Get Enough Calcium!

1. Get Enough Calcium! And Help Prevent Osteoporosis Some slides adapted from University of Nebraska Lincoln (lancaster.unl.edu) and MyPyramid.gov

2. Project Sponsors • USDA project funded through the Food Stamp Program • School District of Philadelphia • Nutrition Center, Department of Biology Drexel University

3. Why Worry About Calcium? • Helps control muscle contraction • Need to build and maintain strong bone throughout life

4. Bones are living organs • Calcium is deposited and withdrawn from bones daily. • Half of the adult skeleton is formed during adolescence. • We need to build up a healthy bone “account” while young and continue to make “deposits” with age. ** Get as much calcium as you can now to prevent weak bones Source: http://www.accessexcellence.org/HHQ/qow/qow06/qow061211.html

5. Bone Mass • After mid-30’s, you begin to slowly lose bone mass. Women lose bone mass faster after menopause, but it happens to men too. • Bones can weaken early in life without a healthy diet and regular physical weight bear activities. Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis:What It Means to You at http://www.surgeongeneral.gov/library/bonehealth

6. Osteoporosis Overview • Osteoporosis causes weak bones • In this common disease, bones lose minerals like calcium • The bones become fragile and can break easily • Osteoporosis can strike at any age female or male Normal Bone Bone with Osteoporosis Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealth

7. Risk factors “Red flags” that you could be at high risk for weak bones • You are older than 65 • You smoke • You are underweight for your height • You have never gotten enough calcium • You are not active • Poor daily nutrition • Low bone density-Osteopenia *Remember: Prevention is the Key! Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis:What It Means to You at http://www.surgeongeneral.gov/library/bonehealth

8. What is Osteopenia? • Loss or decrease of bone mineral density (BMD) that can progress to osteoporosis • BMD is the measurement of levels of minerals in the bone • Indicates strength and density • When BMD is very low compared to normal, it is called osteoporosis Adapted from: http://www.webmd.com/osteoporosis/tc/Osteopenia-Overview

9. Risk Factors • Being of Caucasian or Asian decent • Excessive alcohol use • Family history • Being underweight • Physical inactivity • Tobacco use • Diet deficient in Calcium and Vitamin D • Decrease in bone density Adapted from: http://www.webmd.com/osteoporosis/tc/Osteopenia-Overview

10. The problem in America • 1 in 2 women and 1 in 4 men over 50 will have an osteoporosis-related fracture • Hip fractures account for 300,000 hospitalization annually • 1 in 5 people with a hip fracture end up in a nursing home within a year • Less than ½ of teens get recommended amount of Calcium they need for the day. Source: http://www.accessexcellence.org/HHQ/qow/qow06/qow061211.html and National Osteoporosis Foundation Web site; retrieved July 2005 at http://www.nof.org

11. The most common breaks Breaks usually occur in the wrist, spine, and hip. Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis:What It Means to You at http://www.surgeongeneral.gov/library/bonehealth

12. The good news: Osteoporosis and Osteopenia are preventable for most people! • Start building healthy bones while young. • Healthy diet and lifestyle are important for BOTH men and women.

13. Simple Prevention Steps • Get the recommended amount of calcium and vitamin D • Get regular weight bearing exercise • Avoid smoking and excessive alcohol

14. What’s the recommendation for calcium? Calcium

15. Calcium requirements vary by age Growthspurt Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis:What It Means to You at http://www.surgeongeneral.gov/library/bonehealth

16. Food and supplement labels • Percent Daily Value is used to show how much calcium is in a food 100% DV for calcium = 1000 milligrams (mg) So, for this label there is 30% DV of Calcium How many mg would that be? Do the math: 300 mg  1000 mg = 30%

17. Breakfast Granola bar and 6oz. calcium fortified 100% juice Lunch Turkey, lettuce, tomato and cheese on whole wheat roll Low-fat chocolate milk Dinner Grilled chicken, ½ c spinach salad and ¾ c macaroni and cheese Breakfast Orange juice 300mg Granola bar 150mg Lunch Cheese 300mg Chocolate milk 300mg Dinner Spinach 123mg Mac and cheese 300mg Eating Calcium at Every Meal

18. Is it Enough Calcium? • Breakfast • Orange juice 300mg • Granola bar 150mg • Lunch • Cheese 300mg • Chocolate milk 300mg • Dinner • Spinach 123mg • Mac and cheese +300mg Total Calcium:1473mg

19. Milligrams (mg) and %DV of calcium in common foods Approximate % DV for foods based in part on The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealth

20. Calcium Sources: Milk group • Yogurt1 cup (8 oz.) = 300mg (30% DV) • Milk1 cup = 300mg (30% DV) • Cheese1 ½ oz. natural/2 oz. processed = 300mg (30% DV) • Milk pudding1/2 cup = 150mg (15% DV) • Frozen yogurt, vanilla, soft serve½ cup = 100mg (10% DV) • Ice cream, vanilla½cup = 80mg (8% DV) • Soy or rice milk, calcium-fortified1 cup = varies—check label Choose fat-free or low fat most often

21. Calcium Sources: Grain products group • Cereal, calcium- fortifiedServing size and amount of calcium varies—check label Calcium-fortified

22. Calcium Sources: Vegetable group • Broccoli, raw1 cup = 90mg (9% DV) • Collard greens, cooked1/2 cup = 200mg (20% DV) • Turnip greens, boiled1/2 cup = 100mg (10% DV)

23. Calcium Sources: Fruit group • Orange juice and other calcium-fortified beverages6 oz. = 200mg to 300mg (20-30% DV, varies—check label) Look for 100% juice

24. Calcium Sources: Meat & Beans Group • Baked beans1 cup= 140mg (14% DV) • Salmon, canned, with edible bones3 oz. = 180mg (18% DV) • Sardines, canned, in oil, with edible bones3 oz. = 320mg (32% DV) • Soybeans, cooked1 cup = 260mg (26% DV) • Tofu, firm, with calcium ½ cup = 200mg (20mg% DV); check label

25. What’s the recommendation for vitamin D? Vitamin D

26. Why Do I Need Vitamin D? • Helps the body more easily absorb calcium in the digestive tract. • Promotes bone formation and mineralization • Works with calcium to build a stronger more intact bone Source: Vitamin D Overviewhttp://healthlink.mcw.edu/article/982088787.html

27. 600 IU 600 500 400 IU 400 200 IU 300 200 100 0 up to 50 51-70 over 70 You need more vitamin D as you age Daily vitamin D needs inInternational Units (IU) Age

28. What about Vitamin D? Main dietary sources of vitamin D are: • Fortified milk (400 IU per quart) • Some fortified cereals • Cold saltwater fish (Example: salmon, halibut, herring, tuna, oysters and shrimp) • Some calcium and vitamin/mineral supplements

29. Vitamin D from sunlight exposure • Vitamin D is manufactured in your skin following direct exposure to sun. • Amount varies with time of day, season, latitude and skin pigmentation. • 10–15 minutes exposure of hands, arms and face 2–3 times/week may be sufficient (depending on skin sensitivity). • Clothing, sunscreen, window glass and pollution reduce amount produced. Source: National Osteoporosis Foundation Web site; retrieved July 2005 at http://www.nof.org

30. Are You Lactose-intolerant? Some people lack the enzyme lactase needed to digest lactose (milk sugar). Here are some tips which may help people obtain calcium from dairy products…

31. Tips for Lactose Intolerance • Start with smaller portions • Eat dairy in combination with meals • Try dairy foods other than milk: • Hard cheeses have less lactose than milk: (ex: cheddar, Swiss, parmesan) • Yogurt contains predigested lactose • Try products like: Lactaid and soy milks and cheeses

32. I just don’t like milk

33. Some ideas Add milk to coffee Make oatmeal and cream-type soups with milk instead of water Add powdered milk to food(1 tablespoon = 50 mg calcium)

34. Some more ideas Serve milk-based desserts (puddings, tapioca, frozen yogurt, custard, ice cream). Limit fat and sugar. Try chocolate milk. • 8-oz. has only 2 - 7 mg caffeine. • Average glass provides only 60 more calories than unflavored milk. Make instant hot cocoa with milk, not water.

35. Even more ideas Top baked potatoes with plain yogurt; sprinkle with chives Enjoy plain or flavored low fat yogurt Use flavored yogurt as a fruit salad dressing; experiment with substituting plain yogurt for some or all of the sour cream in vegetable salad dressings

36. Have It YOUR Way Smoothie(serves 2) • 1 cup unsweetened, frozen raspberries or frozen fruit of choice • 1/2 cup 100% calcium fortified orange • 3/4 cup fruit-flavored, low- or non-fat yogurt Blend all ingredients well in blender. Enjoy! Calcium per serving: 243 mg.

37. Fantastic Fruit Parfait Layer yogurt, low-fat granola and fruit in whatever proportions you’d like. Add some nuts and you’ve included a 4th food group.

38. 500 mg What about a supplement? • Take no more than 500mg at a time • Calcium citrate is recommended over calcium carbonate

39. Remember to follow the prevention steps … • Eat a healthy diet with plenty of foods high in calcium and vitamin D. • Engage in regular exercise. • Avoid smoking and excessive alcohol. Support your bones. They support you!

40. Questions ??