Nutrition for Bone Health

Calcium
When you think bone health, what is the first nutrient you think of? I’m going to go out on a limb and guess that you said Calcium! Yep, calcium is crucial for bone health. It is the key component of hydroxyapatite, which makes of the mineral matrix that keeps you teeth and bones sturdy and strong. Our bones are also constantly breaking down and building up – and in order to properly build, they need adequate amounts of calcium. This “adequate amount” ranges from 1,000mg- 1,300mg per day depending on age and gender and mainly comes from dairy products, almonds, leafy greens, tofu, beans, lentils, and some fish fish.

Vitamin D
Now, while calcium is the key component in bone, it pretty much is no good without its partner in crime, vitamin D. Vitamin D is needed for calcium absorption, so no matter how much calcium you eat (or drink), your body isn’t absorbing much of it if you lack vitamin D. Vitamin also helps in that bone remodeling (breakdown and building) process I mentioned.

Vitamin D has become a pretty hot nutrition topic recently. In fact, vitamin D deficiency is on the verge of becoming a global public health issue. Why? Well, if you are reading this post right now, you are likely sitting inside staring at a computer or phone screen as opposed to soaking up the sun’s UV rays. Our primary source of vitamin D comes from the sun so the decreased time spend outdoors and the increased use of sunscreen that have been seen around the globe are causing vitamin D deficiency rates shoot through the roof!

There are a few food sources of vitamin D, including fortified dairy products, some fatty fish, and mushrooms, but these can’t really provide enough to meet our need of 600-800 IU per day (and most people need up to 2,000 IU per day if they are deficient).

Exercise
The final key player in bone health isn’t a nutrient; it is exercise!- specifically weight-baring exercise. Simply carrying the weight of your skeleton in activities like walking, running, jumping, and stair climbing all help in that formation of strong bones. Not to mention, exercise improves strength and balance, which can help decrease risk of falls and broken bones.

Other Nutrients
In addition to these top three, researches have also found that low vitamin C and vitamin K levels also put people at risk of poor bone mineralization. On the other hand, people who had diets high in fruits and vegetables were found to have stronger bones… just one of the millions of reasons to eat more fruits and veggies!

Controversy
A few studies have found that high calcium intake, greater than the recommended daily intake doesn’t provide any additional benefit when it comes to bone mineral density. There have also been associations between high calcium intake (especially from supplements) and heart disease risk. Moral of the story- more calcium isn’t always better.

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Probiotics

Last Wednesday the nutrition department at school had their annual symposium. This year’s topic: the gut microbiome. The microbiome is a pretty hot topic right now. There is so much interesting research on how it affects our health so there is no way I could share everything with you in one post (or even a few!). If you aren’t familiar with the microbiome, it is the collection of the billions of different bacteria (both good and bad) that live inside our guts, and the composition (both the type and number) these bacteria play a role in our health. They can influence whether or not we get certain diseases, how efficiently our metabolism runs, our hormone levels, our immune system, and much, much more. And guess what? Diet is the #1 factor that determines which bacteria live in our gut!

So how do you make sure your microbiome is in tip-top shape? Well, there are many different things to think about, but I am going to just focus on 1 here today — probiotics.

Most of us have probably heard of probiotics in a few contexts – supplements and yogurt. Probiotics are actually live, good bacteria that help create a good balance of the different bacteria in your gut. In other words, they help improve your microbiome, which is good news for your health and digestion.

How much do you need? Taking 1 probiotic supplement every day or consuming 2-4 tablespoons of fermented foods every day is optimal.

If you are going to take a supplement, you want to pay attention to the strains and the CFUs.

  • Strains are the number of different types of bacteria in the supplements. Try to find a supplement with at least 5 different strains to get the most benefit (the more the better).
  • CFUs are the colony forming units or the actual number of live bacteria in the supplement. Aim for a supplement with 25-30 billion CFUs. Some people can benefit from up to 900 billion CFU’s, including those with IBD and celiac, but 25-30 billion is typically enough for healthy individuals.

Sound too science-y and confusing? Eating 2-4 tablespoons of probiotic containing foods is just as good! Probiotics are found in fermented foods like unpasteurized sauerkraut (the stuff you find in the fridge), kefir, yogurt, kimchi, apple cider vinegar, and tempeh. Getting probiotics from just one of these foods is great, but mixing up your sources of probiotics is extra helpful.

Interested in knowing more about the microbiome? Ask me your questions and I would love to share more!

My Experience on Whole30

Don’t mind me just sitting over here indulging in a big bowl of ice cream.

The cycle of restricting foods (and dieting) and then binging on “unhealthy” or “forbidden” foods has never been as clear to me as it is right now. That’s because I just completed day 30 (the last day) of the Whole30 diet.

After my experiment as a vegetarian for a month, I thought I would try out another diet. The lucky winner- Whole30. Whole30 is a diet designed to “end unhealthy cravings and habits, restore a healthy metabolism, heal your digestive tract, and balance your immune system”. Sounds great until you hear what is involved. On Whole30 you aren’t allowed ANY grains, legumes, sugar, sweetener (including things like honey), dairy, soy, or alcohol. What does that leave you ask? I have pretty much spent the last month eating only meat, fish, eggs, fruits, and vegetables. It got real boring, real fast to say the least.

If you catch my drift, it was not an enjoyable experience. If you have read many of my previous posts or know me well, you know that I am not one to cut any foods out of my diet – you name it, I’ll probably eat it (yes, even as a nutrition student and future dietitian I eat (and love) chocolate, ice cream, buttered popcorn, and even a loose with chili cheese fries from Detroit’s Lafayette Coney Island), so having to cut so many things out of my diet was a challenge.

In theory, sticking to a diet made up of whole foods is great, but not allowing any wiggle room leads to overeating all of the “forbidden foods” later on (aka the big bowl of ice cream I am having). Cutting out foods can create an unhealthy relationship with food, it is restrictive, not sustainable, and most of all, it isn’t fun.

So, how was Whole30?

Like I said before, it is really boring because there wasn’t a lot of variety. It was also very difficult to go to restaurants or gatherings with food since there were so many things that were off limits.

Do I feel better?

Honestly, I don’t feel any different – aside from the fact that all I want to do is eat dessert, bread, and a big chipotle burrito bowl. But also remember, my diet was pretty rich in fruits, vegetables, and lean proteins before. It wasn’t like I was starting out eating McDonald’s on the daily.

Would I recommend Whole30?

That would be a big fat NO! I see no reason why you have to cut out things like whole grain bread that is packed with fiber, beans that are a good source of plant based protein, and dairy products that are full of calcium and protein. I actually think you end up in an even worse situation after Whole30. Think about the restricting and binging cycle I mentioned — after 30 days of restricting, all you want to do is overeat/binge on the foods you avoided for a month. (It has even been difficult for me, someone who is very aware of these restrict and binge patterns, to resist eating an entire pint of ice cream and a loaf of bread right now.)

On the other hand, I do think the emphasis of fruits, vegetables, and lean protein is great! Everyone could benefit from eating a few more of these and a few less sugary and starchy foods (since they make up the majority of a standard American diet). Note that I said “a few less”, not “eliminate” the sugary and starchy foods. There is no reason why pizza and chocolate can’t make there way into a healthy, balanced diet.

I think this pretty much sums up my thoughts on Whole30. Have you done Whole30? If so, what are your thoughts?

Being Vegetarian

Exactly four weeks ago I decided to become a vegetarian…temporarily. Yep, I have officially been a vegetarian for one full month. I had been pondering the idea for a while and I had finally used up all the chicken and turkey in my freezer, so I thought it would be a good time to start. (Oh, and I guess I should include that I just cut out all meat and fish. I still ate eggs and dairy.)

By no means did I plan on being a vegetarian forever, but as a future dietitian I thought it would be a good experience to walk in the shoes of vegetarian patients and clients that I will work with.

Anyways, I thought I would share some things I have learned from my experience with you this week.

The good, the bad, and the indifferent

The first question I have gotten from all my friends and family is, “how do you feel”, and honestly, I can’t say that I feel much different. Prior to my vegetarian experiment, I didn’t each much red meat at all; I mostly stuck to chicken, turkey, tuna, and salmon. Research has shown that there are a lot more benefits to cutting out red meat compared to other lean meats, so I don’t know if that has anything to do with the lack of change I have felt.

People are also very concerned about protein, so I’ll also mention that I was keeping track of my food intake using MyFitnessPal at the beginning to make sure I was getting enough protein. While I could easily meet my protein needs for the day, I had to be a lot more conscious of including it at every meal and snack than I was before.

With that being said, eating out was a struggle– not because there aren’t any vegetarian option (you can get pasta and potatoes pretty much anywhere), but because restaurant menus lack vegetarian protein sources. I especially had a hard time in the cafeteria at the hospital. After the first week I started bringing a container of tofu and beans to add to salads and soups to make sure I got my protein in.

So while it may have been a little difficult at times, I actually am really happy that I gave vegetarianism a shot. I had to get super creative in the kitchen, and find new ways to incorporate tofu, tempeh, beans, and eggs into my meals to make sure I got enough protein in for the day (which means lots of new vegetarian recipes and food combination to share in the coming weeks!). I also now have a good basis of vegetarian recommendations for any patients or clients who come to me with questions.

And finally (skip this section if you don’t want to hear about flatulence and bowel movements), vegetarianism has made me very regular. Vegetarian diets tend to be a lot higher in fiber which kept everything moving smoothly. The first week I was a little gassy (probably due to all the beans I was eating), but my body got use to it and I have been fine ever since.

Overall thoughts

I think a lot more good came out of this experiment than bad. I have cooked up some new things in the kitchen and have had experiences that will help me be a better dietitian. Meeting protein needs can be tough but definitely manageable if you plan ahead.

While I think going completely vegetarian isn’t really necessary (unless you would like to, of course), there are lots of benefits to being a vegetarian. Plant-based diets usually have a lot more fiber, vitamins, and minerals. There is also lots of research showing that decreasing meat intake can help prevent chronic diseases, aid in weight loss, and save the environment.

If I were to give any recommendations, I would say that it is always beneficial to cut back on red meat intake (Eat it no more than 1x per week) and increase you fruit and veggie intake. You can also try Meatless Mondays or another modified version of being a vegetarian to get some of the benefits (such as meatless lunches during the week).

Looking forward

This week I am planning on including a lot of fish and meat to see if I feel any different (I give you any updates in next weeks post). After that, I’ll definitely be adding fish and meat back into my diet but probably not in the same quantities as before. I am going to continue to include vegetarian meals on a regular basis because they both healthy and – more importantly – they taste good!

Considerations

If you are or decide to become a vegetarian or vegan long-term (longer than 1-2 months), I suggest seeing a dietitian (or sending me an email, I’m happy to help!) since there are some vitamin and mineral deficiencies that can occur if you aren’t taking supplements.

Protein!

From protein bars, protein pancakes, protein shakes, protein peanut butter, and giant chickens breasts, I was originally planning on writing this posts about the potential risks of a high protein diet. In school we learned that high protein consumption could damage the kidneys and lead to bone disease, health disease, and possibly cancer. But, when I started digging through the research to write this blog post, I was kind of shocked to find out that none of these side effects of high protein intake were really proven.

The research shows that high protein diets can be harmful to the kidneys, but only in people who already have kidney problems (which are usually caused by high blood pressure and diabetes). High protein diets might also increase the amount of calcium we lose in urine, but it hasn’t been found to have an effect on our bones. In fact, more protein can actually prevent bone fractures.

As for heart disease and cancer risk, we should really be focusing more on where our protein comes from. Many protein rich foods, like beef and red meats, are also high in saturated fats. This saturated fat is actually what has been found to increase risk for heart disease and cancer, not the protein. That means, we should focus on eating proteins lower in saturated fat, like lean meats, low fat dairy, and fish.

So now that we have busted some of the myths, here are some benefits of protein for healthy sources:

1. Protein is made up of amino acids, which are the building blocks for cells, muscles, and tissues in the body. Therefore, more protein can help build/preserve muscle mass and repair damaged tissues.
2. Protein tends to be very satiating, which can lead to fewer calories consumed from other foods and weight loss.
3. The jury is still out there on this one, but some research shows that high protein intake can increase your metabolism (that means more calories burned while you sit on the couch!).

How much protein should you eat?

In order to prevent deficiency, you should have 0.35 grams of protein per pound of your body weight, but in reality, most of us can benefit from more than that. I suggest 0.5g-0.75g per pound (I wouldn’t go much higher than 0.90g/lb – there isn’t enough research to know the long term effects anything higher than that). Most of us typically land in this healthy range every day just by eating everyday foods, but like I said before, it is important to focus on those lean, low fat protein sources to meet your daily goals.

And remember, just because protein has the spotlight doesn’t mean you can eliminate carbs and fats – they provide lots of important nutrients we can’t live without!

 

“Should I be eating dairy?”

 

When people find out I am studying nutrition the questions immediately start pouring out, and the topic of dairy is one of the most popular. There is tons of research on both sides, so I’ll try to sum it up for you.

Evolution and Intolerance

The number 1 argument against dairy is that it isn’t “evolutionary” for humans to consume the milk made from other animals. While it is true that humans are the only species to do this, people have been consuming animal dairy products for hundreds of years, and some research shows that our genes have changed and adapted to accommodate the dairy products we consume.

While some genes may have changed, over 75% of the world’s population is still intolerant to the natural sugars in dairy (also known as lactose intolerance). This is likely due to reduction of lactase production (the enzyme used to digests those sugars) that naturally occurs as we age. Why does it decrease with age? Probably because in distant human history, people didn’t have much dairy in their diet after they stopped breast-feeding.

Calcium and Bones

Because dairy is the optimal food for growing animals, it is packed with beneficial nutrients like calcium, vitamin D, protein, phosphorus, and some B vitamins. Dairy products often get the spotlight for calcium content and bone health – which they should since it can be extremely difficult to meet our daily calcium needs from food without dairy. Several studies have shown that people who consume dairy have improved bone mineral density, and have lower risk of osteoporosis and bone fractures. But, other studies have shown that people who are lactose intolerant often have higher bone mineral density and lower risk of osteoporosis. Confusing, right?

More and more research is showing that we should really be focusing on vitamin D when it comes to bone health, but I’ll save that post for another day.

Healthy Fat

While the research on bone health is still “up in the air”, it is pretty well proven that dairy can provide a lot of healthy fats that can decrease heart disease and stroke risk. But there is a disclaimer that comes with this one. The nutrient composition of dairy can differ depending on what the dairy producing animals eat. We only see these healthy fats when dairy comes from animals that were grass fed or pasture raised. And don’t forget, you only get these healthy fats if you buy dairy products with fat in them – low fat and skim won’t have them.

Hormones and IGF-1

Finally, the infamous hormones that people are concerned about. Dairy has been shown to increase a hormone called insulin-like growth factor (IGF-1). IGF-1 is responsible for cell growth – which can be a good thing and a bad thing. It is great for healing damaged tissues and building muscle, but it also means it might help the growth of cancerous cells (that’s why so many people say that dairy causes cancer). While there are few and inconclusive studies showing dairy may increase prostate cancer risk, there are several studies showing dairy can decrease colorectal cancer risk.

In addition to cancer, IGF-1 is also the suspected hormonal link between dairy and acne, headaches, low energy, inhibited weight loss, and many more.

Conclusions

So back to the original question “Should I be eating dairy?”

Do you have digestive symptoms (like abdominal pain, flatulence, and diarrhea) after eating dairy? If you do, avoid it. You can try lactose-free dairy products be those can also cause trouble sometimes.

Do you have any symptoms of hormone imbalances (like acne, headaches, low energy, inhibited weight loss, or mood swings)? If you do, try eliminating dairy and see how you respond. Maybe it will help, maybe not, but it is worth a try.

Other than that, it is really personal preference. While there are some potential health risks, the evidence isn’t conclusive and none of the studies were gold-standard clinical trials. If you aren’t sure, maybe you try to eliminate it for a week or two to see if you feel any different and then make your decision. Remember, everyone is different so just because your neighbor won’t touch a piece of cheese doesn’t mean you shouldn’t have any either.

However, nutritionally, if you choose not to eat dairy, I would suggest a daily calcium + vitamin D supplement, especially if you are under the age of 30.

Micros and Macros

In this post, I thought I would take it back to some basics: micronutrients (the little guys) and macronutrients (the big guys).

Micronutrients

Micronutrients are all your vitamins and minerals, like iron, zinc, vitamin D, and vitamin E – just to name a few. They are called micronutrients because you only need a little bit of them each day. Your fruits and vegetables are packed with tons of these, but they are also in lots of other foods.

Micronutrients are responsible for things like eye sight, bone health, thyroid function, blood pressure, and many, many more.

Right now, on the nutrition fact labels you will always see vitamin A, vitamin C, calcium, and iron. That is because back in 1990’s when the label was designed, those were the nutrients that people often did not get enough of. Now, you may know that there is a new nutrition fact panel coming out, which will be mandatory for manufacturers to use by 2021. On this label you will see vitamin D, calcium, iron, and potassium since these are the micronutrients that most people are low on now.

Macronutrients

Macronutrients are your carbs (including sugar and fiber), proteins, and fats. They are called macronutrients because – you guessed it – you need large amounts of them each day. Protein rich foods include fish, animal meats, and soy products (like tofu and tempeh). Fats come from foods like avocados, nuts, seeds, oils, and butter. Carbs come from grains (quinoa, bulgur, rye, rice, wheat) and foods made from grains like bread and pasta, corn, peas, and fruits. There are also lots of “combination foods” like beans, eggs, and cheese that provide a good mix of 2 or 3 of these macronutrients.

Macronutrients are our main sources of energy, growth, and building blocks for muscles.

Why does this matter?

Micro and macronutrients are both crucial for survival. We can’t live healthfully if any single one within these two groups is missing. I wanted to talk about this because many food products market themselves as “healthy” because they have extra whole grain or protein. For example, I love Kodiak Cake pancakes, which are “protein packed” and made with 100% whole grains. While it is great to have a little extra protein and whole grains these pancakes don’t have many micronutrients. Now think about broccoli and carrots – super healthy right? Yes, they may be packed full of micronutrients but they have very few macronutrients.

See – that’s why variety is important and eating only vegetables all day isn’t really a good thing. There is no single food that can provide all the nutrients we need. Mix things up, try new foods, and maximize your nutrient intake!