Our skeleton starts off life as a delicate membrane-like template late in the second month of pregnancy but soon after the third month a primitive skeleton can be easily seen. Our bones form relatively early on because they are a key factor needed in the healthy growth and development of the growing baby. We tend to forget just how important a skeleton is but without it there would be nowhere for our muscles to attach and our vital internal organs would be extremely vulnerable to damage.
Throughout pregnancy, Mums-to-be are told to eat well and to get plenty of bone forming nutrients such as calcium. This advise extends to breast and bottle feeding and well into the weaning months and early years for good reason; the skeleton of a growing child is highly active and demands a plentiful supply or raw materials. However, there appear to be a gap somewhere between the early to mid teens and late 30’s where the focus of attention is taken away from skeletal health as other health priorities take the lime light and centre stage. For a growing number of people in this age bracket, weight management becomes an issue along with the trend for very restrictive diets in an attempt to drop the excessive weight. It’s not uncommon for levels of physical activity drop off especially in the school leaver population who either choose to avoid sports altogether or are forced into a more restrictive lifestyle that is so common in the digital workplace. Combine this with an increasing tendency to rely on processed and convenience foods and a lack of basic food, cooking and nutritional knowledge in many people and its quite easy to see how and why the early teen through to late 30’s are potentially hazardous to long term health. If we remain focused on the skeletal system, this phase of life is especially important considering that 90% of a girls skeletal mass is acquired by the age 18 and in boys by the age of 20. However, our bones keep developing reaching their lifetime peek mass by the age of 30 in both sexes. After this the skeleton remains quite stable until, in the case of women, the menopause starts when there can be a significant loss of bone mass. Men tend to loose bone mass slowly around the same phase of life but because of their greater skeletal size the effects are less noticeable in most cases. So, there appears to be window that can swing open for an opportunity to optimise skeletal health or slam shut, placing the maturing bone in jeopardy. Its rather like paying into a long term savers account or pension, you should have some reserves for later in life but it does mean you have to contribute early on and for many years to come with no real obvious outward signs of any benefit but in general you will be better off for the efforts.
The bare bones of skeletal nutrition We all know that calcium is important for bone health but it has been rather over played in the past. Our diets abound with calcium and the mature skeleton stores 99% of the bodies calcium reserves. In fact, our blood calcium levels are kept within such tight parameters that any fluctuation above or below the normal is considered a key sign of an underlying hormone disease rather than anything to do with dietary excess or deficiency. In saying that, calcium is still a vital bone mineral and one that is needed on a daily basis to maintain health. Despite many people having a problem in regards to sensitivity to allergy, milk and dairy products still provide a reliable and cost effective source of dietary calcium and protein. There have been some concerns raised about the intake of milk and an increased risk of thin bone disease but these claims have not been substantiated. In brief, the anti-milk theory suggests that the protein and phosphate naturally found in milk and dairy products make them ‘acid-producing’foods causing a shift in the bodies acid (pH) levels and triggering an accelerated loss of calcium from the bones and body; this process is not supported by any scientific evidence. Moreover, studies have confirmed that a higher phosphate intake was actually associated with decreased urine calcium and increased calcium retention. The theory then goes on to link this process with observations of thin bone related fractures in people from countries that consume a lot of milk and dairy foods; this is a case where correlation and causality can be misleading. Studies involving populations living and working in urban and rural environments yield quite different outcomes probably more related to their physical activity levels rather than to their milk and dairy food intake. While some people may find dairy foods a problem for those who do not a sensible level of intake would not appear to have any real detrimental effect on bone health and for some groups of people could be an important source of readily available protein and minerals. Check the tables below and see if you are getting enough calcium from your food (Table 1) compared to the recommended daily intake levels based on Western European, American and Canadian figures (Table 2).
|Table 1: Calcium in common foods (apporoxamate)|
|Food||Serving size||Calcium (mg)|
|Milk, whole||236 ml||278|
|Milk, semi-skimmed||236 ml||283|
|Milk, skimmed||236 ml||288|
|Goats milk||236 ml||236|
|Yoghurt, low fat, plain||150 g||243|
|Yoghurt, low fat, fruit||150 g||210|
|Yoghurt, Greek style, fruit||150 g||189|
|Cheese, cheddar||40 g||296|
|Cheese, cottage||112 g||142|
|Tofu, soya bean, steamed||100 g||510|
|Soya drink||236 ml||31|
|Soya drink, calcium enriched||236 ml||210|
|Broccoli, cooked||112 g||45|
|Curley kale, cooked||112 g||168|
|Apricots, raw||160 g (1 fruit)||117|
|Orange||160 g (1 fruit)||75|
|Figs, ready to eat||220 g (4 fruits)||506|
|Almonds||26 g (12 whole)||62|
|Brazil nuts||20 g (6 whole)||34|
|Sardines, canned in oil||100 g (4 fish)||500|
|Pilchards, canned in tomato sauce||110 g (2 fish)||275|
|Whitebait, fried||80 g||688|
|Bread, white sliced||30 g (1 slice)||53|
|Bread, wholemeal, sliced||30 g (1 slice)||32|
|Pasta, plain, cooked||230 g||85|
|Rice, white, basmati, boiled||180 g||32|
|Table 2: Recommended daily intake of dietary calcium|
|90 years to menopause||1000|
|During pregnancy (1st trimester)||1200|
|65 + years||1300|
As you can see from Table 1, getting adequate dietary calcium is not difficult but you need to know what too eat! A strict vegetarian who also avoids dairy foods will find it much harder to meet the minimum requirements for calcium without consuming specialist foods such as Tofu or taking a calcium supplement. Equally, someone following a strict weight loss may also fall short especially if they choose to follow the diet over a long term basis rather than modify their intake level across a balanced diet. Calcium is important but it is by no stretch of the imagination is it the key nutrient. What needs to be kept in mind is the fact that bone is a living tissue, its not simply a hard calcified mass. If it was it would be very prone to fracture because there would not be any flexibility or ‘give’in the skeleton when we jumped or ran. Proteins give bone its flexibility as well as a framework onto which the minerals (calcium, magnesium, phosphorous) can be deposited. A diet low in dietary protein is also detrimental to bone health. Fad diets that restrict proteins and poor general eating habits can that rely heavily on processed foods and carbohydrates starve the body of the essential protein building blocks of life known as amino acids. Key proteins from meat, fish, and eggs generally form the corner stone to human protein intake in Europe. In essence, there is nothing wrong with animal protein but there is no need to over consume from this food group since there are many great vegetable protein sources as well. Vegetarians and those seeking to rely less on animal proteins need to choose carefully but can increase their vegetable protein intake easily by eating more lentils, kidney beans and broad beans as well as soya, tofu, grain, nuts and seeds. By increasing the intake of vegetable proteins you will also be increasing the levels of other key bone nutrients including magnesium, zinc, B-vitamins (such as folic acid) and vitamin A generating beta carotene especially if you regularly eat the coloured vegetables such as orange, yellow and red peppers. Absorb it or loose it In order to benefit from the calcium in your diet or from your supplement adequate levels of vitamin D are required. Over the past few years vitamin D has become a hot-topic in the press where it has been associated with many health problems ranging from MS through to certain types of cancers and even depression and psoriasis when levels are grossly deficient. The situation involving vitamin D and it’s involvement in such a variety of health problems is complex, poorly understood and undoubtedly linked to genetic susceptibility but when it comes to bone health the cause and effect relationship is very well understood and established. Vitamin D is not an easy vitamin to get in Northern European countries simply because of the lack of intense sunlight (more specifically the ultraviolet-B rays) needed to stimulate its production within the skin. Here we hit another controversy, by recommending sun exposure are we now putting people at risk of skin cancer? The simple answer is no! Just remember that sun exposure is healthy, sun burn is not. Getting 15-20 minutes of sun light per day, best between 10am and 2pm when the sun is at its peek, is all that is needed to boost natural vitamin D levels. For those of us at work stuck inside, shift workers or people confined to inside living some vitamin D can be obtained from a few foods (for example; salmon, mackerel, tuna, sardines, egg and liver) but to get enough you will need to eat quite a lot of it and on a very regular basis to meet the requirements for health let alone optimal health and there is no real vegetarian food option that delivers any vitamin D. In regards to vitamin D the only real option is a supplement especially over the winter periods. Intake recommendations for vitamin D vary greatly but supplements should be in the vitamin D3 form and need to be between 400iu (10mcg) to 1000iu (25mcg) in strength per day unless you have had a vitamin D blood test and need to significantly boost your levels under supervision. If you can’t get a blood test from your own GP we can always arrange this for you but the private lab will carry a lab fee of around £60 per test for a calcium and vitamin D test. You can take your own blood sample at home (a finger prick) and posted off to the lab for analysis. Another vital vitamin for bone health is vitamin K. This is required for the formation of specific bone proteins that actively help to build and strengthen the framework needed a healthy skeleton. Vitamin K is obtained from dark green leafy vegetables such as kale, cabbage and spinach as well as from lettuce. There are more specialist foods made from fermented soybeans that deliver high amounts of vitamin K. A good bone supplement should supply vitamin K but this needs to be avoided in anyone taking anticoagulant medication such as warfarin. Those on warfarin should not increase their vitamin K containing foods form the same reason.
Special situations The window for optimising bone health can be significantly helped by diet and lifestyle choices but there are a few occasions when other health issues can complicate things. People with certain digestive problems that adversely affect nutrient absorption, such a Coeliac disease and some inflammatory bowel problems, need special individualised attention and advise. This may also extend to the long term use of steroid based medications because of its adverse impact on bone health.
Dietary supplements While we have placed great emphasis on food, diet and what can be achieved through lifestyle adjustment, the use of a specific dietary supplement aimed at optimising bone specific nutrition may be appropriate in many cases. The bone specific supplement Calci-D-min delivers a highly absorbable plant calcium known as Aquamin (derived from red algae) that’s easy on the stomach and quickly absorbed and assimilated by the body. Aquamin also delivers magnesium and 74 other naturally occurring trace elements contained in the red algae. The Calci-D-min supplement has been formulated to supply effective levels of vitamin D3, K1 and K2 along with boron selenium and zinc. Depending on the diet, as food supplement two to four capsules are recommended taken with food. Because of the vitamin K ingredient, Calci-D-min is not recommended for anyone taking the anticoagulant drug warfarin. The product is 100% vegetarian and fully approved by the Vegetarian Society.