1. Some slides adapted from University of Nebraska Lincoln (lancaster.unl.edu) and MyPyramid.gov

2. Project Sponsors School District of Philadelphia Nutrition Center, Department of Bioscience & Biotechnology Drexel University USDA project funded through the Food Stamp Program Funded by the PENNSYLVANIA NUTRITION EDUCATION TRACKS, a part of USDA’s Food Stamp Program. To find out how the Food Stamp Program can help you buy healthy foods, contact the PA Department of Public Welfare’s tool-free helpline at 800-692-7462. This institution is an equal opportunity provider and employer.

3. Why Worry About Calcium? Helps control muscle contraction Need to build and maintain strong bone throughout life

4. Bones are living organs Calcium is deposited and withdrawn from bones daily. Half of the adult skeleton is formed during adolescence. We need to build up a healthy bone “account” while young and continue to make “deposits” with age. ** Get as much calcium as you can now to prevent weak bones Source: http://www.accessexcellence.org/HHQ/qow/qow06/qow061211.htmlhttp://www.accessexcellence.org/HHQ/qow/qow06/qow061211.html

5. After mid-30’s, you begin to slowly lose bone mass. Women lose bone mass faster after menopause, but it happens to men too. Bones can weaken early in life without a healthy diet and regular physical weight bear activities. Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealthhttp://www.surgeongeneral.gov/library/bonehealth Bone Mass

6. Osteoporosis Overview Osteoporosis Overview Bone with Osteoporosis Normal Bone Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealthhttp://www.surgeongeneral.gov/library/bonehealth Osteoporosis causes weak bones In this common disease, bones lose minerals like calcium The bones become fragile and can break easily Osteoporosis can strike at any age female or male

7. Risk factors “Red flags” that you could be at high risk for weak bones You are older than 65 You smoke You are underweight for your height You have never gotten enough calcium You are not active Poor daily nutrition Low bone density-Osteopenia *Remember: Prevention is the Key! Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealthhttp://www.surgeongeneral.gov/library/bonehealth

8. What is Osteopenia? Loss or decrease of bone mineral density (BMD) that can progress to osteoporosis BMD is the measurement of levels of minerals in the bone –Indicates strength and density When BMD is very low compared to normal, it is called osteoporosis Adapted from: http://www.webmd.com/osteoporosis/tc/Osteopenia-Overviewhttp://www.webmd.com/osteoporosis/tc/Osteopenia-Overview

9. Risk Factors Being of Caucasian or Asian decent Excessive alcohol use Family history Being underweight Physical inactivity Tobacco use Diet deficient in Calcium and Vitamin D Decrease in bone density Adapted from: http://www.webmd.com/osteoporosis/tc/Osteopenia-Overviewhttp://www.webmd.com/osteoporosis/tc/Osteopenia-Overview

10. The problem in America 1 in 2 women and 1 in 4 men over 50 will have an osteoporosis-related fracture Hip fractures account for 300,000 hospitalization annually 1 in 5 people with a hip fracture end up in a nursing home within a year Less than ½ of teens get recommended amount of Calcium they need for the day. Source: http://www.accessexcellence.org/HHQ/qow/qow06/qow061211.html and National Osteoporosis Foundation Web site; retrieved July 2005 at http://www.nof.orghttp://www.accessexcellence.org/HHQ/qow/qow06/qow061211.htmlhttp://www.nof.org

11. Breaks usually occur in the wrist, spine, and hip. Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealthhttp://www.surgeongeneral.gov/library/bonehealth The most common breaks

12. The good news: Osteoporosis and Osteopenia are preventable for most people! Start building healthy bones while young. Healthy diet and lifestyle are important for BOTH men and women.

13. Simple Prevention Steps 1.Get the recommended amount of calcium and vitamin D 2.Get regular weight bearing exercise 3.Avoid smoking and excessive alcohol

14. What’s the recommendation for calcium?

15. Calcium requirements vary by age If this is your age Then you need this much calcium each day (mg) 0 to 6 months210 7 to 12 months270 1 to 3 years500 4 to 8 years800 9 to 18 years1,300 19 to 50 years1,000 Over 50 years1,200 Growth spurt Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealthhttp://www.surgeongeneral.gov/library/bonehealth

16. Food and supplement labels Percent Daily Value is used to show how much calcium is in a food So, for this label there is 30% DV of Calcium How many mg would that be? Do the math: 300 mg  1000 mg = 30% 100% DV for calcium = 1000 milligrams (mg)

17. Eating Calcium at Every Meal Breakfast –Granola bar and 6oz. calcium fortified 100% juice Lunch –Turkey, lettuce, tomato and cheese on whole wheat roll –Low-fat chocolate milk Dinner –Grilled chicken, ½ c spinach salad and ¾ c macaroni and cheese Breakfast –Orange juice 300mg –Granola bar 150mg Lunch –Cheese300mg –Chocolate milk300mg Dinner –Spinach 123mg –Mac and cheese300mg

18. Is it Enough Calcium? Breakfast –Orange juice 300mg –Granola bar 150mg Lunch –Cheese 300mg –Chocolate milk 300mg Dinner –Spinach 123mg –Mac and cheese+300mg Total Calcium: 1473mg

19. Milligrams (mg) and %DV of calcium in common foods Approximate % DV for foods based in part on The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealthhttp://www.surgeongeneral.gov/library/bonehealth

20. Calcium Sources: Milk group Yogurt 1 cup (8 oz.) = 300mg (30% DV) Milk 1 cup = 300mg (30% DV) Cheese 1 ½ oz. natural/2 oz. processed = 300mg (30% DV) Milk pudding 1/2 cup = 150mg (15% DV) Frozen yogurt, vanilla, soft serve ½ cup = 100mg (10% DV) Ice cream, vanilla ½ cup = 80mg (8% DV) Soy or rice milk, calcium-fortified 1 cup = varies—check label Choose fat-free or low fat most often

21. Calcium Sources: Grain products group Cereal, calcium- fortified Serving size and amount of calcium varies— check label

22. Calcium Sources: Vegetable group Broccoli, raw 1 cup = 90mg (9% DV) Collard greens, cooked 1/2 cup = 200mg (20% DV) Turnip greens, boiled 1/2 cup = 100mg (10% DV)

23. Calcium Sources: Fruit group Orange juice and other calcium-fortified beverages 6 oz. = 200mg to 300mg (20-30% DV, varies— check label ) Look for 100% juice

24. Calcium Sources: Meat & Beans Group Baked beans 1 cup = 140mg (14% DV) Salmon, canned, with edible bones 3 oz. = 180mg (18% DV) Sardines, canned, in oil, with edible bones 3 oz. = 320mg (32% DV) Soybeans, cooked 1 cup = 260mg (26% DV) Tofu, firm, with calcium ½ cup = 200mg (20mg% DV); check label

25. What’s the recommendation for vitamin D?

26. Why Do I Need Vitamin D? Helps the body more easily absorb calcium in the digestive tract. Promotes bone formation and mineralization Works with calcium to build a stronger more intact bone Source: Vitamin D Overview http://healthlink.mcw.edu/article/982088787.htmlhttp://healthlink.mcw.edu/article/982088787.html

27. You need more vitamin D as you age Age Daily vitamin D needs in International Units (IU) 600 IU 200 IU 400 IU 0 100 200 300 400 500 600 up to 5051-70over 70

28. What about Vitamin D? Main dietary sources of vitamin D are: Fortified milk (400 IU per quart) Some fortified cereals Cold saltwater fish (Example: salmon, halibut, herring, tuna, oysters and shrimp) Some calcium and vitamin/mineral supplements

29. Vitamin D from sunlight exposure Vitamin D is manufactured in your skin following direct exposure to sun. Amount varies with time of day, season, latitude and skin pigmentation. 10–15 minutes exposure of hands, arms and face 2–3 times/week may be sufficient (depending on skin sensitivity). Clothing, sunscreen, window glass and pollution reduce amount produced. Source: National Osteoporosis Foundation Web site; retrieved July 2005 at http://www.nof.orghttp://www.nof.org

30. Are You Lactose-intolerant? Some people lack the enzyme lactase needed to digest lactose (milk sugar). Here are some tips which may help people obtain calcium from dairy products…

31. Tips for Lactose Intolerance Start with smaller portions Eat dairy in combination with meals Try dairy foods other than milk: –Hard cheeses have less lactose than milk: (ex: cheddar, Swiss, parmesan) –Yogurt contains predigested lactose Try products like: Lactaid and soy milks and cheeses

32. I just don’t like milk

33. Add milk to coffee Add powdered milk to food (1 tablespoon = 50 mg calcium) Make oatmeal and cream-type soups with milk instead of water Some ideas

34. Make instant hot cocoa with milk, not water. Try chocolate milk. 8-oz. has only 2 - 7 mg caffeine. Average glass provides only 60 more calories than unflavored milk. Serve milk-based desserts (puddings, tapioca, frozen yogurt, custard, ice cream). Limit fat and sugar. Some more ideas

35. Enjoy plain or flavored low fat yogurt Top baked potatoes with plain yogurt; sprinkle with chives Use flavored yogurt as a fruit salad dressing; experiment with substituting plain yogurt for some or all of the sour cream in vegetable salad dressings Even more ideas

36. Have It YOUR Way Smoothie (serves 2) 1 cup unsweetened, frozen raspberries or frozen fruit of choice 1/2 cup 100% calcium fortified orange 3/4 cup fruit-flavored, low- or non-fat yogurt Blend all ingredients well in blender. Enjoy! Calcium per serving: 243 mg.

37. Fantastic Fruit Parfait Layer yogurt, low-fat granola and fruit in whatever proportions you’d like. Add some nuts and you’ve included a 4th food group.

38. What about a supplement? Take no more than 500mg at a time Calcium citrate is recommended over calcium carbonate 500 mg

39. Remember to follow the prevention steps … Eat a healthy diet with plenty of foods high in calcium and vitamin D. Engage in regular exercise. Avoid smoking and excessive alcohol. Support your bones. They support you!

40. Questions ??