Healthy bones and keeping bone loss at bay!

I am giving a talk this month (10th May) in Eastbourne, to local members of the Osteoporosis Society. Nutrition and bone health is a vast subject, but there are always concerns and questions about calcium, and other nutrients that we need for health bones...

Being informed about bone health and how to keep your bones strong is more important than ever before. Osteoporosis is a worry for many, and although there are more women sufferers than men, it is not a disease totally confined to females. To be precise, in the UK, I in 3 women over the age of 50 suffer from osteoporosis, compared to 1 in 9 men. This immediately tells us that the hormonal differences in the sexes are highly involved, but there are also many other factors that determine the development and presentation of this bone-thinning disease.

So what is “Osteoporosis”?

What is Osteoporosis...

Well, as I have just mentioned, it is literally a “thinning” of bones, or to be more technical – a loss of bone density. The density of bone refers to the amount of bone in a particular area (e.g. the hip or lower spine). Bone mass, on the other hand, refers to the total amount of bone in the whole body. When we lose bone density, it usually occurs in “trabecular” bone, which is the spongy framework in the middle of many bones (legs and arms, as well as the spine), rather than from the cortical bone, which is the hard outer layer of bone. Trabecular bone renews every 2-3 years, whereas cortical bone renews every 10-12 years – quite a difference. Bone is made up of bone protein in the form of collagen, calcium crystals, magnesium and phosphorous – which helps us to appreciate the nutritional connection to bone turnover (i.e. breakdown and renewal), and long-term bone health. Understanding what actually “makes” and builds bone will also help many to realise that its not just calcium that is important to the health and strength of the bones… if only it were that simple! There are at least 17 other essential nutrients needed for healthy bones, including magnesium, zinc, manganese, boron, silicon, copper and phosphorus. The most important bone-building vitamins are D, C, A, B6, K, folic acid and pantothenic acid (B5). Vitamin D serves as the “key” to calcium absorption, and also works with the kidneys to help resorb calcium that otherwise would be excreted. By the way, we also need adequate stomach (hydrochloric) acid to properly absorb calcium, and other minerals.

Losing bone and restoring bone is under the tight control of 2 bone hormones – calcitonin and parathyroid hormone. Calcitonin inhibits osteoclasts (bone cells that dissolve bone), and stops the release of calcium from the bones – a process that can also be heavily influenced by the diet. Parathyroid is stimulated when blood calcium and magnesium levels fall, and acts on the osteoclasts to release calcium from bone to make up the deficit in the blood. Parathyroid also activates Vitamin D, in order for you to absorb more calcium from food – hence why Vitamin D is crucial to bone health. BUT… if there is not enough vitamin D stored in the body, or in the diet AND not enough calcium in the diet, the body struggles to maintain calcium homeostasis, pulling calcium out of the bones.
The bone renewal process also makes use of the sex hormones, oestrogen, progesterone and testosterone. Oestrogen stimulates calcitonin, which builds bone, as well as helps to stop production of parathyroid, which removes calcium form bones. Testosterone stimulates the osteoblasts (bone formation cells) as well as stimulating an enzyme that forms calcium crystals in the bone – one reason why men tend to have denser, thicker bones than women.

Risk factors for osteoporosis
Several risk factors are associated with developing osteoporosis, but remember that there are lots of things you can do to reduce your risk and strengthen bones with some dietary and lifestyle changes.
Genetics is always a factor in development of any disease or condition, and there are a few genes that have been identified as key players in osteoporosis. Asians and those of European descent are immediately at greater risk than Caucasians, but interestingly, African women are relatively immune to osteoporosis, due possibly to higher oestrogen levels!
Smoking increases a person’s risk, as does heavy alcohol and caffeine intake. Taking certain medications long-term can also leave you more susceptible. Medications to watch out for include corticosteroids such as Prednisolone and Hydrocortisone, Heparin, diuretics and laxatives that increase loss of calcium and magnesium from the body, thyroid medication and antacids. Hormonal factors that heighten risk include being post-menopausal, having an early menopause, having erratic, irregular or no periods, and also never having children.
Chronic malabsorption problems, as seen in Coeliac or Crohn’s disease affects absorption of nutrients needed for general health, and unsurprisingly, bone health can also compromised.
Probably, “THE ONE” lifestyle factor that is guaranteed to “eat away” at your bones is STRESS!
High cortisol levels can upset many bodily processes leading to disease, and bone metabolism is no exception. Cortisol is a glucocorticoid – i.e. a steroid hormone. High levels of steroid hormones (whether via drug therapy or via the body’s own production) increase bone resorption or loss of bone. Cortisol also stops the osteoblasts from building bone, as well as upsets the working of vitamin D, hampering the absorption of calcium from the gut. Another critical point to make here is that stress interferes with the normal functioning of the ovaries in women, which over time, will lead to a disrupted menstrual cycle.

If you are worried or concerned that you may have one or more risk factors associated with osteoporosis, visit your GP, who will organise a screening for you. You will also want to look closely at your diet…

Eating for strong bones...

As I have already mentioned, there are numerous vitamins and minerals necessary for optimal bone health, so a fresh, healthy and varied diet full of wholegrains, fruit and vegetables is crucial.
Calcium, as we know, is very important… after all 99% of calcium in the body is located in the bones. However too much, and the body will lose it in the urine, or worst of all, it will be dumped in tissue, causing either calcification in joints or arteries. Recommended daily intakes across the globe range from 700mg–1200mg, and somewhere within these figures would lie most people’s bodily needs – whether male, female, young, old, active or non-active. Obviously very young children don’t need quite this amount – for instance a 4 year old needs about 450mg.
Magnesium is just as important as calcium for bone health, as not only does it help metabolise calcium, it also happens to be the next most abundant mineral in bone – 60% of the body’s supply is found in the skeleton. Magnesium also works with Vitamin C and Vitamin D, and is needed to maintain normal levels of an important enzyme (alkaline phosphatase), which indicates that your bones are renewing adequately. The best dietary sources of magnesium include green leafy veg, figs, lemons, nuts, seeds, chickpeas, oats and brown rice.

You are probably wondering how this sort of information equates in food terms, so I will give you an idea of a simple day’s food intake that can easily meet your calcium and magnesium requirements.

Breakfast – A bowl of Muesli, almond milk and plain yogurt
Snack – A pear and a small handful of almonds
Lunch – Chick pea dahl, green salad with tomato and cucumber and a slice of rye bread
Snack – An apple and 2 dried figs
Supper – Tinned salmon with a vegetable stir-fry and brown rice

The Acid: Alkaline balance
Once food has been digested, it leaves an “ash” in the stomach, which is absorbed into the body. This can either be acid or alkaline based. One of the roles of calcium in the body is to act as a neutraliser. A diet that is high in acid or acid-forming foods causes the body to call upon calcium to fulfil the role of “acid neutraliser”. It is the calcium reserves in the bone that are used to effectively neutralise the blood. So… for many of us, we may actually be losing more calcium than we are getting from the diet OR from supplements. It is also worth noting that as we age, the body’s ability to get rid of acid decreases, so we become more acidic as we get older. An overly acidic body has been linked to many disease states such as heart disease, arthritis and, of course, osteoporosis. It can also age you!
One of the most highly acid-forming substances is protein, particularly red meat and cheese. Sugar too is also very acidic.

The 80:20 rule is good to go by here…
80% of the diet wants to be based around alkaline-foods such as vegetables, fruits, some grains (quinoa, buckwheat and millet are most alkaline), and sprouted seeds and beans. Spinach is the only vegetable to watch, as it is high in oxalic acid, which can block calcium absorption.

Only 20% of the diet ideally should contain the more acidic foods such as fish, eggs, nuts, seeds, beans and other grains (e.g. brown rice and oats). Adding fresh fruit or raisins to oats can increase the alkaline content of the dish, and serving veggies with fish or eggs can also help to offset the acidity of a meal. Limit your dairy, especially cheese, and choose organic live yogurt, and milk.

Foods NOT conducive to healthy bones
Caffeine – causes calcium loss in the urine, and lowers calcium absorption in the gut so watch the amount you have.
Sugar and sugary foods – too acidic so avoid!
Red meat and cheese – moderate amounts of protein are fine, as long as you are balancing these foods with plenty of vegetables! Choose fish, nuts, seeds, tofu, beans and eggs
Alcohol – lowers the activity of the bone-building cells, so just be sensible.
Fizzy drinks – avoid these like the plague! They are very high in phosphoric acid which leaches calcium from bones and teeth - a quick ticket to weak bones.

The more unusual foods beneficial to bone health!
Dandelion is a rich source of boron, which helps to raise oestrogen levels in the blood, and in turn helps preserve bone. It is also a rich source of calcium and a fair source of silicon, which some studies suggest helps strengthen bone. Drink Dandelion tea or dandelion root coffee, which is also high in beta-carotene.
Alfalfa – sprouted alfalfa is easy to grow indoors and makes a wonderful salad, sandwich or stir-fry ingredient. Alfalfa is rich in minerals and is thought to be a great blood cleanser!
Flaxseeds – or linseeds to the English! Taking 1-2 tablespoons of ground linseeds daily has to be one of the healthiest dietary changes/additions you can make. Linseeds are rich in lignans and isoflavones, so especially therapeutic for women with hormonal upsets or simply to maintain good female health. The soluble fibre in flaxseeds promotes regular cleansing of the colon and daily elimination.
Tofu – soya bean curd is an alkaline food, so very bone-friendly. It also happens to be a very good source of calcium!
Sea vegetables such as Nori, Wakame or Arami – gram for gram, seaweeds have the highest calcium content of any other food. They are so easy to add to a general diet… some need soaking, some not. You can make your own sushi rolls using Nori sheets, add Nori flakes to salads or even scrambled eggs, or simply add seaweed strips to salads or stir-fries. Algaes taken in supplement form are also good for bone health as they contain an array of minerals – look for spirulina or chlorella.
Cider vinegar – although acid in nature, cider vinegar can increase calcium absorption from foods! It also balances potassium levels, which has an alkalising effect, so paradoxically, it is excellent for the bones!

A lot of the above information is contained in Marilyn Glenville’s new book called “Osteoporosis the silent epidemic”. I highly recommend this to anyone who wants to read more on the subject.

Tips and recipes…
Some bone-building ideas for you!

Breakfast:
4 oz of homemade muesli (organic oats, millet & rice flakes, raisins and a mixture of almonds, walnuts and hazelnuts, with sunflower and pumpkin seeds) that is best soaked overnight in a mixture of fresh lemon juice, a tsp of honey and a little hot water.
Add 2 chopped dried figs and top with 150g pot of soya yogurt or plain live Bio yogurt
Serve with calcium fortified soya milk (e.g. Alpro), or try semi-skimmed goat’s milk
1 cup of Indian tea (high in Mg) or green tea
(The above breakfast contains approx 730mg calcium and 560mg magnesium!)

Lunch or supper:
Quick Salmon Stew
Chunky vegetables and green vegetables such as courgette, brocolli and spinach, tinned tomatoes, garlic, fresh herbs and tomato puree and 1 large tin of pink or red salmon. Cut or slice the veggies, and simmer with all the other ingredients. Serve with Parmesan cheese or grilled goat’s cheese.
OR…

Grilled tofu, onion, mushroom, red & green pepper and tomato kebabs
Cut a block of tofu into cubes (100g per person), and “skewer with large chunks of the other vegetables”. Brush will olive oil and tamari sauce and place under a medium hot grill for 10-15 mins, turning frequently.

Make a large bowl of “Tabbouleh” by soaking (or boiling) bulghar wheat in hot water – 1 part bulghar to 2 parts water. Add chopped fresh tomatoes, lots of finely chopped fresh parsley, lemon juice and olive oil. Serve with a large mixed salad, drizzled with flaxseed oil & balsamic vinegar.
For dessert, try a little Greek style yogurt and stir in some honey and lemon juice!

Comments

[Beryl Whiting]

Hi Lucy-Ann and Claire and thank you so much for this fascinating article on Osteoporosis. It is a subject that interests me particularly as I am a yoga teacher and work with students on exercises to increase bone density. I am not prepared to accept the statement often quoted by mainstream medicine that it is impossible to build up bone density after 35 years of age. The eating plan you suggest is inspiring and much more helpful than the standard 'drink milk' advice.

[Lucy-Ann Prideaux]

Thank you for your comments Beryl... I hope you will make use of the food ideas and suggest them to your clients. There is a lot we can do to protect our bones via diet and lifestyle change!

[Rose]

Great article. It is always helpful to know that we can turn things around with osteoporosis--with the correct information. A great book to read is: What Your Doctor May Not Tell You About Menopause, by John R. Lee M.D.