Portsmouth Hospitals NHS Trust. Love Your Bones. Diet and Osteoporosis. Richenda Rook Community Dietitian June 2016

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1 Portsmouth Hospitals NHS Trust Love Your Bones Diet and Osteoporosis Richenda Rook Community Dietitian June 2016

2 Page 2 Measures to Reduce the Risk of Osteoporosis Nutrition: - Calcium - Vitamin D - Nutrients which affect action of calcium & Vitamin D: Vitamin K, protein, salt, alcohol, phosphorous Body Weight

3 Page 3 Calcium Bones are made of collagen fibres filled with calcium Calcium is a mineral that keeps bone healthy & prevents bone thinning From our mid-30s our bones start to lose calcium Adequate calcium combined with a bonefriendly diet & lifestyle is essential to minimise bone thinning

4 Page 4 How much calcium do we need? 700mg/day for adults should be able to get enough via a healthy, balanced diet 1000mg/day for those diagnosed with osteoporosis may need a calcium supplement

5 Page 5 Dairy Sources of Calcium 700mg = 3-4 portions/day 1000mg = 5 portions/day One portion: ⅓ pint milk (cow/goat/calcium-enriched soya) Pot yoghurt (125g) 1oz (30g) cheddar/edam 8oz (224g) cottage cheese 3oz (80g) cream cheese 7oz (196g) fromage frais ½ can rice pudding

6 Page 6 Non-Dairy Calcium Sources One portion: ½ small can sardines (with bones) (112g) 1 small can pilchards (with bones) 2oz (56g) tofu 5oz (130g) cooked spinach 8oz (224g) cooked broccoli 3 slices bread 1 can of kidney beans

7 Page 7 Non-Dairy Calcium Sources One portion: 4 dried figs 32 dried apricots 36 Brazil nuts 3oz (80g) almonds 3 tbsp sesame seeds 1 ½ heaped tsp tahini

8 Page 8 Calcium and a Non Dairy Diet Non-dairy alternatives enriched with calcium. ½ pint of Rice Milk Soya Milk Lacto-Free Milk Semi Skimmed Milk 335mg 370mg 342mg 355mg When choosing an alternative to cow s milk look for products that have approximately 300mg of calcium per 250ml serving.

9 Page 9 Incorporating Calcium into the Diet Cereal with milk Cheese in sandwiches & mashed potato, on toast, jackets, crackers Tinned sardines on toast, jackets, with salad Add grated cheese and milk/milk powder to soups Eat dark green leafy vegetables Yoghurt or cheese & crackers for dessert Include beans, lentils & tofu in the diet Milky drinks Snack on nuts, dried fruit, yoghurt, cereal with milk, cheese & crackers

10 Page 10 Vitamin D

11 Page 11 How do we get our Vitamin D? Mostly obtained from the action of sunlight on our skin Between Mid March October in the UK (10am 3pm) mins per day, several times a week Body able to store Vitamin D over the winter months Ability to synthesis Vitamin D from sunlight decreases with age Those who are housebound, elderly, have dark skin or keep their skin covered may at risk of deficiency Lack of this vitamin can lead to rickets in children and osteomalacia (soft bones) and osteoporosis in adults

12 Page 12 Vitamin D from Food The remaining 10% of our vitamin D is supplied by diet Good sources include: Eating a balanced diet will ensure you receive 10% of your vitamin D requirements A normal diet cannot supply all the vitamin D we need without exposure to sunlight

13 Page 13 Recommended Dietary Intakes of Vitamin D For adults, RNI only made for: - People aged >65 years - Pregnant and lactating women - People likely to get little sun exposure Recommendations = 10 µg/day Equates to: - 9 ½ eggs - 125g smoked mackerel - 200g sardines - 240g bran flakes May need to consider supplementation!

14 Page 14 Calcium & Vitamin D Supplements Vitamin D supplement for young children, breastfeeding women, those aged over 65, those with dark skin or those with little sun exposure (e.g. housebound) Osteoporosis: A daily supplement of mg of calcium and 10-20µg Vitamin D is recommended Most calcium supplements will contain Vitamin D e.g. Calcichew-D3 forte Take calcium supplements with food and in 500mg doses, to maximise absorption

15 Page 15 Factors Affecting Action of Calcium/Vitamin D Protein Vitamin K Vitamin A Sodium Alcohol Caffeine Fizzy drinks

16 Page 16 Protein Too little Contributes to bone loss, risk of falling and response to injury Too much meat Can lead to calcium being drawn out of the bone, due to high uric acid content Recommendations: Eat protein foods twice a day e.g. meat, fish, beans, pulses, nuts, eggs, seeds, tofu, seeds

17 Page 17 Protein Portion Sizes Have 2 portions a day One portion is: - 5 oz (125g) lean meat, fish - 3 slices of cold meat - 3 fish fingers - 2 eggs - ½ can baked beans - 4 tbsp cooked lentils, dhal - 4 tbsp kidney beans, chick peas, butter beans - 4 oz (100g) soya, tofu - 2 tbsp nuts, peanut butter, tahini, seeds

18 Page 18 Vitamin K Helps form bone-hardening protein, osteocalcin A higher Vitamin K intake is linked to a higher BMD & reduced fracture incidence Vitamin K is found in green vegetables e.g. spinach, kale and broccoli. The greener the plant, the higher the vitamin K content Deficiency of Vitamin K is rare

19 Page 19 Vitamin A A high Vitamin A intake increases risk of fractures Avoid an intake of >1.5mg/day Limit intakes of liver/liver products to once a week Check high strength cod liver oil supplements Avoid high dose supplements if you eat liver weekly

20 Page 20 Sodium Too much salt can raise blood pressure speeds up the body s loss of calcium via urine Reduce salt and increase potassium rich fruit and vegetables to reduce blood pressure and risk of osteoporosis We should eat less than 6g of salt a day On food labels salt may be labeled as sodium limit to 2.4g/day

21 Page 21 Alcohol A high alcohol intake: reduces bone formation increases risk of falling A moderate alcohol intake is linked to a higher BMD particularly in postmenopausal women Alcohol recommendations: 14 units/ week for both men and women Regular alcohol free days Don t save up units for a binge

22 Page 22 Caffeine High intakes caffeine increased amount of calcium being excreted in our urine Habitual intakes of caffeine from the equivalent of 4 or more cups of coffee a day may be associated with decreased bone density

23 Page 23 Carbonated Drinks Fizzy drinks contain phosphoric acid which can lead to excessive calcium excretion via urine.

24 Page 24 Body Weight Being underweight increases risk of osteoporosis Being underweight also increases the risk of broken bones in a fall Aim to be a healthy body weight

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