Adult Gastroenterology Associates
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Osteoporosis Diet Purpose Calcium is essential to the body. It is the most common mineral in the body and is required for proper functioning of most organs, such as the heart and brain. It is particularly needed in the normal development of the bones and teeth. Osteoporosis is a bone disease where calcium leaves the bones, causing them to weaken. There are many things that help to cause osteoporosis. Not getting enough calcium in the diet is an important one. Osteoporosis is most likely to occur with increasing age, especially after the age of 45. Both men and women can develop it. Women, however, usually eat less, so they take in less calcium throughout their lifetimes. They have smaller bones than men, and the loss of the hormone estrogen after menopause speeds up the loss of bone. Because of these differences, women are six times more likely to develop the disease than men. Thin women and women who have never borne children are more at risk. The disease is also more common in whites than in blacks. Other things that may contribute to osteoporosis are lack of exercise, cortisone or steroid use, genetic factors, cigarette smoking, heavy alcohol use, and certain diseases. Nutrition To prevent osteoporosis, it is very important to maintain a nutritionally balanced diet which includes adequate calcium intake. A nutritionally balanced diet also includes the proper amounts of other vitamins and minerals to help the body absorb calcium. Low calorie diets are often also low in calcium. It is difficult to meet the recommended dietary allowance (RDA) of calcium and vitamins in diets of 1200 calories or less. Special Considerations Vitamin D is necessary for absorption of calcium. It is formed by the body when the skin is exposed to sunlight (ultraviolet light). For those who avoid exposure to sunlight and for black people who are protected from ultraviolet light by skin pigment, vitamin D fortified milk or a vitamin D supplement may be necessary. Phosphorus is a mineral people get from eating protein rich foods such as meat and milk. Some soft drinks, such as colas, also contain phosphorus. While phosphorus is needed to form bones and teeth, medical studies have shown that too much phosphorus in the diet may upset the calcium balance in humans. A good guide is not to go over twice the RDA of protein, and to limit the intake of carbonated beverages. Fiber should be part of a healthy diet. There are certain types of fiber that can affect the amount of calcium the body absorbs. Rhubarb, spinach, chard, and beet greens contain oxalate, which may decrease the absorption of calcium. Phytic acid, found in wheat bran, combines with calcium and also decreases its absorption. Fiber, however, is very helpful to the digestive tract, so it is important to balance the level of calcium intake with the amount and type of fiber in the diet. A diet containing up to 35 grams of fiber per day should be adequate for healthy bowel movements, without adversely affecting calcium absorption. Caffeine increases the loss of calcium through the kidneys and intestines. While a moderate amount of caffeine per day (300-400 mg) has only a small effect, more caffeine may cause a much greater loss of calcium. Therefore, avoid drinking more than three cups of regular coffee or other high caffeine beverages a day. Excessive alcohol intake may lead to loss of calcium in the bone. Poor nutrition is often related to abuse of alcohol. It has also been shown that alcohol has a toxic effect on the formation of bone cells. Do not have more than one or two drinks per day. One drink would be 12 oz of beer, 5 oz of wine, or 1.5 oz of 80 proof distilled spirits. Lifestyle can have an effect on the risk of developing osteoporosis. Cigarette smoking increases bone loss, and it may cause lower estrogen levels. Regular exercise, including moderate weight-bearing exercise, helps prevent bone loss and increases the total amount of bone in the body. This is especially important for the elderly who tend to become sedentary. Examples of weight-bearing exercises include walking, cross-country skiing, jogging, aerobic dancing, and weight-training. The use of estrogen replacement therapy is very helpful for women who are no longer producing estrogen. Estrogen replacement must be prescribed by a physician. Food sources of calcium include milk and dairy products, which are the best sources of absorbable calcium. About 25% to 35% of the calcium in dairy products is absorbed in normal healthy people. Dark green leafy vegetables also contain moderate amounts of calcium, but their content of oxalate and fiber may cause less of the calcium to be absorbed. Whole grain flours contain more calcium than milled white flours; however, whole grain flours contain more fiber and phytic acid. Fish and tofu (processed with calcium) are also good sources of calcium. Foods such as orange juice, breakfast cereals, breads, milk, and yogurt are often fortified with calcium. Product labels should be checked for the amount of calcium the foods contain. Calcium supplements may be necessary to get adequate calcium intake. A physician or registered dietitian should be consulted about the need for calcium supplements. Several different forms of calcium supplements are available. Calcium carbonate is generally recommended because it contains the highest percentage of absorbable calcium, 40%. Calcium citrate is 21% calcium; calcium lactate is 13%; and calcium gluconate is only 9% calcium. Bone meal and dolomite are not recommended because they may contain toxic substances such as lead, mercury and arsenic. Chelated calcium is expensive and has no advantage over other forms. Long-term ingestion of excessive amounts of calcium can lead to unhealthy side effects, but taking 1000 mg to 2000 mg of calcium a day should not produce any serious problems. Recommended Dietary Allowance for Calcium       Category Age RDA (mg) Children 1-5 6-10 800 800-1,200 Adolescents/Young Adults 11-24 1,200-1,500 Male Adults 25-64 65+ 1,000 1,500 Female Adults 25-49 50-64 (on estrogen) 50-64 (not on estrogen) 65+ 1,000 1,000 1,500 1,500 Pregnancy/Nursing   1,200-1,500 Calcium Content of Some Commercial Calcium Supplements SUPPLEMENT Calcium Carbonate (MG) PER TABLET Tums™ Calcium Rich Rolaids™ TumEx™ Extra Strength Rolaids™ Titralac™ (liquid, 1 tsp) Os-Cal 500 Caltrate™ 600 200 220 300 400 400 500 600 Calcium Lactate   Formula™ 81 81 Calcium Citrate   Citracal™ 200 200 Food Sources of Calcium High Calcium Foods mg Foods With Less Calcium mg Lowfat Yogurt, 1 cup 345-415 Regular Tofu, 1/2 cup 108 Sardines, 7 322 Instant Nonfat Dry Milk, 2 Tbsp 105 Skim Milk, 1 cup 302 Almonds, 1/4 cup 94 2% Milk, 1 cup 297 Cooked Kale, 1/2 cup 90 Gruyere Cheese, 1 oz 287 Chicken Taco, 1 87 Salmon, 5 oz 278 Cooked Mustard Greens, 1/2 cup 75 Firm Tofu, 1/2 cup 258 Turkey Frankfurter, 1 58 Frozen Yogurt, 1 cup 240 Medium Orange, 1 52 Cheddar Cheese, 1 oz 204 Baked halibut, 3 oz 51 7" Homemade Waffle, 1 179 Cooked Broccoli, 1/2 cup 47 Vanilla Ice Cream, 1 cup 176 Fig Bar Cookie, 4 40 American Cheese, 1 oz 174 4" Frozen Waffle, 1 28 Cooked Rhubarb, 1/2 cup 174 Cream Cheese, 2 Tbsp 23 Ricotta Cheese, 1/4 cup 167 Whole Wheat Bread, 1 slice 20 Instant Oatmeal, 3/4 cup 163 Cooked Oatmeal, 1 cup 20 2% Cottage Cheese, 1 cup 155 Half & Half Cream, 1 Tbsp 16 Baked Custard, 1/2 cup 149 Baked Chicken Breast, 3 oz 14 Pudding, 1/2 cup 146 Medium Apple, 1 10 Blackstrap Molasses, 1 Tbsp 137 Cooked Pasta, 1 cup 10 Frozen Cooked Spinach, 1/2 cup 122 Lean Ground Beef, 3 oz 9     Medium Banana 7 Sample Menu Breakfast Lunch Dinner grapefruit 1/2 dry cereal 3/4 cup banana 1/2 cup whole wheat toast 2 slices margarine 2 tsp jelly or jam 1 Tbsp skim milk 1 cup coffee/tea vegetable soup 1 cup lean hamburger patty 2 oz hamburger bun sliced tomato 2 oz lettuce with dressing 1 Tbsp fresh fruit salad 1/2 cup oatmeal cookie 1 fruit punch 1 cup tomato juice 1 cup broiled chicken breast 2 oz herbed brown rice 1/2 cup broccoli spears 2 cheese sauce 1/4 cup hard dinner roll 1 margarine 1 tsp carrot/raisin salad 1/2 cup frozen strawberry yogurt 1/2 cup skim milk 1 cup This Sample Diet Provides the Following Calories 2120 Kcal Fat 54 gm Protein 84 gm Sodium 3130 mg Carbohydrates 326 gm Calcium 1200 mg