Sunday, May 5, 2019

Strong Bones - do you have to drink milk?

May is National Osteoporosis Month. So let's talk about bones again.

I get a lot of questions from patients about preventing osteoporosis so I'll cover that today. The word osteoporosis means porous bone. All bone is porous but strong bones are much less porous then weaker osteoporotic bones.

This image is showing enlarged spaces between bone structure that weakens the bone progressively until it is easily broken. This is important because as we age we naturally lose more bone mass and this can increase our risk of hip fracture (or other fracture) with a fall.

Menopausal women are especially at risk as their estrogen levels fall with age and their rate of calcium absorption goes down. When your body doesn't get enough calcium in the diet it breaks your bones down to get some because calcium is essential to your metabolism!

It has been reported that the one year mortality rate (rate of death from an injury at one year after the injury) from a hip fracture is somewhere between 14-58%. So you definitely want to protect your bones and decrease your chances of a fracture from a fall!

So how can we best protect our bones? For women that means considering estrogen replacement as we go into menopause. I found one resource from the National Institutes for Health written in the mid-90s that recommended 1000mg of calcium a day for menopausal women on estrogen and 1500mg a day for menopausal women not on estrogen. I think that's huge! This recommendation just shows how important adequate estrogen is to bone health.

Of course, if you can't take estrogen for whatever reason you can still protect your bones. The first place to focus is on foods that contain calcium. I will add a caveat before I get into the specifics. Calcium absorption is very low when conditions for absorption are not ideal. Here and here are some of the factors that can hinder absorption. Some of the nutrients that need to be adequate for better absorption include vitamin D3, vitamin K2 and magnesium. Vitamin C is also critical to absorption.

So when you look up calcium rich foods dairy is usually mentioned as if it is the only option - in fact, the National Osteoporosis Foundation - advertising National Osteoporosis Month - has a video on their website that draws a huge picture of a glass of milk and a piece of cheese and other options are minimized. So what's a dairy intolerant person to do?


1. Seeds - make chia pudding (chocolate chia pudding in the photo) or sprinkle chia seeds into smoothies. Sprinkle sunflower seeds or pumpkin seeds onto salads.

2. Beans and lentils - sprinkle black beans on a Taco Salad or make black bean salsa by mixing canned (organic!) black beans into either prepared or homemade salsa. Make dal with lentils or add cooked lentils to your hummus recipe to add extra calcium.

3. Almonds or almond butter - add 2 tablespoons to a smoothie recipe and get a little protein, fat and calcium boost.

4. Soy - choose organic, non-GMO soy beans or tofu and enjoy edamame or a good tofu stir-fry.

5. Leafy greens - choose low oxalate kinds for best absorption but most leafy greens provide good amounts of calcium. Make a chopped salad or a soup with added greens. I even add chopped greens to my spaghetti sauce.

6. Broccoli rabe - I just had a bunch of this Thursday night since it is in season and I was fortunate enough to get a bunch from a local grower. I just steamed it and ate it but I also have a good recipe for Ginger Sesame Soy Rabe with asian noodles that amps up the calcium content.

7. Oranges - I'm allergic to orange peel but if you peel it and break it into wedges I'll enjoy it with you!

8. Dried fruit - especially dried figs - enjoys whole or chop into smoothies. Other dried fruits with calcium include raisins, prunes, apricots and dates.

9. Okra! I love it roasted in a pan, drizzled with olive oil, but you can smother it or add it to soup or a pot of beans (double bone whammy).

10. Fortified non-dairy milk - check your non-dairy almond or other milk and see if they've added calcium.

So the bottom line is this - dairy does have a lot of calcium but the absorption of calcium from plant sources is higher. If you tolerate dairy don't rely only on diary as your source of calcium. If you do consume dairy make sure it is grass-fed organic dairy so you don't expose yourself to pesticides, antibiotics, hormones and other substances in industrial-based cow dairy products.

What about supplements? There are lots of options to make sure you get adequate calcium and other essential nutrients for bone health.

See a Functional Medicine provider like myself to make sure you have adequate levels of the nutrients (like K2 and vitamin D3 and vitamin C) needed to absorb and use calcium from your diet. You can also discuss with your provider when to test for bone density, what to do about osteopenia and whether supplementation with calcium is right for you.

Chocolate Chia pudding:

Mix together 2 tablespoons of organic cacao powder and 3/4 c. warmed hemp, almond or soy milk to dissolve the cacao. While whisking add in 3 tablespoons agave or maple syrup. I also added a packet of powdered monk fruit. Add in 1 tsp organic vanilla extract and a pinch of salt. Once it is well mixed pour in 1/4 cup of chia seeds and whisk. It should begin to thicken after about a minute. Pour into ramekins and place in fridge for 4 hours or overnight. Enjoy. Makes 2 small ramekins - may double if needed to make 4 servings.

This is nice sprinkled with cacao nibs or wild blueberries and a dash of cinnamon. Have it as a light dessert after your fajita feast today! Happy Cinco de Mayo!

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