8.

1 ounce soy nuts

12.

6 ounces tofu

14.

1 ounce lean beef, poultry, or fish

7.

5 ounces skinless chicken breast or fish fillet

35.

3 ounces sirloin steak (size of a deck of cards)

21.

Keep in mind that fattier cuts of beef will provide less less protein ounce per ounce when compared to leaner cuts. That's because the fat content takes up s.p.a.ce and displaces protein. Reduced-fat and fat-free milk, cheese, and yogurts provide protein ounce per ounce when compared to leaner cuts. That's because the fat content takes up s.p.a.ce and displaces protein. Reduced-fat and fat-free milk, cheese, and yogurts provide more more calcium ounce per ounce than their full-fat counterparts, for the same reason. When fat is removed, the lost volume is replaced with more calcium-rich, reduced-fat dairy. Double bonus-less fat, more calcium! calcium ounce per ounce than their full-fat counterparts, for the same reason. When fat is removed, the lost volume is replaced with more calcium-rich, reduced-fat dairy. Double bonus-less fat, more calcium!

BEST FOODS FOR PROTEIN: Turkey breast, chicken breast, seafood and fish, veal, pork tenderloin, lean ham, lean beef, egg whites, yogurt (fat-free, low-fat), milk (fat-free, 1% reduced-fat), enriched/fortified soy milk, cheese (fat-free, reduced-fat), beans (lima, black, navy, pinto, garbanzo), lentils, split peas, tofu, tempeh, soybeans, nuts (soy nuts, peanuts, almonds), peanut b.u.t.ter Turkey breast, chicken breast, seafood and fish, veal, pork tenderloin, lean ham, lean beef, egg whites, yogurt (fat-free, low-fat), milk (fat-free, 1% reduced-fat), enriched/fortified soy milk, cheese (fat-free, reduced-fat), beans (lima, black, navy, pinto, garbanzo), lentils, split peas, tofu, tempeh, soybeans, nuts (soy nuts, peanuts, almonds), peanut b.u.t.ter FOODS TO LIMIT.

VITAMIN A.

Too much vitamin A can harm bones, increasing the risk of fractures. Although more research needs to be done, it looks as though too much vitamin A may stop vitamin D from doing its job of making calcium available to bones. In food, vitamin A comes from two sources: beta carotene and retinol-and recent studies suggest that only retinol only retinol causes problems. To avoid overdosing on retinol, the troublesome form of vitamin A, do not regularly eat liver or foods that are fortified with vitamin A. Furthermore, don't take any supplement that contains more than 2,000 IU retinol, including your multivitamin. Your multivitamin should provide 100% DV for vitamin A, but at least 50% should come from beta carotene or mixed carotenoids. Look for this information on your bottle's nutrient listing, right next to vitamin A. causes problems. To avoid overdosing on retinol, the troublesome form of vitamin A, do not regularly eat liver or foods that are fortified with vitamin A. Furthermore, don't take any supplement that contains more than 2,000 IU retinol, including your multivitamin. Your multivitamin should provide 100% DV for vitamin A, but at least 50% should come from beta carotene or mixed carotenoids. Look for this information on your bottle's nutrient listing, right next to vitamin A.

SALT.

Salt causes the body to lose a little bit of calcium through what scientists call renal excretion renal excretion, and what everyone else calls peeing peeing. The actual amount is very small, but if you are already fighting a calcium deficiency, or if you have bone density problems, every little bit counts. In addition, salt seems to increase bone resorption. Limit your salt intake, and on those days when salt can't be avoided, just try to eat an extra serving of reduced-fat dairy to make up for it.

BONUS POINTS.

- Talk with your doctor about osteoporosis prevention. Because every individual is different, it is important to start talking with your doctor about your particular risk for osteoporosis as soon as possible. Topics to discuss include whether you need to get a bone density scan, whether your history of disease and medication makes you more likely to develop osteoporosis in the future, and whether some of the new bone-building medications might be right for you. Because every individual is different, it is important to start talking with your doctor about your particular risk for osteoporosis as soon as possible. Topics to discuss include whether you need to get a bone density scan, whether your history of disease and medication makes you more likely to develop osteoporosis in the future, and whether some of the new bone-building medications might be right for you.

- Exercise. When you're younger, exercise helps build and maintain strong bones by turning on bone-building activities. When you move your muscles (and, by extension, your bones), the action stimulates osteoblasts to create more bone. That's why it's critical for children and young adults to get plenty of exercise during their bone-building years. And although this bone-building action does not appear to continue as we age, exercise remains equally important for bone health. That's because regular physical activity maintains muscle tone and strength surrounding the bone and will help prevent falls and injuries that could lead to breaks and fractures. Weight-bearing exercises-those that require your body to carry its own weight, such as walking-are very helpful. Even better, however, are resistance exercises that require use of resistance bands, dumbbells, free weights, or weight machines. These types of exercises build healthy lean muscle ma.s.s which in turn protects your precious bone tissue underneath. When you're younger, exercise helps build and maintain strong bones by turning on bone-building activities. When you move your muscles (and, by extension, your bones), the action stimulates osteoblasts to create more bone. That's why it's critical for children and young adults to get plenty of exercise during their bone-building years. And although this bone-building action does not appear to continue as we age, exercise remains equally important for bone health. That's because regular physical activity maintains muscle tone and strength surrounding the bone and will help prevent falls and injuries that could lead to breaks and fractures. Weight-bearing exercises-those that require your body to carry its own weight, such as walking-are very helpful. Even better, however, are resistance exercises that require use of resistance bands, dumbbells, free weights, or weight machines. These types of exercises build healthy lean muscle ma.s.s which in turn protects your precious bone tissue underneath.

- Maintain a healthy weight. Although many women believe that there is no such thing as "too thin," there is. Eating disorders, celiac disease, and other medical problems can cause weight to drop to levels that are unhealthy for bones. Check the chart on Chapter 3 to see if you fall in the category called "underweight." If so, you might want to consider talking with your doctor about how to bring your weight up to a healthy level. Although many women believe that there is no such thing as "too thin," there is. Eating disorders, celiac disease, and other medical problems can cause weight to drop to levels that are unhealthy for bones. Check the chart on Chapter 3 to see if you fall in the category called "underweight." If so, you might want to consider talking with your doctor about how to bring your weight up to a healthy level.

- Stop smoking. For more than 20 years, smoking has been linked with a higher risk of osteoporosis, but the reasons why aren't clear. It could be that people who smoke have other risk factors that make them more likely to have low bone density, such as lower body weight, infrequent exercise, or poor food choices. It could also be that cigarette smoke spurs changes in some body hormones that might trigger bone loss. Some research with laboratory animals suggests that nicotine may have a direct effect on bone, namely inhibiting the production of bone-building osteoblasts. For more than 20 years, smoking has been linked with a higher risk of osteoporosis, but the reasons why aren't clear. It could be that people who smoke have other risk factors that make them more likely to have low bone density, such as lower body weight, infrequent exercise, or poor food choices. It could also be that cigarette smoke spurs changes in some body hormones that might trigger bone loss. Some research with laboratory animals suggests that nicotine may have a direct effect on bone, namely inhibiting the production of bone-building osteoblasts.

- Encourage those you love to stop smoking. You want the people you love to protect their health, but on a more selfish level, their smoking may be hurting You want the people you love to protect their health, but on a more selfish level, their smoking may be hurting your your bones. Harvard researchers studied bone health in more than 14,000 people in China, and discovered that nonsmoking women who were exposed to second-hand smoke were three times more likely to develop osteoporosis as women who had no exposure to smoke. The theory is that cigarette smoke may affect levels of estrogen, a hormone that regulates bone turnover. If you can't persuade the smoker in your life to quit the habit, try to establish house rules that will minimize your exposure such as only smoking outdoors or by an open window. bones. Harvard researchers studied bone health in more than 14,000 people in China, and discovered that nonsmoking women who were exposed to second-hand smoke were three times more likely to develop osteoporosis as women who had no exposure to smoke. The theory is that cigarette smoke may affect levels of estrogen, a hormone that regulates bone turnover. If you can't persuade the smoker in your life to quit the habit, try to establish house rules that will minimize your exposure such as only smoking outdoors or by an open window.

- Drink alcohol only in moderation. Alcohol can be your bones' friend or foe, depending on how much you drink. Heavy drinking weakens bone, but light drinking may actually make bones stronger. In a study of hundreds of women ages 65 to 77, researchers discovered that women who did not drink alcohol at all had the lowest bone density of all. Bone density was highest in women who drank two to four alcoholic drinks per week ( Alcohol can be your bones' friend or foe, depending on how much you drink. Heavy drinking weakens bone, but light drinking may actually make bones stronger. In a study of hundreds of women ages 65 to 77, researchers discovered that women who did not drink alcohol at all had the lowest bone density of all. Bone density was highest in women who drank two to four alcoholic drinks per week (not per day!). Women who drank more than four alcoholic drinks per week had lower total body bone mineral density (although still higher than nondrinkers). Scientists believe that alcohol works by reducing bone breakdown, and perhaps by increasing levels of estrogen. If you don't already drink alcohol, I can't recommend starting. But if you do drink, moderate drinking is optimal for bone density-four drinks per week should be your max. per day!). Women who drank more than four alcoholic drinks per week had lower total body bone mineral density (although still higher than nondrinkers). Scientists believe that alcohol works by reducing bone breakdown, and perhaps by increasing levels of estrogen. If you don't already drink alcohol, I can't recommend starting. But if you do drink, moderate drinking is optimal for bone density-four drinks per week should be your max.

- Yo-yo no more. Even though thin women are generally more susceptible to osteoporosis than overweight women, women who are chronic dieters may also be at increased risk of weak bones Even though thin women are generally more susceptible to osteoporosis than overweight women, women who are chronic dieters may also be at increased risk of weak bones regardless of how much they weigh regardless of how much they weigh. Researchers believe that years of dieting cause women to eat so poorly that they don't get the nutrients they needed to build bones up to a healthy, strong level. Dieting by severely restricting total food intake is never a good idea. If you want a better way to lose weight, see Weight Loss on Chapter 3.

SUPPLEMENTS.

If you are concerned about osteoporosis, or if you have been diagnosed with osteopenia, and want to consider supplements in addition to in addition to the food fixes, I recommend: the food fixes, I recommend: 1. Multivitamin. Because so many micronutrients are important for bone health, I always recommend taking a multivitamin. Look for a brand that contains 400 IU vitamin D in the form of D Because so many micronutrients are important for bone health, I always recommend taking a multivitamin. Look for a brand that contains 400 IU vitamin D in the form of D3 (cholecalciferol, the most potent form), and at least 50 milligrams of magnesium. Your multi should also provide 100% DV of vitamin A (with at least 50% coming from beta carotene or mixed carotenoids). In addition, your multi should have 100% DV for several other nutrients, including vitamin B (cholecalciferol, the most potent form), and at least 50 milligrams of magnesium. Your multi should also provide 100% DV of vitamin A (with at least 50% coming from beta carotene or mixed carotenoids). In addition, your multi should have 100% DV for several other nutrients, including vitamin B6, vitamin B12, folate, zinc, copper, and manganese. Avoid iron in your supplement unless you are a premenopausal woman.

2. Calcium with vitamin D (and optional magnesium). In addition to taking a multivitamin, I encourage my female clients to take calcium supplements as safety net. In studies, calcium supplements (with vitamin D In addition to taking a multivitamin, I encourage my female clients to take calcium supplements as safety net. In studies, calcium supplements (with vitamin D3) reduced the risk of hip and spine fractures by about 25 percent. That's an amazing benefit for taking just two little pills each day. When buying supplements, remember that calcium is worthless worthless without vitamin D without vitamin D3. It's also a bonus to buy a supplement with added magnesium since most people seldom get enough of this important mineral through food and their multivitamin pill. It is important to note that supplements need to be continued indefinitely-once stopped, bone density falls again, and risk of fracture increases.

Special note for men: Some research shows a possible link between increased calcium intake and prostate cancer. Men should aim to get no more than 1,000 milligrams of calcium from food sources daily-about two to three servings. Men with diagnosed bone density issues should follow their doctors' advice about supplementation. Some research shows a possible link between increased calcium intake and prostate cancer. Men should aim to get no more than 1,000 milligrams of calcium from food sources daily-about two to three servings. Men with diagnosed bone density issues should follow their doctors' advice about supplementation.

Because calcium is better absorbed when you take no more than 600 milligrams at a time, calcium supplements need to be taken twice a day, known as a divided dose. That means taking half the day's dosage early in the day, and the other half later in the day. I tell my clients to be religious about the time and place they take calcium supplements so that it becomes as automatic as brushing your teeth. Keep a bottle of supplements next to where you store your breakfast foods to jog your memory about the first dose of the day. You can keep a second bottle on your desk at work as a reminder to take one at lunch. (If you are a woman taking a multivitamin with iron, never take the multi at the same time as the calcium supplement-iron can keep the body from absorbing calcium properly.) There are two main types of calcium supplements for you to choose from, depending on your preferences and other health issues.

- Calcium carbonate. This is the most common and least expensive form of calcium. It must be taken with food or drink. Look for brands that contain 500 to 600 milligrams of calcium, plus at least 200 IU vitamin D3 per pill. Take 500 to 600 milligrams (one tablet) twice each day-once with breakfast or lunch, and a second time with dinner or an evening snack. (Aim to get a total 800 IU vitamin D per pill. Take 500 to 600 milligrams (one tablet) twice each day-once with breakfast or lunch, and a second time with dinner or an evening snack. (Aim to get a total 800 IU vitamin D3 daily; at least 400 IU from your multivitamin plus at least 400 IU from your calcium supplements. If for some reason you cannot take a multivitamin and/or calcium supplement with added D daily; at least 400 IU from your multivitamin plus at least 400 IU from your calcium supplements. If for some reason you cannot take a multivitamin and/or calcium supplement with added D3, I strongly suggest a separate vitamin D3 supplement. supplement.

- Calcium citrate causes the least gastrointestinal problems, so this form of calcium is better tolerated by people with indigestion or more serious GI concerns. You do not have to take calcium citrate with food and it is also more easily absorbed by the body. However, it is bulkier, so if you are not a committed pill-popper, you won't do well with calcium citrate. Each pill contains just 200 to 300 milligrams of calcium so you have to take twice as many pills as people who get their calcium supplement from calcium carbonate pills. Take 500 to 600 milligrams (two or three tablets) twice each day. I recommend taking your calcium citrate once with breakfast or lunch, and a second time before you go to bed. Look for a brand that also provides a daily c.u.mulative dose of at least 400 IU Vitamin D causes the least gastrointestinal problems, so this form of calcium is better tolerated by people with indigestion or more serious GI concerns. You do not have to take calcium citrate with food and it is also more easily absorbed by the body. However, it is bulkier, so if you are not a committed pill-popper, you won't do well with calcium citrate. Each pill contains just 200 to 300 milligrams of calcium so you have to take twice as many pills as people who get their calcium supplement from calcium carbonate pills. Take 500 to 600 milligrams (two or three tablets) twice each day. I recommend taking your calcium citrate once with breakfast or lunch, and a second time before you go to bed. Look for a brand that also provides a daily c.u.mulative dose of at least 400 IU Vitamin D3. If you choose a calcium supplement without vitamin D3, I strongly recommend a separate dose. At the end of the day, ensure your daily Vitamin D3 totals 800 IU. totals 800 IU.

JOY'S 4-STEP PROGRAM FOR OSTEOPOROSIS Follow this program if you have osteopenia or osteoporosis, or a family history of bone density problems.

STEP 1...START WITH THE BASICS These are the first things you should do to help preserve bone density: - See your doctor for advice about osteoporosis diagnosis or prevention if...you are a woman in menopause who has never had a bone density scan...you have ever had an eating disorder...you have taken corticosteroid medications for three or more months at any time in your life.

- Take a multivitamin. See guidelines on Chapter 10.

- Begin taking calcium supplements with vitamin D3 and optional magnesium. If you're a man, speak with you physician before taking calcium supplements. and optional magnesium. If you're a man, speak with you physician before taking calcium supplements.

- Start an exercise program.

- If you smoke, quit. Encourage people in your life to quit smoking, too.

STEP 2...YOUR ULTIMATE GROCERY LIST A nutrition plan is only as good as the foods that you choose. This list contains foods with high levels of nutrients that help strengthen bones, plus some foods used as ingredients in the meal plans and recipes. You don't have to purchase every item...but these foods should make up the bulk of what you eat for the week. If you find yourself getting bored, try some unfamiliar foods from the list-they may become favorites.

FRUIT.

ApricotsBananasBerries (boysenberries, blackberries, raspberries, strawberries)CantaloupeClementinesGrapefruit and juice (pink, red)GuavaJuice, calcium-fortifiedKiwiLemons (and juice)Limes (and juice)LycheesMangosMelon, honeydewOranges (and juice)PapayaPersimmonsPineapplePlumsPrunes (and juice)RaisinsTangerinesWatermelon

VEGETABLES.

Artichokes (including hearts)ArugulaAsparagusAvocadoBeans (black, white, pinto, kidney, lima, garbanzo, navy)BeetsBok choyBroccoliBroccoli raabBrussels sproutsCabbage (including Chinese, red)CarrotsCauliflowerChickpeas (garbanzo beans)Collard greensCornCorn (for meal plan): baby corn or frozen kernelsEndiveEscaroleKaleKohlrabiLentilsLettuce (all varieties, especially romaine)Mushrooms (especially shiitake)Mustard greensOkraParsleyParsnipsPeas (black-eyed, split)Peas, greenPeppers (hot; yellow/red/green)Pepper, jalapenoPotatoes, sweetPotatoes, whitePumpkinRadicchioRutabaga.s.seaweedShallotsSnow pea.s.soybeans (including edamame)SpinachSquash, summer (all varieties)Squash, winter (acorn, b.u.t.ternut)Swiss chardTomatoes (including cherry tomatoes, green tomatoes; tomato sauce, juice, paste)Tomatoes, canned, diced, no salt added (for meal plan)Turnip greensWatercressYams

SEAFOOD.

ALL seafood and fish are good sources of proteinBlack cod (sablefish)HerringMackerel (not king)Salmon, wild (with bones)Sardines (with bones)Snapper

LEAN MEATS/EGGS/SOY FOODS.

Beef, leanChicken breastEggsHam, leanNatto (fermented soybeans)Pork tenderloinSoy crispsTempehTofu, extra-firm (for meal plan)Tofu with calciumTurkey breastVeal

NUTS AND SEEDS (PREFERABLY UNSALTED).

AlmondsCashewsFlaxseedPeanut b.u.t.terPeanutsPistachio nutsPumpkin seedsSesame seedsSoy nutsSunflower seeds

WHOLE GRAINS.

AmaranthBread, whole grainCereal, fortified whole grainMilletOatmealPasta, preferably whole wheatQuinoaRice, brownWaffles, calcium-fortified whole grainWheat germ

DAIRY.

Cheese (fat-free, reduced-fat)Cheese (for meal plan): fat-free, reduced-fat, Cheddar, feta, mozzarella, Parmesan, SwissCheese, soyIce cream, low-fatMilk (vitamin D-fortified fat-free, 1% reduced-fat, enriched/fortified soy)Yogurt (fat-free, low-fat)Yogurt, frozen (fat-free, low-fat)Yogurt, soy

MISCELLANEOUS.

Basil, freshBay leavesBread crumbs, whole wheatBroth, chicken, fat-free, low-sodiumChocolate syrup, lightCinnamon, groundCornstarchDill, freshFlour, all-purposeFlour, soyGarlicGinger, freshHoneyHot cocoa, diet (less than 200 calories)Hot sauceMargarine, vitamin-D-fortified, soft tub, trans fat-freeMayonnaise, reduced-fatMint, freshMustard, DijonNonstick cooking sprayNutmegOil, canolaOil, sesameOregano, driedPaprikaParsley, freshPepper, blackPepper, crushed redRosemary, dried and freshSalad dressing, reduced-calorieSalsaSoy crispsSoy sauce, reduced-sodiumSugarTaco seasoning, mild or hotTaco sh.e.l.ls, hard or softThyme, freshVinegar, apple ciderVinegar, balsamic

STEP 3...GOING ABOVE AND BEYOND If you want to do everything you can to prevent or control osteoporosis, here are some additional things you might try: - Limit the amount of salt you eat.

- Limit alcohol consumption to no more than four drinks per week.

- If you need to diet for weight loss, do it in a way that is smart for your bones. See Weight Loss, Chapter 3, for more information.

- If you are underweight, talk with your doctor to learn the healthiest ways to bring your weight up.

HOW TO PILE ON THE POUNDSIf you need to gain weight as part of your strategy to avoid bone loss, it is important to add healthy pounds, as opposed to ice cream and doughnut pounds. Aim to add about 500 calories each day, for a gain of about 1 pound per week. Start by subst.i.tuting products that are higher in healthy fats. For example, saute vegetables in olive oil instead of steaming them, use full-fat salad dressing instead of light varieties, and add avocado to salads and sandwiches. Incorporate two or three healthy mini-meals each day, in addition to breakfast, lunch, and dinner. Hummus, guacamole, sunflower seeds, nuts (and nut b.u.t.ters), trail mix, energy bars, dried fruit, fruit-yogurt smoothies, granola bars, and healthy homemade m.u.f.fins add good calories to your daily count. If your appet.i.te is poor, or if you cannot gain weight, talk with your doctor.

STEP 4...MEAL PLANS These sample menus include foods that have been shown to strengthen bones, specifically foods high in calcium, vitamin D, magnesium, vitamin K, pota.s.sium, protein, vitamin C, and other nutrients.

Every day, choose one one option for each of the three meals-breakfast, lunch, and dinner. Then, one or two times per day, choose from a variety of my suggested snacks. Approximate calories have been provided to help adjust for your personal weight management goals. If you find yourself hungry (and weight is not an issue), feel free to increase the portion sizes for meals and snacks. Beverage calories are option for each of the three meals-breakfast, lunch, and dinner. Then, one or two times per day, choose from a variety of my suggested snacks. Approximate calories have been provided to help adjust for your personal weight management goals. If you find yourself hungry (and weight is not an issue), feel free to increase the portion sizes for meals and snacks. Beverage calories are not not included. included.

BREAKFAST OPTIONS.

(Approximately 300 to 400 calories)

Strawberry-Nut Yogurt Parfait Spoon 1/3 cup vanilla fat-free yogurt into a parfait gla.s.s. Top with 2 heaping tablespoons sliced strawberries (or raspberries or blackberries) and 1 tablespoon soy nuts (or sunflower seeds or slivered almonds). Repeat the three layers two times (yogurt, berries, and then nuts).

Cereal with Milk and Fruit 1 cup whole grain cereal (120 calories or less) mixed with 1 cup milk (fat-free, 1% reduced-fat, or enriched/fortified soy). Enjoy with 1 cup sliced pineapple (or watermelon, berries, or grapefruit, banana, mango, 1 orange, or 1 kiwi).