Building
Building and maintaining healthy bones is of course an issue that is important to all of us.
I often see patients in my clinic who are in the early stages of osteoporosis, and who ask how the process can be slowed down or stopped…
From the moment we begin to grow until we reach our mid-twenties, we build our bone strength. After this we must maintain the strength we have built up, and slow down as much as possible the rate of bone thinning. In postmenopausal women, the rate of bone depletion increases significantly, which increases the risk of women suffering from osteoporosis.
So what can be done?
Well, if you want to maintain healthy bones, first keep in mind that it is essential to do weight-bearing exercise: such as walking, running, tennis, football, or any other activities that you can persevere with.
Nutritionally, it is important to pay attention to eating a balanced diet that includes an abundance of bone-building components – throughout life. In childhood it helps to build bone strength, and in adulthood it helps us maintain bone health.
What are these components? Calcium, vitamin D, magnesium, potassium, zinc, essential fatty acids, vitamin C, and B vitamins. Vitamin D can be absorbed also through exposure to sunlight and not just through diet.
The average adult should aim to eat about 700 mg of calcium a day. How do you get there? Let’s see!
Fruits and vegetables:
Fruits and vegetables provide an abundance of vitamins, minerals, antioxidants and fibre. It is recommended to eat at least five servings of fruit and vegetables per day, and preferably in as many colours as possible. Especially recommended are the leafy green vegetables such as kale, bok choy, Chinese cabbage, chard and more, which are a wonderful source of calcium. Figs are also an excellent source of calcium, as well as magnesium and potassium (even when the figs are dried!). And citrus fruits are a particularly tasty source of vitamin C.
Whole grains:
Whole grains such as whole rice, oats, whole wheat, rye, barley, millet, corn and others are excellent sources of fibre, antioxidants, proteins, minerals, and B vitamins. Although whole grains contain nutrients that help maintain bone health, they may also contain phytic acid, which prevents the optimal absorption of calcium, so it is recommended not to eat them as part of calcium-rich meals.
Nuts and seeds:
Nuts and seeds such as almonds, pecans, walnuts, cashews, sesame seeds, pumpkin seeds, sunflower seeds and more are an excellent source of essential fatty acids, as well as an abundance of magnesium.
Protein:
Protein sources such as legumes – beans and lentils, soy products, nuts and seeds, eggs, dairy products, and meat are of paramount importance for the proper functioning of the body, including bone maintenance. Consuming a variety of protein sources provides a variety of building blocks that the body uses to build bones. Soy products are rich in calcium, as well as phytoestrogens that help maintain the body’s hormonal balance. Legumes are rich in fibre, magnesium, essential amino acids, vitamins and other minerals.
It is important to include the entire list above in your diet on a daily basis, depending on your needs and personal requirements of course. But that’s not all. There are also things that are better to reduce or avoid:
Processed foods and beverages (which contain a high amount of sugar, fat and salt):
Products high in sugar and fat should be eaten in moderation. Reasons for this include the fact that maintaining a normal body weight may be significant in maintaining bone health, but mainly the fact that fizzy and sweetened beverages contain phosphorus, which impedes calcium absorption, and these foods also contain a large amount of sodium, which encourages calcium excretion from the body. Another important thing is that most diets that are high in processed foods do not contain all the ingredients we talked about earlier.
Oxalic acid:
Oxalic acid, found in spinach, chives, nuts, tea and cocoa, for example, prevents the absorption of calcium, so it is also recommended not to eat these foods as part of calcium-rich meals.
Smoking and caffeine and alcohol consumption:
All of these cause poor calcium absorption and increased excretion of calcium in the urine.
Other than that, you should know that there is controversy regarding the consumption of animal-based products. Some argue that these are good sources of calcium, but there are others who disagree, due to the fact that animal-based products often contain high amounts of phosphorus, which impairs calcium absorption, and that high amounts of protein can lead to loss of bone mass.
At this point there is no unequivocal trend in the research, so I cannot reach a final conclusion.
My personal opinion is that a vegetarian diet has many health benefits over an omnivorous  diet, but a personalised diet should always be tailored to suit the individual and his or her desires.
Another potential controversy when it comes to bone health, is calcium supplementation.
Many doctors suggest all women should use a calcium supplement. While calcium is absolutely important when it comes to maintaining bone health, the supplement form of calcium has not shown great benefits for bone health in women, and rather has shown an increased risk for kidney stones, and a potential risk for adverse cardiovascular effects from calcium supplementation. A recent meta analysis published last year (2021) concluded that calcium supplementation was associated with cardiovascular and all-cause mortality amongst women, but not men. Meanwhile, they suggested that moderate dietary calcium intake may protect against cardiovascular and all-cause mortality and incident stroke.
As such, I recommend in most cases avoiding the supplement and increasing the nutritional intake of calcium.
