[MUSIC] The Sam and Rose Stein
Institute for Research on Aging is committed to advancing lifelong health and
well-being through research, professional training, patient care, and
community service. As a non-profit organization at the University of California, San Diego School of Medicine, our research and educational
outreach activities are made possible by the
generosity of private donors. It is our vision that successful aging will be an
achievable goal for everyone. To learn more, please visit our website at aging.ucsd.edu. [MUSIC] Well, this is one of
my favorite topics. I retired five years
ago already from UCSD, but I continue to teach in the community and this
particular topic [NOISE] is near and dear to me because I've already experienced
two back fractures. This is kind of what I've
learned when I thought I knew everything already about
healthy eating and living. One of the things
that you'll hear me repeat over and over again is how important it is for us to keep on exercising [NOISE] especially
weight-bearing exercise. I'll say a few words about that, but then we'll also
get into some of the dietary issues
and we'll try to get beyond just calcium issues, although calcium is certainly something we have to
pay attention to. As I mentioned, both physical activity and
diet are critically important. One of the points that I wanted to make before we get into that further is I think we sometimes forget that our
bones actually are made up of a protein matrix into which there are
minerals that are embedded. Did some of you, when you had younger children do that
little egg experiment or the chicken [NOISE] bone
experiment where you submerged a raw egg in its shell
in vinegar overnight? Did any of you do that? Yes. Did a few of you? [inaudible] Okay. Well, it's
really interesting because then what happens in the morning is
you see that egg, but all of the minerals have come out in the acidic vinegar. That's basically the
way our bones are. We need to think both
about enough protein but not too much proteins so that
we have healthy bone matrix and then we also
need to think about the other nutrients that
are required to keep our bones healthy. [NOISE] I
think one of the other things that's really good
for us to keep in mind is that our
bones are dynamic, so they are building up and
breaking down all the time. It's just that the building up takes prominence
earlier in our life and we have a little
bit more breaking down in terms of the tipping
of the scale as we're older. One of the things that's
a little bit challenging is that we reach peak bone mass by around the age of 30 or 35. A lot of us [NOISE]
are just dealing with what we've
got and we're just trying to do what we can to hold onto what we have and to try not to lose it any
faster than possible. You've seen these curves before. The blue is women, we tend not to gain as much bone mass by the time we reach peak
bone mass at around 30, men tend to have a little higher bone
mass as you can see, but both men and
women do drop off in bone mass as they get older and especially after
the age of 60. You'll see as we get a
little further on that, one of the things that
they're coming to realize is that the loss of bone mass is actually happening as early as
between 35 and 50, and that came as a surprise to the researchers that just
published this paper. Do you see that second
point there that men usually have fractures even though they have a
higher bone mass and it often is in
the lumbar spine, which is that part that's around our
waist, you could say? One of the things that we'll
be talking about is how important it is to
maintain core strength. How many of you already do
Pilates? Probably many. Learning to sit properly
and to build our core is one of the important things
will hold our spine in place. This study was the one
that I referred to, it was just published literally a couple of months ago and they looked at 173 adults between
the ages of 35 and 50. They asked them
about what they ate, how much calcium they took in, how much and what
types of exercise, and other risk factors related to osteoporosis and osteopenia. If you see on that second point, one out of every
three men already had osteopenia or lower than optimum bone mass and that was between the
ages of 35 and 50, and for women, it was about
one out of every four. It was surprising, I think, to these researchers and I'm wondering if it has
something to do with, again, our lack of activity
and our sitting a lot in front of our
devices, potentially. It's not just us that are
older that have an issue. It's important that we
move as much as possible, especially weight-bearing
and you've heard this a lot, but it helps incentivize me to remember that as my
muscles are pulling, they're actually telling my body to keep my bones stronger. Just moving, even if it's not [NOISE] hugely hard activity, some moving is better
than no moving. Men tend to have higher
bone mass because they have larger muscles and weight-bearing is
particularly important. Interestingly enough,
women sometimes will have healthier hip bones just because they've
been out there walking. One of the things they found with this earlier study with
the younger adults is that the men actually
tended to cycle more, they used bicycles, which
was not weight-bearing and so they actually had more difficulty in
terms of bone mass. Actually, getting on the
treadmill [LAUGHTER] or women for us
walking, hopefully, a pill some of the time, trying to maybe have some little weights in our
hands or in our backpack, all of that can be very helpful. We want to remember core
muscles important for supporting our spine,
weight-bearing. I guess the other thing that has particularly interested
me as I've gotten older is how important it is to work on stabilizer muscles. I don't know how many
of you do balancing exercises already or there's certain yoga poses that we do where you
have to balance, but it's very
important to work on that because even
if we tend to fall, if we're more able to catch ourselves before we
go full-on down, it can really make
a big difference. I think the other thing
before I get into diet, is this issue about postural alignment and getting loaded over our
joints appropriately. Some of you are nodding
like, of course, you've heard this before
[LAUGHTER] that's wonderful. I don't know how many of you have done Feldenkrais which is a very simple
exercise where I tell people it's kind of like you're lying on the ground
rolling around and you end up feeling better [LAUGHTER]
Have some of you tried it? Yeah. Do you agree It's like
rolling around on the floor? [NOISE] Pilates, many of
you already said you do, Qi Gong and Tai Chi
are others that can be very helpful in terms of
balance and coordination. Couple of more things
about posture. Do you see this
picture on the left? I keep trying to keep that in my mind to think about
how I'm sitting, because we tend to sit like a C and that puts incredible
pressure on our lumbar spine. All of us now just move back and put your butt back in the chair, and try to get in
that L position. That helps you to
sit up straight. One of the things that you see, I walk on the beach pretty
much every day and I'm surprised by how many people including me do not
have enough glute. Muscles are not strong, so we really need to work on those to be able
to hold ourselves up, it's an ongoing challenge. Getting into diet. This was just published
a few months ago, and this was a meta-analysis. That means that they took many different studies and they collapsed the data together. These were studies that had been done in the United States, they had been done
in Canada, Japan, China, and a couple of
European countries. They were looking at dietary
pattern and the impact of dietary pattern on bone
health, you could say. Not surprisingly, they found that those
people that we're following a healthier dietary
pattern and that was assessed in various ways that bottom lines into a
Mediterranean type of diet, plenty of fruits and vegetables, healthier fats, not too
much processed food. They compared that to a diet
that was pretty heavy in milk products and
or the standard, you could say processed
food diet that had a lot of meat in it, and refined grains. The one that came out
the most bone healthy was actually the one that they called the healthy
dietary pattern. You'll find out as we move along that fruits and vegetables, in addition to helping protect us from heart
disease and cancer, are also very helpful in
terms of bone health. Some general things to keep
in mind when we talk about optimum dietary habits and
how those impact our bones, I think we want to think about the importance of acid
alkaline balance. We're also going to talk
about how important it is to balance calcium,
magnesium, and phosphorus. Calcium and magnesium are
more alkaline minerals, phosphorus more acidic, and
we need those imbalance. The same with sodium
and potassium, which are more alkaline, and then chloride,
which is more acidic. Did you notice sodium
chloride, which is salt? It's funny because we think
of sodium as being alkaline, but there's a lot of
chloride there that tense when you have a
really high salt diet to be a problem in terms
of keeping us at the right alkaline
and acid balance. We've had a general shift toward acidity as we moved into this
current way that we eat. I'm guessing not any
of you because I'm betting a lot of you eat
lots of plant foods. But if you think about the average American
processed food diet, it tends to be one that
tends toward acidity. It tends to have
more animal protein, not as much plant food in it. If you think about being
good to your bones, you want to shift yourself more toward having plenty
of fruits and vegetables and we'll
go into some of the additional reasons
to think about that. Animal foods tend
to be acid forming, grains tend to be
weakly acid forming. When you're constantly putting acid forming foods in your body, the kidneys are going to
try to keep things neutral, which means that they're going to look for alkaline minerals. Where do they find some of those? They find calcium and
magnesium in your bones. One of the ways to try to
keep the alkaline minerals in your bones is to not
overdo acid forming foods. The other thing I
mentioned was salt. You'll see as we move along that people that use a
lot of salted foods, and it's not really as
much salt that you're putting on at the table
or in food preparation. Actually, more than 70
percent of the salt that we take in as Americans is
coming from processed food. Just staying away from packaged pre-prepared food and preparing food yourself is going to make a big difference. We need enough protein for the protein matrix in our bones, but we just don't
want too much of it. The quick and dirty way of figuring out how much
protein you need is to take your body weight in
pounds and divide it in two. If you were a 100 pounds, you'd need 50 grams of protein, if you're a 150 pounds you
need 75 grams of protein. Your body likes to get that
protein not all at once, but rather through the day, couple or three
meals, for example. If you don't have much protein like in the
morning or for your noon meal, and you tend to get most
of your protein at dinner, you're not going to use all of it for
building and repair. Some of it is just going
to be used for energy, and if you don't need the energy which a lot of
people don't at night, they're just going to store it. We really need to think about protein adequacy and then
spreading it through the day. Say you're a person who weighs a 150 pounds and you need 75
grams of protein in the day. An ounce of meat, fish, or poultry has seven grams in it. Some of you have heard
me speak before, but all of us have
an index finger. If this was a piece of meat, fish or poultry, think
about a chicken breast, and you just had a
little slice of it, that would be one ounce of
cooked meat, fish or poultry. If you had three
fingers on your plate, that would be three ounces
or 3 times 7. That's 21. One of the things that we
need to do is keep our meat, fish and poultry portions
small because we don't need half the plate to
be meat, fish, or poultry. An egg has seven grams
of protein in it. If you did beans as your
protein source instead of meat, you would count about
a half a cup of something like cooked black beans and that would have
about seven grams. Milk. If you're thinking about having half a cup of milk in
your coffee in the morning, maybe and another
half on your cereal, that would be about eight grams. It's not hard to get
enough protein and many of us get much
more than we need, and it can overdo the
acid forming part, putting a little stress on our kidneys to keep
things neutral. One of the things you can
do that's helpful for your bones and also
for the planet, is not eating as
much animal protein, especially red meats. They tend to be
more acid forming. It's not like we have to
completely cut them out, but when you can go more
toward vegetable protein, you're going to help the planet and you're probably also
going to help your bones. Phosphorus is more
acid producing, you could say, a very
important nutrient. But also, again, if
we eat a lot of meat, we're going to probably get
more of it than we need, but the other part I
think is when we're eating a lot of processed food, we're getting a lot of
phosphate food additives. I don't know how many of
you are label readers, but I think it's
surprising when you're really get into
looking at labels, how often you find phosphate
on your food labels. It's an Andy caking
agent, flavor enhancers, emulsifiers, you'll be
surprised how often it's there. Again, moving toward
fresh food that you prepare is a good thing for lots of reasons,
including your bones. The alkaline minerals that
most of us know a lot about, calcium, magnesium
and potassium are the ones we really want to
make sure we get enough of. Calcium, all of us that are
50 years of age or older, need about 1200 milligrams a day. We don't need any more than that and I'm sure you all
read a number of years ago some of the surprising
news that people that were doing too much calcium actually had more heart disease. We want enough calcium, not too much calcium. It's better if we don't, again, get all the
calcium at one time. A lot of times people will get some of their calcium from food, but then they'll go ahead and
have to supplement a little extra if they don't
think they've quite made it up to that
1200 milligrams. You kind of think about when you want to
use a supplement. If you're already having, say, milk product with breakfast, that maybe isn't
the time you take a calcium supplement because you don't really need
it at that time. But maybe your dinner didn't have much calcium and so
maybe that's the time that you would take
a calcium supplement if you needed to plug
in a little extra. We all know that milk
products, things like yogurt, even cheeses which were served as a snack are good sources
[NOISE] of calcium. The other really almost
preferable source is dark, green, leafy vegetables
of the cabbage family. When I say the cabbage family, you know what I mean by that? It's all of those, like kale type cabbage, the ones that have that
sulfur byte to them, and what makes them
special is that, that's a green leafy vegetable, where the calcium is actually
available to your body. Whereas other green
leafy vegetables, beet greens, spinach, chard, they have a lot of oxalic acid and that ties of the calcium so you
cannot absorb it. Have you experienced that
where you've had like a raw spinach salad
[BACKGROUND] and your teeth kind of felt choky? That's because the oxalic acid
was attacking your enamel [BACKGROUND] These are
still healthy foods, but when we look at
a food table and it tells us that spinach is
a good source of calcium, it's really misleading because it has a lot of calcium in it. It's just that you
can't absorb it well, whereas you can absorb
it well from kale, and that's one of the
reasons I think kale has gotten a lot of good
press these days. Some of you have heard me talk before and you know
that I'm always pushing sardines [LAUGHTER] and
canned fish with edible bones because we don't chew on bones from fresh fish because
we would choke on them. But canned fish have
edible bones that you can chew on and that's a
very good source of calcium. They're also sardines or
low on the food chain, so they're a kind of ecological choice and they're very rich in omega-3 fatty acids. Tofu can be a good
source of calcium, but only if it's been
made with calcium salts. Some tofu has been made
with magnesium salts, so you actually have
to read the label to determine if there
is calcium in it. We'll talk about calcium
fortified beverages in a moment. Magnesium, super
important nutrient, we need RDA is 320 will
say to 420 or 450. When you're looking at
people over the age of 70, 70-80 percent of us are not getting enough magnesium
according to national data. Magnesium is a hugely important nutrient for lots of reasons, but one of them is bone health. Dark green leafy vegetables
of all kinds are a good source of
magnesium; peas, beans, and lentils are a great source, whole grains, nuts,
seeds and milk products. Then potassium [BACKGROUND] and I'll say more about
that as we move along is found primarily, the richest sources are plant
foods, fruits, vegetables, and legumes in particular
[NOISE] and then we need enough vitamin D to be able to absorb calcium and magnesium. I think we all know that we
need about 600 units per day. A lot of people have been using milk substitutes these days
for a variety of reasons. Some people are allergic
to milk protein, some people can't digest
and absorb milk sugar, so there's a variety of reasons people are not doing milk. If you're allergic
to milk protein, it could be casein, what's called A1
casein from cow milk. If that's the issue, you often can handle
things like goat milk, or goat cheeses, or sheep cheese. But a lot of people are using these other non-dairy milks like a soy milk and the thing
that I like to point out is, I think people sometimes don't realize that they'd say cheese, or hemp milk, or an almond milk, or a coconut milk substitute, it will not have
anywhere near the amount of protein that a cow, goat, or sheep milk will have. Just to keep that in mind, if you were thinking of that
as part of your protein, then you need to
find other sources. Soy milk is closest in protein content to
regular animal milks [NOISE] but most of these milk substitutes
are basically water with calcium added to them. You need to check your labels. A typical cup of
milk, for example, is going to have like
250 to 300 milligrams of calcium in it. Soy milk, if you
looked at this one, the daily value on your label
is a really easy number, it's a 1000 milligrams, so 30 percent is
easy to do the math, that would be 300
milligrams in a cup. But if you look at other milks, this is an almond milk,
Trader Joe's variety. Do you notice how
different the protein is? There's a gram of protein
in a cup compared to eight in a cup of cow milk and then the calcium is much higher than a typical
animal milk would be. Probably, unnecessarily
high, so I questioned sometimes these substitutes that we're using in terms of are
they nutritionally adequate, I would just pay
attention to the labels. With regard to magnesium, very important to realize that half the body's magnesium
is stored in the bones. When we're routinely not getting enough dietary magnesium, we're really putting
a stress on the body that's having to go
to that storage area, which is not great if you're
talking about bone health. The magnesium that's
in bone actually is helpful when you're losing
magnesium from the bone, you get a more brittle bone that potentially could break
or fracture more easily. Again, the best sources of magnesium are dark
green leafy vegetables, legumes and whole grains. I'm told you already about
folks that are older, 70-80 percent are getting
enough dietary magnesium, but women in general, more than half are
not getting enough, all women over the age of 19 and then even if you talk
about adolescent girls, that's disturbing
that almost everybody is not getting enough magnesium. When you're thinking
about young women putting on maximum bone-mass, they're ending up going into their adulthood with less than would be optimal
in terms of bone-mass. With regard to vitamin D and I'm guessing that most
of you are having your vitamin D checked
pretty regularly because I think the medical profession
is very onto this. But even with all of the emphasis on
getting enough vitamin D, there's still a
substantial number of people that are vitamin
D insufficient, and there's a variety of ways
that that can be assessed. The Institute of Medicine
says that you have insufficient vitamin D
if your blood levels are below 20 nanograms
per milliliter. The Endocrine Society
has a different cut-off. They think you're insufficient
if you're lower than 30. If you use the Endocrine
Society cut-off, you're looking at 2/3 of people, more or less that are not getting enough vitamin D. It's
really important to make sure that you're checking your vitamin D and that you
have an adequate amount, certainly over 20 and probably 30 would be
better and there's many people that
think that even 40 or up to 50 is a good number. How many of you have heard
of Grassroots Health? Anybody? Few of you. That was started,
Cedric Garland who may have talked here
at Stein previously. Some of the researchers from UCSD School of
Medicine actually were very concerned about
vitamin D intakes. They worked with a variety of
other researchers and some advocates in the community
and put together this advocacy group
for vitamin D, trying to educate people
into how to get enough, and they have an application
on their website that I just did a quick and
dirty summary of here. But what it's basically telling you is if
you went in and you found that your
blood level was say 25 and you want it to
get it closer to 30, then this is saying that you
need an extra 600 units a day for several months
until you're tested again and hopefully you're going to get moving in the
right direction. But I think keeping an eye on your vitamin D
level is important, so many of us are worried
about skin cancer. We're not going out in the sun, we're slathering ourselves
with various sunscreens. We're definitely not making
any through sun exposure. So if you're not getting
dietary sources of vitamin D, you may not be getting enough. Vitamin K, lot of good information coming
at us recently about the importance of vitamin K. Women need at least 90
micrograms per day, hopefully coming from their diet, men need higher amounts, 120, very important
for bone health. Some pretty good
evidence that it's important to have
enough as a way of keeping calcium in our bones and reducing the risk of having
calcified blood vessels. We get vitamin K from dark
green leafy vegetables. We also get it from fermented
foods and from eggs, that would be the yolks of eggs. For years, we were worried about cholesterol
and people were throwing away yolks and that was unfortunate from a
vitamin K standpoint. One of the things that
animals do for us is they eat green leaves and they change that into a more active and biologically
available form of vitamin K. [NOISE] Some of you may even have chickens or you might
have grown up where there were chickens and you notice that chickens can
eat green things, but they also eat bugs that eat green things and then they have more of these fat soluble
nutrients in their yolk, so they have more colorful yolks, which not only is carotenoids, but could also include
vitamin K. Couple of studies, this one from 2014, used quite a high dose of
vitamin K. They were actually able to show that this very high dose increased
bone mineral density. It's definitely something
to pay attention to. Are you getting your
green leafy vegetables? Are you allowing yourself
to eat egg yolks? If you are using a multiple
vitamin mineral supplement, does it have vitamin K in it? But check and make sure
you're getting enough. Then, might surprise
you to think that vitamin C is also
important for bone health. It actually stimulates
bone forming cells. It prevents or decreases
the degradation of bone, and it's very important
for collagen synthesis or the making of that matrix of the bone that the minerals
actually go into. We know fruits and vegetables, very good sources of vitamin C, but we do need to do a good job of getting
our vitamin C foods in. This was surprising. This was a couple of things here. One published in 2009. This was an NHANES data that's national sample of Americans. In this case, it
was from 2003-2004. They found that seven percent of males that were sampled and four percent of females actually were
vitamin C deficient, which is amazing when
you think about all of the even junk foods that have
vitamin C put into them. There was this big study
that was published in 2017 that actually also brought up the
issue of how important vitamin C adequacy
is for bone health. They actually reported greater
dietary vitamin C intake was associated with a third
less risk of osteoporosis. Again, think about are you getting adequate
amounts of vitamin C, mostly from fruits
and vegetables. I don't know how many of
you ever think about boron. I remember thinking
about boric acid. Does that ring any bells? Boron turns out to be
a trace element that is also important for
the health of our bones, and it really was not something that we were
ever concerned about previously because it was just
assumed that our soils had enough boron in
them and therefore the plants that grew on those
soils had adequate boron. Now we unfortunately are finding that our soils are
getting depleted because of the use of synthetic
fertilizers and also various things
like glyphosate that are being sprayed
on our crop lands, which is impacting
the soil microbiome, which is then impacting
the health of the soil which is then impacting
the health of the plants. Boron is essential
for the growth and maintenance of bone
and it also boost the absorption of
magnesium and it's involved in the body's
use of hormones and vitamin D. So it
has several places that it plays an important role in keeping our bones healthy. If you're eating fruits and
vegetables and legumes, plant foods that are growing on organic soil that's healthy soil, you're likely going
to be getting enough. If you're somebody who depends on a well-balanced low-potency multiple
vitamin mineral supplement, take a look at the label and see if there's any boron in it. It's probably a good idea
to get a little bit. [NOISE] They actually have done studies showing that getting as little as three
milligrams a day, which is the
recommended amount is beneficial in terms of lowering
the risk of osteoporosis. Back to salt for a minute. As I mentioned before, salt is sodium chloride. If you take a look
at that graphic, one of the things I
think we always have well in our mind
is the connection between salt intake and
high blood pressure. But I think what we
don't necessarily think about is that when we eat
a very high salt diet, we tend to get more calcium
coming out in our urine. That probably if you're
talking about trying to keep calcium where it belongs and not getting
where it doesn't belong, good idea to be on a lower salt diet and that
means less processed foods. Potassium, very important
as an alkalizing mineral. The best sources,
fruits and vegetables. An average 1/2 cup cut up
fruit or vegetables can have about 200-250 milligrams
of potassium in it. I brought along my show-and-tell. Do all you guys have
this in your kitchen? This is a quart-size
measuring cup. That's four cups or
eight 1/2 cup servings. All of us need to try
to get that much fruit or vegetable in a day, minimum. So that's eight of these. Do an experiment
with yourself for a few days actually in the morning or at
night or the next day. Cut up a variety of fruits and vegetables and figure out how you're going to get that in. Because even if you got
eight 1/2 cup servings, you're only getting about 2,000 milligrams of
potassium and you really need to get
2,600-3,400 milligrams a day. Most of us are not doing what we should in
terms of potassium. I think when we think potassium, the first thing we go
to is we go to bananas. That's fine, they're pretty
high also in natural sugar. Dates and prunes also would be good sources of soluble
fiber and potassium. I have a lot of recipes on my website where I've
actually use prunes or dates as a sweetener
in baked goods. They add extra fiber and it's
a natural source of sugar, so you can take a look. Leafy greens,
mushrooms, potatoes, sweet potatoes, and spinach are especially rich in potassium. So they actually
have a little more than that 250 on average. The more of those
you eat probably, the more you're going
to help your potassium. Then the other thing
to notice is that when you eat peas, beans, or lentils as your
protein source, you're getting a lot of extra
potassium that you wouldn't necessarily get if you ate
animal sources instead. I don't know how many of you saw the headlines that hit
a little while ago, but there was a study
published where the intervention group
actually was given five prunes a day. These were older women
between 65 and 79 years. They found that the women
in the group that got the extra prunes actually did better from a standpoint
of bone loss. It was funny when I was reading the article
because they were speculating about what could
it have been in the prunes. They said, "Well, maybe
it was the iron." I thought that's odd. To me, I would have thought
it was the potassium. But then the other
thing that we're realizing is it could also have been that prunes are an excellent source
of soluble fiber. One of the interesting
things we're seeing as the literature is
evolving is that soluble fiber is helping to keep the friendly bacteria in
the gut healthy and happy. There's some very interesting
work coming out about the health of the gut biome
and the health of our bones. I think that's something
to keep an eye on. Maybe Rob Knight
can come and talk about that some other time. I'm one of those
people that keeps a little extra potassium
in my home pharmacopoeia. Not that I would use
it all the time, but I keep these little tabs. I happen to use a
potassium gluconate. They come like 100
milligrams in a little tab. It's one of those nutrients that you don't want to overdo, but if you think that a half cup of cut
up carrots has 250, taking one little tab of
100 is not dangerous. You can look through
your day and think, "How do I do from a
standpoint of potassium? Would a little extra help?" Again, always with
supplements, you're cautious. You don't overdo and
do great big amounts, but a little extra can be useful. I showed you this
comparison because this is looking at the cost
per 100 milligrams. I've had some folks that I know recommended this product
by Apex Energetics. It's a really expensive
way of getting potassium. It's almost 30 cents
for 100 milligrams, whereas some of these
others perfectly good sources of potassium
are three cents. So shop around. Again, mostly your
fruits and vegetables. Only if you're not
getting enough, do you add a little extra. I talked about eight or nine 1/2 cup servings
being really important. There have been some
interesting recent studies and two of them are noted here. This particular one by Sim, published about a year ago, showed reduced falls and
fractures in older women over the age of 70 if they had greater intake of
fruits and vegetables. So less problems with their bones with more
fruits and vegetables. Then there was another one, this was published in 2015, that showed reduced bone
turnover and loss of calcium in the urine with people that were eating
more fruits and vegetables. In general, you just can't get enough fruits and
vegetables, I'm telling you. We need to do better. Then the other thing, I worked in cancer research for, as you heard 20 years, and we were very focused on
the plant protectors and food because they were considered good ways of reducing
the risk of cancer. I think we just gotten so much additional information on the benefits of
these plant protectors. This particular study that
was published in just 2018, a year ago, talked about some
of these plant protectors. It's always a little
troubling because there's interest in finding
the magic bullet in the fruit or vegetable, so you can put it into a capsule and sell it
for lots of money. Me as a dietitian keeps
wanting to just say, just eat the fruits
and vegetables. We say, go for the
bold, big color, and strong flavor because that's where you find
most of these protectors. For those of you that want to spend a little extra money on
a plant anti-inflammatory, the supplement
called Zyflamend is a reputable product that
has a lot of those in it. Just quickly about the gut
biome and bone health. This was again published
just last year. I think we're going
to see a lot more in this topic area as
time moves along. But this particular
study actually showed that the diets
that were higher in fiber and therefore
promoted the growth of healthy bacteria in the
gut actually were showing to be you could say
bone-healthy because they actually
favored osteoblasts, which are the guys that actually build bone as
opposed to breaking it down. I think we're going
to learn a lot more about that as we move along. I'm always telling people
we need more fiber. Soluble fiber is what actually grows those healthy gut bacteria. Fruits, vegetables,
and legumes are the very best sources of soluble fiber but even whole
grains have soluble fiber. If you go back to that
my eight half cups, between fruits and
vegetables, you did eight, you would get eight grams more
or less of soluble fiber. Then say you had a half cup
of black beans for lunch. That would be another two grams. So you've gotten to that at least 10 grams
of soluble fiber, which is your goal per day. You need all kinds of fiber. You need insoluble also, but when you're
eating whole food, you're getting soluble
and insoluble. So it's not hard to do. You hear a lot about controlling your sugar intake to prevent
diabetes and heart disease. It also turns out
that people with diabetes have higher
risk of fracture, and we know that people
with blood sugar problems have more difficulty
with bone formation, holding on to healthy bone, and they don't heal
breaks as effectively. So cutting down on sugar
also very helpful. In terms of if you do need
to use a calcium supplement, here are a few and I always
tell people that I change my recommendations
depending on what I'm learning or what products
come to my attention, and I like to break it down
to how much nutrient are you getting per tablet because
as you've probably noticed, some of the calcium
supplements tell you that the dose on the label
is like one tab. Some say three tabs will
give you this dose. Some say six tabs will
give you this dose. It's super confusing. The one that I particularly like is Bone Strength
by New Chapter. This could change if
you come and hear me in six months depending
on what I'm learning. But I these ones that have roughly the amount of
calcium that would come in a cup of milk
or a serving of yogurt. This one has a little magnesium. You'd need to do a good job of getting magnesium
from other sources. It has half the
RDA for vitamin D, has a little vitamin K, and has a little strontium
also and there's some evidence that
that might be helpful. Jarrow makes BoneUp, which got a good rating
from ConsumerLab. Do you all know about
ConsumerLab.com? ConsumerLab.com is like consumer
reports for supplements. It doesn't take any money from supplement manufacturers and it analyzes supplement contents to make sure that
what's on the label is actually what's in the pill. It's a good place
you can go to for reputable information
on supplement quality. This is a soluble form of calcium lactate if you needed
a little extra calcium. This one has in a
half a tablespoon about the amount of calcium
in a cup of yogurt or milk. It has a little extra magnesium
and some vitamin D in it. This is a possible supplement
that you could use. I'm not a big fan of Viactiv. Have you all noticed
how much sugar is in one of those chews? It's like a teaspoon per chew, so beware of that. This is in your handout, but I think it's very worth paying attention
to the number of commonly prescribed drugs
that can affect bone mass. It's very important
to have a chat with your physician about
if you are using them, is there any chance that
you could try a lower dose? Many times that's not possible. Then you just have to do a better job of
paying attention to your exercise and your nutrients to hold onto the bone
that you've got. But there's lots. This is a good
reference for you to look up for more information. In summary, I want
to emphasize again the importance of weight-bearing
and strength training. Again, think about pulling
on those bones with your muscle to tell your body
where to put the nutrients. You want to reduce
your risk of falls because I didn't know, for example, that I was going
to reach peak bone mass at 30 and I wasn't doing any
weight-bearing exercise. I was a swimmer. Some of us are already
dealing with deficits, so we need to work very
hard to make sure that we have good balance and if we start to fall we can
catch ourselves. We want to get enough and not too much protein and calcium. We've got to get enough D, K, magnesium, and boron
to be optimum. Try to reduce or cut out
completely processed food, especially any that has
added salt and sugar. Get plenty of fruits
and vegetables, especially the colorful
and flavorful ones. If you feel like
you're a little short in some of those key nutrients for bone health and strength, then use supplements judiciously. Just don't overdo it. Then talk to your doctor
about medication to see if you can maybe adjust
it a little bit. Two books that I found
incredibly useful. One is called Crooked, written by a woman who
experienced a fracture. She was only, I think, in her late 30s, early 40s, and was talked into doing back surgery which did not end well. She has written a very
user-friendly book about how important taking these other actions
can be to try to avoid surgery or minimize
the amount of surgery. The other one by Lara Pizzomo is called Your
Bones, it's very helpful. I also have my book, Food for Thought in case
anybody's interested. Lots of healthy
recipes in that and tables of calcium and magnesium content of
food in the back. Thank you all for listening. Thank you. [APPLAUSE] [MUSIC]
