I recently invited Linda Simon, a registered dietitian and certified personal chef, to advise us on how best to avoid osteoporosis. Linda blogs at blog.kitchentherapy.us, where she posts delicious – and healthy! – recipes and advice. Over to you, Linda…

Thanks Lucy, for asking me to write about preventing osteoporosis. This is a topic important to all folks with gluten intolerance. Specific U.S. and U.K. recommendations may be different. And like nearly every topic, not everyone agrees with the consensus. But we are all people, and I think general recommendations would apply to most of us.


milk and sunshineOne of the many serious complications of celiac disease and gluten intolerance is osteoporosis. In fact, diagnosis of osteoporosis early in life can be a tip off to test for celiac disease. But then it may be too late to prevent a hip fracture or broken wrist. We want to build maximum bone by during childhood and adolescence.

Prevention is the name of the game, so how can we prevent it?

Follow a gluten free diet.

The gut needs to heal to absorb nutrients effectively. Unhealthy villi cannot absorb bone-building nutrients. We hear about calcium all the time, and it is important. But healthy bones also require many nutrients, these range from boron to zinc. See the U.S. Surgeon Generals report for an easy to read chart on all nutrients that that are beneficial in bone health (PDF). A truly gluten free diet is the first priority, to have a healthy gut and absorb everything we need.

Eat enough calcium.

One to two percent of our weight is calcium, mostly in our bones. The recommendation for “enough” varies with age and sex. U.K. DRV (dietary reference value) for calcium is 450-1000 mg per day.

Dairy products are the best natural source of calcium. One serving of milk or yogurt is 250 ml. They contain about 300 to 450 mg calcium. A 30 gm piece of cheese has about 150 to 250 mg calcium. Getting the recommended amount of calcium is a challenge for most people, celiac or not.

And many folks with gluten intolerance are also lactose intolerant. They may tolerate low lactose dairy products like hard cheeses, yogurt and kefir. Or they may be able to use non-dairy products fortified with calcium. In the U.S., soymilk and some orange juice have added calcium.

Healing the gut may cure lactose intolerance. The enzyme that digests lactose is produced at the very end of healthy villi. So healing the gut and growing longer villi may allow one to enjoy milk again. A young celiac friend says he is very proud of his new “hairy” villi. Though it will not work in every case, you might be able to drink milk after successfully following the gluten free diet long enough to heal and feel well.

Canned fish, with the bones, are also excellent sources of calcium. These include salmon, sardines and anchovies. A 100gm serving averages about 200 mg of calcium.

Other good natural sources of calcium are greens, such as turnip greens, collards, spinach, and kale. A 50 gm serving of cooked greens averages about 100 mg of calcium.

Or you might consider calcium supplements. Some people find them constipating though. That might be helpful for some, a problem for others.

Get enough vitamin D, the sunshine vitamin.

This is very hard to do with diet and sunlight alone. Few foods have natural vitamin D. They are limited to oily fish like herring, salmon, tuna, mackerel and eel. A 100 gm serving averages about 200 IU vitamin D.

Cod liver oil is especially rich in vitamin D, 15 gm has 1350 IU. But it tastes worse than terrible. And it also contains vitamin A, so much you might overdose on it.

Few of us spend enough time in the sun to meet our vitamin D needs. I think of misty gloom rather than warm sunshine in the U.K. Most people will need to take a supplement.

The current U.S. recommendations are 200 to 600 IU per day, depending on your age. I could not find a U.K. DRV. But many experts believe it should be raised for adults to 1000 IU D3 per day. D3 is the active form of vitamin D. See Grassroots Health for a thorough review of current research and their recommendations. I take 1000 IU D3, most days, when I remember it.

Exercise

Step away from the TV and the computer and get out of the house! Walk, jog, run, dance, and take the stairs instead of the elevator. Or skip rope, jump on a trampoline, do Pilates or yoga, play soccer or tennis, skate, ski… Use those bones, get moving!!

Enjoy a healthy lifestyle

Limit alcohol, do not smoke and get rid of soft drinks. The smokes and soft drinks are contributing nothing, I will repeat, nothing to your health.

Thanks Linda – good advice for all of us.