Ministry of Health's National Coordinating Committee on Food and Nutrition, sets these amounts for girls and women:
| Group | Calcium per day (RNI 2017) |
|---|---|
| Teenage girls, 10 to 19 years | 1,300 mg |
| Women, 20 to 49 years | 1,000 mg |
| Women, 50 years and older | 1,200 mg |
| Pregnant women, 20 to 49 years | 1,000 mg (teenagers: 1,300 mg) |
| Breastfeeding women, 20 to 49 years | 1,000 mg (teenagers: 1,300 mg) |
| Upper limit for adults 19 to 50 | 2,500 mg from food and supplements together |
Sources: Recommended Nutrient Intakes for Malaysia 2017.
Recommendations differ between countries: the NHS in the UK, for example, advises 700 mg a day for adults. In Malaysia, follow the RNI 2017 figures above.
Most Malaysian women fall short. The Malaysian Adult Nutrition Survey (MANS) 2014 found that the median calcium intake was 353 mg a day overall and only 333 mg for women, about a third of the RNI (as reported in RNI 2017).
Makanan tinggi kalsium (calcium-rich foods)
This table uses figures from the Malaysian Food Composition Database, as listed in RNI 2017. Values are per 100 g of food, so a typical serving may contain more or less.
| Food | Calcium (mg per 100 g) | Notes |
|---|---|---|
| High-calcium milk powder | 2,000 | Check the label; varies by brand |
| Ikan bilis (dried, without head and gut) | 500 | Eaten with the bones; often salty, so watch the portion |
| Sardines (canned) | 234 | Eat the soft bones |
| Almonds | 222 | Also high in calories |
| Watercress (sai yong choy) | 200 | Good absorption |
| Kailan (Chinese kale) | 179 | Absorbed about as well as milk |
| Cooked dhal | 171 | Good for vegetarians |
| Sawi (mustard greens) | 138 | Good absorption |
| Tauhu (tofu) | 135 | Varies; tofu set with calcium is higher |
| Low-fat milk | 132 | About 300 mg per 240 ml glass |
| Low-fat yoghurt | 127 | |
| Full-cream milk | 109 | Removing fat does not remove calcium |
| Tempeh | 69 | |
| Spinach (bayam) | 69 | Poorly absorbed because of oxalate |
| Plain soy milk | 20 | Choose calcium-fortified soy milk (about 180 mg) |
Sources: Recommended Nutrient Intakes for Malaysia 2017 (Table 17.1, from Tee et al. 1997); MedlinePlus.
What 1,000 mg looks like in a day. These rough examples, worked out from the table above and MedlinePlus serving sizes, show that you can reach close to 1,000 mg with ordinary Malaysian food:
| Example | Approximate calcium |
|---|---|
| 1 glass (240 ml) of low-fat milk or calcium-fortified soy milk | About 300 mg |
| 100 g tauhu in a lauk | About 135 mg |
| 100 g canned sardines with bones | About 234 mg |
| 100 g kailan or sawi, stir-fried | About 140 to 180 mg |
| 20 g (about 2 tablespoons) ikan bilis | About 100 mg |
| Total | About 900 to 950 mg |
Sources: Calculated from RNI 2017 Table 17.1 and MedlinePlus; actual amounts vary by product and recipe.
Ikan bilis is often salty, and a high-salt diet makes the body lose more calcium in the urine (RNI 2017), so balance them with fresh foods. For more ideas on building balanced meals, see our guide to healthy Malaysian meal planning.
Sumber kalsium selain susu (non-dairy sources)
Dairy foods are an easy source because the body absorbs their calcium well (MedlinePlus), but many Malaysian women do not drink milk, are lactose intolerant or follow a vegetarian diet. Good non-dairy choices include:
- small fish eaten with the bones: ikan bilis and canned sardines;
- soy foods: tauhu, tempeh and calcium-fortified soy milk (plain soy milk is low in calcium);
- green vegetables from the cabbage family: kailan, sawi, broccoli and bok choy; calcium from these vegetables is absorbed about as well as calcium from milk (RNI 2017);
- legumes and nuts: dhal, beans, almonds and sesame paste (tahini);
- fortified foods: breads, cereals and juices with added calcium.
Sources: RNI 2017; MedlinePlus.
Why not spinach? Spinach contains calcium, but it also contains a lot of oxalate, which binds the calcium so the body cannot absorb much of it (NHS; MedlinePlus). Wheat bran has a similar effect. Vegans should include soy products and fortified foods to get enough (MedlinePlus). People with mild lactose intolerance can often still eat hard cheeses and yoghurt, or choose lactose-free milk (MedlinePlus).
Cara tubuh serap kalsium (getting the most from your calcium)
- Get enough vitamin D. The body needs vitamin D to absorb and use calcium (MedlinePlus). Many Malaysian women are low in vitamin D; see our guide to kekurangan vitamin D.
- Steam or stir-fry vegetables instead of boiling them for a long time, to keep more calcium in the food (MedlinePlus).
- Eat less salt. High sodium intake increases the calcium lost in the urine (RNI 2017).
- Spread calcium through the day. The body absorbs calcium best in amounts of 500 mg or less at a time (MedlinePlus).
- Separate calcium and iron tablets. Calcium can reduce the absorption of iron, zinc and magnesium (RNI 2017), and calcium carbonate should be taken 1 to 2 hours apart from other medicines (MedlinePlus). This matters if you take iron pills for kurang darah (anaemia).
Kalsium untuk ibu mengandung dan menyusu (pregnancy and breastfeeding)
Pregnant women aged 20 to 49 need 1,000 mg of calcium a day, the same as other women their age. The baby's needs are met mainly because the mother's body absorbs about twice as much calcium from food during pregnancy, and trials have not shown a benefit from calcium above normal needs for most women (RNI 2017). Breastfeeding women also need 1,000 mg; bone calcium used during breastfeeding is usually restored after weaning, and a history of breastfeeding does not appear to raise the long-term risk of osteoporosis (RNI 2017).
Calcium and pre-eclampsia. The World Health Organization recommends daily calcium supplements of 1.5 to 2.0 g of elemental calcium for pregnant women in populations with low dietary calcium intake, to reduce the risk of pre-eclampsia, a serious high blood pressure condition in pregnancy (WHO). Because many Malaysian women eat far less calcium than recommended, ask your doctor or antenatal clinic whether you should take calcium tablets, and how to take them alongside iron. See also our guide to darah tinggi (high blood pressure).
Leg cramps are common in pregnancy, but the evidence that calcium helps them is weak; see our guide to kaki kejang (leg cramps).
Kalsium untuk tulang selepas umur 50 (bones after menopause)
After menopause, falling oestrogen speeds up bone loss, which is why the RNI rises to 1,200 mg a day for women from age 50. Calcium does not stop the bone loss of the first few years after menopause, but it may slow it (RNI 2017).
- Malaysian evidence: in a 2-year trial of 200 Chinese women in Malaysia aged 55 to 65, those who drank high-calcium skimmed milk providing 1,200 mg of calcium a day lost much less bone at the spine and hip than women who continued their usual diet (Chee 2003).
- If you have osteoporosis: Malaysian clinical guidance says adequate calcium (1,000 mg a day from diet and supplements combined) and vitamin D (800 IU a day) remain important, but medicines are the main treatment (Yeap 2016).
Calcium is only one part of bone health; our menopause guide also covers exercise and other ways to protect your bones.
Tanda kurang kalsium (signs of low calcium)
There are two different problems that people call "kurang kalsium":
- Low calcium intake over many years: this usually causes no symptoms at first, because the body keeps blood calcium normal by taking calcium from the bones (Cleveland Clinic). The first sign may be a fracture from a minor fall, or a low bone density result. Long-term lack of calcium or vitamin D can also cause soft bones (osteomalacia) (NHS).
- Low calcium in the blood (hypocalcaemia): mild cases often have no symptoms, or cause muscle cramps in the back and legs. Severe cases can cause tingling in the lips, tongue, fingers or feet, throat spasms that make breathing difficult, and an abnormal heart rhythm. The most common causes are low parathyroid hormone (for example after thyroid surgery), vitamin D deficiency and kidney failure, not diet alone (Cleveland Clinic).
See a doctor if you have tingling around the mouth or fingers, muscle spasms or cramps that keep coming back, especially after neck or thyroid surgery. A blood test can check your calcium, vitamin D, magnesium and parathyroid hormone levels.
Pil kalsium dan calcium carbonate 500 mg (calcium supplements)
Food is the preferred source of calcium, but some people need a supplement (MedlinePlus), for example if you rarely eat dairy, ikan bilis or other calcium-rich foods, follow a vegan diet, or have osteoporosis. The two most common forms are:
| Calcium carbonate | Calcium citrate | |
|---|---|---|
| Calcium per tablet | About 40% of the weight is calcium | About 21% of the weight is calcium, so tablets are larger |
| When to take | With food or just after a meal | With or without food |
| Good for | Most people; also used as an antacid | People with low stomach acid |
| Cost | Cheaper | More expensive |
Sources: MedlinePlus; calcium content calculated from the chemical formulas.
Calcium carbonate 500 mg untuk apa? Calcium carbonate is used as a supplement when your diet does not provide enough calcium, and also as an antacid for heartburn and indigestion (MedlinePlus). Read the label carefully: "500 mg" may mean 500 mg of calcium carbonate, which contains only about 200 mg of elemental calcium, or 500 mg of elemental calcium. It is the elemental calcium that counts towards your daily needs.
How to take calcium tablets safely:
- take calcium carbonate with food or just after a meal, with a full glass of water (MedlinePlus);
- take no more than 500 mg at a time; split larger doses (MedlinePlus);
- choose a supplement that also contains vitamin D, or make sure your vitamin D is adequate (MedlinePlus);
- take other medicines 1 to 2 hours apart from calcium carbonate (MedlinePlus);
- do not use calcium carbonate as an antacid for more than 2 weeks unless your doctor tells you to (MedlinePlus);
- count the calcium from food too, and stay below the upper limit of 2,500 mg a day for adults up to 50 (RNI 2017), or 2,000 mg after 50 (MedlinePlus);
- in Malaysia, check that a supplement has a registration number (MAL) on the NPRA website before buying it.
Side effects and risks. Calcium carbonate can cause an upset stomach, constipation, wind or belching, stomach pain and a metallic taste (MedlinePlus). Taking too much calcium can lead to kidney stones, a condition called milk-alkali syndrome, and lower absorption of iron, zinc and magnesium (RNI 2017). Calcium from food, on the other hand, may help prevent kidney stones; see our guide to batu karang (kidney stones). Tell your doctor before taking calcium if you have kidney disease, have had kidney stones, or are pregnant or breastfeeding (MedlinePlus).
Frequently asked questions (FAQ)
Apa fungsi kalsium (what does calcium do)?
Calcium builds and maintains strong bones and teeth, which hold more than 99% of the body's calcium. It is also needed for muscles to contract, including the heartbeat, for nerves to send signals and for blood to clot normally (NHS; Malaysian RNI 2017).
Berapa kalsium yang wanita perlukan sehari?
Under Malaysia's Recommended Nutrient Intakes (RNI) 2017, women aged 20 to 49 need 1,000 mg of calcium a day, rising to 1,200 mg from age 50. Pregnant and breastfeeding women aged 20 to 49 also need 1,000 mg, and teenagers aged 10 to 19 need 1,300 mg (RNI 2017).
Apa makanan tinggi kalsium di Malaysia?
Good local sources include ikan bilis (about 500 mg per 100 g), canned sardines eaten with the bones (234 mg), cooked dhal (171 mg), tauhu (135 mg), watercress or sai yong choy (200 mg), kailan (179 mg), sawi (138 mg), almonds (222 mg) and milk, yoghurt and cheese. High-calcium milk powders and calcium-fortified soy milk, bread and juice also help (RNI 2017, based on the Malaysian Food Composition Database).
Apa sumber kalsium selain susu?
If you do not drink milk, choose ikan bilis or sardines with their bones, tauhu and tempeh, calcium-fortified soy milk, dhal and beans, almonds, and green vegetables such as kailan, sawi and broccoli. Calcium from kailan and similar vegetables is absorbed about as well as calcium from milk, but spinach is a poor source because its oxalate blocks absorption (RNI 2017; MedlinePlus).
Apa tanda kurang kalsium?
Eating too little calcium usually causes no symptoms at first, because the body takes calcium from the bones to keep blood levels normal. Over many years, this weakens the bones and can lead to osteoporosis (Cleveland Clinic; MedlinePlus). Low calcium in the blood (hypocalcaemia), which can cause muscle cramps and tingling in the lips or fingers, is usually caused by problems with parathyroid hormone, vitamin D or the kidneys rather than diet alone (Cleveland Clinic).
Calcium carbonate 500 mg untuk apa?
Calcium carbonate is used as a calcium supplement when diet is not enough, and also as an antacid for heartburn and indigestion (MedlinePlus). Check the label: a 500 mg tablet may mean 500 mg of calcium carbonate, which gives only about 200 mg of actual (elemental) calcium, or 500 mg of elemental calcium. Take it with food, and do not use it as an antacid for more than 2 weeks unless a doctor advises it.
Bila masa terbaik makan pil kalsium?
Take calcium carbonate with a meal or just after, because it needs stomach acid to be absorbed; calcium citrate can be taken with or without food. The body absorbs calcium best in doses of 500 mg or less at a time, so split larger amounts. Take other medicines 1 to 2 hours apart from calcium (MedlinePlus).
Ibu mengandung perlu ambil kalsium ke?
Pregnant women aged 20 to 49 need 1,000 mg a day, the same as other women, because the body absorbs calcium about twice as well during pregnancy (RNI 2017). The World Health Organization recommends calcium tablets of 1.5 to 2.0 g a day for pregnant women in populations with low calcium intake, to lower the risk of pre-eclampsia (WHO). Ask your antenatal clinic whether you need them.
Berapa banyak kalsium terlalu banyak?
The upper limit for adults aged 19 to 50 is 2,500 mg a day from food and supplements together (RNI 2017), and 2,000 mg after age 50 (MedlinePlus). Too much calcium from supplements over a long time can raise the risk of kidney stones in some people and reduce the absorption of iron, zinc and magnesium (RNI 2017; MedlinePlus). The NHS says taking 1,500 mg or less a day from supplements is unlikely to cause harm.
Kalsium menyebabkan batu karang ke?
Calcium from food does not usually cause kidney stones; in a trial of men with recurrent calcium stones, a diet with normal calcium but less salt and animal protein halved the risk of new stones compared with a low-calcium diet (Borghi 2002). High amounts of calcium from supplements over a long time can raise the risk in some people (MedlinePlus). If you have had kidney stones, ask your doctor before taking calcium tablets.
Disclaimer
This article is for general information only and is not a substitute for advice from a doctor, dietitian or pharmacist. Ask a healthcare professional before starting a calcium supplement, especially if you are pregnant, have kidney disease or take other medicines.
References
- Recommended Nutrient Intakes for Malaysia 2017 (Chapter 17: Calcium) — National Coordinating Committee on Food and Nutrition, Ministry of Health Malaysia
- Calcium — NHS
- Calcium in diet — MedlinePlus Medical Encyclopedia
- Calcium Carbonate — MedlinePlus Drug Information
- Hypocalcemia — Cleveland Clinic
- Calcium supplementation during pregnancy to reduce the risk of pre-eclampsia — World Health Organization
- Chee WSS, et al. The effect of milk supplementation on bone mineral density in postmenopausal Chinese women in Malaysia. Osteoporos Int. 2003;14(10):828-34.
- Yeap SS, et al. A summary of the Malaysian Clinical Guidance on the management of postmenopausal and male osteoporosis, 2015. Osteoporos Sarcopenia. 2016;2(1):1-12.
- Borghi L, et al. Comparison of two diets for the prevention of recurrent stones in idiopathic hypercalciuria. N Engl J Med. 2002;346(2):77-84.
