Download Calcium - European Food Safety

Nutrition and Osteoporosis
Alice Henneman, MS, RD
Lancaster County Extension Educator
Linda Boeckner, PhD, RD
Extension Nutrition Specialist
University of Nebraska Cooperative Extension
Institute of Agriculture and Natural Resources
June 2001
University of Nebraska Cooperative Extension educational programs
abide with the nondiscrimination policies of the University of Nebraska and the
United States Department of Agriculture
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.
Comments from a 70+ year
old woman with osteoporosis
“I’ve lost six inches in height and
none of my clothes fit me
anymore. Plus, it’s hard to get
clothes that look nice when my
back is so hunched over.”
Comments continued
“It seemed like it took forever for
my bone to heal when it broke. I
don’t want that to happen again.
It’s so frustrating always worrying
about falling.”
Comments continued
“If somebody had told me sooner
what I know now about
osteoporosis, none of this might
be happening to me!”
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
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
4 Prevention Steps (NOF)
2. Weight-bearing
exercise
4 Prevention Steps (NOF)
3. Healthy lifestyle
with no smoking
or excessive
alcohol use
4 Prevention Steps (NOF)
4. Bone density
testing and
medications when
appropriate
Osteoporosis is preventable
for most people!
• Start building
healthy bones
while young
• Healthy diet and
lifestyle are
important for
BOTH men &
women
Today’s presentation . . .
• 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
Using food/supplement labels
to assess calcium intake
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 Nutrition Facts label
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
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
Percent Daily Value (DV) for
calcium in common foods*
*Approximate % DV
for foods based in
part on information
provided in: “Calcium!
Do You Get It?” by
U.S. FDA/CFSAN
% DV calcium:
Grain products group
calciumfortified
cereal
• Ready-to-eat
cereal, calciumfortified. 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,
calcium-fortified;
1 cup = 30% DV
% DV calcium:
Milk group
• Yogurt; 8 oz. = 35% DV
• Milk, whole, 2%, 1%, skim,
chocolate; 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.
Additional dietary concerns
Concerns:
Food is best calcium source
• There may be
other factors found
in calcium food
sources that also
affect absorption
and utilization by
the body
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 lactoseintolerant 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 lactoseintolerant person
• Start with small
portions of foods
such as milk and
gradually increase
serving size
Help for the lactoseintolerant person
• Eat dairy foods in
combination with a
meal or solid foods
Help for the lactoseintolerant 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 lactoseintolerant 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
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.
Calcium supplement
considerations
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-thecounter 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
Putting it all together
• Consider also:
 Other dietary factors
 Weight-bearing exercise
 A healthy lifestyle with no
smoking or excessive alcohol
use
 Getting recommended bone
density tests and medications
when appropriate
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
For More Information
• National Osteoporosis Foundation
www.nof.org
• Strong Women, Strong Bones by
Miriam Nelson, Ph.D.
Further questions?
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
Support your bones.
They support you.
-
Massachusetts Osteoporosis
Awareness Program