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Nutrition and Osteoporosis

Nutrition and Osteoporosis. Alice Henneman, MS, RD Lancaster County Extension Educator Linda Boeckner, PhD, RD Extension Nutrition Specialist. Modified by the GA Agriculture Education Curriculum Office July 2002. Disclaimer.

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Nutrition and Osteoporosis

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  1. Nutrition and Osteoporosis Alice Henneman, MS, RDLancaster County Extension EducatorLinda Boeckner, PhD, RD Extension Nutrition Specialist Modified by the GA Agriculture Education Curriculum Office July 2002

  2. Disclaimer The following information on the dietary aspects of osteoporosis is provided as information for general healthy eating and should not be considered a substitute for seeking dietary advice from your own healthcare provider. The calcium and vitamin D recommendations are based on those developed for the United States and Canada. They may not be appropriate for all countries due to differing dietary patterns and environmental factors.

  3. Concerns • 10 million Americans have osteoporosis and 18 million have low bone mass placing them at risk of osteoporosis (National Osteoporosis Foundation [NOF]) • The “silent disease” • First sign may be a fracture • A sudden strain or bump can break a bone

  4. Concerns continued • 80% of those affected are women • A woman’s hip fracture risk equals her combined risk of breast, uterine and ovarian cancer • 1 in 2 women and 1 in 8 men over 50 will have an osteoporosis-related fracture • 24% of hip fracture patients 50 and over die during the year following their fracture

  5. 4 Prevention Step (NOF) The National Osteoporosis Foundation (NOF) recommends a combination of 4 steps to help prevent osteoporosis

  6. 4 Prevention Steps (NOF) • Balanced diet rich in calcium & vitamin D • Weight-bearing exercise • Healthy lifestyle with no smoking or excessive alcohol use • Bone density testing or medications when appropriate

  7. Overview • Using food and supplement labels to assess calcium intake • Recommended daily calcium and vitamin D • % Daily Value for calcium in common foods • Additional dietary concerns • Help for the lactose-intolerant person • When you don’t like to “drink” milk • Calcium supplements • Putting it all together

  8. Nutrition Labels & Calcium • FDA uses “Percent Daily Value” (% DV) to describe amount of calcium needed by general U.S. population daily • 100% DV for calcium = 1,000 mg • “Nutrition Facts” on food labels • “Supplement Facts” on vitamin/mineral labels

  9. Sample Nutrition Facts Label Nutrition Facts Serving Size 1/2 cup (93 g) Servings Per Container 4 -------------------------------------------- Amount Per Serving Calories 25 Calories from Fat 0 -------------------------------------------- % Daily Value* Total Fat 0 g 0% Saturated Fat 0 g 0% Cholesterol 0 mg 0% Sodium 20 mg 1% Total Carbohydrate 5 g 2% Dietary Fiber 3 g 12% Sugars 2 g Protein 3 g -------------------------------------------- Vitamin A 35% • Vitamin C 60% Calcium 4% • Iron 4% -------------------------------------------- * Percent Daily Values are based on a 2,000 calorie diet.

  10. Example of Daily Value If a food or supplement has 200 mg of calcium per serving, the "Nutrition Facts" or "Supplement Facts" panel shows:20% DV for calcium(200/1,000 = 20%)

  11. Using Serving Size • Serving size on "Nutrition Facts" panel is based on what people typically eat—it’s not a recommended amount • Adjust calcium % DV if you eat a different serving size than on label • Example: If label states a half cup serving of broccoli provides 4% DV, a cup would provide 8% DV

  12. % DV recommendations Vary by Age Example: Individuals 51 years and older need to consume 1,200 mg of calcium daily Their daily goal should be 120% of the calcium DV

  13. Example of Calculating Total % DV for Calcium Food% DV Fruit yogurt 35% Oatmeal 10% Nachos 20% Turnip greens 15% Total % DV = 80%

  14. Recommended Daily Calcium and Vitamin D Intakes • Remember: • The 100% DV for calcium is based on 1,000 mg calcium • The 100% DV for vitamin D is based on 400 IU vitamin D • Some people will need more or less than the 100% DV value based on their age and reproductive status

  15. Upper limits: Calcium and Vitamin D The National Academy of Sciences (NAS), 1997, suggests a tolerable upper intake level (UL) for persons age one and up for calcium no higher than 2,500 mg daily and for vitamin D no higher than 50 micrograms or 2,000 IU (40 IU = 1 microgram) daily from foods and supplements combined.

  16. Recommended Daily Value: Calcium & Vitamin D* • Birth - 6 months210 mg calcium (21% DV)200 IU vitamin D (50% DV) • 6 months - 1 year270 mg calcium (27% DV)200 IU vitamin D (50% DV) *Values based on 1997 NAS recommendations

  17. Recommended Daily Value: Calcium & Vitamin D* • 1 - 3 years500 mg calcium (50% DV)200 IU vitamin D (50% DV) • 4 - 8 years800 mg calcium (80% DV)200 IU vitamin D (50% DV) *Values based on 1997 NAS recommendations

  18. Recommended Daily Value: Calcium & Vitamin D* • 9 - 18 years1,300 mg calcium (130% DV)200 IU vitamin D (50% DV) • 19 - 50 years1,000 mg calcium (100% DV)200 IU vitamin D (50% DV) *Values based on 1997 NAS recommendations

  19. Recommended Daily Value: Calcium & Vitamin D* • 51 - 70 years1,200 mg calcium (120% DV)400 IU vitamin D (100% DV) • 71 and older1,200 mg calcium (120% DV)600 IU vitamin D (150% DV) *Values based on 1997 NAS recommendations

  20. Recommended Daily Value: Calcium & Vitamin D* Pregnant & Lactating • 14 - 18 years1,300 mg calcium (130% DV)200 IU vitamin D (50% DV) • 19 - 50 years1,000 mg calcium (100% DV)200 IU vitamin D (50% DV) *Values based on 1997 NAS recommendations

  21. % DV Calcium: Grain Products Group • Ready-to-eat calcium-fortified cereal • Serving size varies; check product label.

  22. % DV Calcium:Vegetable Group • Broccoli with cheese; 1/2 cup = 20% DV • Collards; 1/2 cup = 20% DV • Turnip greens; 2/3 cup = 15% DV • Kale; 2/3 cup = 10% DV • Bok choy; 1/2 cup = 10% DV • Broccoli; 1 stalk = 6% DV

  23. % DV Calcium:Fruit Group • Orange juice, calcium-fortified • 1 cup = 30% DV

  24. % DV Calcium:Milk Group • Yogurt; 8 oz. = 35% DV • Milk,whole, 2%, 1%, skim, • Chocolate Milk 1 cup = 30% DV • Cheese; 1 oz. = 20% DV • Milk pudding; 1/2 cup = 10% DV • Frozen yogurt; 1/2 cup = 10% DV • Ice cream; 1/2 cup = 6% DV • Soy milk, calcium-fortified; 1 cup = 30% DV

  25. % DV Calcium:Meat & Beans Group • Tofu prepared with calcium sulfate; 3 oz. = 60% DV • check Nutrition Facts label • Baked beans with sauce; 1/2 cup = 8% DV • Pork & beans with sauce; 1/2 cup = 6% DV

  26. Vitamin D Dietary Sources The main dietary sources of vitamin D are fortified milk (400 IU per quart), some fortified cereals, cold saltwater fish (for example: salmon, halibut, herring, tuna, oysters and shrimp) and some calcium and vitamin/mineral supplements. Also, vitamin D can be manufactured in your skin following direct exposure to sunlight. The amount varies according to such factors as time of day, season and latitude.

  27. Concerns:Calcium Load at One Time • Body can best handle about 500 mg at one time from food and/or supplements • Consume calcium sources throughout day vs. all at one time

  28. Concerns:Fiber • Excessive fiber can interfere with absorption • Example: sprinkling extra fiber on food at time of consuming a calcium source • Natural fiber that is part of a food is probably not a problem

  29. Concerns:Excessive caffeine • Can increase urinary calcium excretion • Limit to about 400 mg daily • About 100 mg/6 oz. coffee • About 40 mg/6 oz. regular brewed tea; may be less for green tea • Some soft drinks comparable to tea • Some medications have caffeine

  30. Concerns:Excessive sodium • Can increase urinary calcium excretion • Food and Nutrition Board recommends limit of 2,400 mg daily • Sodium given on “Nutrition Facts” panel on foods

  31. Concerns:Alcohol • Consuming more than 7 drinks per week is associated with greater risk of: • low bone density • falls • fractures

  32. Concerns:Oxalic acid • In foods such as spinach, chard, beet greens and chocolate • Binds calcium • Doesn’t seem to affect calcium in other foods, including chocolate milk • These greens still good for you; may help calcium absorption in other ways

  33. Concerns:High protein • Unbalanced, excessively high protein diets could increase urinary excretion of calcium

  34. Concerns:Soy • Not all soy milk is calcium-fortified; check “Nutrition Facts” panel • 4 8-oz. glasses of soy milk is usually equal to 3 8-oz. glasses of cow’s milk in availability of calcium

  35. Concerns:Fruits and Vegetables • Contribute to maintenance of bone mineral density • Food Guide Pyramid recommendations: • 2 to 4 fruits daily • 3 to 5 vegetables daily

  36. Help for the Lactose-Intolerant Person Some people lack the enzyme needed to digest lactose (milk sugar) but still may be able to obtain calcium from dairy products

  37. Help for the Lactose- Intolerant Person • Start with small portions of foods such as milk and gradually increase serving size

  38. Help for the Lactose-Intolerant Person • Eat dairy foods in combination with a meal or solid foods

  39. Help for the Lactose-Intolerant Person • Try dairy foods other than milk • Many cheeses (Cheddar, Swiss, Parmesan) have less lactose than milk • Yogurt made with live, active bacteria

  40. Help for the Lactose-Intolerant Person • It may be easier to digest lactose that is pre-digested or broken down to its simple sugar components (glucose and galactose) • Lactose-hydrolyzed milk and dairy products • Commercial lactase preparations

  41. When You Don’t Like to “Drink” Milk • Make oatmeal with milk instead of water • Add milk to your coffee • Make soups (tomato, chowders and cream-type) with milk instead of water • Add powdered milk to food (1 tablespoon = 50 mg of calcium) • Make instant hot cocoa with milk

  42. When You Don’t Like to “Drink” Milk • Make instant hot cocoa with milk, not water • Serve milk-based desserts (puddings, tapioca, frozen yogurt, custard, ice cream) • Enjoy chocolate milk • 8-oz. has only 2 - 7 mg caffeine • Average glass of chocolate milk has only 60 more calories than unflavored milk

  43. When You Don’t Like to “Drink” Milk • Use plain/flavored yogurt as salad dressing • Top baked potatoes with yogurt • Enjoy smoothies for snacks • Add 1/2 to 1 cup frozen fruit to 1 cup milk & blend. Sweeten with 1 - 2 teaspoons sugar or honey, or use an artificial sweetener. Can add about 1/4 teaspoon vanilla. Drink right away.

  44. Calcium carbonate Needs acid to dissolve and for absorption Less stomach acid as we age Often taken at meals when more stomach acid Calcium citrate Doesn’t require stomach acid for absorption May be taken anytime—check with your healthcare provider May cost more Supplements:Calcium Carbonate vs. Citrate

  45. Supplements:Vitamin D • Vitamin D • Choose a supplement with vitamin D unless you’re getting vitamin D from other sources • Consider amount for your age group • Avoid going over a daily combined total of 50 micrograms (2,000 IU)

  46. Supplements:Time of Day • If you take calcium once daily, evening may be best. Miriam Nelson (author, Strong Women, Strong Bones) advises calcium carbonate at dinner time and calcium citrate before bed. Check with your healthcare provider.

  47. Supplements:Calcium Load at One Time • Limit calcium intake at one time to about 500 mg from food and supplements combined • Consume food and supplements throughout the day

  48. Supplements:Absorption • Absorption test: put a calcium tablet in a cup of vinegar. Stir every 5 minutes. If it doesn’t dissolve in 30 minutes, it probably won’t dissolve in your stomach either.

  49. Supplements:Increase Amount Slowly • Start with 500 mg daily for about a week, gradually adding more • Gas and constipation can be side effects • Increase fluids and fibrous foods • Try a different form if problems continue

  50. Supplements:Check for Interactions • Check with physician or pharmacist for interactions with other prescriptions and over-the-counter drugs

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