An anti-inflammatory diet can help prevent osteoporosis

A newly published study found that people with signs of systemic inflammation (as measured by blood markers such as C-reactive protein and IL-6) lost more bone mineral density over three years than those with lower levels of these markers.  Translation: Chronic inflammation may increase your risk of osteoporosis.

This sort of systemic inflammation, which is often completely without symptoms, is quite common and increases your risk for all kinds of other health problems as well, including heart disease, Alzheimer's, diabetes, and depression. Inflammation can be driven driven by stress, smoking, being overweight, and diet choices. As a result, an anti-inflammatory diet has become a popular prescription for all that ails us.

The IF (Inflammation Factor) Ratings can be a useful tool in identifying which foods tend to fuel inflammation and which foods tend to quell it.  Foods with positive IF Ratings are considered anti-inflammatory and those with negative Ratings are considered inflammatory.

However, it's not necessary to avoid all negatively-rated foods in order to have a healthy diet. The idea here is simply to balance your choices so that the combined IF Rating over the course of an entire day is in the positive range.

For more on the IF Ratings see our Inflammation Help page as well as several FAQs that I answered in this recent blog post.

Phosphorus: a double-edged sword

We're halfway through Osteoporosis Awareness and Prevention Month and it seems like a good time to take on the complicated issue of phosphorus and bone health.

You've probably seen warnings about soft drinks being bad for your bones. The phosphates used to make soda are a rich source of phosphorus, and excessive intake of this mineral can leach calcium from your bones.

What you rarely see mentioned, however, is that phosphorus deficiency can also contribute to the development of osteoporosis. Most people get the recommended amount of phosphorus from their diets. Yet phosphorus deficiency is becoming more common, particularly among older people. The chief cause? Overly aggressive calcium supplementation!

Calcium and phosphorus are the two main components of bone tissue. It's important to get sufficient amounts of both nutrients for good bone health. But, the ratio of these nutrients is also quite important. If your diet is high in phosphorus and low in calcium, your body will indeed pull calcium from the bone reserves.  But it works the other way as well. Excessive amounts of calcium will decrease your ability to absorb phosphorus, which in turn weakens bone. 

So, say you've taken Osteporosis Awareness Month to heart. You've cut out sodas. You're careful to get three or four servings of dairy every day. Plus, you take 2,000 mg of calcium a day as a supplement.  That's well over the recommended amount of calcium, of course, but perhaps you figure that you need to make up for inadequate calcium intake during your misspent, cola-swilling youth. Better safe than sorry, right?  Maybe not.

Some guidelines:

1. Be sure that you are consistently getting  the recommended amount of calcium (1,000 to 1,500mg from diet and supplements.)

2. Also make sure your diet contains the recommended amount of phosphorus (700mg for adults), especially if you are over 60. This is not hard to do; phosphorus is found a wide variety of foods.

3. But keep in mind that a diet that is very high in either calcium or phosphorus will increase your requirement for the other. 

4. If you take calcium supplements, consider using a form of calcium that contains phosphorus, such as tricalcium phosphate.

Not sure how much calcium or phosphorus (or other nutrients) your diet provides? You can use our diet tracking tools to find out. (Don't forget to add in any supplements you use.) Tracking your diet may reveal that you are getting way more or way less of certain nutrients than you realize, or that the balance between nutrients like calcium and phosphorus is out of whack.

To identify foods that are high or low in certain nutrients, take advantage of our Nutrient Search Tool, as well.

Osteoporosis Awareness: new guidelines focus on men at risk

Although women are routinely screened for osteoporosis starting at around age 50, physicians typically do not worry about the bone health of their male patients. They should.

One in six men will have osteoporosis by age 65 and the vast majority will go undiagnosed and, therefore, untreated--until their bones are so brittle that they may break during everyday activites. By that time, it's usually too late to get much benefit from bone-preserving therapies that can slow bone loss and prevent injury and disability.  Consider this: men who break a hip are twice as likely to die within one year.

New guidelines released this month by the American College of Physicians call for osteoporosis screening for men, beginning at age 65 or earlier, if men are at increased risk. Things that increase risk include:

• taking anti-androgenic drugs (used to treat prostate cancer)
• low body weight
• physical inactivity
• smoking
• low calcium and vitamin D status

May is Osteoporosis Awareness and Prevention Month: Are you doing enough to protect yourself from osteoporosis?

Vitamin A: all your questions answered

I got three questions about vitamin A this week...must be something in the air!

Q. The Nutrition Facts for carrots shows that they are very high in Vitamin A. I thought that vitamin A was only found in animal products and that vegetable sources like carrots contained beta-carotene, a compound that's converted to vitamin A. Can you explain?

A. The type of Vitamin A found in animal foods is called retinol. it's also sometimes referred to as pre-formed vitamin A.  Plants contain precursors to vitamin A (such as beta-carotene), which are converted to retinol in your liver.  The figure that you see in the Nutrition Facts label represents the vitamin A potential of a food--or how much vitamin A your body can either absorb or make from the precursors in that food.

If you scroll down the analysis page to the detail section, you'll see the various vitamin A compounds listed separately (retinol, beta-carotene, lutein, and so on). There, you'll see that carrots contain no retinol but lots of carotenoids. The carotenoids are converted to retinol activity equivalents (how much vitamin A your body can produce from them) and the total is then converted one more time into IU (international units).

Q. In your recent post about vitamin D, you mention that we should be cautious about our intake of vitamin A exceeding 10,000 IU. What are the issues with that? It seems that I get quite a bit of A in my diet (thanks to your website, I now know this!), and there is so much conflicting information out there, it's hard to know what's what.

A. The most important thing to realize is that the concerns about excessive vitamin A intake apply only to retinol and not to vitamin A precursors like beta-carotene.  To see where the vitamin A in your diet comes from, scroll down to the detail section, where you can see how much is in the form of retinol and how much is from carotenoids.

One major concern is that retinol intake of 5,000IU a day can increase the risk of osteoporosis in  older people.  This is the amount found in many multivitamins.  Excessive intake of preformed vitamin A (retinol) can also cause liver damage.  The recommended upper limit for retinol is 10,000IU or 3,000mcg a day.  Note that this is only about three times the recommended daily intake!

The typical diet is not going to exceed this amount. High-dose vitamin supplements and/or taking lots of cod liver oil are the most common culprits. If you take a mult-vitamin, try to find one that provides some or all of the vitamin A activity in the form of beta-carotene. There is no reason to be concerned about getting too much beta-carotene from foods.

Q. Monica, could you please mention something about Retinyl Palmitate as I've seen it in supplements. Is this a synthetic Vit A that we should avoid?

A.  Most of the vitamin A in your liver is stored as retinyl palmitate, which is a compound made of retinol (which is unstable by itself) and palmitic acid (which stabilizes it).  Synthetic retinyl palmitate is frequently used in vitamin supplements and fortified foods and is identical to the retinyl palmitate your liver makes.  Other than the cautions outlined above, there's no reason to avoid it.

Beyond calcium: effect of protein on bone density

May is Osteoporosis Awareness and Prevention month.  Getting enough calcium is, of course, a big part of osteoporosis prevention--but there are other aspects of your diet that you need to pay attention to as well if you want strong, healthy bones. 

For example, did you know that a high protein diet may increase your calcium requirement?

Studies done in the 1960s and 70s found that vegetarians had higher bone density than meat eaters and for a long time it has been thought that high-protein diets thinned the bones. The generally accepted explanation is that proteins leave an acidic residue when they are digested. In order to balance the pH of the blood, calcium is leached from the bones, resulting in a loss of bone density. 

On the other hand, more recent studies have shown that protein consumption can increase the absorption of calcium, but only when calcium intake is high.  So the real culprit may not be a high-protein diet but rather a diet that is both high in protein and low in calcium. 

If you are a big meat eater (or follow a low-carb diet), make sure to get at least the recommended amount of calcium, which is 1,000 to 1,500 mg a day.  That doesn't mean that you have to take a 1,500mg calcium supplement. Figure out how much calcium you get from your diet and then make up the difference with a supplement. Or, even better, increase your intake of calcium rich foods!

To get a rough estimate of your intake, a typical diet provides about 250mg of calcium, not counting dairy products. Each serving of dairy contributes another 200mg or so.  For a more accurate count, you can track your calcium with our diet tracking tools.

If you are a vegetarian or near-vegetarian, don't be lulled into thinking you don't need to worry about bone health. Take care to get enough calcium (especially if you don't eat dairy), as well as vitamins D and K, which are often found in (and best absorbed from) protein foods.

For everyone, strictly limit your intake of soda (both diet and regular).  A high intake of phosphates, partcularly in conjunction with low calcium intake--which is what happens when we let our kids drink soda intead of milk--is a nightmare scenario for bone health!

Folate for strong bones: but what about cancer risk?

When you think about nutrients that build and protect bone density, you probably think of calcium, vitamin D, and magnesium.  Add folate.  A 5-year Italian study found that women with low folate levels lost more bone mineral density. Folate deficiency has also been linked to increased risk of heart disease and Alzheimer's disease.

It would seem that folic acid supplements would be a good idea, but as you may recall from this previous post, there are new concerns that folic acid supplementation may increase the risk of colon cancer, particularly in individuals with pre-cancerous lesions (which may be undetected).

We're between a rock and a hard place with this research. On the one hand, folate deficiency appears to significantly increase our risk of several grave illnesses. On the other hand, folic acid supplementation may increase our risk for another serious condition.

I recently spoke with Dr. Kilmer McCully, author of the Homocysteine Revolution and widely regarded as one of the world's leading experts on folate biology, to see what his recommendations might be in light of these latest developments. It was a long and fascinating discussion.

Here are Dr. McCully's chief observations about the latest research:

1. Although it merits further investigation, the evidence linking the implementation of folic acid fortification policies and an increase in colon cancer rates is extremely inconclusive. The rates of colon cancer began to rise before the policy was implemented and have since  decreased, even though fortification policies continue. The observed increase may have a lot to do with more widespread screening and better detection.

2. Folic acid is a double-edged sword. Folic acid does not cause colon cancer; in fact, it acts to prevent it in healthy individuals. However, if colon cancer is present, folic acid may fuel its growth.

3. Although preliminary research suggested that some people might benefit from taking 1600mcg or more folic acid per day, subsequent studies have shown no additional protective benefit from supplementation beyond 800mcg per day.

4. The form of folic acid used in supplements and in fortification of grain products is substantially different than the form of folate found naturally in foods. The concerns about colon cancer pertain primarily to the synthetic form of folic acid.

Dr. McCully is still strongly of the opinion that the risks of folate deficiency far outweigh the possible risks associated with folic acid fortification. To get the undeniable protective benefits of folate nutrition without undue risk,  Dr. McCully recommends:

1. Get most of your folate from natural food sources, which include leafy greens, legumes, and whole grains.

2. Minimize your intake of synthetic folic acid from supplements and do not exceed 800mcg of synthetic folic acid from supplements and fortified foods.

3. Get regular colon cancer screenings.

ND Tip: Our nutrient analysis lists amounts for both folic acid (the synthetic form found in fortified foods) and food folate (the naturally-ocurring form). This post contains more details about how folate amounts are reported on Nutrition Data.

You can also do a Nutrient Search for either form of the nutrient. The recommended Daily Value for folate intake is 400mcg per day. The government has established 1000mcg/day as the safe upper limit for folate, chiefly to minimize the risk of undetected B12 deficiency. (High folate intakes can mask B12 deficiency.)

Chocolate thins your bones? Say it isn't so!

Just in time for Valentine's Day, the American Journal of Clinical Nutrition just published a new study finding that elderly women (aged 70 to 85) who ate chocolate on a daily basis had lower bone density than those who ate it once a week or less frequently.  The Australian researchers hypothesize that the oxalates in chocolate are the culprit. Oxalates bind to and inhibit the absorption of calcium.

Does this mean you should give up your daily square of dark chocolate (which is, of course, purely for medicinal purposes)? 

Well, I don't see anyone suggesting that you stop eating spinach to protect your bones. Yet one cup of raw spinach has approximately 200mg of oxylates while an ounce and a half of dark chocolate has half as much.

If you're concerned about chocolate (or spinach's) effect on bone density, take care not to eat them at the same meal with calcium-rich foods. (Yes, that's right: No more spinach-and-yogurt smoothies!). 

And don't overlook the importance of weight-bearing exercise and resistance training to preserve and increase your bone density.  For tips on how to get the most bone-building benefit out of your strength training, see also fitness trainer Steve Cabral's post "Battle Osteoporosis with Weight Training" on the NutritionData Weight Loss Blog.

Is vitamin D deficiency a public health crisis?

An article in this week's New England Journal of Medicine charges that the government's current recommendations for vitamin D intake are woefully inadequate.  The author, Dr. Michel Holick, claims that the current guidelines, which recommend 200 IU per day, are not enough to prevent vitamin D deficiency in most people. Dr. Holick would like to see the RDA increased to 800-1,000 IU per day.

Without enough vitamin D, your body absorbs only a fraction of the calcium you take in.  According to Dr. Holick, the absorption of calcium can be as low as 15% in the absence of vitamin D.  The most serious consequence of vitamin D deficiency is an increased risk of osteoporosis (in adults) and skeletal deformaties (in children). It can also cause muscle weakness and immune defiencies.

Vitamin D is not very widespread in the food supply.  Oily fish like sardines and herring are good natural sources.  But most Americans get the lion's share of their dietary vitamin D from vitamin supplements or fortified foods. (Milk, for example, is often fortified with vitamin D.)  Keep in mind, though, that the amount of vitamin D in vitamin supplements and fortified foods is based on the current RDA of 200 IU--so even if you faithfully swallow a multi-vitamin every day, you may be coming up short.

The Sunshine Vitamin

The other chief source of vitamin D is not dietary but environmental.  Your body can manufacture its own supply of vitamin D if you expose your unprotected skin to the sun's rays.  Experts estimate that a daily 15-minute sunbath at mid-day (with the sun hitting your arms, face and neck, for example) would be enough to top off your vitamin D stores. But these days, most of us are trying to mimize our sun exposure to prevent skin damage, and wearing sunscreen blocks the vitamin D-making  process. And even without sunscreen, those who live further from the equator (such as in the Northern United States and Europe) will have trouble getting enough sun exposure to ward off deficiency in the winter.

How much vitamin D are you getting?

Are you even getting the current (and, some say, inadequate) RDA of vitamin D on a daily basis? Use NutritionData's total consumption report to analyze a typical day's diet and see. Don't forget to add in any supplements you may be taking. (You can add those to your pantry as a custom food.)

Convinced that the current recommendation is too low? You don't have to wait for the government to change the RDA for vitamin D--those wheels turn awfully slowly! You can set your own daily target for vitamin D or any other nutrient using the preferences setting on NutritionData. Read this post to learn how.

Are you taking any of these bone-thinning drugs?

Did you see the study that came out last week about antidepressants and bone fractures? The study found that people over 50 who take antidepressant medications like Prozac and Paxil for five years or more have twice the risk of bone fractures due to decreased bone density. Just last month, I remember seeing a similar study, which found that popular antacid medications like Prilosec and Prevacid also thin the bones and substantially increase the risk of hip fractures.  Both studies found that the longer people took either medication, the more they increased their risk.

The reason that these two studies jumped out at me is that these two classes of drugs, antidepressants and acid reducers, are among the most commonly prescribed drugs. Tens of millions of people take one or the other--many take both. Tens of millions more (most of them women) also take thyroid medications like Synthroid and Levothroid, which also increase your risk of bone loss and osteoporosis.

Osteoporosis is already a huge health care crisis among today's elderly. These new findings make me worry that the problem could be exponentially worse for the next generation. Osteoporosis is no small thing. It's painful, it's debilitating, and it can rob you of your quality of life. But knowledge is power. And there are steps you can take to substantially reduce your risk of osteoporosis--even if you need to take one of these medications.

Here's what to do if if you take one or more of these drugs.

Dairy free? Be sure to get your D

In a recent post, we've been discussing the pros and cons of milk. Michelle finds dairy to be a convenient source of protein and calcium, while Sam points out that the saturated fat and cholesterol in dairy may contribute to disease. (Click here for an alternative perspective on whether or not saturated fat and cholesterol damage your heart.)

If for whatever reason you choose not to eat dairy products, you can certainly find other sources of protein and calcium. Use the ND nutrient search tool to generate lists of calcium and protein-rich foods in any category you choose. But keep in mind that dairy products are also a significant source of vitamin D.   Vitamin D helps prevent osteoporosis by helping your body absorb and use dietary calcium.

Vitamin D deficiency is actually fairly common, especially in the winter time when we don't get as much sunshine on our skin. (Your skin manufactures vitamin D when exposed to ultraviolet rays.)  So if you don't eat dairy, be sure you are getting enough vitamin D from other sources.