A Diet for Healthy Bones University of California, Berkeley • Center for Weight & Health http://www.cnr.berkeley.edu/cwh/ This project has been funded with federal funds from the U.S. Department of Agriculture, under the Food Stamp Nutrition Education Program. The contents of this training session or of these educational materials do not necessarily reect the view or policies of the U.S. Department of Agriculture, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. government. USDA is an equal opportunity employer. Lesson 1 Lesson 1 A Diet for Healthy Bones Goal • Increase knowledge of osteoporosis and the importance of diet for healthy bones. Key Messages • Osteoporosis is a common condition that can be prevented. • Eating a balanced diet that includes adequate amounts of foods rich in calcium and vitamin D will help prevent or delay osteoporosis. Summary This lesson will describe osteoporosis and discuss how to maintain healthy bones through all stages of life. Participants will learn about the risk factors for osteoporosis, as well as ways to improve bone health. Emphasis is on including calcium and vitamin D-rich foods as part of a balanced diet. Learning Objectives 1. Identify the risk factors for osteoporosis. 2. Identify foods that promote bone health. By the end of the lesson, participants will be able to: • Define osteoporosis. • List the risk factors for osteoporosis. • Learn how osteoporosis is diagnosed. • Identify calcium needs for each age group. • Identify calcium-rich foods and sources of vitamin D. • Identify calcium-rich foods that people with lactose intolerance can eat. • Explain when a calcium supplement may be recommended. Lesson 1: Page 1 Learning Activities 1. Getting started 2. Pretest (optional) 3. Calcium screener (optional) 4. Learning about osteoporosis 5. Osteoporosis: risks and prevention 6. Calcium and vitamin D-rich foods 7. Post test (optional) Materials • Styrofoam (9 x 12 inch sheet can be purchased at a fabric store or craft store, to be cut into smaller pieces) • Bone model (provided) • “Picture Your Bones” packet and/or powerpoint presentation (English, Spanish, Vietnamese) • “Bone Health Q & A” discussion cards (English, Spanish, Vietnamese) • “Yogurt with Fresh Fruit Recipe” ingredients for food demonstration Handouts (English, Spanish and Vietnamese) • Lesson 1 Pre and post test (optional) • “Calcium Screener” (optional) • “A Diet for Healthy Bones” with goal setting pamphlet • “Yogurt with Fresh Fruit Recipe” recipe cards Lesson 1: Page 2 Suggested time: 60 minutes (5 minutes) (5 minutes) (5 minutes) (10 minutes) (10 minutes) (20 minutes) (5 minutes) 1. Getting Started (5 minutes) • Greet the participants. • Complete FSNEP forms as required. • The theme of this lesson is bones are a complex living tissue. 2. Pretest (optional) (5 minutes) Handout • Pretest • Pass out and collect pretest. The pretest questions can be used as openers for discussion. 3. Calcium Screener (optional) (5 minutes) Handout • “Calcium Screener” (English, Spanish and Vietnamese) The calcium screener is a quick and easy way to determine who may not be getting enough calcium from their diet. There are many high calcium foods that are not on this screener. The screeners are ethnic-specific, and are in English, Spanish and Vietnamese languages. They each have different foods to better represent the calcium intake of the diets of African Americans, Latinos and Vietnamese. Learning Activity • Pass out the ethnic-appropriate screener and have the participants check the boxes under the pictures of foods they eat one or more times each week. • Have participants follow the instructions in the last panel. • Discuss the results with the class. • Collect the screeners. Lesson 1: Page 3 Frequently Asked Questions Q: What is a calcium screener? A: A calcium screener helps identify who may have a very low calcium diet. It doesn’t tell us exactly whether someone is getting enough calcium nor does it tell us specifically how much calcium is in our diet. To get a complete analysis of your dietary intake of calcium, you may need a more extensive review of your diet. Q: Why can’t we keep the calcium screener? A: The calcium screener was not designed as an educational tool. We have developed other materials that will provide you with information on calcium- rich foods, such as the “A Diet for Healthy Bones” pamphlet. 4. Learning about Osteoporosis (10 minutes) Materials • Picture Your Bones Packet and/or Picture Your Bones powerpoint presentation Osteoporosis is often called the “silent disease” because a person can have it and not know. You usually won’t experience any pain, signs or symptoms during the early stages. Then one day, you break a bone while doing a routine task, or break a wrist or a hip after a fall. Many people don’t know they have osteoporosis until a fracture happens. Getting enough calcium from your diet and doing weight-bearing exercises help make bones healthy and work to prevent or slow down osteoporosis. Weight bearing exercise is about being on your feet. Walking is a good example of a weight bearing exercise. When you’re young, bone grows larger, stronger and denser as the rest of the body is developing. As we age, we begin to lose bone. One of the symptoms of osteoporosis is a loss of height. One could lose as much as 2 to 4 inches of height in later life due to bone loss. It is possible to slow bone loss through proper diet and exercise. Lesson 1: Page 4 Calcium is a mineral essential for strong bones. The body does not make calcium, so we must get it from food. Children and teenagers need to eat a lot of calcium-rich foods because their bodies and bones are actively growing. Adults need calcium to maintain their bones and to slow down bone loss. If you cannot get enough calcium from foods, talk to your doctor or health professional about taking calcium supplements. Bone is complex living tissue. The body is constantly building new bone tissue and breaking down old bone. Today we will learn how diet and exercise affect bone growth and what we can do to keep our bones healthy. 4.1 Learning Activity Osteoporosis means “porous bones”. Porous bones become weak and easily break. With a loss of bone tissue, bones that were once dense and strong may not be able to withstand the stress of even normal activity, such as bending over or twisting. • Use the bone model to show the difference between a normal and an osteoporotic bone. • Use the styrofoam to show how easily a porous bone can break by snapping the styrofoam in half. • Show “Picture Your Bones” picture (slide 1). • Share the information on the picture (slide). Did You Know? • One out of two women will have osteoporosis in her lifetime. • Two out of every ten men will develop osteoporosis. 4.2 Learning Activity There is no cure for osteoporosis. However, you can slow down bone loss by increasing your daily calcium and vitamin D intake, and doing 30 minutes of physical activity each day. • Show “Picture Your Bones” picture (slide 2). • Share the information on the picture (slide). Lesson 1: Page 5 Discussion Questions • “Does anyone here know someone with osteoporosis?” • “How is his or her life affected by osteoporosis?” • “How common is osteoporosis?” 4.3 Learning Activity Bone fractures impact the quality of life. Promoting bone health early in life can prevent fractures later in life and help older people live more independent lives. Having weak or porous bones can increase the risk of fracturing or breaking bones. Older people with osteoporosis are especially at risk for breaking bones in the hip, spine or wrist. Fractures are painful, serious health conditions and can: • be disfiguring • be disabling • limit quality of life by severely reducing the ability to lead an active life • Show “Picture Your Bones” picture (slide 3). • Share the information on the picture (slide). Discussion Questions • “Has any elderly person you know fallen and broken or fractured a bone?” • “How did that affect his or her life?” 4.4 Learning Activity Age and the effects of osteoporosis can cause a curvature of the spine called kyphosis. • Show “Picture Your Bones” picture (slide 4). • Share the information on the picture (slide). Lesson 1: Page 6 Discussion Question • “Have you ever noticed an elderly relative or friend who became shorter as she/he aged?” 4.5 Learning Activity A common way to diagnose osteoporosis is to have a DXA scan (pronounced “dexa”) that tells us how strong your bones are. The DXA scan: • measures how dense bones are • measures the bones in the hip, spine, wrist, forearm and other areas • is painless • is safe • Show “Picture Your Bones” picture (slide 5). • Share the information on the picture (slide). Discussion Questions • “Has anyone here had a DXA scan?” • “What did it feel like?” Frequently Asked Questions Q: I think I have strong bones. I eat pretty well and exercise too. Do I really need to have a DXA scan to know if I have osteoporosis? A: For now, it is the best way to tell if you have osteoporosis. Q: At what age should a person get a DXA scan? A: A DXA scan is generally recommended for women after menopause, or sometimes earlier. It may also be recommended if repeat bone fractures have occurred or a person has lost more than two inches of height. Lesson 1: Page 7 5. Osteoporosis: Risks And Prevention (10 minutes) Handout • “A Diet for Healthy Bones” Osteoporosis can affect everyone as we get older. Women are more likely than men to get osteoporosis because of their different hormonal makeup. White and Asian women are at highest risk for developing osteoporosis; however, African American and Hispanic women, and men can still get osteoporosis. 5.1 Learning Activity • Pass out “A Diet for Healthy Bones” pamphlet for participants to refer to during the discussion. Discussion Questions • “Do any of you think you might be at risk for osteoporosis?” Here are factors that increase a person’s risk for osteoporosis: • Not eating enough calcium-rich foods • Not getting enough vitamin D • Not doing enough weight-bearing exercise • Hormonal changes with menopause or stopped menstruation • Having had a hysterectomy or ovaries removed • Family history • Current smoking • Drinking too much alcohol • “What can I do to prevent osteoporosis?” Building healthy bones by getting enough calcium and exercising is important at every stage of life. Children and teenagers need more calcium because their bodies and bones are actively growing. Lesson 1: Page 8 Adults need calcium to maintain their bones and help slow bone loss as they get older. It is very important for a person who has been diagnosed with osteoporosis to get enough calcium to slow further bone loss. The four steps to osteoporosis prevention 1 • Meeting your daily value of calcium and vitamin D • Getting 30 minutes of weight-bearing exercise daily • Avoiding smoking and drinking alcohol only in moderation • Talking to your doctor or health professional about bone health and bone mineral density tests Frequently Asked Questions Q: What is a weight-bearing exercise? A: Weight-bearing exercise is any exercise where your feet and legs carry your own weight. Examples are walking, jogging and dancing. Q: What does drinking alcohol “in moderation” mean? A: Studies show that drinking too much alcohol can hasten bone loss and reduce the body’s ability to absorb calcium. If you drink alcohol, limit intake to no more than one ounce a day for women and two ounces a day for men. An ounce equivalent would be a small glass (3 to 4 ounces) of wine for a woman; a two ounce equivalent would be two beers for a man. Q: At what age do I have to start being concerned about osteoporosis? A: At all ages. Building strong bones during childhood and adolescence through exercise and a healthy diet, adequate in calcium, can be the best defense against developing osteoporosis. Osteoporosis is largely preventable for most people. Although osteoporosis is generally diagnosed during later life, we should be aware of the importance of taking steps toward developing strong bones during early life. 1 National Osteoporosis Foundation. Available at: http://www.nof.org/prevention/. Lesson 1: Page 9 [...]... and may have stomach discomfort after eating milk or dairy foods This is known as lactose intolerance Asians and African Americans are more likely to have lactose intolerance than whites or Latinos Lactose intolerance is not the same as milk allergy Many people lose the ability to break down lactose in their body as they get older People who have lactose intolerance still need calcium for healthy bones. .. There are many foods other than milk or dairy foods that have calcium Discuss Menu 2 in the A Diet for Healthy Bones pamphlet 4 USDA National Nutrient Database Lesson : Page 16 Calcium-rich foods for people with lactose intolerance include: • actose free milk or calcium-fortified soymilk L • anned sardines and canned salmon with bones C • ranges or calcium-fortified orange juice O • lmonds A • lack and... much Sardines are high in salt If packed in oil, sardines are also high in fat Try sardines packed in tomato sauce for a lower-fat variety with the same amount of calcium Latinos Pinto beans and cheese are excellent sources of calcium, along with milk Whole milk, reduced-fat, low fat and nonfat milk all have the same amount of calcium in them Try using low fat or nonfat milk as they are low in fat but... itamin and calcium D Frequently Asked Questions Q hat are fortified foods? W A ortified foods are foods that have vitamins and minerals added to them by the F anufacturer Examples are vitamin D-fortified milk and calcium-fortified m range uice o j 6.4 Learning Activity What is lactose intolerance? Lactose is the natural sugar found in milk and dairy foods Some people cannot digest lactose and... intake of calcium, you may need a more extensive review of your diet Q: Why can’t we keep the calcium screener? A: The calcium screener was not designed as an educational tool We have developed other materials that will provide you with information on calcium- rich foods, such as the A Diet for Healthy Bones pamphlet 4 Learning about Exercise and Bone Health (10 minutes) Materials • • Blackboard... circule una respuesta para cada pregunta 1 Circule el nombre de la condición donde los huesos se ponen frágiles y están más propensos a quebrarse a b c d e 2 Circule el grupo de alimentos que las personas con intolerancia a la lactosa pueden comer para obtener calcio a b c d e 3 Leche entera, queso en tiritas, leche sin grasa Arroz, tomate, pollo Salmón con huesos, leche de soya fortificada con calcio,... los huesos absorban calcio a b c d e Vitamina A Vitamina B Vitamina C Vitamina D No estoy seguro /a favor de voltear la página Nombre: Fecha de Hoy: 5 ¿Cuántos vasos de 8 onzas de leche baja en grasa le proveen 1,000 miligramos de calcio? a b c d e For office use only: Pre / Post Primer nombre Apellido 0-1 vaso 1-2 vasos 2-3 vasos 3-4 vasos No estoy seguro /a Lesson 1 Tên: Tên Họ Ngày Hôm Nay: Các Loại... build healthy bones? Vitamins are substances that are needed for health You can get most of your recommended daily vitamins from eating healthy foods Vitamin D is a vitamin that works to form and maintain strong bones by helping the bones properly absorb calcium Without vitamin D, bones can become thin, brittle, soft, or misshapened Vitamin D • • • • i s found in a few foods c an be found in dairy... Demonstration M aterials • Food for food demonstration (optional) Lesson : Page 18 H andouts • • A Diet for Healthy Bones “Yogurt with Fresh Fruit Recipe” recipe cards Ask participants what foods they will be able to try this next week and invite them to write down their goals on the last page of their A Diet for Healthy Bones pamphlet • Pass out “Yogurt with Fresh Fruit Recipe” cards • Show calcium... eat Make sure all of your food i n one day does not add up to more than 200% DV for calcium Q: hat affects calcium absorption? W A: itamin D is key to calcium absorption Milk has added vitamin D (100 IU per cup) V hich helps your body absorb the calcium w Lesson : Page 14 ther factors that decrease calcium absorption are: O • aking an iron supplement at the same time you are eating high-calcium . need calcium for healthy bones. There are many foods other than milk or dairy foods that have calcium. Discuss Menu 2 in the A Diet for Healthy Bones pamphlet is known as lactose intolerance. Asians and African Americans are more likely to have lactose intolerance than whites or Latinos. Lactose intolerance is