Is There Calcium In Breast Milk


Is there calcium in breast milk? That would depend on what you define as calcium. The actual calcium elements, calcium cation (Ca2+) and calcium anion (CaO+), are in breast milk. But let’s be clear: breast milk is not a source of supplemental mineral or vitamins and it never will be if you want your child to get the best benefits out of it.

Is There Calcium In Breast Milk

Adequate calcium intake is vital for infant health, and some cases of rickets have been associated with a low concentration of calcium in breastmilk. The concentration of calcium in breastmilk has been shown to vary widely both between mothers, and over the course of lactation. To address potential concerns about the adequacy of calcium intake for infants who are exclusively breastfed, we discuss the factors likely to be affecting the concentration of calcium in breastmilk. We review and provide new evidence for a physicochemical model of the interactions of calcium with other components of breastmilk, particularly phosphate, citrate and casein. A proposed mechanism for the control of the concentration of calcium in milk is described that highlights the influence of the concentrations of citrate and casein. Understanding these interactions clarifies why the concentration of calcium in breastmilk is not affected by manipulations of maternal dietary calcium and vitamin D.

Schematic diagram of calcium interactions in the Golgi apparatus


The concentrations of total calcium (■), citrate (●) and ionised calcium (X) in breastmilk samples collected throughout lactation


Measured concentration of ionised calcium (Ca 2+ ), calculated concentration of calcium citrate (CaCit -), and colloidal calcium calculated as the difference between the total and diffusible calcium


Proposed schematic representation of the determination of calcium concentration of breastmilk by casein and citrate

The interaction ofcalcium with other milk components
has been modelled and studied in milk of animals and women
(Holt, Dalgleish & Jenness 1981; Holt & Muir 1979; Kent,
Arthur & Hartmann 1998; Neville 2005; Neville et al 1994)
and a mechanism for the accumulation of calcium in milk has
been proposed (Holt 1981). In order to elucidate the control
of the concentration ofcalcium in breastmilk, this paper
reviews the normal changes in concentration throughout
lactation and provides new data on calcium interactions in
breastmilk. Understanding these interactions clarifies why
the concentration of calcium in breastmilk is not affected by
manipulations of maternal dietary calcium and vitamin D.
The median concentration of calcium in breastmilk is
252 mg/L (6.0 mM), with a very large range of 84–462 mg/
L (2.1–11.5 mM) (Dorea 1999). While the extremes are of
concern, very few samples collected between 1 and 6 months
of lactation had measured concentrations of <100 mg/L (2.5
mM) or more than 300 mg/L (7.5 mM). Compared to control
populations, teenage mothers and mothers in Egypt, the
Gambia and Zaire had low concentrations of calcium in their
milk. Despite this, the infants of these mothers showed no
adverse effects. However, cases of rickets have been reported
recently in exclusively breastfed infants <6 months old born to
vitamin D deficient mothers (Nickkho-Amiry et al 2008) and
a few breastfed Nigerian children (Thacher et al 2006). These
cases led to speculation that rickets in such infants might arise
in part because of low breastmilk concentrations of calcium.

Breastfeeding: your choice

In the end, it’s an individual choice – but it should be an informed choice.

If you decide not to breastfeed, it’s good to know that formulas give your baby adequate nutrition. And if you need to supplement breastmilk with formula, it doesn’t mean that breastfeeding has to stop completely.

How long to feed your baby breastmilk

It’s recommended that you breastfeed exclusively until you introduce solid foods when your baby starts showing signs that they’re ready. This usually happens around six months. It’s around this time that babies start to need extra nutrients for growth and development.

Your baby needs only small amounts of food for the first few months of solids, and breastmilk is still baby’s main source of nutrition. Once you introduce solids, it’s best for your baby if you keep breastfeeding along with giving your baby solids until your baby is at least 12 months old.

After that, it’s really up to you and your baby how long you keep going. If you decide to breastfeed for longer, your baby will get added benefits like protection against infections in the toddler years.

Secretion of calcium into milk
Milk is synthesised and secreted by the lactocytes of the
mammary gland. The calcium in breastmilk is derived from
the blood, as are all components of breastmilk. The total
concentration ofcalcium in the blood is about 2.5 mM of
which about half is bound to proteins. Most of the remainder
is free or ionised calcium and its concentration is tightly
controlled at about 1.25 mM.
The calcium concentration of human milk is even lower
than predicted by the general relationship between calcium
and casein. This low concentration can be attributed to
the different types of casein in human milk, which result
mole of casein in the micelles (Neville et al 1994), compared
with bovine milk in which 20 moles of calcium are bound
per mole of casein (Jenness 1979). These differences in
both the concentration and type of casein in human milk
contribute to its low concentration of calcium as compared
with milk from other species. However, this normally poses
no problems for the breastfed infant. Infants take over three
months to double their birth weight and this slow growth rate,
and therefore low requirement for calcium for mineralisation
of bones, is compatible with the low concentrations of
calcium and casein in human milk. On the other hand, the
high concentrations of calcium and casein in bovine milk are
appropriate for calves that take only one month to double
their birth weight.
Calcium partitioning and modeling of interactions
The model of micelle formation explains the general
relationship between species with regards to calcium and
casein concentration (Holt & Jenness 1984). However, when
the concentration of casein is low, such as in sows’ milk
during secretory activation or in breastmilk, other components
in addition to casein make a significant contribution to the
determination of the concentration of calcium (Kent, Arthur
& Hartmann 1998). The study ofthe relationships between
calcium and other milk components has been facilitated by the
partitioning of milk as shown in Figure 2. Alternatively, the
diffusible fraction containing ionised calcium, free phosphate,
free citrate, calcium phosphate and calcium citrate can be
prepared by ultrafiltration of whole milk.
In the diffusible fraction of milk, the concentrations of
calcium occurring as ionised calcium, calcium phosphate and
calcium citrate are dictated by physicochemical principles. The
interactions of ionised calcium, free phosphate and free citrate
are in equilibrium and there are defined equilibrium constants.
In turn, the interactions of free phosphate and free citrate with
other components in the diffusible fraction of milk are also in
equilibrium. For example, magnesium binds both free phosphate
and free citrate, so the concentration of magnesium will affect
the concentration of calcium phosphate and calcium citrate. All
of these interactions can be quantified using physicochemical
modelling. A model has been developed and tested in milk from
cows, sows and women (Holt, Dalgleish & Jenness 1981; Kent,
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The decrease in the total concentration of citrate in human
milk between 5 days and 6 months contributes to the decline
in the total concentration of calcium. The concentrations of
both calcium and citrate decreased between 6 months and
12 months while the concentration ofprotein was stable,
indicating that the decreased concentration of citrate was
causing the decrease in the concentration of calcium. After
12 months, the concentration of citrate continued to decrease
while the concentration of casein increased, thus resulting in a
stable concentration of total calcium.
The relatively constant concentration of ionised calcium
in milk of women from initiation until late lactation suggests
that there is a homeostasis of ionised calcium in milk, as there
is in blood. The minimum concentration of ionised calcium
must be 1 mM for casein micelle stability (Holt, Davies & Law
1986) and 2–4 mM for lactose synthesis by lactose synthase
(Powell & Brew 1976). The upper limit is determined by
the free phosphate concentration, since precipitation of
calcium phosphate in the mammary gland must be avoided.
The ionised calcium concentration in the Golgi apparatus is
maintained within these limits by calcium-ATPase against a
concentration gradient from the cytosol. The regulation of the
activity of the calcium-ATPase is thus an important factor in
understanding the control of the secretion of calcium in milk
that warrants further exploration. While vitamin D promotes
intestinal calcium absorption it has no known effect on calcium
transport across the membrane of the Golgi apparatus.

Breastfeeding in the First Few Weeks

Don’t count minutes. “You can leave your baby on the first breast until she comes off on her own and then offer the second breast. It’s typical for some babies to take one breast at some feedings and both breasts at some.” – Nancy Mohrbacher, IBCLC, lactation consultant in the Chicago area and author of Breastfeeding Answers Made Simple

Avoid pacifiers at first. “The AAP recommends delaying the pacifier for the first month because it can suppress hunger cues and steal time from the breast during a critical period. After that, offering a pacifier shouldn’t hurt.” – Dr. Jones

Lie on your side. “It lets you rest your shoulders and lower back if you tend to hunch over, and it’s good for moms who’ve had a C-section, who have carpal tunnel syndrome, or who are just exhausted. Put a pillow between your knees and your arm under your head, and bring the baby in facing you. Have someone help you at first.” – Brown

Try a nursing stool. “It can help give you more of a lap, especially if you’re short, and it takes the pressure off if you’ve had an episiotomy. When I watch a mother use one, I can see right away on her face how much more comfortable she is.” – Brown

Offer the first bottle at 4 to 6 weeks. “If you wait until 8 weeks, you risk bottle refusal. Have someone other than you give the first one – and get out of the house so you’re not tempted to help out.” – Dr. Jones

Don’t buy a whole nursing wardrobe. “It can be easier to just lift up your shirt. If you wear a blouse over a camisole, you’ll have a lot of coverage

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