A Diet for Healthy Bones

• Bone model provided• “Picture Your Bones” packet and/or powerpoint presentation English, Spanish, Vietnamese • “Bone Health Q & A” discussion cards English, Spanish, Vietnamese • “Yog

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 reflect 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

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

• 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)

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

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.

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

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)

• Show “Picture Your Bones” picture (slide 2).

• Share the information on the picture (slide)

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

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:

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

Lesson 1: Page 

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 prevention1

• 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/.

Q: Where can I go for more information on osteoporosis?

A: Your health professional can provide you with additional information on osteoporosis If you have access to the internet, the National Osteoporosis Foundation website has a lot of information on osteoporosis Their website can be found at: http://www.nof.org

Materials

• “Bone Health Q &A” discussion cards (optional)

• “Yogurt with Fruit Recipe” ingredients for food demonstration and tasting (optional)

Handouts

• “A Diet for Healthy Bones”

• “Yogurt with Fruit Recipe” recipe cards

6.1 Learning Activity

What foods have calcium?

• Discuss the list of calcium content in foods from the “How much calcium is in foods?”

table in the “A Diet for Healthy Bones” pamphlet.

• Engage class in a discussion using the “Bone Health Q & A” cards.

Lesson 1: Page 10

Food2 Serving size ~Calcium in milligrams

Milk, fat free, 1%, 2%, whole, lactose free 1 cup 300 mg Orange juice, calcium-fortified 1 cup 350 mg Milk, nonfat dried 1/4 cup 375 mg Yogurt 1 cup 370 mg Soymilk, calcium-fortified 1 cup 365 mg Sardines, canned, with bones 3 oz 325 mg Cheese 1 oz 205 mg Salmon, canned, with bones 3 oz 165 mg Almonds, raw 2 oz 150 mg Beans, black, cooked 1 cup 120 mg Nopales, cooked 1/2 cup 120 mg Cereal, calcium-fortified 1 cup 100 mg Greens, turnip, cooked 1/2 cup 100 mg Kale, cooked 1/2 cup 45 mg Beans, red, cooked 1 cup 90 mg Okra, cooked 1/2 cup 60 mg Broccoli, cooked 1/2 cup 35 mg Greens, collard, cooked 1/2 cup 130 mg Orange, fresh 1 medium 50 mg Sweet Potato, baked 1 medium 40 mg

Calcium is found in many foods, but some foods have more calcium than others Dairy foods such as milk, yogurt and cheese are good sources of calcium It is important to have a balanced diet If for some reason you avoid dairy foods, there are other foods that have calcium Some of these are listed below

Ethnic-Specific Tips

If most people in your class are from a certain ethnic group, you may want to include some of the following tips for increasing calcium intake:

Vietnamese

When making soup with chicken or other animal bones, add one teaspoon of vinegar

to the soup This will enable the calcium to cook out of the bones and will make a calcium-rich soup base Also when making curry sauce, use reduced-fat or low fat milk instead of coconut milk

African Americans

If you like eating sardines, remember that they are a good source of calcium However,

be careful not too eat too 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 still high in calcium

“saving” calcium for your future by eating more calcium-rich foods in your younger years

Nonfat and low fat dairy foods are healthy choices because they have the same

amount of calcium as whole milk, but less fat Every cup of milk has about 300

milligrams of calcium

Encourage your children to drink milk or water instead of soda Children have small stomaches and fill up quickly If they drink soda and other sweet drinks, they won’t have room for milk and the healthy foods they need to grow Eating a balanced diet with a variety of foods, emphasizing water and limiting sodas is the best way to ensure children will build healthy, strong bones

* American Academy of Pediatrics recommends exclusive breastfeeding for approximately the first 6 months after birth It is recommended that breastfeeding continue for at least 12 months Infants weaned before 12 months of age should not receive cow’s milk but should receive iron-fortified infant formula.

3 http://dietary-supplements.info.nih.gov/factsheets/calcium.asp

• For children under one year old, breastfeed or use a formula with iron, unless your doctor tells you otherwise Infants have difficulty digesting the protein in cow’s milk Breastmilk has all of the nutrients required by babies; iron-fortified formula is recommended when breastmilk is not available For children less than one year old, cow’s milk does not have all the necessary nutrients.

• For children, one to two years old who are no longer breast feeding, use whole milk They need the fat in whole milk for proper brain development

• For children over two years old, use low fat or fat free milk

• Women who are pregnant or breastfeeding need the same amount of calcium as other women their age

Frequently Asked Questions

Q Why do children and teenagers need more calcium?

A Because they are growing, they need more calcium to help build strong bones As you get older, your bones do not absorb calcium as well and your body draws on the calcium stored in your bones It is important to “bank” bone tissue when you are younger so that your bones remain healthy as you get older

Q: Is it possible to get too much calcium?

A: Yes, it is possible and it is harmful Too much calcium (more than 2,500 mg per day) can lead to decreased absorption of other minerals or possible kidney problems It

is best to stay with the recommended daily value of calcium for your age

To be on the safe side, read the labels on food packages to figure out the “percent daily value” (% DV) of calcium in the food items you eat Make sure all of your food

in one day does not add up to more than 200% DV for calcium

Q: What affects calcium absorption?

A: Vitamin D is key to calcium absorption Milk has added vitamin D (100 IU per cup) which helps your body absorb the calcium

Lesson 1: Page 14

6.3 Learning Activity

What is vitamin D and how does it help 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

Did You Know?

• All milk is fortified with vitamin D

• Fat free, 1% (low fat), 2% (reduced-fat) and whole milk all have the same amount of vitamin D and calcium

Frequently Asked Questions

Q What are fortified foods?

A Fortified foods are foods that have vitamins and minerals added to them by the manufacturer Examples are vitamin D-fortified milk and calcium-fortified orange juice

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 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.

Milk, fat free, 1%, 2% whole, fortified with vitamin D 1 cup 100 IU Orange juice, fortified with vitamin D 1 cup 100 IU Pink salmon, canned 3 oz 530 IU Sardines, mackerel, canned 3 oz 220 IU Cereal, fortified with vitamin D 1 cup 40-50 IU

Vitamin D in Foods

4 USDA National Nutrient Database

Lesson 1: Page 16

• Eat calcium-rich, nondairy foods, including calcium-fortified foods, such as orange juice.

• Eat small amounts of dairy foods throughout the day instead of all at once

• Try eating dairy foods with a meal or other foods instead of by themselves

• Try dairy foods besides milk, like low fat cheese or yogurt These have less lactose but just as much calcium

6.5 Learning Activity

Who should take calcium supplements?

It is always best to try to get calcium from foods Usually, the body more easily absorbs calcium from food Elderly people who do not eat very much might be unable to meet their calcium needs with food They may need to take a calcium supplement

Calcium supplements are pills that have calcium in them Your doctor can tell you if you need a calcium supplement Your body can absorb only 500 mg of calcium from

a supplement Do not take more than 500 mg of calcium from a supplement at one time Take calcium supplements with meals

Frequently Asked Questions

Q Are some calcium supplements better than others?

A Calcium carbonate is the least expensive calcium supplement and is fairly well absorbed by the body Many of these supplements are flavored and chewable Be sure to keep them out of the reach of children

Q: What if I take medications?

A: Talk with your doctor or pharmacist Calcium supplements can interfere with some drugs or minerals

Did You Know?

• One TUMS® antacid tablet has 200 mg of calcium There are generic or store-brand antacid tablets with comparable amounts of calcium

Handouts

• “A Diet for Healthy Bones”

• “Yogurt with Fresh Fruit Recipe” recipe cards

First Last Today's Date:

A Diet For Healthy Bones

Directions: Please circle the best answer for each question Circle only one.

1 Circle the name of the condition where bones become fragile and more likely to break.

a Diabetes

b Osteoporosis

c Pneumonia

d Arthritis

e Iʼm not sure

2 Circle the group of foods that people with lactose intolerance can eat to get calcium.

a Whole milk, string cheese, nonfat milk

b Rice, tomato, chicken

c Salmon with bones, calcium-fortified soymilk, broccoli

d Banana, apple, steak

e Iʼm not sure

3 The strength of your bones when you are between the ages of 40 and 60 years is

mostly determined by how well the bone was developed during _?

a Infancy (0-1 year)

b Childhood and teenage years (2 – 19 years)

c Twenties and thirties

d Iʼm not sure

4 Circle the vitamin that helps bones absorb calcium

a Vitamin A

b Vitamin B

c Vitamin C

d Vitamin D

e Iʼm not sure

5 About how many 8-ounce glasses of low fat milk provide you with 1,000 milligrams of

Pre / Post

Instrucciones: Por favor circule la mejor respuesta para cada pregunta Solo circule

una respuesta para cada pregunta

1 Circule el nombre de la condición donde los huesos se ponen frágiles y están más

2 Circule el grupo de alimentos que las personas con intolerancia a la lactosa pueden

comer para obtener calcio.

a Leche entera, queso en tiritas, leche sin grasa

b Arroz, tomate, pollo

c Salmón con huesos, leche de soya fortificada con calcio, brócoli

d Plátano, manzana, bistec

e No estoy seguro/a

3 ¿La fuerza que tienen sus huesos cuando usted tiene entre 40 y 60 años se determina

mayormente de como se desarrollaron sus huesos durante _?

a Su infancia (0-1 año)

b Niñez y juventud (2 - 19 años)

c Entre los veinte y treinta años

Primer nombre Apellido Fecha de Hoy:

Una Alimentacion Para Tener Huesos Saludables

favor de voltear la página

Primer nombre Apellido Fecha de Hoy:

Lesson 1 For office use only:

Các Loại Thức Ăn Tốt Cho Xương Cốt

Chi Tiết Hướng Dẫn: Xin khoanh tròn câu trả lời nào đúng nhất cho các câu hỏi sau Chỉ

nên khoanh tròn một câu trả lời thôi

1 Khoanh tròn bệnh chứng nào làm cho xương trở nên yếu và dể bị gãy:

a Bệnh tiểu đường (Diabetes)

b Bệnh rỗng xương (Osteoporosis)

c Bệnh viêm phổi (Pneumonia)

d Bệnh thủy đậu (Chicken pox)

e Tôi không biết chắc

2 Khoanh tròn nhóm đồ ăn nào mà những người bị khó tiêu chất đường sữa có thể ăn

để hấp thụ chất vôi:

a Sữa nguyên chất, phó mát sợi, sữa không chất béo

b Cá hồi (Salmon) với xương, sữa đậu nành với chất vôi, bông cải xanh

c Cơm, cà chua, gà

d Chuối, bôm/táo, thịt bò

e Tôi không biết chắc

3 Sự rắn chắc của xương cốt vào giữa tuổi 40 đến 60, phần nhiều ã được định đoạt bởi sự

phát triển tốt trong lúc _?

a Thơ ấu (0-1 tuổi)

b Trẻ con và thiếu niên (2-19 tuổi)

c Tuổi giữa hai mươi và bốn mươi

d Tôi không biết chắc

4 Khoanh tròn loại sinh tố (vitamin) nào mà giúp cho xương hấp thụ chất vôi

a Vitamin A

b Vitamin B

c Vitamin C

d Vitamin D

e Tôi không biết chắc

lật qua trang sau

Lesson 1 For office use only:

Building Strong Bones with Exercise

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 reflect 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

Lesson

2

• “Building Strong Bones with Exercise” with goal setting handout

Suggested time: 60 minutes

(5 minutes)(5 minutes)(5 minutes)(10 minutes)(5 minutes)(25 minutes)(5 minutes)

1 Getting Started (5 minutes)

• Greet the participants

• Complete FSNEP forms as required

• If participants did the goal setting activity for the last lesson, have them share what they have done since the last lesson

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 2: Page 3