Friday, January 21, 2022

NUTRITION FOR BONE HEALTH

 



Bone mass increases from birth until it reaches its maximum, known as peak bone mass, which occurs for cortical bone at age 30 to 35 and earlier for trabecular bone. Approximately 40% of adult bone mineral content is accumulated in adolescence.

After age 40, age-related bone loss occurs due to a slow loss of cortical bone in both sexes. At menopause, women lose cortical bone at a rate of 2 to 3% per year, which is superimposed upon the age-related loss.

While osteoporotic changes are commonly thought to begin with menopause, in many women half of the total vertebral (trabecular) bone loss occurs before menopause.

The cumulative lifetime losses of bone mass range from 20 to 30% in men to 40 to 50% in some women.

 

Diet:

A high dietary intake of fruits and vegetables - 5 or more servings per day. A Mediterranean type diet is one of the best to eat. Daily consumption of dairy products (Calcium + vitamin D), fruit and vegetables (anti-oxidants and phytoestrogenes) , with fish meals (Calcium + vitamin D+protein + n-3 fatty acids) several times/week. Combined with daily outdoor activities providing sun exposure (vitamin D) and physical training (bone and muscle strength) will most likely build bone strength throughout life and reduce the fragility fracture risk in the elderly.

Limit protein intake to one gram of protein per kilogram of body weight (I kg equals about 2.2 lbs.), which translates into around two to three ounces of protein (equivalent to one chicken breast) daily for the average woman. High animal protein diet and salt and sugar intake cause the body to excrete increased amounts of calcium.

Avoid:

Excess phosphorus and phosphate-containing foods and drinks, such as soda and alcohol. Wheat bran, raw spinach, fructose (as in high-fructose corn syrup in soft drinks), caffeine, salt, alcohol, and tobacco can all interfere with calcium absorption.

Eat:

Avocado, broccoli, cabbage, chestnuts, clams, dandelion greens, eggs, most dark green leafy vegetables, flounder, hazelnuts, kale, kelp, molasses, oats, onions, oysters, parsley, salmon, soy products, tahini, tofu, turnip greens, and wheat germ.

Supplements:

Experts and research recommend supplementation of the average American diet for vitamin D, calcium, magnesium, silicon, vitamin K, and boron. The following supplements are suggested but are not prescriptions.


Calcium: 800-1200 mg per day (levels greater than 2,500 mg/day are not recommended)

Absorbability of calcium supplements varies considerably, but it is thought by some that the most absorbable type of calcium is microcrystalline hydroxyapatite compound (MCHC). The second most absorbable is calcium citrate, which is not made from animal bones. Bone meal contains absorbable forms of calcium, but it may be contaminated with lead. Calcium carbonate should be taken with meals, as this form of calcium needs a lot of acid (hydrochloric acid produced by the stomach or as a supplement) for absorption.  Calcium chloride is irritating to the gastrointestinal tract. Other good forms of calcium are calcium aspartate, calcium succinate, and calcium malate.

Some early studies show that microcrystalline hydroxyapatite compound (MCHC) has prevented bone loss and the progression of osteoporosis

The highest bone resorption occurs during the night and reaching a peak at 7 a.m. It is therefore appropriate for a large proportion of calcium supplements to be taken at night.

Those persons who have already had a kidney stone and who have absorptive hypercalciuria should not take excess calcium. And those taking the drug Digoxin, also known as Lanoxin, should avoid high doses of calcium ascorbate If you are taking Thyroid hormone, anticoagulant drugs, or diuretics, consult your prescribing physician before taking any calcium supplements.

Calcium absorption is also increased by the parathyroid hormone, vitamin A, vitamin D, and the amino acids lysine and arginine. Taking a calcium supplement with vitamin C can significantly increase calcium absorption. Magnesium, phosphorus, boron, selenium, iron, manganese and vitamin E are also important for calcium metabolism.


Boron: (3 mg. maximum)

Studies have shown that 3 milligrams (mg) of boron daily reduces urinary excretion of calcium and magnesium, especially when dietary magnesium is low (note: if you are taking a calcium complex containing boron, omit this supplement).


Vitamin D: (400 IU)

To ensure adequate calcium absorption, a daily intake of 400-600 IU of vitamin D is recommended, either through sun exposure or through diet or supplementation.

 

 Magnesium: (400-600 mg.)

For each 100 mg of magnesium, take 200 mg of calcium, as this ratio increases the amount of magnesium the body can use. Those with kidney problems should not exceed 3000 mg of magnesium a day. People who consume even moderate amounts of alcohol or use proton pump inhibitors may have increased loss of magnesium in the urine and may benefit from a supplement.


Ipriflavone: (600 mg.)

Similar to the isoflavonoids found in soy foods. This helps bone resorption.

 

 

References:

Price CT, Langford JR, Liporace FA. Essential Nutrients for Bone Health and a Review of their Availability in the Average North American Diet. Open Orthop J. 2012;6:143-149. 

Palacios, Cristina. (2006). The Role of Nutrients in Bone Health, from A to Z. Critical reviews in food science and nutrition. 46. 621-8.

Rizzoli R, Biver E, Brennan-Speranza TC. Nutritional intake and bone health. Lancet Diabetes Endocrinol. 2021 Sep;9(9):606-621. doi: 10.1016/S2213-8587(21)00119-4. Epub 2021 Jul 6.

T. Cederholm, 13 - Nutrition and bone health in the elderly, Editor(s): Monique Raats, Lisette de Groot, Wija van Staveren, In Woodhead Publishing Series in Food Science, Technology and Nutrition, Food for the Ageing Population, Woodhead Publishing, 2009, Pages 252-270, ISBN 9781845691936,




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