Lesson 1: A Diet for Healthy Bones

1. FSNEP BONE HEALTH CURRICULUM Lesson 1: A Diet for Healthy Bones Katie Clark Jo Ann Johnson May C. Wang

2. Program Background • Bone health curriculum: pilot test • Three one-hour lessons • NEAs teach FSNEP class participants • Developed by UC Berkeley, College of Natural Resources

3. Osteoporosis Background • “Porous bone” • Peak bone mass during first 3 decades of life • Affects all ages, ethnicities and both genders • No cure but can slow natural bone loss rate

4. FSNEP Bone Health CurriculumProgram Goal To promote bone health among FSNEP participants

5. Curriculum Focus The two areas of emphasis for promoting bone health are: • Calcium and vitamin D-rich FOODS • Weight-bearing EXERCISE

6. Curriculum Outline Lesson 1: A Diet for Healthy Bones Lesson 2: Building Healthy Bones with Exercise Lesson 3: Overcoming Barriers to Building Stronger Bones

7. Lesson 1: Key Messages • Osteoporosis is a common, largely preventable disease. • Including adequate amounts of calcium and vitamin D-rich foods as part of a balanced diet throughout life will help to prevent or delay the onset of osteoporosis.

8. Lesson 1: Goal Increase knowledge of osteoporosis and the importance of diet for healthy bones.

9. Lesson 1:Learning Objectives • To identify the biological risk for osteoporosis • To identify foods that promote bone health

10. Lesson One Focus on: • Osteoporosis • Preventing osteoporosis through diet • Daily calcium needs for different age groups • Role of vitamin D in bone health • Lactose intolerance • Calcium supplements

11. Handouts Curriculum guide Calcium screener Pre- and post-tests “Picture your Bones” packet “A Diet for Healthy Bones” Handout “Bone Health Pledge” “Bone Health Trivia” game instructions Lesson 1: Materials Needed

12. Lesson 1: Materials Needed (cont.) Other Materials • Styrofoam • Bone model • One pen per participant • “Bone Health Trivia” cards (optional) • “Yogurt with Fresh Fruit” recipe cards (optional)

13. Lesson 1: Outline Total Time – 1 hour • Introduction – 5 minutes • Pre-test – 5 minutes • Calcium screener – 5 minutes • Learning about osteoporosis – 10 minutes • Osteoporosis: risks and prevention – 10 minutes • Calcium and vitamin D-rich foods – 20 minutes • Post-test – 5 minutes

14. 1. Introduction • Greet participants. • Pass around sign-in sheet. • Demonstrate weakness of osteoporotic bone by snapping styrofoam. • “Bone is a complex, living tissue affected by diet and exercise.”

15. 2. Pre-Test • Pass out pre-test to all participants. • Pre-test is five questions long. • Give participants five minutes to complete. • Explain that pre-test is not to test how much they know but rather to test how well we are teaching the information.

16. 3. Calcium Screener • “The screener is a quick way to show who might need more calcium in their diet.” • Pass out screener. • Give participants a few minutes to complete. • Discuss results: • Five or more checked boxes means adequate calcium. • Less than five checked boxes means need to increase calcium.

17. 4. Learning aboutOsteoporosis What is osteoporosis? • Called the “silent disease”. • Osteoporotic bones become weak and fragile. • Osteoporotic bones more likely to break.

18. 4. Learning aboutOsteoporosis (cont.) What is osteoporosis? (cont.) • Calcium is a mineral found in bones and teeth. • The body doesn’t make calcium, need to get it from diet. • There is no cure for osteoporosis. • You can slow down bone loss by increasing calcium and vitamin-D intake and exercise.

19. 4. Learning about Osteoporosis (cont.) • Learning Activity • “Picture your Bones” packet • Show picture 1 of the normal and osteoporotic bone to the class. Read the back of the picture out loud. • Discussion Questions

20. 4. Learning aboutOsteoporosis (cont.) How do bone fractures impact the quality of life? • Bone fractures • Elderly at risk • Hunched back (kyphosis) Promoting bone health early in life can prevent fractures later in life.

21. 4. Learning about Osteoporosis (cont.) How is osteoporosis diagnosed? • Bone Mineral Density (BMD) test • Dual Energy X-ray Absorptiometry (DXA) • Pronounced “dexa” • Radiation concerns • Discussion Questions • Frequently Asked Questions

22. 5. Osteoporosis:Risks and Prevention Am I at risk for osteoporosis? • Osteoporosis can occur in anyone • More likely in women than men • More likely in whites and Asians than African American and Hispanics

23. 5. Osteoporosis:Risks and Prevention (cont.) • Learning Activity • Pass out “A Diet for Healthy Bones” handout to all participants • Introduce risk factors for osteoporosis list • Discussion Question • Frequently Asked Questions

24. 5. Osteoporosis:Risks and Prevention (cont.) What can I do to prevent osteoporosis? The four steps to osteoporosis prevention are: • Eat and drink your daily value of calcium and vitamin D. • Do regular weight-bearing exercise. • Avoid smoking and drink alcohol in moderation. • Talk to your doctor about bone health, bone mineral density tests, calcium supplements and medicine for osteoporosis.

25. 6. Calcium andVitamin-D Rich Foods What foods have calcium in them? • Dairy foods are the best source of calcium. • Many other foods besides dairy have calcium in them. • Learning Activity • Discuss the list of calcium in foods from “A Diet for Healthy Bones” Handout • Discussion Questions

26. 6. Calcium andVitamin-D Rich Foods (cont.) How much calcium do I need? • Bone bank concept • Nonfat, low-fat and reduced-fat dairy foods are better than whole milk foods. • 1 cup of milk = about 300 mg calcium. • Don’t give nonfat, low-fat or reduced-fat milk to babies less than two years old.

27. 6. Calcium andVitamin-D Rich Foods (cont.)

28. 6. Calcium andVitamin-D Rich Foods (cont.) Is it possible to get too MUCH calcium? • Upper limit is 2,500 mg per day • More than 2,500 mg per day = decreased absorption of other minerals, potential kidney problems • Keep % Daily Value (%DV) calcium at less than 200% daily

29. 6. Calcium andVitamin-D Rich Foods (cont.) What decreases calcium absorption? • Smoking does • Take calcium and iron supplements separate from each other • Drink water instead of soda • Having a balanced diet is the best way to maximize calcium absorption

30. 6. Calcium andVitamin-D Rich Foods (cont.) What is vitamin D and how does it help build healthy bones? • Vitamin D: • Helps the body absorb calcium. • Is in fortified foods like milk. • Also made by the body after sun exposure. • Did you Know? • Frequently Asked Questions

31. 6. Calcium andVitamin-D Rich Foods (cont.) What is lactose intolerance? • Lactose is the natural sugar found in milk. • Some people can’t digest lactose well. • These people are “lactose intolerant”. • Asians and African Americans more likely to be lactose intolerant.

32. 6. Calcium andVitamin-D Rich Foods (cont.) What is lactose intolerance? (cont.) • Calcium-rich foods for lactose intolerant people list • Things lactose intolerant people trying to get enough calcium can do • Discussion Question • Did you Know? • Ethnic specific hints

33. 6. Calcium andVitamin-D Rich Foods (cont.) Who should take calcium supplements? • Try to get your calcium from foods, not pills. • Some people who don’t eat enough or the elderly might need a calcium supplement. • Calcium supplements are pills with calcium in them. • 500 mg doses • Did you Know? • Frequently Asked Questions

34. 6. Calcium andVitamin-D Rich Foods (cont.) Bone Health Pledge: Calcium Goals

35. 6. Calcium andVitamin-D Rich Foods (cont.) Optional Learning Activities – Time Permitting • Bone Health Trivia Game • Yogurt and Fresh Fruit Recipe demonstration

36. 7. Post-Test • Post-test questions are the same as pre-test. • Pass out post-test to all participants. • Give them five minutes to complete. • Collect post-tests. • Thank participants for time. • Answer any remaining questions.