A calcium rich diet is an important component of managing osteoporosis well. Calcium is particularly good for the bones. An adequate intake of calcium in the young will help them achieve a peak of bone mass and in the elderly it helps to reduce age-related bone loss. The best sources of calcium are to be found in dairy products, such as milk and cheese. Vitamin D helps the body absorb calcium.
There are lots of calcium supplements available in the market but most of the people we talked to were prescribed calcium tablets and vitamin D by their GP or consultants, in particular Adcal D3 and Calcichew D3 Forte. Vitamin D is made by the skin when exposed to sunlight but in some groups, like the elderly, deficiency can occur due to lack of sun exposure. Most people residing in the UK is vitamin D deficient at the end of winter. Lack of vitamin D can cause bone loss, and replenishing vitamin D may also help prevent fractures from falls. Foods that are good sources of vitamin D are: liver, butter but the main source is oily fish, like sardines and mackerel. There are vitamin D supplements available over the counter in health food shops and chemists.
Most of the people we talked to said that they had a ‘good diet’ meaning that they have a balanced diet that includes food from the main four group categories’ fruit and vegetables, protein (dairy products, eggs and meat), carbohydrates and pulses. Some people said that they were amazed to have been diagnosed with osteoporosis because all their lives they have had a diet rich in calcium.
Following diagnosis many of the people we talked to had made a conscious choice to increase their intake of calcium in their diets by eating more dairy products like milk and cheese. Also some people had researched the best sources of calcium, apart from dairy products, and mentioned food like broccoli, sardines, oily fish, sesame seeds, calcium fortified cereals and tofu as good additional sources of calcium.
Before being diagnosed with osteoporosis several people had a dairy-free diet for medical reasons or to alleviate pain caused by arthritis. Gloria’s doctor put her on a low fat diet to prevent the recurrence of kidney stones. Jenny who suffered from ME and Betty who was diagnosed with osteoarthritis avoided eating dairy products for many years. Betty said that the pain and inflammation she had from her osteoarthritis was lessened by it. But she is unsure as to whether it was the dairy free diet or other factors that eased the pain. Since being diagnosed with osteoporosis she has started to include dairy products in her diet.
Michelle, Jane and Ann were diagnosed with coeliac disease and this has added an additional aspect to the management of their osteoporosis because they had to balance a gluten free diet with a high calcium-intake diet. This can be time consuming and tricky for working people like Jane and Michelle. Jane also finds it socially limiting because she prefers not to eat out.
Jane, Sarah and Iris have had the opportunity to talk about food and nutrition with a dietician. Iris was referred by the osteoporosis specialist nurse because she had been suffering for years with irritable bowel symptoms. The specialist helped Iris to identify her triggers and by excluding oats and red wine she was able to control it. Seeing the dietician has also given Iris the confidence to make changes to her diet. Keith was asked to fill in a questionnaire about diet and lifestyle when he went to the hospital to have his DXA scan and was told it was good on calcium sources but low on vegetables.
Some of the people we talked to were unable to tolerate dairy products in their diets and relied on calcium supplements. A few also said that they drank goats or soya milk instead of cow’s milk. Both Michelle and Jenny felt unsure as to whether it provided the same benefits as the calcium that is provided from food.
Many people had reduced their consumption of animal protein, such as meat and cheese. They know that eating it regularly and in large amounts encourages the body to draw calcium from the bones to aid its digestion. Some people described themselves as ‘semi-vegetarians’ and avoid eating red meat altogether. Emma is vegetarian for cultural reasons and most of her life, except for the period when she arrived in the UK, has not consumed any meat. After diagnosis she was concerned that her diet was inadequate for someone with osteoporosis but her GP has reassured her that she has a healthy and a good diet.
Marylin admits that her diet is poor because she tends to eat lot of biscuits and cakes. This has always been the case even in the past when she was training hard to run marathons. She remembers losing a lot of weight in her teen years and thinks that maybe it is related to her developing osteoporosis.
Not becoming overweight is helpful in most conditions including osteoporosis and many people we talked to tried to control their weight though exercise and diet. Some people said that they have put on weight following a fracture and/or retirement. And the main reason for it is not overeating or eating the wrong food but lack of exercise. Robert feels unfit and gets out of breath easily and said that he is three stones heavier than his original weight.
Several of the people we talked to believed in the importance of diet and of maintaining an adequate weight for their height and age to manage osteoporosis. The body mass index (BMI) is a useful measure of healthy weight. BMI is measure of body fat based on height and weight that applies to both adult men and women. A BMI over 30 significantly increases the risk of osteoarthritis [million women study], but a BMI under 22 also increases the risk of osteoporosis: so you don’t want to be too fat or too thin!
Several people decided to lose weight and said that they felt better for it.
However, a few of the elderly people we talked to complained of lack of appetite and of losing weight as a result of stomach problems caused by their medication. Some were taking Lanzoprazole to help alleviate the pain cause by acid reflux. Beryl said that she has lost a lot of weight, around three stones.
Several of the elderly people we talked to stressed that they have an adequate diet but now they can only manage smaller portions and prefer a snack in the evening.
Many of the people we interviewed live on their own, and are unable to lift and carry things. This causes problems when shopping for groceries and people had to think of ways of getting around it. Some like Joan and Betty have learnt to use a computer and order the bulk of their shopping online. James and his wife do the groceries once a week in a supermarket that has delivery facilities. Sydney on the other hand, goes into the city centre twice a week to buy his groceries (see also Impact on home life
Many people we talked to did not take vitamins or other supplements and some said that they did not need it because they had a good, balanced diet. Those who took them on a regular basis saw supplements as part of their self-help programme. A few said that they take them to compensate for a less than adequate diet during the week, or because they are not taking any prescribed medication for osteoporosis, or because certain ones like omega3 and cod liver oil help them with their pain. But others, like Marylin have stopped taking any supplements after diagnosis because she thinks it didn’t do her any good.