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CHAPTER 10.

OSTEOPOROSIS.

All too often, the first sign of osteoporosis is a broken bone. For my client Janice, it was her wrist. At age 64, her overall good health was the envy of more than one of her close friends-she felt good, looked younger than her age, and regularly saw her internist and gynecologist for routine checkups. Then she slipped and fell in the snow...and osteoporosis, which had been silently developing for years, made itself known.

Osteoporosis is defined by low bone mineral density (BMD), as measured by an x-ray bone density scan. If a scan shows your bone density is a bit low, your diagnosis is osteopenia, or pre-osteoporosis. If BMD is quite low, the diagnosis is osteoporosis. The results of bone density scans are expressed in terms of T scores. Scores ranging from -1.0 to-2.5 indicate osteopenia; less than-2.5 means osteoporosis.

Regardless of the cause, if you have low bone density you're facing a higher-than-average risk of breaking a bone. If you are lucky, your doctor will recognize some of the risk factors and send you for a bone density scan before before you have to endure the pain and recovery of a break. Unfortunately for Janice, the first clue was that sickening crunch of her wrist breaking. you have to endure the pain and recovery of a break. Unfortunately for Janice, the first clue was that sickening crunch of her wrist breaking.

When I first saw Janice, she had just started taking osteoporosis medication, but her doctor wanted her to have an intensive nutrition intervention as well. During our first meeting, I found out why she needed my help. She ate terribly, making meals from whatever food was on hand-generally lots of processed foods-without giving a thought to what nutrients she might be missing.

FAQSI know I need to get more calcium in my diet because my diet is pretty bad. I don't exercise much, and I've always been on the thin side, so I guess I could be at risk of osteoporosis. If I'm taking a multivitamin with calcium in it, do I really need to take a separate calcium supplement, too?

Calcium is bulky, so there is no way to fit a day's supply in a multivitamin. Most multivitamins have, at most, 100 to 200 milligrams of calcium-much less than the 1,000 to 1,200 milligrams you'll need. So yes, you really should be taking a separate calcium supplement. But if you radically change your diet, you may be able to get enough calcium from diet alone. Start counting your servings of high-calcium foods. If you consistently eat at least three servings of a high-calcium food every day, you're probably safe. But if your diet is erratic, then take 500 to 600 milligrams of calcium with D3 once a day in the morning or afternoon. By the evening, think back to how you ate during the day. If you ate two or more servings of a high calcium food that day, then you can skip the evening dose. If not, take an additional 500 to 600 milligrams with a snack before bed. (However, if you have been diagnosed with osteoporosis or osteopenia, always take the second dose of calcium.) once a day in the morning or afternoon. By the evening, think back to how you ate during the day. If you ate two or more servings of a high calcium food that day, then you can skip the evening dose. If not, take an additional 500 to 600 milligrams with a snack before bed. (However, if you have been diagnosed with osteoporosis or osteopenia, always take the second dose of calcium.)

I rose to the challenge. For 90 minutes, I gave her a thorough lesson in osteoporosis, and a comprehensive meal plan filled with food choices rich in nutrients that would help her condition-more about these in the pages to follow. I also recommended that she start taking a calcium supplement with vitamin D3 (cholecalciferol, the most potent form of vitamin D). I explained the benefits of exercise, and how to alternate strength training and weight-bearing exercises. I suggested that she walk on the treadmill five times per week, 40 minutes per session, at a speed of 3.5 miles per hour. By the time Janice left, I felt confident that she had all the tools she needed to turn a corner. (cholecalciferol, the most potent form of vitamin D). I explained the benefits of exercise, and how to alternate strength training and weight-bearing exercises. I suggested that she walk on the treadmill five times per week, 40 minutes per session, at a speed of 3.5 miles per hour. By the time Janice left, I felt confident that she had all the tools she needed to turn a corner.

Two weeks later, Janice returned to the office with her food journal filled out and ready for my evaluation. She had done nothing! Well, next to nothing. She took the calcium supplements, but she didn't do any exercise, and, most distressing of all, she had made no changes in her diet.

Janice understood my instructions, but when it came time to implement them, she felt overwhelmed. Embracing a new way of eating meant overcoming the inertia of eating patterns she'd established decades ago. She'd never been that interested in planning and cooking meals anyway. To my eyes-brutal honesty alert!-her eating life was just so boring boring. Every day for breakfast Janice ate a toasted English m.u.f.fin with peanut b.u.t.ter washed down with a cup of black coffee. Every morning. For years! The thing was, it didn't matter to her. She ate the same foods day in and day out because it was just easier that way. I have nothing against peanut b.u.t.ter or whole wheat English m.u.f.fins-that's a fine quick breakfast-but it didn't supply her with essential nutrients we all need and it did nothing to help her fight low bone mineral density.

I learned an important lesson from Janice. I know I advised her well nutritionally, but there's a second, sometimes greater challenge to tackle beyond that-changing a lifetime of apparently harmless eating habits. Janice felt healthy. Janice looked terrific. But all the while, Janice's bones had quietly been losing ma.s.s, becoming thinner and thinner. Breaking her wrist was frightening and painful, but didn't mean she could instantly embrace a whole new way of eating.

I decided to take another tack. This time I gave Janice three specific goals to focus on. First, I told her she that if she wanted to eat the same foods for breakfast day after day, fine, but she had to switch to foods that would specifically address her needs-namely cereal with skim milk, sliced banana, and a gla.s.s of calcium-fortified orange juice. Second, she could eat whatever she wanted for dinner, but she had to eat a high-calcium appetizer. She decided on pre-dinner salad of leafy greens topped with 1 ounce of feta or shredded cheddar cheese and, in signature Janice fashion, ate that every day. And third, before bed, I instructed her to eat a snack of yogurt. Those changes alone gave her four hits of high-calcium, bone-strengthening foods (plus pota.s.sium from the orange juice, dairy, and banana; vitamin C from orange juice; folic acid from fortified cereal, orange juice, and leafy greens; vitamin K from leafy greens; and vitamin D from the morning milk). In addition, Janice decided that instead of 40 minutes of treadmill walking, she would walk her dog for an additional 15 minutes per day and join Curves gym with a friend.

At the end of a year, these few changes (with medication) helped Janice do more than arrest bone loss-she actually increased increased bone density in her spine. bone density in her spine.

Initially Janice was one of the least compliant people I've ever seen in my practice. So why am I telling you her story? Because you don't have to be perfect right off the bat or at every meal to see real results. By the end of this chapter, you'll have all the tools you need to make your bones healthier. It's a lot of information. If you can't do it all right away, that's perfectly fine. Do one thing. Then do another. Eventually, all those little things add up. But you have to do something-your bones are too important to ignore.

WHAT AFFECTS OSTEOPOROSIS?.

Children are taught that bones are like steel girders, the framework of the glorious structure that is the human body. The problem with that a.n.a.logy is that girders are designed to last hundred of years without losing strength. In reality, bones are more like the interstate highway system-they fall apart, crack, get potholes, and then get patched up again so we can continue using them.

Nor are our bones uniformly dense. The outer layer is called compact bone compact bone, and it is relatively solid. But just under the compact bone is another layer called spongy bone spongy bone, which isn't soft, but it is porous, with holes like a sponge or Swiss cheese. And because bone is live tissue, there are also nerves and blood vessels to feed the cells, as well as other structures. Bones also contain specialized cells that help form bone (osteoblasts) and break down or resorb resorb bone ( bone (osteoclasts). Osteoclasts and osteoblasts work like little construction crews, constantly remodeling, working to keep the bones healthy and strong. If your overall health is good and you eat nutritionally sound meals, there is a balance-for every bit of bone lost, an equal amount of bone is created.

With osteoporosis, though, more bone is lost than formed. As you might imagine, the spongy bone-with all its holes and slender walls-becomes weak and compromised more quickly than compact bone. Breaks can occur anywhere, but the most common sites are the hip and wrist, which are more likely bear the impact of a fall. The bones of the back (vertebrae) are also affected, but they don't break...they are crushed. The weight of the body is enough to compress the back bones, causing a mult.i.tude of tiny fractures in the spongy bone. Over time people with osteoporosis can become shorter-they lose a little height each time a vertebra compresses.

No one knows definitively what causes some people to develop osteoporosis, but some factors are clear: HORMONAL CHANGES.

Estrogen and testosterone are important for bone health because they regulate bone loss, or resorption. Both these hormones seem to inhibit the formation of osteoclasts (the cells that break down bone), so when hormone levels are high, there are more bone-building cells than bone-destroying cells. If hormone levels fall, the balance shifts, and bone density is lost.

The question, then, is what causes levels of estrogen or testosterone to fall? The most common cause is aging. Men can develop osteoporosis when they get older as testosterone levels slowly decline. For women, menopause causes an extreme drop in estrogen, and their greatest bone loss occurs within the first ten years after menopause. That's why many physicians recommend that women get a bone density scan when they turn 50 or when they enter menopause, whichever comes first. That first test acts as a baseline. The scan should be repeated one or two years later to get a sense of the rate of bone loss.

Menopause isn't the only thing that triggers osteoporosis. Unfortunately, I've been seeing a lot of young women in my practice, women referred to me by their doctors because eating disorders have begun to ravage their bones. When a woman's weight drops too low, her hormones get out of whack, her estrogen levels fall, and she stops menstruating. In terms of bone health, a too-thin woman in her 20s looks a lot like a post-menopausal woman in her 60s. The only real cure is for the young woman to gain enough weight to start menstruating again, and then to maximize her bone density while she can-that is, until about age 30, when bone density reaches its peak.

CORTICOSTEROIDS.

Corticosteroid medications are used to treat a number of common illnesses, including asthma and some autoimmune disorders. But steroids seem to inhibit the bone-building activity, and may also increase bone resorption. It has been estimated that up to half of all people who take steroids long-term will end up with osteoporosis. Significant bone loss can occur after even a relatively short course of corticosteroids-7.5 milligrams of prednisone for two to three months may require treatment to prevent bone loss.

BODY WEIGHT.

Bones get stronger if they get more use. In the earlier stages of life, exercise helps build bone. And as much as it pains me to say it, weight builds bone. When it comes to osteoporosis, thin women have a greater risk than heavy women. Think about it-bones that support a 170-pound woman work harder than bones that carry a 110-pound woman. Studies have shown that lean muscle ma.s.s helps strengthen bone density more than fat, but overall weight still contributes to strong bones.

Of course, my advice is not for you to put on a few pounds for the sake of strengthening your bones! Being overweight puts you at greater risk for so many life-threatening diseases that it is never a wise choice. But women who diet excessively to keep their weight fashionably low are hurting their bones, now and in the future.

FAQSI've heard that coffee makes your body lose calcium. Is that true?

Well, it happens, but not significantly. Does coffee affect absorption of calcium? Does coffee affect absorption of calcium? Yes, but hardly at all. A person can safely drink up to three cups of coffee a day without putting their stores of calcium at risk. Any shortfall can be recouped with just 2 tablespoons of milk per cup. Adding low-fat milk to your coffee should be plenty to keep your calcium levels in the black. Yes, but hardly at all. A person can safely drink up to three cups of coffee a day without putting their stores of calcium at risk. Any shortfall can be recouped with just 2 tablespoons of milk per cup. Adding low-fat milk to your coffee should be plenty to keep your calcium levels in the black.

OTHER DISEASES.

Any disorder that reduces the body's ability to absorb calcium and other nutrients can cause osteoporosis. The most common is celiac disease, an autoimmune disorder that causes the small intestines to lose their absorption capability. Previously thought to be a rare disease of childhood, celiac disease is now known to affect about 1 percent of Americans, and can strike at any age. (For more information, see Celiac Disease, Chapter 18.) HOW FOOD AFFECTS OSTEOPOROSIS.

Next to genetic predisposition, poor nutrition is the most common cause of osteoporosis. Making healthy food choices can help prevent dangerous bone loss, and food is one of the most important treatments recommended by physicians and nutritionists alike once osteoporosis is diagnosed.

GOOD FOODS TO CHOOSE.

CALCIUM AND VITAMIN D.

When it comes to osteoporosis prevention or treatment, the two most important nutrients are calcium and vitamin D.

Bone is made mostly of calcium. In addition, calcium fuels many other body functions, such as muscle movement, nerve operation, and immune activation. Typically, we get our daily dose of calcium from food. But if your diet isn't the greatest, your body will use your bones as a lending inst.i.tution, borrowing the calcium it needs today from the abundant supply in your bones. This creates a kind of calcium debt to your bones. If you eat enough high-calcium foods to keep functioning, any excess will be used to pay back the debt. But if you eat poorly, the debt never gets repaid. While you can skate by for a few years, eventually the debt will catch up with you in the form of weakened, thinning bones.

As we physically develop, our bones get denser and denser if we supply them by eating calcium-rich foods. After about age 30, our bones are as dense as they will ever be. That's why it is so important for children and young adults to get enough calcium in their diets; if they later need to "borrow" calcium from their bones, strong dense bones are the equivalent of a high spending limit on a credit card. After menopause, all women lose bone density because of hormonal changes. A woman with dense bones will be able to lose some density without developing osteoporosis. After menopause, it is still important to get enough calcium so that you don't run up a calcium debt any larger than necessary.

On the other hand, it is possible to get too much of good thing. Most people struggle to get the recommended 1,000 to 1,500 milligrams of calcium daily. But some folks can't help but go overboard when they finally see the light about bone health-they change their diets and take supplements...lots of supplements. Unfortunately, you can't make up for lost calcium overnight. The upper recommended limit for calcium consumption is 2,500 milligrams per day-taking more can reduce the body's ability to absorb other minerals, and may lead to kidney stones.

One interesting note: Some foods-most notably spinach and rhubarb-contain lots of calcium, but they also contain oxalates, substances that bind to the calcium, making it unavailable to your body. My list of calcium-rich foods includes only the absolute best sources, so every serving serves your bones.

BEST FOODS FOR CALCIUM: Yogurt (fat-free, low-fat), milk (fat-free, 1% reduced-fat), enriched/fortified soy milk, calcium-fortified fruit juice, cheese (fat-free, reduced-fat), tofu with calcium, sardines (with bones), wild salmon (with bones), soybeans, frozen yogurt (fat-free, low-fat), low-fat ice cream, calcium-fortified whole grain waffles, bok choy, white beans, kale, broccoli, almonds Yogurt (fat-free, low-fat), milk (fat-free, 1% reduced-fat), enriched/fortified soy milk, calcium-fortified fruit juice, cheese (fat-free, reduced-fat), tofu with calcium, sardines (with bones), wild salmon (with bones), soybeans, frozen yogurt (fat-free, low-fat), low-fat ice cream, calcium-fortified whole grain waffles, bok choy, white beans, kale, broccoli, almonds Calcium is useless without vitamin D. Vitamin D allows calcium to move from the gastrointestinal tract to the parts of the body that need it-including the bones. Without enough vitamin D, a child's bones can become so weak that they bow under the body's own weight, a condition called rickets rickets. In adults, lack of vitamin D means that the body borrows calcium from bones to feed the rest of the body's needs. Eventually osteoporosis will set in.

Vitamin D can be made in the body through a reaction of the skin and sunlight. Just 10 to 15 minutes of sun on the bare skin of the arms three or four times a week is enough to keep most of us healthy. Of course, too much sunlight causes skin damage and premature aging, and may lead to skin cancer. That's why I recommend getting vitamin D from food sources and supplements.

BEST FOODS FOR VITAMIN D: Wild salmon (with bones), mackerel (not king), sardines (with bones), herring, fortified milk (fat-free, 1% reduced-fat), enriched/fortified soy milk, egg yolks, mushrooms (especially shiitake), vitamin-D-fortified margarine (soft tub, trans fat-free), fortified whole grain cereals Wild salmon (with bones), mackerel (not king), sardines (with bones), herring, fortified milk (fat-free, 1% reduced-fat), enriched/fortified soy milk, egg yolks, mushrooms (especially shiitake), vitamin-D-fortified margarine (soft tub, trans fat-free), fortified whole grain cereals OTHER NUTRIENTS.

Although calcium and vitamin D are the superstars of osteoporosis prevention and treatment, there are many other nutrients that play a supporting role, including: Magnesium: You don't need a chemistry cla.s.s to know that acids can be corrosive. The same is true for acids formed in your body during the process of metabolism. These metabolic acids need to be balanced and neutralized by alkaline compounds, otherwise they can cause bone loss. Magnesium can help neutralize these acids. You don't need a chemistry cla.s.s to know that acids can be corrosive. The same is true for acids formed in your body during the process of metabolism. These metabolic acids need to be balanced and neutralized by alkaline compounds, otherwise they can cause bone loss. Magnesium can help neutralize these acids.

FAQSI've heard that calcium can be leeched from bones by the phosphorus in soft drinks. Is that true?

No, it's a fallacy. In reality, there is much more phosphorus naturally found in meat than there is in soda. The main problem with soft drinks is that they replace calcium and vitamin D-rich milk in the diet. Back in the "good old days," kids drank milk with lunch and dinner, and they often started the day with a bowl of cereal and milk. More recently, milk has fallen out of favor, and soda has become the drink of choice. Studies have shown that kids who drink soft drinks instead of milk often have less bone density than kids who get plenty of calcium in their diets. The same is true for adults. So while soft drinks are partly to blame for low bone density, it's not because of the phosphorus.

In addition, magnesium helps your body absorb calcium. For calcium to be absorbed in the body, it needs two things: vitamin D (as we already discussed) and parathyroid hormone (PTH). Because magnesium affects PTH, it indirectly-but very critically-affects how much calcium is available for building and maintaining bone.

In scientific research, dietary magnesium gets mixed reviews-some studies show little or no effect, while others show significant increases in bone density or decreases in fractures. Despite these conflicting findings, magnesium is necessary for health, and I believe it is impossible to properly treat osteoporosis without including magnesium.

BEST FOODS FOR MAGNESIUM: Pumpkin seeds, spinach, Swiss chard, amaranth, sunflower seeds, cashews, almonds, quinoa, tempeh, sweet potatoes, white potatoes, soybeans, millet, beans (black, white, navy, lima, pinto, kidney), artichoke hearts, peanuts, peanut b.u.t.ter, chickpeas (garbanzo beans), brown rice, whole grain bread, sesame seeds, wheat germ, flaxseed Pumpkin seeds, spinach, Swiss chard, amaranth, sunflower seeds, cashews, almonds, quinoa, tempeh, sweet potatoes, white potatoes, soybeans, millet, beans (black, white, navy, lima, pinto, kidney), artichoke hearts, peanuts, peanut b.u.t.ter, chickpeas (garbanzo beans), brown rice, whole grain bread, sesame seeds, wheat germ, flaxseed Pota.s.sium helps to increase bone formation, improves calcium balance, increases bone mineral density, and reduces bone resorption by neutralizing metabolic acids. Researchers from the United Kingdom looked at the effects of dietary pota.s.sium on bone mineral density of more than 3,000 pre- and postmenopausal women. For women who were still menstruating, eating lots of pota.s.sium-rich foods increased bone mineral density by 8 percent-a relatively modest gain, but one that the researchers estimated could translate into a 30 percent reduced risk of fracture in later years. helps to increase bone formation, improves calcium balance, increases bone mineral density, and reduces bone resorption by neutralizing metabolic acids. Researchers from the United Kingdom looked at the effects of dietary pota.s.sium on bone mineral density of more than 3,000 pre- and postmenopausal women. For women who were still menstruating, eating lots of pota.s.sium-rich foods increased bone mineral density by 8 percent-a relatively modest gain, but one that the researchers estimated could translate into a 30 percent reduced risk of fracture in later years.

Of course, it is difficult to separate the effects of pota.s.sium specifically from the effects of fruits and vegetables in general. Fruits and veggies, many of which contain significant quant.i.ties of pota.s.sium, have a whole rainbow of nutrients that contribute to bone health. A few studies have shown that supplements of pota.s.sium salts can reduce the amount of calcium lost in urine, but no one has yet determined whether that translates into healthier bones. The important thing to take away from all this is that pota.s.sium-rich foods foods will help keep your bones as healthy and strong as possible. will help keep your bones as healthy and strong as possible.

BEST FOODS FOR POTa.s.sIUM: White potatoes, yams, yogurt, soybeans, Swiss chard, snapper, sweet potatoes, avocado, cantaloupe, artichokes, bananas, spinach, lettuce (especially romaine), radicchio, arugula, endive, black cod (sablefish), honeydew melon, pumpkin, milk (fat-free, 1% reduced-fat), carrots, beans (white, black, navy, kidney, pinto), lentils, lima beans, apricots, papaya, split peas, pistachio nuts, winter squash (acorn, b.u.t.ternut), enriched/fortified soy milk, watermelon, beets, tomatoes (including sauce, juice), kale, mushrooms, raisins, peanuts, plums, almonds, sunflower seeds, prunes (and juice), chickpeas (garbanzo beans), oranges (and juice), broccoli White potatoes, yams, yogurt, soybeans, Swiss chard, snapper, sweet potatoes, avocado, cantaloupe, artichokes, bananas, spinach, lettuce (especially romaine), radicchio, arugula, endive, black cod (sablefish), honeydew melon, pumpkin, milk (fat-free, 1% reduced-fat), carrots, beans (white, black, navy, kidney, pinto), lentils, lima beans, apricots, papaya, split peas, pistachio nuts, winter squash (acorn, b.u.t.ternut), enriched/fortified soy milk, watermelon, beets, tomatoes (including sauce, juice), kale, mushrooms, raisins, peanuts, plums, almonds, sunflower seeds, prunes (and juice), chickpeas (garbanzo beans), oranges (and juice), broccoli

FAQSMy kids won't drink milk, and I can't stand drinking it myself-should I worry about the amount of calcium we're getting?

Milk is an easy way to get calcium, but it is certainly not the only way. All dairy foods contain calcium, and many kids enjoy eating yogurt and string cheese. Whenever possible, subst.i.tute foods your kids already eat with calcium-fortified versions. For example, there are calcium-fortified waffles and orange juice. If they still don't get enough calcium, you can always try one of the candy-flavored chewable calcium supplements, such as Viactiv or Nature's Made brands. My experience has shown that most kids don't like the chocolate flavors that adults are drawn to-they may eat them for a couple days, but then the appeal wears off. Instead, choose one of the other flavors, such as orange, strawberry, or caramel. (Always be careful to store the supplements where your children can't get them-if they think of them as candy, you can bet they'll be looking for opportunities to sneak extras. Too much calcium can be dangerous.) Another sneaky-but effective!-way to ensure your children get the calcium and vitamin D they need, is to buy a pill crusher at your local pharmacy, and mix one crushed calcium pill with a few tablespoons of yogurt or low-fat pudding.

Vitamin K is important for the formation of osteocalcin, a type of protein found only in bone. People who suffer from fractures tend to have low vitamin K levels...and those who have high blood levels of vitamin K also tend to have high bone density. In studies of people with vitamin K deficiencies, those who took vitamin K supplements had less bone loss and fewer fractures. Therefore I highly recommend loading up on foods rich in vitamin K. One caveat: vitamin K is a natural blood thinner, so people who are taking blood-thinning medication (such as warfarin) should talk with their doctors before eating vitamin K-rich foods. is important for the formation of osteocalcin, a type of protein found only in bone. People who suffer from fractures tend to have low vitamin K levels...and those who have high blood levels of vitamin K also tend to have high bone density. In studies of people with vitamin K deficiencies, those who took vitamin K supplements had less bone loss and fewer fractures. Therefore I highly recommend loading up on foods rich in vitamin K. One caveat: vitamin K is a natural blood thinner, so people who are taking blood-thinning medication (such as warfarin) should talk with their doctors before eating vitamin K-rich foods.

BEST FOODS FOR VITAMIN K: Kale, spinach, collard greens, Swiss chard, turnip greens, endive, escarole, mustard greens, lettuce (all varieties), parsley, broccoli, Brussels sprouts, watercress, asparagus, okra Kale, spinach, collard greens, Swiss chard, turnip greens, endive, escarole, mustard greens, lettuce (all varieties), parsley, broccoli, Brussels sprouts, watercress, asparagus, okra Folate: h.o.m.ocysteine is an amino acid that is usually a marker for atherosclerosis and heart disease. But scientific research now suggests that h.o.m.ocysteine may also be a marker for osteoporosis. In a 2006 Norwegian study, women with high levels of h.o.m.ocysteine also had low bone mineral density. In addition, women with low bone density also had low levels of the B vitamin called folate, which is known to lower h.o.m.ocysteine levels. Although more research needs to be done to clarify the role of folate, the hope is that women can reduce their risk of osteoporosis by eating more folate-rich foods. h.o.m.ocysteine is an amino acid that is usually a marker for atherosclerosis and heart disease. But scientific research now suggests that h.o.m.ocysteine may also be a marker for osteoporosis. In a 2006 Norwegian study, women with high levels of h.o.m.ocysteine also had low bone mineral density. In addition, women with low bone density also had low levels of the B vitamin called folate, which is known to lower h.o.m.ocysteine levels. Although more research needs to be done to clarify the role of folate, the hope is that women can reduce their risk of osteoporosis by eating more folate-rich foods.

BEST FOODS FOR FOLATE: Fortified whole grain cereals, lentils, black-eyed peas, soybeans, oatmeal, turnip greens, spinach, mustard greens, green peas, artichokes, okra, beets, parsnips, broccoli, broccoli raab, sunflower seeds, wheat germ, oranges (and juice), Brussels sprouts, papaya, seaweed, berries (boysenberries, blackberries, strawberries), beans (black, Fortified whole grain cereals, lentils, black-eyed peas, soybeans, oatmeal, turnip greens, spinach, mustard greens, green peas, artichokes, okra, beets, parsnips, broccoli, broccoli raab, sunflower seeds, wheat germ, oranges (and juice), Brussels sprouts, papaya, seaweed, berries (boysenberries, blackberries, strawberries), beans (black, pinto, kidney, garbanzo, navy), cauliflower, Chinese cabbage, corn, whole grain bread, pasta (preferably whole wheat) pinto, kidney, garbanzo, navy), cauliflower, Chinese cabbage, corn, whole grain bread, pasta (preferably whole wheat) Vitamin C is essential for the health of collagen and other connective tissue, including the connective tissue in bones. Without enough vitamin C, bone density loss accelerate. Some studies have shown that eating lots of foods high in vitamin C increases bone mineral density and results in fewer fractures. is essential for the health of collagen and other connective tissue, including the connective tissue in bones. Without enough vitamin C, bone density loss accelerate. Some studies have shown that eating lots of foods high in vitamin C increases bone mineral density and results in fewer fractures.

BEST FOODS FOR VITAMIN C: Guava, bell peppers (yellow, red, green), orange juice, hot chile pepper, oranges, grapefruit juice, strawberries, pineapple, kohlrabi, papaya, lemons, broccoli, kale, Brussels sprouts, kidney beans, kiwi, cantaloupe, cauliflower, red cabbage, mangos, grapefruit (pink, red), white potatoes (with skin), mustard greens, cherry tomatoes, sugar snap peas, snow peas, clementines, rutabagas, turnip greens, tomatoes, raspberries, Chinese cabbage, blackberries, green tomatoes, cabbage, watermelon, tangerines, lemon juice, okra, lychees, summer squash (all varieties), persimmons Guava, bell peppers (yellow, red, green), orange juice, hot chile pepper, oranges, grapefruit juice, strawberries, pineapple, kohlrabi, papaya, lemons, broccoli, kale, Brussels sprouts, kidney beans, kiwi, cantaloupe, cauliflower, red cabbage, mangos, grapefruit (pink, red), white potatoes (with skin), mustard greens, cherry tomatoes, sugar snap peas, snow peas, clementines, rutabagas, turnip greens, tomatoes, raspberries, Chinese cabbage, blackberries, green tomatoes, cabbage, watermelon, tangerines, lemon juice, okra, lychees, summer squash (all varieties), persimmons Soy protein: Soy foods contain natural chemicals called isoflavones, which are phytoestrogens-plant substances that mimic estrogen. Knowing that women lose bone density after menopause because of the loss of estrogen, some scientists believe that the plant estrogens in soy foods could help increase bone density. It's still not clear whether that's true. In laboratory rats, isoflavones helped preserve bone. But in people, the effects are more complicated. Scientists theorize that soy may only help women before menopause (when they lose estrogen receptors as well as estrogen), or it could be that only certain forms of soy protein may be beneficial after menopause. For example, a j.a.panese study of postmenopausal women found that bone mineral density was higher in women who ate fermented soybeans (natto), but not in women who ate tofu or other soy products. But other studies have shown that long-term addition of soy protein in the diet seems to reduce bone turnover and may prevent bone loss after menopause. Although the optimal amounts of soy protein haven't been determined, I recommend you try to incorporate high quality soy foods into your diet a few times each week. Soy foods contain natural chemicals called isoflavones, which are phytoestrogens-plant substances that mimic estrogen. Knowing that women lose bone density after menopause because of the loss of estrogen, some scientists believe that the plant estrogens in soy foods could help increase bone density. It's still not clear whether that's true. In laboratory rats, isoflavones helped preserve bone. But in people, the effects are more complicated. Scientists theorize that soy may only help women before menopause (when they lose estrogen receptors as well as estrogen), or it could be that only certain forms of soy protein may be beneficial after menopause. For example, a j.a.panese study of postmenopausal women found that bone mineral density was higher in women who ate fermented soybeans (natto), but not in women who ate tofu or other soy products. But other studies have shown that long-term addition of soy protein in the diet seems to reduce bone turnover and may prevent bone loss after menopause. Although the optimal amounts of soy protein haven't been determined, I recommend you try to incorporate high quality soy foods into your diet a few times each week. Important caveat: Important caveat: although the topic of soy intake and breast cancer remains controversial because of the estrogen-like activity, I do NOT recommend soy foods for women who have had breast cancer. Furthermore, I would never recommend isoflavone although the topic of soy intake and breast cancer remains controversial because of the estrogen-like activity, I do NOT recommend soy foods for women who have had breast cancer. Furthermore, I would never recommend isoflavone supplements supplements for anybody (breast cancer or not) because they have not yet been proven safe at high doses. for anybody (breast cancer or not) because they have not yet been proven safe at high doses.

BEST FOODS FOR SOY PROTEIN: Tempeh, tofu, soybeans, natto (fermented soybeans), soy nuts, soy flour, soy cheese, enriched/fortified soy milk, soy yogurt, soy crisps Tempeh, tofu, soybeans, natto (fermented soybeans), soy nuts, soy flour, soy cheese, enriched/fortified soy milk, soy yogurt, soy crisps Protein: For many years, conventional wisdom was that protein increased the risk of osteoporosis because people who ate large amounts of protein had a large amount of calcium in their urine. Scientists thought that protein was somehow leeching calcium from the bones, which then found its way out of the body through urine. Excessive amounts of protein may indeed pose a problem, However, more recent research suggests the bigger issue may be eating too little protein. For many years, conventional wisdom was that protein increased the risk of osteoporosis because people who ate large amounts of protein had a large amount of calcium in their urine. Scientists thought that protein was somehow leeching calcium from the bones, which then found its way out of the body through urine. Excessive amounts of protein may indeed pose a problem, However, more recent research suggests the bigger issue may be eating too little protein.

Protein is an important component of bone, and absolutely necessary for bone strength. Studies show that people who don't get enough protein may have reduced calcium absorption, reduced bone density, and higher rates of bone loss. People who eat relatively large amounts of protein have a reduced risk of fractures and higher bone mineral density. Although more research needs to be done to understand the biochemical mechanisms involved, it doesn't seem to matter whether you get your protein from animal sources or vegetable sources. But, as mentioned earlier, too much protein from any source may still be harmful, so don't go protein crazy: no high-protein/no-carb diets or excessive amounts of protein bars or shakes.

The bottom line is that you need to ensure that you're getting an appropriate amount of protein through lean meats, poultry, fish, eggs, legumes, dairy, and soy foods. What defines appropriate depends on your weight. Here's a simple rule of thumb-take your weight, divide it in half and that's approximately how many grams of protein you need to eat every day for good bone health. If you weigh 140 pounds, you need about 70 grams of protein. The following guide will give you a sense of whether you're eating enough. Of course, many more foods than those listed below provide protein-even some brands of bread and cereal. I encourage you to read labels, and tally your protein grams for a day or two to make sure you're on track.

FOOD.

APPROXIMATE GRAMS OF PROTEIN.

1 egg

6.

1 cup milk (fat-free, reduced-fat)

8.

1 ounce cheese (fat-free, reduced-fat) 7 to 8 cup cottage cheese (fat-free, 1% reduced-fat)

14.

1 cup fat-free yogurt 8 to 14 cup beans 7 to 9 1 ounce almonds

6.

1 ounce peanuts