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Bone Health: Ask the Expert

What should I eat to keep my bones healthy? We went straight to EatingWell advisor Miriam Nelson, Ph.D., author of Strong Women, Strong Bones and an associate professor of nutrition at Tufts University, for expert advice on eating to maintain bone health.

What are the most important things you can do to improve your bone health and prevent osteoporosis?

“There are a number of things. If you smoke, stop. If you drink more than one alcoholic drink a day, or a man who drinks more than two, cut back. Make sure you’re getting your calcium and vitamin D and eating an overall good diet with fruits and vegetables, grains. And then be sure to get lots of physical activity, especially a combination of aerobic and strength exercises. If you just rely on diet, that isn’t going to be nearly as effective as combining it with other lifestyle changes. It’s the whole package that matters. Bone is incredibly stubborn; it doesn’t want to improve. You have to do a lot. It’s not just one thing.”

If you've already developed a lot of your bone by the time you're 20 or 30, will improving your diet even make any positive difference in your bone health?

“You’ve probably developed most of your bone by the time you’re in your late twenties. Most of the gain is in your late teens, but we’ve seen 60- and 70-year-olds who gain some bone over time by supplementing with calcium and vitamin D and increasing exercise. Even if you’re in your twenties and thirties, you want to do everything you can to not lose bone. Developing healthier lifestyle habits is a way to maximize your peak bone density and then to minimize the loss. Once you improve your habits, you can regain some of what you’ve lost, not a lot, but some.”

Some people say that calcium doesn't really keep bones strong. How do you respond to that?

“There’s controversy over this—some people say calcium doesn’t actually reduce risk of fractures—but I think that, overall, the data suggest that women who eat a diet that is abundant in calcium, as well as fruits and vegetables, have reduced risk of fractures. The problem is that everybody would like to have a hero in terms of one vitamin, one mineral, or something else in the diet that’s the deciding factor, but there isn’t one single entity that helps bones. It’s not just calcium, it’s not just vitamin D. Vitamin K in fruits and vegetables, magnesium in grains—these nutrients are important for bone health too. It’s all of them put together that really create an environment that is the healthiest for bones.”

Do all women need a calcium supplement?

“I recommend that every woman over the age of 40 consider taking a calcium and vitamin D supplement. Everyone should focus on foods first, but most women have a hard time getting enough calcium and vitamin D in their diets. A supplement is a good insurance policy.”

Do I need to take vitamin D supplements too? Can't I just get enough from the sun?

“It’s true that your body manufactures vitamin D after being exposed to sun. But it’s hard to produce vitamin D in the skin during the winter—even on a beautiful sunny day—because of the angle of the sun. The recommended intake for women 50 and under is 200 IU per day. For women 50 to 70, it’s 400 IU and if you’re over 70, it’s 600. [Many experts are starting to call for even higher intakes.]

“It’s almost impossible to get enough vitamin D from our diet: milk, our main dietary source, has only 50-100 IU per cup. It’s also difficult to get enough from the sun without exposing our skin to damaging rays. Vitamin D and calcium are two nutrients where a little bit more is probably better, and we have a hard time getting it in diet—so I do recommend that most women take supplements.”

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