Bone health

Osteoporosis and calcium Supplements in the Perimenopause/Menopause

Bone loss: can be a problem in over 50's, especially in post-menopausal women where, unlike in children, bone breakdown exceeds bone formation increasing the risk of osteoporosis over time.

Calcium: is a mineral that is needed throughout our life not just for strong bones and teeth, but also for several important functions such as nerve transmission, hormonal secretion and muscle contraction.

However, only 1% is needed for these vital functions while 99% of calcium is bound in the bones. Levels in the blood are very tightly controlled and do not really change with dietary intake as it is the calcium from the bones that acts as the store to help maintain constant levels in the blood and cells.

Calcium Requirements:

The amount of calcium needed in one's diet varies throughout life with requirements of about 1000mg for men and women over 50. Most of this calcium can come from one's diet.

Should I take a supplement?

If you generally follow a very healthy low fat high fibre plant based diet, rich in beans and grains, all fruit and vegetables, exercise regularly and enjoy sunshine, vitamin B12 and Vitamin D are really the only vitamins you really need to take.

However, as diets may vary, it is recommended that a single daily multivitamin supplement in the morning with about 200mg of calcium (20% of daily requirement) along with Vitamin D3 (400-600 IU, equal to 5 micrograms (100% of the recommended daily requirement) taken with food, to reduce bloating or constipation, should be enough to protect bones. If one is over 50, unless other medical indications, taking a multivitamin supplement, preferably without iron and copper to reduce risk of Alzheimer's can be helpful.

You can also take 500mg -100mg of calcium with Vitamin D if your doctor advises you or if you particularly at high risk from osteoporosis and your diet is not as optimal as you would like it.

Exercise:

Regular moderate exercise, particularly strength exercises as well as walking for 20- 30 minutes per day helps in strengthening bones. Running, swimming, yoga, Pilates or going to the gym are also good forms of exercise. All these help in warding off osteopenia (low bone mass) and osteoporosis (thin weaker bones) and bone fractures. At the same time exercise improves heart health and mood. Being active helps to move calcium into bones, being inactive results in greater calcium and bone loss, increasing the risk of osteoporosis.

Helping calcium absorption:

Exposure of your skin ( arms, neck, legs) to the sun for 15 minutes a day when possible also improves Vitamin D levels which in turn helps in calcium absorption. With this level of exposure, there should be no increase in risk of skin cancer

It is important to remember that absorption of calcium from most foods and supplements is very similar, so following a diet mainly plant based ( all beans and lentils, whole grains such as brown rice, quinoa, oats, barley, brown seeded bread, all vegetables and fruit) helps not only with reducing risk of osteoporosis but in reducing risks of the major killers including heart disease, diabetes and cancer.

What should I avoid to prevent excessive bone loss?

Avoiding smoking, fizzy drinks, excess caffeine, salty foods and alcohol help in reducing calcium and bone loss at the same time improving general health.

Do I need to eat dairy or meat to have strong bones?

No, one does not need to have dairy or meat to have a healthy diet. Although dairy products are rich in calcium, they contain animal protein and growth factors (IGF) and sometimes drugs and hormones all of which may be responsible in contributing to the increasing risks of breast and prostate cancer.

It is also important to avoid too much animal protein in one's diet as it can be responsible for leaching calcium from the bones to help flush excess protein out of our kidneys into the urine, increasing osteoporosis risk and as a result increased risk of fractures. Plant proteins from beans, grains and vegetables do not seem to have this effect.

In the 12-year Harvard Nurses Study of 78,000 women, those who drank milk three times a day actually broke more bones than women who rarely drank milk.

Another study from Sydney, Australia, showed that those with the highest dairy product consumption had approximately double the risk of hip fracture compared to those with the lowest consumption.

How do I know if I am not getting enough calcium?

In the short term, there are usually no symptoms. Over time, there may be low bone mass (osteopenia) , resulting in osteoporosis and bone fractures. Other features may include dry skin, brittle nails, muscle cramps, and increased Pre-menstrual symptoms.

In more serious situations, numbness and tingling of fingers, convulsions and abnormal heart rhythms may be features of of calcium deficiency which need urgent medical attention.

Are there any risks from too much calcium?

Too much calcium from diet or supplements may increase calcium deposits in the heart and in other tissues and may increase the risk of kidney stones, prostate cancer and heart disease.

What foods should my diet contain?

Aim for a plant strong diet that is naturally low in fat and high in fibre. Get most of your calcium from greens, beans, or fortified foods which tend to be the most healthful sources.

Green leafy vegetables such as broccoli, brussels sprouts, kale and other greens (1 cup cooked or raw has calcium ( 90 mg to 350 mg ) and magnesium as well as fibre and other nutrients. The exception is spinach, which contains a large amount of calcium but tends to also have oxalate that reduces absorption.

All beans including chickpeas, butter beans, pinto and kidney beans are very good sources of calcium and protein and fibre. Calcium enriched tofu or soy milk, some enriched cereals, fortified orange juice or apple juice are excellent sources of calcium as are 10 dried figs containing over 250 mg of calcium as well as sesame seeds and almonds.

Many fish and dairy products are rich sources of calcium while eggs are high in Vitamin D but as with all animal protein should not be consumed in excess.

Nitu Bajekal, March 2014