Avoid these diet pitfalls to protect your bones and prevent osteoporosis
By Natasha Persaud
As many as 34 million people in the United States are estimated to have low bone mass, according to the National Osteoporosis Foundation. Women are particularly at risk. The good news is, for most people, osteoporosis is largely preventable.
Are you getting as much calcium and other bone-healthy nutrients from your diet as you think? Check out the following myths and facts, and find out.
1. Myth: Only people with high blood pressure need to watch their salt (sodium) intake.
Fact: "In addition to raising blood pressure, excess sodium causes calcium loss that may weaken bones," says Felicia Cosman, M.D., clinical director of the National Osteoporosis Foundation. "Although we can usually make up for these losses with adequate dietary and supplemental calcium, it’s wise to avoid excess sodium." And most of us—a whopping 9 in 10 American adults, according to the Centers for Disease Control and Prevention (CDC)—are consuming much more than a healthy limit of 2,300 mg of sodium a day (if you have high blood pressure, are older than 40, or are African American, that limit is 1,500 mg a day).
What's pushing us over the edge? The top culprits are restaurant meals (including take-out) and processed foods, according to the CDC report.
To kick the salt habit, follow these tips:
- When you eat out, choose an entrée from the low sodium menu or ask to have your meal prepared with little or no salt. Also, ask for sauces and dressings on the side.
- When buying groceries, limit high sodium items such as condiments (e.g., catsup, salad dressings, etc.), frozen meals, canned vegetables, smoked meats, pickled and brined foods, tomato sauce, soups and prepared mixes. Note: Some low-fat products that seem healthy actually contain extra sodium as a flavor enhancer to replace fat. Before you put an item in your cart, check the sodium content on the nutrition label in the back.
- When cooking at home, use less salt and more herbs and spices to add flavor.
2. Myth: Drinking cola is okay.
Fact: When it comes to your bone health, it's best to avoid colas entirely or reduce your consumption to less than one cola daily. "Emerging research shows that there is something in colas specifically, perhaps the phosphorus or more likely some other substance, that harms bone," says Dr. Cosman. At mealtime, opt for water with a twist of lemon or fruit or vegetable juice.
3. Myth: Spinach is a good source of calcium.
Fact: While you may have heard that dark leafy greens provide some calcium, spinach, rhubarb and beet greens are among the exceptions. "They contain high amounts of a substance called oxalate that interferes with calcium absorption," says Dr. Cosman. "Of course, these vegetables are nutritious in other ways, so continue to eat them." But if you're looking to increase your calcium intake, have your spinach salad with tofu (fortified with calcium), low-fat mozzarella or beans. You body can absorb calcium from many other vegetables—such as cabbage, cauliflower and Brussels sprouts—so get your fill.
4. Myth: Adding milk to coffee and tea is a good way to sneak in more calcium.
Fact: The caffeine in coffee and tea might actually prevent some calcium absorption, though the effect is not major, says Dr. Cosman. Adding milk can contribute toward your daily intake, she says. The bottom line: Continue to enjoy your morning cup of joe, but don't overdo it. Also, have a glass of milk or orange juice fortified with calcium and vitamin D.
5. Myth: 100% bran cereal with a 1/2 cup of milk provides lots of calcium.
Fact: Although a calcium-rich breakfast, cereals that contain lots of bran may be providing less calcium than you think it is. "100% wheat bran might reduce the absorption of calcium in other foods that are eaten at the same time," says Dr. Cosman. "That's probably because it's high in both phytate and fiber, two substances that impair calcium absorption." A simple fix: Add more milk to your cereal.
6. Myth: Soaking dry beans reduces their nutrients, including their calcium content.
Fact: Not so. Legumes, such as pinto beans, navy beans and peas, are high in phytate, which lowers the body's ability to absorb calcium. But you can reduce phytate levels by soaking dry legumes in water for several hours; discarding the water, rinsing them, and then cooking them in fresh water.
7. Myth: For stronger bones, eat more meat.
Fact: Eating more meat is good for some people, bad for others, says Dr. Cosman. The young and very old may need extra protein from meat, as well as dairy products, to make and repair bone. But the vast majority of us in the middle years are probably getting far more protein from meat than we need. "Aim to get more protein from dairy and plant food sources, rather than meat," she says. "And consume more produce. According to emerging research, fruits and vegetables may neutralize acids produced by meat proteins that weaken bone."
8. Myth: A 500-mg calcium supplement contains 500 mg of calcium.
Fact: Not necessarily. In nature, calcium exists in combination with other substances in what is called a compound. Supplements, for example, contain calcium carbonate, calcium citrate, calcium lactate or calcium phosphate.
"What you need to know is how much elemental calcium your supplement contains," says Dr. Cosman. Check the nutrition facts label in the back, and look for the amount of calcium per serving. "Make sure you check the serving size so that you can figure out how much calcium is in each pill." Another tip: Look for supplements with the USP (United States Pharmacopeia) label.
The National Osteoporosis Foundation recommends adults under 50 get 1,000 mg of calcium daily from foods and supplements to maintain bone mass and prevent bone losses; if you’re over 50, get 1,200 mg. For better absorption, take your calcium supplement with food.
9. Myth: To protect your bones, it's all about getting enough calcium.
Fact: While calcium is very important, a variety of vitamins and minerals contribute to bone health. "Vitamin D, magnesium, vitamin K, vitamin B6 and vitamin B12 are some of the many minerals and vitamins that are important for maintaining bone strength and preventing losses," says Dr. Cosman.
Vitamin D plays a crucial role. "You need vitamin D in order to metabolize calcium in the body," explains Dr. Cosman. Only a few foods naturally contain vitamin D, including egg yolks, saltwater fish and liver, although some foods, such as milk, are fortified with vitamin D. Your body can also produce vitamin D through sunlight. But most people don't get enough sun exposure to produce adequate vitamin D. One reason: Sunscreen dramatically reduces the amount of vitamin D your skin makes through sunlight exposure. (But it's still important to wear sunscreen.)
For these reasons, taking a vitamin D supplement is your best bet, according to Dr. Cosman. The National Osteoporosis Foundation recommends that adults under 50 get 400 to 800 International Units (IU) of vitamin D daily, and adults over 50, 800 to 1,000 IU.
10. Myth: To maintain your bone strength, just focus on your diet.
Fact: In addition to getting the daily recommended amounts of calcium and vitamin D, it’s important to take these four steps, advises Dr. Cosman:
- Engage in regular weight-bearing and muscle-strengthening exercise.
- Avoid smoking and drinking excessive alcohol.
- When appropriate, have a bone density test.
- Take medication if you are at high risk.
Balancing Your Diet for Bone Health
The bottom line: You don't need to micromanage your diet to get your daily nutrients, according to Dr. Cosman. Just remember two important points:
- Get enough calcium and vitamin D. "If you get adequate calcium, you're going to overcome the negative effects of the dietary factors—such as oxalate, phytate, bran—mentioned." Talk to your doctor about your vitamin needs before you start taking supplements.
- Eat a nutritious diet, including dairy products and five to ten servings of fruits and vegetables. "Produce contains a variety of plant chemicals that are very beneficial to bone."
Is More Calcium Always Better?
"While it’s important to get enough calcium—around 1,000 to 1,200 milligrams a day—we discourage people from overdoing it," says Dr. Cosman. "There's no research to suggest that taking more calcium benefits bone. In fact, consuming excess calcium—by taking too many supplements, for example—may harm your health. It's all about balance. Take a calcium supplement only when you need one."
What's on the Menu?
Your body absorbs only about 500 mg of calcium at a time efficiently (if you take more, some of it will go to waste). So it makes sense to spread out your calcium intake over the course of the day. Think about having foods with calcium at each meal or as snacks. Here are some tasty suggestions:
- Oatmeal or fortified cereal with milk
- Fruit smoothie made with milk, yogurt or fortified orange juice
- Omelet with broccoli and cheese
- Fortified tofu with vegetables
- Canned salmon sandwich or salad
- Grilled cheese sandwich
- Grilled vegetables
- Baked beans
- Vegetarian chili made with beans
- Part-skim mozzarella cheese
- Almonds and dried fruit
- Carrots, celery and other vegetables with yogurt dip
- Chowder or tomato soup made with milk
- Shrimp with broccoli
- Macaroni with cheese made with milk
- Lasagna made with ricotta cheese
Quick tip: Adding two to four tablespoons of nonfat powdered milk to casseroles, soups or gravy and baked goods will boost the calcium. Each tablespoon contains about 50 mg of calcium.