Expert: What to Eat (and Not Eat) to Build Stronger Bones  

As nutrients go, calcium is one of the most important.

It’s essential for healthy bones, teeth, muscles, nerves, blood vessels, and a stable heart rhythm. People with low levels of calcium and/or vitamin D are at higher risk for developing low bone density. Osteopenia is the early stage of this condition; osteoporosis is more advanced and can increase your risk of a bone fracture. 

When discussing bone health, “You are what you eat” is particularly appropriate. For decades, dairy was heavily promoted to build strong bones.

Unfortunately, cow’s milk and other dairy products contain proteins and sugars some individuals cannot tolerate. And the saturated fat and dietary cholesterol in many dairy foods and beverages may in fact contribute to obesity and cardiovascular disease. There are plenty of other foods that contain as much or even more calcium than dairy and many non-dairy options are fortified with calcium and vitamin D.   

Getting the most bang for your buck  

More and more, evidence suggests that whole food, plant-based nutrition plans are optimal for preventing and treating many chronic medical conditions. Good sources of calcium are found in: 

• Tofu 
• Dark leafy greens (kale, collards, turnip, beet, or mustard greens) 
• Broccoli 
• Almonds  
• Calcium-fortified unsweetened almond or rice milk 
• Sardines  
• Sesame seeds and tahini 
• Calcium-fortified orange juice 

These options are also much lower in cholesterol or contain none whatsoever. Though not plant-based, plain Greek or regular yogurt is another calcium-rich food.  

The dynamic duo: Calcium and Vitamin D 

To absorb and use calcium, your body also needs vitamin D. Sunshine helps your body produce this vitamin. While many of us benefit from fresh air and sunshine, too much of a good thing leads to sunburn, heat exhaustion, premature aging, and skin cancer.  

Our bodies don’t store this vitamin.

Make sure you get enough by eating some of these foods at least twice a week: 

• Wild caught salmon 
• Tuna 
• Trout 
• Herring 
• Sardines  
• Egg yolks 
• Mushrooms  
• Non-fat yogurt 
• Vitamin D-fortified foods such as non-dairy or dairy milk, cereals, and oatmeal 

Cod liver oil is one of the best sources of D, if you can tolerate the taste.  

However, since many of these foods contain high levels of sodium, if you suffer from a chronic condition such as high blood pressure, congestive heart failure, or kidney disease, taking a vitamin D supplement may be a better approach. 

Calcium-depleting culprits 

Certain plant compounds such as oxalic acid can reduce calcium absorption, so eat only moderate amounts of spinach, beans, and sweet potatoes. Eating smaller amounts of plant-based foods throughout the day still allows you to reach your daily recommended intake.  

Caffeine and phosphorus from sodas also reduces calcium absorption. Alcohol can interfere with pancreas and liver function; these organs need to function well for your body to activate and absorb calcium. Excessively salty foods also leach calcium from the body. 

Should you take supplements? 

It’s best to get most of your calcium from food. Taking too many calcium supplements can create kidney stones. Most people only need supplements if they are not eating enough calcium-rich foods, have had certain bariatric surgeries or other gastrointestinal issues that cause poor calcium absorption, such as celiac disease. Pregnant or post-menopausal women require more calcium than most people; check with your doctor to determine the correct amount.   

Do medications affect calcium? 

Medications can alter serum calcium levels by influencing intestinal calcium absorption, renal calcium absorption, and bone remodeling. They that increase blood calcium levels include lithium, thiazide diuretics, estrogen, and tamoxifen.

Some medications that may reduce blood calcium levels are bisphosphonates, certain antibiotics, chemotherapy, calcitonin, proton pump inhibitors (antacids), among others. Ask your doctor if your prescription or over-the-counter medicine might cause an imbalance.  

Determine your calcium level 

Your doctor can order a serum calcium blood test to find out if your levels are healthy. Depending on the results, additional tests may be needed to evaluate your vitamin D, parathyroid hormone, and ionized calcium level. A DEXA scan can measure your bone density to see if you are at risk for osteopenia or osteoporosis.  

Simply put, calcium is essential, but more is not always better. By avoiding processed foods, soda, too much caffeine or alcohol, and eating a healthy, balanced diet, most people get enough calcium through their diet. Those at risk for osteoporosis should speak with their doctor to achieve the right balance.

Speaking of balance, regular weight-bearing exercise is just as important as food when it comes to building better bones and reducing your risk of bone fractures.

By Michelle Pearlman, M.D. 

Dr. Pearlman is a gastroenterologist specializing in weight management at the University of Miami Health System. To make an appointment, call 305-243-8644. 

Tags: bone strength, calcium, Dr. Michelle Pearlman, Nutrition