The Diet Detective: How Nutrition and Diet Affect Bone Health

Protecting our bones is obviously important, but figuring out exactly how to do that in terms of our diet can be confusing. With that in mind, I contacted a few bone experts to give us the highlights and answer some of the more frequently asked questions. This is the first of a two-part series about the impact of nutrition and diet on bone health. The first part deals with general bone health and the role played by calcium. The second part will focus on other foods and nutrients that help or hurt bone health.

What is osteoporosis, and what does it do to our bones?

According to Tejaswini Rao, Ph.D., R.D., a professor of nutrition at State University of New York at Buffalo, "Osteoporosis or porous bones is a disease characterized by low bone mass leading to fragile bones and resulting in an increased susceptibility to fractures of the hip, spine and wrist."

At what age do our bones start to deteriorate?

Our bones reach their peak level of density (or mass) in the mid-20s (on average), says Dorothy Teegarden, Ph.D., a professor of nutrition at Purdue University. "Roughly after age 35, both men and women start to lose bone at a slow rate of one to two percent per year. This bone loss is accelerated in women around and after menopause to about five percent per year for five to seven years, and then the bone loss in women returns to a baseline of one to two percent per year. Men don't go through the accelerated menopausal bone loss but continue to lose bone at the rate of one to two percent per year," says Primal Kaur, M.D., director of the Osteoporosis Clinic at Temple University School of Medicine in Philadelphia.

Is osteoporosis mostly a female problem?

It's true that osteoporosis is less common in men than women, because men start out with more bone density than women and do not go through menopause, which accelerates bone loss, says Rao. But after age 65, men and women lose bone at the same rate. By age 75, one-third of men have osteoporosis as do a third of women.

What is the bone-calcium connection?

"Calcium [which is, incidentally, the most abundant mineral in the body] is the material that gives bone strength, much as bricks do for a building, but the bones need an underlying structure of proteins that are special for bone to hold on to the calcium," according to Ruth Freeman, M.D., professor of medicine at Albert Einstein College of Medicine Montefiore Medical Center. "Basically, there are two types of cells active in bone--one, the osteoclast, makes pockets in the bone, chewing it up so that good bone can replace any damaged bone. The second type, the osteoblast, comes in and fills in the bone pockets that the osteoclast created. Over about 10 years' time all bone is replaced to remove little damaged areas. But after age 40 the osteoblasts don't adequately refill the pockets created by the osteoclast, so there is a net loss of bone. Anything, therefore, that speeds up turnover of bone, like loss of estrogen, will increase the loss of bone in people who are over age 40."

What is the link between estrogen and bone health?

Estrogen is important in maintaining bone mass in adult women; in part it slows bone remodeling (replacing old bone with new bone). And while bone remodeling is normally a good thing, it takes place over weeks and months. Therefore, it leaves a woman more susceptible to bone fracture—estrogen helps to slow this process down. So basically, the estrogen maintains the proper balance between the activity of bone-forming cells (i.e., osteoblasts) and bone-resorbing cells (i.e., osteoclasts).

Are low-fat dairy products much higher in calcium than whole-milk products?

Not significantly so. There is slightly more calcium in skim milk because the fat has been removed, leaving more room for other components of the milk and, therefore, more calcium.

How much calcium do I need?
1-3 years of age: 500 mg
4-8 years: 800 mg
9-18 years: 1,300 mg
During pregnancy & lactation: 1,000–1,200 mg
Adults: 1,000 mg
Post-menopausal women on hormones: 1,200 mg
Post-menopause without hormones: 1,500 mg

What are the main sources of calcium in our diet?

Certainly dairy, but make sure to go with low-fat or fat-free versions of yogurt, cheese and milk. Nondairy sources include soybeans and tofu, bok choy (Chinese cabbage), broccoli and green, leafy vegetables such as collards, kale, mustard greens and turnip greens. Salmon and sardines canned with their soft bones are good sources, as well as shellfish, almonds, Brazil nuts and dried beans.

  • Milk, nonfat, 1 cup, 302 mg calcium
  • Yogurt, plain, low-fat, 1 cup, 300 mg calcium
  • Baked beans, 1 cup, 142 mg calcium
  • Cottage cheese, 1 percent milk fat, 1 cup, 138 mg calcium
  • Broccoli, raw, 1 cup, 90 mg calcium
  • Tofu, (processed with a calcium salt solution), ? cup, 138 mg calcium

Check out this source, which provides a helpful calcium calculator:

www.cdc.gov/powerfulbones/parents/toolbox/calculator.html

Do spinach and peanut butter deplete calcium absorption?

They do not "deplete" calcium absorption; however, they contain oxalate or oxalic acid, both of which combine with calcium to form calcium oxalate and thus prevent its absorption, says Kaur. In fact, "Calcium in spinach is absorbed at a very low efficiency (about five percent) compared to 30-60 percent absorption of calcium from other sources," adds Teegarden.

What about the link between soft drinks (diet and regular) and poor bone health?

One of the biggest problems is that soft drinks replace intake of milk, which is a good source of calcium. Additionally, carbonated drinks have a high phosphate content, "which binds calcium in the bowel and reduces the absorption," says Freeman. Phosphate also forms acid in the bloodstream. "Calcium is then released from the bone to maintain the calcium-phosphate balance and to counteract the acid in the bloodstream," says Kaur.


CHARLES STUART PLATKIN is an Active Expert ,?nutrition and public health advocate, author of the bestseller Breaking the Pattern (Plume, 2005), The Diet Detective's Count Down (Simon & Schuster, 2007) and founder of Integrated Wellness Solutions. Sign up for the free Diet Detective newsletter at www.dietdetective.com.

Copyright 2007 by Charles Stuart Platkin

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