To Ensure Bone Health, Start Early- NYTimes

By JANE E. BRODY

Most people don’t start thinking about the health of their bones until midlife or later, by which time it can be too late to do very much to protect against serious bone loss and resulting fractures.

Researchers who study bone health say concern about the strength of one’s bones should start in childhood and continue through adolescence, when the body builds most of the bone that must sustain it for the remaining years of life.

Once peak bone mass has been reached, further gains are minimal, so childhood through adolescence is the best time to pay attention to bone development. By age 20, girls have gained between 90 and 96 percent of their peak bone mass. For boys, the peak occurs a few years later.

About 26 percent of total adult bone is accrued in two years around the time that bone mass increases the most — at age 12.5 in girls and 14.1 in boys. The amount of bone added during those two years is about the same as what is typically lost in the 30 years between ages 50 and 80.

Lifelong studies have not been done in people, but the best available evidence strongly indicates that increasing peak bone mass in childhood by just 10 percent could delay osteoporosis, especially in postmenopausal women, by about 13 years.

Although nothing can be done about the three factors with the greatest influence on bone mass — age, gender and genetics — two others under personal control can make the difference between suffering crippling fractures in midlife and escaping the effects of osteoporosis until after age 90. Those are physical activity and the bone-building nutrients, calcium and vitamin D.

While the focus here will be on the effects of exercise, it should be noted that calcium consumption by adolescent girls is often seriously inadequate, compromising their ability to build strong bones that will last a lifetime.

Exercise affects bone strength in two ways: in response to the pressure of gravitational forces like those experienced when walking, running or jumping, and in reaction to the stress exerted by muscle contraction.

You might think that any kind of exercise is good for bones, and the more active a child is, the better. That is largely, but not always, true. On average, as with adults, active children have higher bone mineral density and reduced risk of fractures compared with their inactive counterparts, Dr. Kirk L. Scofield noted last year in Current Sports Medicine Reports. But some types of activities are better than others. Studies have found that the bone mineral density of young endurance runners is consistently lower than that of sprinters, gymnasts or ball sports athletes. In fact, those engaged in endurance and non-weight-bearing activities sometimes have weaker bones and a greater risk of fractures, both while actively competing and later in life, than their inactive peers.

“Repetitive stress can tear down bone and is not the best for increasing bone strength,” Dr. Scofield said in an interview. “It’s not that running, walking, cycling or swimming are bad. They’re just not as good for bone strength as other types of athletic activities.”

Bones, he said, seem to respond best to a combination of stress, rest and variety, which suggests that youngsters engaged in endurance activities should also do cross-training to maximize bone strength.

Dr. Scofield, a sports medicine specialist at the University of Minnesota in Minneapolis, said that the most effective form of stress on bones is that which works against gravity and starts and stops, as happens when playing soccer, basketball, or tennis; doing gymnastics or dancing; using resistance equipment; or lifting weights.

In a study of 99 college women who participated in NCAA Division 1 sports, runners had the lowest bone density values at every site measured except their legs. Swimmers and divers also showed bone deficits when compared with those who played soccer or field hockey, for example.

An earlier study of young female aerobic dancers, squash players and speed skaters found that sports training that involves “high strain rates in versatile movements and high peak forces is more effective in bone formation than training with a large number of low-force repetitions.”

A major bone-robbing issue for some young athletes, especially women, is what sports specialists call “energy availability” — the amount of energy they consume during exercise minus the amount they expend, divided by their lean body mass (muscle and bone). It represents the energy left to support all the body’s functions, including formation of new bone.

Low energy availability can result from insufficient calorie intake, excessive calorie expenditure during exercise, or a combination of the two, even if the athlete does not appear to be underweight and is not undernourished, Dr. Scofield said.

Runners, for example, may burn so many calories there’s not enough energy left to maintain normal bone health. He recommends a nutrition consultation for young athletes who suffer stress fractures, an indication of bone weakness that can be from low energy availability.

A related concern that can result from excessive training is a syndrome called “female athlete triad” — an interrelationship between energy availability, menstrual function and bone density. Girls who overexercise and don’t consume enough calories to support all bodily functions can suffer menstrual irregularity or lose their periods entirely, which can lead to muscle and bone injuries.

In a study of 249 females athletes at three high schools published in The Journal of Athletic Training last year, researchers in Provo, Utah, found that nearly 20 percent experienced menstrual irregularities and 63 percent developed musculoskeletal injuries, with the highest percentage of injuries among those with irregular or missing periods.

I asked Dr. Scofield what advice he would give to the parents of young children and adolescents. His response: “Get kids away from electronics and encourage them to play actively and do a lot of different activities. Equally important is to avoid pressuring them to be too thin.”

He also urged adequate consumption of calcium-rich foods, like dairy products and canned salmon and sardines with the bones. An assessment of calcium intake can be determined from a Web-based calcium calculator.

Children ages 4 through 8 should consume 800 milligrams of calcium daily and those 9 through 18, 1,300 milligrams. If children are not getting enough calcium from their diet, Dr. Scofield recommends that they take a calcium supplement with vitamin D.

Vitamin D is needed for the body to absorb and utilize dietary calcium, and children ages 1 through 18 need 800 International Units daily. Most vitamin D is obtained when skin is exposed to sunlight, but the widespread use of potent sunscreens has greatly reduced this source, so a supplement may be essential.

Most People Can Skip Calcium Supplements, Prevention Panel Says : Shots – Health News : NPR

Most People Can Skip Calcium Supplements, Prevention Panel Says

by NANCY SHUTE

Women have been told for years that if they don’t take calcium supplements religiously, they’re putting themselves at risk of crippling hip fractures in old age.

Now the word from a major government panel: Why bother?

There’s no evidence that taking calcium supplements reduces the risk of fractures for most people, the U.S. Preventive Services Task Force said. The recommendations were published online Monday by the Annals of Internal Medicine.

That applies to postmenopausal women, the target audience for calcium supplements.

“We’re not saying don’t use it,” says Linda Baumann, a member of the task force and a professor emerita of nursing at the University of Wisconsin-Madison. “But think about it, because we’re not sure it has the benefit you think it has.”

The task force said that taking up to 1,000 milligrams a day of calcium supplements and up to 400 international units of vitamin D daily did nothing to prevent fractures in healthy people, while slightly increasing the risk of kidney stones.

That’s just a bit less than the 1,200 milligrams of calcium a day recommended for postmenopausal women by a 2011 Institute of Medicine report. More might be better, the USPSTF panel concluded, but there’s no evidence that’s true. The panel gives independent recommendations to the federal government on the risks and benefits of treatments.

Reports like this always come with caveats, so here goes: The recommendations don’t apply to people who already have osteoporosis or vitamin D deficiency. And the advice doesn’t apply to people over 65 who are at risk of falls.

The task force members would have loved to review data on whether taking calcium and vitamin D supplements earlier in life would be useful, Baumann tells Shots. Teenagers’ calcium intake is pathetically low, even though they’re still growing.

“The other thing that’s really unclear is the appropriate dose and dosing regimen,” Baumann says. The studies the panel relied on were all over the map on how much people took — and when. And because most studies have looked at calcium and bone health in white women, there’s no good data on men or minority groups.

Vitamin D supplements have become trendy of late, promoted as preventing cancer, heart disease, and diabetes. Some doctors recommending up to 50,000 IU in a week.The USPSTF is looking at whether D influences cancer, so stay tuned for that.

An accompanying editorial concludes, “While we wait for the results of further research, the USPSTF’s cautious, evidence-based advice should encourage clinicians to think carefully before advising calcium and vitamin D supplementation for healthy individuals.”

Calcium supplements aren’t as trendy, but some women are “taking three, four, five calcium pills a day,” says Cliff Rosen, an author of the 2011 IOM report, and an osteoporosis researcher at the Maine Medical Center Research Institute. Taking that much can up the risk of kidney stones by 17 percent, he says. And there’s also evidence that calcium supplements may contribute to heart disease.

The calcium in food doesn’t seem to cause those problems, Rosen says. So the best advice for everyone, from teens to their grandmas, is get calcium from food. “A glass of milk is 300 milligrams. Three glasses of milk a day, and you get there without a problem.”

And if that doesn’t grab you, there’s another option, Rosen says: “Of course, ice cream has calcium in it.”

via Most People Can Skip Calcium Supplements, Prevention Panel Says : Shots – Health News : NPR.

Research Finds Kids Who Drank More Milk Have Faster Walking Times And Better Balance As Older Adults

Research Finds Kids Who Drank More Milk Have Faster Walking Times And Better Balance As Older Adults

Article Date: 18 Nov 2012 – 0:00 PST

Starting a milk drinking habit as a child can lead to lifelong benefits, even improving physical ability and balance in older age, according to new research. A new study published in Age & Aging found an increase of about one glass of milk a day as a child was linked to a 5% faster walking time and 25% lesser chance of poor balance in older age. The researchers suggest a “public health benefit of childhood milk intake on physical function in old age” – a finding that has huge potential for adults over 65, a population expected reach more than 70 million by the year 2030, doubling over just 30 years.

The team of British researchers used historical diet records from two large studies to assess the childhood habits of more than 1,500 men ages 62-86. They measured the impact of diet, specifically milk, protein, calcium and fat intake, on current performance and mobility in follow-up. Elderly participants were put through a series of activities, including walking, get-up-and-go, and balance tests. Childhood calcium, protein and milk intake were all associated with advantages in mobility later in life.

The researchers also found that childhood milk drinkers were also likely to be adult milk drinkers, emphasizing the benefits of establishing lifelong healthy habits. Among the many health habits to begin at a young age, experts recognize the importance of beginning the day with breakfast. In fact, studies show that milk drinkers and breakfast eaters have more nutritious diets than non-milk drinkers and breakfast skippers. Milk in the morning is a healthy habit that helps provide kids with nutrients they need for the day and benefits that extend well beyond the morning.

While decades of research support the bone-building benefits of milk, this is the first study to specifically find a physical performance benefit that can last a lifetime. Milk is the top food source of bone-building calcium and vitamin D in the American diet, and each glass provides 8 grams of high-quality protein. The 2010 Dietary Guidelines recommend two glasses of milk for toddlers (ages 2-3), 2.5 cups for children (ages 4-8), and 3 cups for adolescents, teens and adults Milk at breakfast is an ideal opportunity to help your kids start the day right, and get the recommended milk each day.

via Research Finds Kids Who Drank More Milk Have Faster Walking Times And Better Balance As Older Adults.

NPR.org » Too Much Calcium Could Cause Kidney, Heart Problems, Researchers Say

Federal health officials recommend people under 50 consume 1,000 milligrams of calcium per day, but some are overdoing it.

by Patti Neighmond

When it comes to a healthy diet — especially for women, and especially after menopause — nutritionists, doctors, everybody it seems, will tell you: calcium, calcium, calcium.

Federal health officials recommend women and men under age of 50 consume 1,000 milligrams of calcium per day. The recommendation goes up to 1,200 mg after the age of 70 for men and after menopause for women when a major drop in estrogen causes bone loss.

So, in a culture which often considers “more” to be “better,” one might ask, if 1,200 milligrams of calcium is good, is 2,000 mg of calcium better?

No, says Dr. Ethel C. Siris, director of the Tony Stabile Center for the Prevention and Treatment of Osteoporosis at Columbia-Presbyterian Medical Center in New York. “You need enough; you don’t need extra,” she says.

“Extra calcium does you no good and there is a small risk that if you take too much you might get a kidney stone,” says Dr. Siris. That’s because the body can only handle 600 milligrams of calcium at once. Extra calcium can build up in the bloodstream and, when excreted through kidneys in urine, it can cause a kidney stone.

That’s been known for a while. But recently, a few studies raised concern that excess calcium may also calcify coronary arteries in susceptible individuals and even precipitate heart attack.

Robert Eckel, a cardiologist and endocrinologist at the University of Colorado, is past president of the American Heart Association. While these studies are far from conclusive and far more research needs to be done, he says they do raise the question about whether there’s potentially some danger in over-the-counter calcium supplements which go beyond our usual dietary intake of calcium.

“So, at this point in time, there’s a bit of a signal” that should raise caution, but remains highly controversial. “I don’t think anyone has stepped up to say calcium supplements should be abandoned,” says Eckel.

Particularly since calcium is so critical for bone health. The best plan of action, says Siris: Eat more calcium rich foods.

“If you’re somebody who has a glass of milk with breakfast, that’s 300 milligrams of calcium; a container of yogurt will give you another 200 to 300 milligrams; a couple of ounces of cheese will give you 200 to 300 milligrams,” she says. For most healthy adults under age 50, that’s about all you need for bone health.

And, if you don’t eat dairy, Siris says there are plenty of other foods that also contain calcium. These include vegetables like broccoli, bok choy, and turnip greens; oranges, figs, salmon and sardines. Cereals and soy milk often have added calcium, along with added Vitamin D, which is essential to help the body absorb calcium.

So, estimate your daily intake of calcium from food, says Siris, and then calculate whether you need to take an extra supplement. You may just need 300 or 600 milligrams of calcium extra and you may not even need that every day. [Copyright 2012 National Public Radio]

via NPR.org » Too Much Calcium Could Cause Kidney, Heart Problems, Researchers Say.

To supplement or not to supplement?

 

I just had a really great question. Here’s my answer:

So far all of my classes have emphasized the importance of getting your vitamins and minerals from foods. Some of the effects of overdose from vitamins are just as bad as not getting enough. When you juggle various supplements it’s much easier to risk toxicity, which is virtually impossible with real food.

Also the vitamins and minerals from foods are much more bioavailable. Have you ever looked at your pee after a vitamin B or multivitamin supplement? That’s a lot of the cost of your vitamin being flushed down the drain! Also there’s a lot of other goodness that comes from eating, for example, a peach than just the vitamin C. Eating a whole food like that gives you also fiber and phytonutrients – and potentially fills you up so you don’t reach for something more naughty.

All that being said though I do take a multivitamin and calcium everyday. A healthy diet is supposed to have a regular variety of all of the macronutrients. That’s all well and good but I think many of us have some easy go to foods we enjoy and we may not always be mixing it up or eating the most nutritious things. (I like to buy in bulk to save some $$, and that kind of hinders variability!)

One thing I learned recently, though, is that we can only absorb a certain amount of some nutrients at a time. One way that vitamin marketers make their products stick out is by offering the vitamin with more of a certain nutrient so you think you’re getting a better deal. For example, your body can only absorb about 500 mg of calcium at once, but a lot of supplements come in 1000 mg. It’s best to either cut those in half or buy the smaller dosage. I do that with my calcium and multis.

For vitamins that we tend to have a deficiency in, like vitamin D, I think it’s important to get your levels checked yearly during your annual physical. I used to take a vitamin D supplement but have since found out my levels are perfectly normal with the foods I eat and the amount of sun exposure I get. My husband though takes the same supplement I used to and his levels are still too low, so he knows he can potentially go over the usual daily dose.

I guess the final answer is – there are pros and cons to both. If you’re the type of person that only eats fast food everyday, by all means – take a multi vitamin! Just try not to overdo it or mix too many supplements at once. (Also be very careful when supplementing the fat-soluble vitamins. Those don’t flush out like water soluble ones do and have a higher likelihood of toxicity.)

Thanks for the awesome question @joyonmyjourney! You can find some really awesome, healthy recipes on their page here – http://joyonmyjourney.com/