Transcript 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
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.
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
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
4 Prevention Step (NOF)
The National Osteoporosis
Foundation (NOF)
recommends a
combination of 4 steps to
help prevent osteoporosis
4 Prevention Steps (NOF)
1. Balanced diet rich in
calcium & vitamin D
2. Weight-bearing
exercise
3. Healthy lifestyle
with no smoking or
excessive alcohol use
4. Bone density testing
or medications when
appropriate
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
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
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.
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%)
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
% 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
Example of Calculating Total %
DV for Calcium
Food
% DV
Fruit yogurt
Oatmeal
Nachos
Turnip greens
Total % DV = 80%
35%
10%
20%
15%
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
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.
Recommended Daily Value:
Calcium & Vitamin D*
• Birth - 6 months
210 mg calcium (21% DV)
200 IU vitamin D (50% DV)
• 6 months - 1 year
270 mg calcium (27% DV)
200 IU vitamin D (50% DV)
*Values based on 1997 NAS recommendations
Recommended Daily Value:
Calcium & Vitamin D*
• 1 - 3 years
500 mg calcium (50% DV)
200 IU vitamin D (50% DV)
• 4 - 8 years
800 mg calcium (80% DV)
200 IU vitamin D (50% DV)
*Values based on 1997 NAS recommendations
Recommended Daily Value:
Calcium & Vitamin D*
• 9 - 18 years
1,300 mg calcium (130% DV)
200 IU vitamin D (50% DV)
• 19 - 50 years
1,000 mg calcium (100% DV)
200 IU vitamin D (50% DV)
*Values based on 1997 NAS recommendations
Recommended Daily Value:
Calcium & Vitamin D*
• 51 - 70 years
1,200 mg calcium (120% DV)
400 IU vitamin D (100% DV)
• 71 and older
1,200 mg calcium (120% DV)
600 IU vitamin D (150% DV)
*Values based on 1997 NAS recommendations
Recommended Daily Value:
Calcium & Vitamin D*
Pregnant & Lactating
• 14 - 18 years
1,300 mg calcium (130% DV)
200 IU vitamin D (50% DV)
• 19 - 50 years
1,000 mg calcium (100% DV)
200 IU vitamin D (50% DV)
*Values based on 1997 NAS recommendations
% DV Calcium:
Grain Products Group
• Ready-to-eat calcium-fortified
cereal
 Serving size varies; check product
label.
% 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
% DV Calcium:
Fruit Group
• Orange juice, calciumfortified
 1 cup = 30% DV
% 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
% 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
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.
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
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
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
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
Concerns:
Alcohol
• Consuming more than 7 drinks per
week is associated with greater risk
of:
 low bone density
 falls
 fractures
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
Concerns:
High protein
• Unbalanced, excessively high protein
diets could increase urinary excretion of
calcium
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
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
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
Help for the Lactose- Intolerant
Person
• Start with small
portions of foods
such as milk and
gradually increase
serving size
Help for the Lactose-Intolerant
Person
• Eat dairy foods in combination with a
meal or solid foods
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
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
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
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
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.
Supplements:
Calcium Carbonate vs. Citrate
• 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:
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)
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.
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
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.
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
Supplements:
Check for Interactions
• Check with physician or pharmacist for
interactions with other prescriptions
and over-the-counter drugs
Supplements:
Food is Still Important
• High calcium foods also contain other
KEY nutrients that are important in the
diet
• Try to obtain at least some of your calcium
from your diet
Putting it All Together
1. List foods/supplements you ate yesterday or in a
typical day
2. Determine % DV of calcium/vitamin D
3. Adjust % DV if serving size was different than on
label
4. Total amounts; compare score to recommended %
DV for age
Related Materials
For more information and/or a handout about the points discussed in this
presentation, refer to the article Nutrition and Osteoporosis by Alice
Henneman, MS, RD and Linda Boeckner, PhD, RD at:
lancaster.unl.edu/food/ftm-j01.htm
Alice Henneman, MS, RD
Lancaster County Extension Educator
[email protected]
Linda Boeckner, PhD, RD
Extension Nutrition Specialist
[email protected]
University of Nebraska Cooperative Extension
Institute of Agriculture and Natural Resources
For More Information
•
National Osteoporosis Foundation www.nof.org
•
Strong Women, Strong Bones by Miriam Nelson, Ph.D.