GOUT ! (P2) - The Affliction of Kings

Some informations about GOUT find out in BBC.co.uk

I used to associate gout with the ankles of a degenerate great-grandfather; I didn't realise it could also afflict the wrists of the virtuous. Now I know better.
The above quote is from Muddling Through in Madagascar by the Irish travel writer Dervla Murphy (John Murray, 1985) and refers to the agony she suffered after drinking the local home-made brew.

Rich Man's Dessert

Gout has been recognised as a disease for many millennia and was mentioned by the Ancient Greek physician Hippocrates almost 2500 years ago. It was considered to be a disease of over-indulgence in food and alcohol, as it mostly afflicted the wealthy.

In the Middle Ages it was described as a disease of the overweight, wealthy and middle-aged man. An English physician by the name of Thomas Sydenham said of gout in 1683:

Gouty patients are, generally, either old men, or men who have so worn themselves out in youth as to have brought on a premature old age - of such dissolute habits none being more common than the premature and excessive indulgence in venery, and the like exhausting passions.

Sydenham also provides us with the first clear documentation of gout symptoms:

The victim goes to bed and sleeps in good health. About two o'clock in the morning he is awakened by a severe pain in the great toe; more rarely in the heel, ankle or instep. The pain is like that of a dislocation, and yet parts feel as if cold water were poured over them. Then follows chills and shivers, and a little fever... The night is passed in torture, sleeplessness, turning the part affected, and perpetual change of posture; the tossing about of body being as incessant as the pain of the tortured joint, and being worse as the fit comes on...

Members of the famous gout sufferers' club are: Alexander the Great, Charlemagne, Henry VIII, Queen Anne, Christopher Columbus, Nostradamus, Leonardo da Vinci, John Milton, Isaac Newton, Alfred Lord Tennyson, Thomas Jefferson and Benjamin Franklin among many others.

Modern Understanding

Advances in medicine and science have brought with them a better understanding of the physiology behind this condition, making it easier to control. Secondary (or symptomatic) gout is the result of a systemic1 condition called hyperuricaemia, and is a form of arthritis. When uric acid builds up in the blood, it sometimes forms sharp crystals which settle in the joints, usually the big toe. This turns the joint into a large hot red swelling, causing excruciating agony and irreversibly damaging the joint.

The condition of high blood serum levels of uric acid is called hyperuricaemia (primary or non-symptomatic gout). Most people with hyperuricaemia do not develop gout; however, if the excess uric acid forms crystals, secondary gout symptoms may develop. Crystals form at different serum levels for different people and the relationship between hyperuricaemia and gout is not yet fully understood.

The Main Culprit

Acquiring hyperuricaemia is a process beginning with the metabolism of purines. These are nitrogen-containing compounds. Purines can be divided into two types: Endogenous purines are made in the body's cells as a byproduct of our metabolism. Exogenous purines are obtained from foods. Most mammals (except humans, unfortunately for us) possess an enzyme called uricase. This metabolises (breaks down) purines to a soluble product called allantoin. In humans (devoid of uricase) purine is metabolised in the liver into uric acid. Under normal circumstances, uric acid dissolves in the blood, is picked up in the kidneys and passes inoffensively out of the body in urine. Uric acid will, however, build up in the body's tissues if not adequately eliminated.

Purines are found in many foods, especially offal (organ meats such as heart and liver), yeast, dried beans and peas, and some seafood (including herring, mackerel and sardines). Other foods with significant purine content are lentils, spinach, tomatoes, beer and wine. Purines also increase lactate production which will compete with uric acid for excretion, compounding the build-up even further.

Uric acid can build up in the blood for several reasons by using two mechanisms:

Uric acid output of the liver increases.

Less uric acid passes out in urine (often because kidney function is altered, somehow disabling its filtering function).

Who Gets Gout?

Gout is usually a hereditary condition common in men. Unfortunately, it occurs most often in overweight men over 30 who drink beer and wine. However post-menopausal women and even children have been known to suffer from this condition.

Lead toxicity (causing saturnine gout), a high niacin intake, kidney disease, and some autoimmune conditions can predispose a person to gout. Gout is also listed as a possible side effect of certain medications, including diuretics, aspirin, cyclosporine2, and levodopa3 as well as various therapies, including pancreatic enzyme replacement therapy. Gout may even arise as a symptomatic response to an illness such as cancer.

Gout attacks in the chronic sufferer can be triggered by a bewildering array of events. Stress, upset or anger can bring on an attack. Binge eating or drinking will bring on an attack, as will a sudden or crash diet. A stubbed toe or twisted ankle can bring on a gout attack as well, and a damaged or stressed joint will succumb to an attack repeatedly.

Diagnosis

If seen by a health professional during an acute attack, you may (if you can bear it) have synovial fluid drawn from the joint for crystal and bacterial analysis, the joint may be X-Rayed and you may have blood drawn. If you are not having an acute attack, blood should be drawn and an X-Ray may be taken as well. High uric acid serum levels are not always evident during a gout attack (flare-up), presumably because the uric acid is concentrated in the crystals in the joint by then.

Mimicking Conditions

There are other conditions sometimes mistaken for gout. The most common culprit is pseudogout or hypercalcaemia. This is a similar affliction where the crystals are not formed by uric acid but by calcium. Other conditions that must be ruled out at diagnosis include septic and rheumatoid arthritis.

Prognosis

Nearly 90 percent of gout sufferers will experience some degree of kidney disfunction as a result. Gout sufferers are also at greater risk of developing kidney stones, high blood pressure, kidney disease, diabetes mellitus, high levels of triglycerides, and atherosclerosis or hardening of the arteries. In chronically recurrent and untreated gout, some crystals clustered in tophi may actually burst through, often from the skin around the cartilage of the ear (this is rare these days with the advent of good diagnostic skills). Painful arthritic joints and a degree of disability are a real long-term risk of recurring gout.

It really is best to address gout as soon as it is diagnosed, and there are several ways to do this.

Prescription Medication

Allopurinol is the drug most commonly prescribed for gout. It is a xanthine oxidase inhibitor and acts to reduce serum uric acid in cases where uric acid is over-produced by the liver. Unfortunately it will not help in an acute attack and during the first few months of taking it, gout attacks may increase.
Probenecid works on the kidney's tubules, increasing the level of uric acid excretion through urine and is therefore prescribed when the kidneys are not excreting uric acid sufficiently. Unfortunately, reduced renal (kidney) function is a long term effect of gout and Probenecid is not suitable for patients with renal disease.
NSAIDs are often prescribed in varying strengths for the pain and inflammation, however they have two downfalls: they can cause gastric problems and they can exacerbate the condition they are being prescribed for by triggering an attack and must therefore be used cautiously.

Steroids are a method of attempting to control the inflammatory response. These are sometimes taken in pill form over a period of time. The downside to this is the potential for severe joint damage over time. Corticosteroid injections into the joint are a direct though often unbearable method of delivering relief which is sometimes administered after application of a local anaesthetic, another injection usually.
Colchicine is an anti-inflammatory drug with a difference. It retards mitosis (cell division) in white blood cells. In ideal situations, Colchicine would be administered during an attack to eliminate the inflammatory response and therefore reduce the pain. Unfortunately, the dosage required to achieve this result is difficult for the majority of people to tolerate as the often severe gastrointestinal side effects will appear before the optimal dose is reached. For this reason, colchicine is often thought of as a preventative, to avert a gout attack. There are two immediate problems with this, though. First is the possibility of developing leukaemia due to this drug's inhibition of white blood cells and second is the danger of further damaging gouty joints which are full of crystals but devoid of pain and swelling.

Alternative Medicine

Despite concerns over the efficacy and safety of herbs and plants as medication, there are many people of the persuasion that these methods do work and a global industry dedicated to providing them with the means to try.

Proven herbs and plant extracts include bromelain, a proteolytic enzyme extracted from pineapples. This is usually prescribed in conjunction with quercetin (found in apples and other fruit) which has an action on the crystals, helping to redissolve them back into the blood serum. Cherries and blueberries contain anthocyanidins that increase collagen integrity and decrease inflammation and pain as well. Folic acid inhibits xanthine oxidase (required for uric acid production). Vitamin C, however, is controversial as it is reputed to lower serum uric acid at 8g per day for many or raise it for a small subset of people. As with any treatment that hopes to help eliminate uric acid, a healthy consumption of water is absolutely essential.

Food'll Fix It

If you or someone you care for has had an attack of gout, it is crucial to receive the correct diagnosis initially and then to ensure periodic follow-up including blood analysis. Tests should also check for blood lipids and kidney function to keep track of the ongoing effect on the body.

The one method of control, advocated by both4 medical doctors and alternate practitioners, as the most important aspect of daily gout management is the diet. While drugs and herbs can help, they do not address the long-term potential for joint damage, kidney damage, coronary heart disease and other long term effects of gout. It is only the control of uric acid levels in the blood that will help alleviate this. There are three equally urgent aspects to this.

Water

Excretion is essential and for this to take place properly, hydration is necessary. Whether taking medication, herbs or nothing, it is very important to drink the correct amount of water, enough to flush the kidneys and keep uric acid moving through the urine.

Weight Control

It is essential to maintain a healthy weight and to avoid crash dieting or 'binge' eating (or drinking) which can flood the blood with uric acid. Aerobic exercise, such as walking and swimming, is an important part of the health maintenance strategy as it helps to keep joints flexible, the metabolic rate high and the weight down.

Garbage In, Garbage Out

Keeping the obvious for last, it is useful to remember the adage 'garbage in, garbage out'. High purine foods will cause havoc and should be avoided to avert a gout attack. Depending on the severity of the condition, you may be able to indulge in medium purine foods such as lentils, spinach and mushrooms occasionally. Alcohol, sadly, is your poison as it is a diuretic and causes dehydration: the opposite of the goal in managing gout and keeping uric acid flowing out through the urine. Beer and wine are high in purine, another reason to abstain.

A healthy diet concentrates on complex carbohydrates and a variety of low purine fruits and vegetables with sensible fat and protein intake. Refined carbohydrates (white starches such as bread, rice and pasta) and saturated fats help raise serum levels of uric acid whereas complex carbohydrates, which are less refined, lower it. Some people have benefited from selecting the low purine foods from the 'alkaline' diet to successfully maintain low serum levels of uric acid.

The best advice seems to be to first control the gout and then maintain it with regular blood tests to keep track of serum levels of uric acid, glucose and fats.

Caveat

If you decide you would like to try any medical or alternative treatment, it is advisable to take the time to research your practitioner and prescribed medication or herb very carefully. It is especially important to read the contraindications before taking any drug.

There are reputable associations for Traditional Chinese Medicine (TCM), acupuncturists, homeopaths, naturopaths and nutritionists. Some of these have medical backgrounds and others have commercial interests attached to their practices. Do be cautious and ask lots of questions before putting your health in the hands of any health professional.

One effect of medicating gout that is too rarely discussed is the continuing damage to joints. Pain relief from the use of anti-inflammatory drugs and herbs is a blessing and a relief; however, it does not remove the crystals from between the joints. The crystals grind and damage the cartilage and bone, damaging the joints beyond repair. It is urgently important, therefore, to address the hyperuricaemia and gout, not only the symptoms which are so uncomfortable.

A patient's greatest asset is information; add to that the ability to ask the right questions and understand the answers - then a successful management strategy can be implemented.

GOUT ! (P1)

In modern life, there're too much people have to against with modern problems. One of it is GOUT - very easy to meet in developing countries. So, let's talk about GOUT .

Gout (also known as podagra when it involves the big toe is a medical condition usually characterized by recurrent attacks of acute inflammatory arthritis—a red, tender, hot, swollen joint. The metatarsal-phalangeal joint at the base of the big toe is the most common affected, in around half of all cases. However, it may also present as tophi, kidney stones, or urate nephropathy. It is caused by elevated levels of uric acid in the blood which crystallize and are deposited in joints, tendons, and surrounding tissues.

Diagnosis is confirmed clinically by the visualization of the characteristic crystals in joint fluid. Treatment with non-steroidal anti-inflammatory drugs (NSAIDs), steroids, or colchicine improves symptoms. Once the acute attack has subsided, levels of uric acid are usually lowered via lifestyle changes, and in those with frequent attacks allopurinol or probenicid provide long-term prevention.

Affecting around 1–2% of the Western population at some point in their lives, gout has increased in frequency in recent decades. This is believed to be due to increasing risk factors in the population such as metabolic syndrome, longer life expectancy, and changes in diet. Gout was historically known as "the disease of kings" or "rich man's disease".

Signs and symptoms

Gout can present in a number of ways, although the most usual is a recurrent attack of acute inflammatory arthritis (a red, tender, hot, swollen joint).The metatarsal-phalangeal joint at the base of the big toe is affected most often, accounting for half of cases.Other joints such as the heels, knees, wrists and fingers may also be affected. Joint pain usually begins over 2–4 hours and during the night. The reason for onset at night is due to the lower body temperature during this time. Other symptoms that may occur along with the joint pain include fatigue and a high fever.

Long-standing elevated uric acid levels (hyperuricemia) may result in other symptomatology including hard, non-painful deposits of uric acid crystal known as tophi. Extensive tophi may lead to chronic arthritis due to bone erosion. Elevated levels of uric acid may also lead to crystals precipitating in the kidneys resulting in stone formation. This may result in urate nephropathy.

What Causes Gout?

Gout results from the deposit of needle-like uric acid crystals in the connective tissue, the joint space between two bones, or both. Uric acid is the end-product caused by the breakdown of purines. Purines are naturally found in the body and are found in many foods. It is excess uric acid in the body which causes the formation of uric acid crystals. Excess uric acid (hyperuricemia) in the body can be caused by:

- An increase in production of uric acid by the body

- Under-elimination of uric acid by the kidneys

- Increased intake of foods high in purines

The Stages of Gout

Gout can progress through four stages according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS):

- Asymptomatic gout - There is elevated uric acid levels in the blood but no other symptoms. Typically, at this stage no treatment is required.

- Acute gouty arthritis - Hyperuricemia causes deposit of uric acid crystals in the joint spaces. The intense symptoms of pain and inflammation are experienced. Early, acute attacks usually subside within 3-10 days even without treatment.

- Interval gout - The period between acute gout attacks when there are no symptoms and there is normal joint function.

- Chronic tophaceous gout - The most disabling stage of gout which occurs after many years, associated with permanent damage to the affected joints and sometimes the kidneys.

CANXI & YOUR BONES

CALCIUM-RICH FOODS, VITAMINS, AND SUPPLEMENTS FOR STRONG BONES

Calcium is one of the key nutrients that your body needs in order to stay strong and healthy. It is an essential building block for lifelong bone health in both men and women, among many other important functions. Because calcium has so many important jobs, it’s important to get enough of it in your diet.
The amount of calcium you need depends on a number of different factors, including your age. But no matter who you are, one thing’s true for everyone: you and your bones will benefit from eating plenty of calcium-rich foods, limiting foods that deplete your body’s calcium stores, and getting your daily dose of magnesium and vitamins D and K—nutrients that help calcium do its job.

Calcium: The key to strong bones and lifelong bone health

Calcium can seem confusing. How much should you get? Where should you get it? And what’s the deal with vitamin D, magnesium, and vitamin K? But once you understand the basics, it’s not that hard to include it in your diet and get the calcium you need.

Calcium is the most abundant mineral in the body, one that plays many vital roles. Your body uses it to build healthy bones and teeth, keep them strong as you age, send messages through the nervous system, help your blood clot, and regulate the heart’s rhythm, among other things.

Your body gets the calcium it needs in one of two ways. The first and best way is through the foods you eat or the supplements you take. However, if you’re not consuming enough calcium, your body will get it in a different way, pulling it from your bones where it’s stored. That’s why diet is key.

Getting enough calcium in your diet is particularly important when you’re under the age of 30 and still building bone mass. Making smart choices now will help you avoid serious bone loss later in life. But no matter your age, you can take steps to protect your bones and put the brakes on osteoporosis.

The calcium and osteoporosis connection

Osteoporosis is a “silent” disease characterized by loss of bone mass. Due to weakened bones, fractures become commonplace, which leads to serious health risks such as the inability to walk. People with osteoporosis often don’t recover after a fall and it is the second most common cause of death in women, mostly women age 60 and older. Men are also at risk of developing osteoporosis, but typically 5 to 10 years later than women. Fortunately, osteoporosis is preventable for most people, and getting enough calcium in your diet is the first place to start.

Food is the best source of calcium

Your body is able to absorb more calcium from food than it can from supplements. In fact, studies show that even though people who take calcium supplements have a higher average daily intake, those who get most of their calcium from food have stronger bones. On top of the better absorption rates, calcium from food often comes with other beneficial nutrients that help calcium do its job.

Good food sources of calcium

Dairy: Dairy products are rich in calcium in a form that is easily digested and absorbed by the body. Sources include milk, yogurt, and cheese.
Vegetables and greens: Many vegetables, especially leafy green ones, are rich sources of calcium. Try turnip greens, mustard greens, collard greens, kale, romaine lettuce, celery, broccoli, fennel, cabbage, summer squash, green beans, Brussels sprouts, asparagus, and crimini mushrooms.
Beans: For another rich source of calcium, try black beans, pinto beans, kidney beans, white beans, black-eyed peas, or baked beans.
Herbs and spices: For a small but tasty calcium boost, flavor your food with basil, thyme, dill weed, cinnamon, peppermint leaves, garlic, oregano, rosemary, and parsley.
Other foods: More good sources of calcium include salmon, tofu, oranges, almonds, sesame seeds, blackstrap molasses, and sea vegetables. And don’t forget about calcium-fortified foods such as cereals and orange juice.

Calcium and milk: The pros and cons

There is some debate in the nutrition world over the benefits of dairy products. Many nutritionists believe that consuming milk and dairy products will help prevent osteoporosis. On the other hand, some believe that eating a lot of dairy will do little to prevent bone loss and fractures and may actually contribute to other health problems.

One thing, however, is certain: milk and other dairy products contain a lot of calcium in a highly absorbable form. Dairy products are a quick and easy way to get calcium in your diet, one you may already be enjoying on a regular basis. But you should also be aware of the potential downsides.

Dairy products are often high in saturated fat. A diet high in saturated fat increases the risk of heart disease. To limit your saturated fat intake, choose low-fat or non-fat versions of your favorite dairy foods. Switch out your 2% milk for 1%, and once you adjust to that, try skim milk. You can also find many reduced-fat cheeses, low-fat ice cream and frozen yogurt, and healthy butter substitutes. Some taste better than others, so shop around.

Most milk contains high levels of estrogen. Some studies show a possible link between the natural estrogens found in milk and breast, prostate, and testicular cancer, which rely on sex hormones to grow. Part of the problem is modern dairy practices, where the cows are continuously pregnant and milked over 300 days per year. The more pregnant the cow, the higher the hormones in the milk. Despite being labeled “hormone-free” organic milk can still be high in natural hormones. To reduce your exposure, stick to skim milk. Because the hormones are found in the milk fat, skim milk has a much lower level.

Many people are lactose intolerant, meaning they are unable to digest lactose, a sugar found in milk and milk products. Symptoms range from mild to severe, and include cramping, bloating, gas, and diarrhea. Beyond the discomfort it causes, lactose intolerance can also interfere with calcium absorption from dairy. Certain groups are much more likely to have lactose intolerance: 90 percent of Asians, 70 percent of blacks and Native Americans, and 50 percent of Hispanics are lactose intolerant, compared to about 15 percent of Caucasians.

If you are lactose intolerant but still want to enjoy dairy:

Before eating dairy, take a pill (capsule or chewable tablet) containing enzymes that digest milk sugar.
Buy milk that has the lactase enzyme added to it.
Experiment to see how you do if you eat small portions of dairy and gradually increase the serving size.
Combine dairy with other foods. This may lessen your symptoms.
You may be able to tolerate cheese, which has less lactose than milk. Aged cheeses, in particular, have very little lactose (parmesan, cheddar, swiss).
The bottom line for getting calcium from dairy products
If you choose to consume dairy, then it’s best to opt for 1% or nonfat milk and other low-fat dairy products, which are lower in saturated fat and natural hormones. Choosing organic products when possible will also decrease your exposure to synthetic hormones and other additives. And if you decide that dairy is not the best choice for you, or you can’t tolerate milk products, there are other ways to include calcium in your diet.

Calcium rich foods: Tips for upping your calcium intake

When you eat a diet rich in whole foods—vegetables, whole grains, nuts, seeds, and fruits—not only do you get a wonderful variety of tastes on your plate, but you also give your body the different nutrients, including calcium, that it needs. To boost your daily intake, try to include calcium rich foods in multiple meals or snacks.

Tips for adding more dairy to your diet—even if you don’t like milk
Use milk instead of water when making oatmeal or other hot breakfast cereals
Substitute milk for some of the liquid in soups such as tomato, squash, pumpkin, curries, etc.
Milk can be added to many sauces or used as the base in sauces such as Alfredo and Béchamel sauce.
Make whole-wheat pancakes and waffles using milk or yogurt.
Get creative with plain yogurt. Use it to make a dressing or a dip, or try it on potatoes in place of fattier sour cream.
Add milk or yogurt to a fruit smoothie. You can even freeze blended smoothies for popsicles!
Enjoy a small piece of cheese for dessert or as a snack. Try cheddar, mozzarella, Gouda, jack, Parmesan, or a type of cheese you’ve never had before.

Tips for getting your calcium from non-dairy sources

Greens, herbs and spices can easily be added to soups, casseroles, or stir-fries. Greens that are especially good are: kale, collard greens, and parsley. Also good: turnip greens, dandelion greens, mustard greens, beet greens, broccoli, and cabbage. Spice up these and other dishes with garlic, basil, thyme, oregano, and rosemary to add more nutrients.
Eat dark green leafy salads with your meals. Try romaine hearts, arugula, butter lettuce, mesclun, watercress, or red leaf lettuce (avoid iceberg lettuce as it has very little nutrient value). You can also add herbs to the salads or the dressings for flavor and nutrients – dill and basil taste especially good in salads.
Add extra servings of veggies to your meals, i.e. asparagus, fresh green peas, broccoli, cabbage, okra, bok choy.
Top salads or make a sandwich with canned fish or crustaceans with bones, such as sardines, pink salmon, and shrimp.
Use beans/legumes as part of your meals. They are wonderful in stews, chili, soup, or as the protein part of a meal. Kinds to try: tofu, tempeh, black-eyed peas, black beans, and other dried beans. You can also snack on edamame.
Start your day with oats. Steel cut oats or rolled oats make a wonderfully comforting and filling breakfast. For an added punch include cinnamon
Snack on nuts and seeds such as almonds and sesame seeds. You can also add these to your morning oatmeal.
Drink tea. Try green tea, which you can substitute for coffee, as well as herbal teas and infusions, such as oatstraw, nettle, and red clover.
Order or prepare sandwiches on whole grain wheat bread.

Avoid high-protein diets: Too much protein draws calcium from the bones
The body needs protein to build healthy bones. But as your body digests protein, it releases acids into the bloodstream that the body neutralizes by drawing calcium from the bones. Following a high-protein diet for a short time is unlikely to make much of a difference. But over a long period of time, eating a lot of protein could weaken your bones.

Magnesium, vitamin D & vitamin K: Calcium’s necessary counterparts
When it comes to your bones, calcium alone is not enough. There are a number of other vital nutrients that help your body absorb and make use of the calcium you consume. The most important of these are magnesium, vitamin D, and vitamin K.

Calcium and magnesium
Magnesium helps your body absorb and retain calcium. Magnesium works closely with calcium to build and strengthen bones and prevent osteoporosis. Since your body is not good at storing magnesium, it is vital to make sure you get enough of it in your diet. Magnesium is found in nuts, seeds, whole grains, seafood, legumes, tofu, and many vegetables.

Swiss chard and spinach are excellent sources of magnesium. Include spinach in your salads or add chard to soup.
Eat more summer squash, turnip and mustard greens, broccoli, sea vegetables, cucumbers, green beans, and celery.
Replace refined grains (i.e. white flour and white rice) with whole grains.
Add pumpkin, sesame, flax, or sunflower seeds to cereal, salad, soup, and other dishes.
Snack on nuts (almonds and cashews are especially high in magnesium).
Reduce sugar and alcohol, which increase the excretion of magnesium.

Calcium and vitamin D

Vitamin D is another critical nutrient that helps the body absorb calcium and regulates calcium in the blood. Your body synthesizes vitamin D when exposed to the sun. However, a large percentage of people are vitamin D deficient—even those living in sunny climates.

If you don’t spend at least 15 minutes outside in the sun each day or you live in above 40 degrees latitude (north of San Francisco, Denver, Indianapolis, and Philadelphia), you may need an extra vitamin D boost. Good food sources of vitamin D include:

fortified milk
eggs
cheese
fortified cereal
butter
margarine
cream
fish
shrimp
oysters

You may also want to consider taking a vitamin D supplement. Optimal vitamin D intake is between 1,000 IU and 2,000 IU per day.

Calcium and vitamin K

Vitamin K helps the body regulate calcium and form strong bones. Include vitamin K in your diet by eating green, leafy vegetables or taking a supplement with vitamin K. You should be able to meet the daily recommendation for vitamin D (120 micrograms for men; 90 micrograms for women) by simply eating one or more servings per day of broccoli, Brussels sprouts, dark green lettuce, collard greens, or kale.

Other tips for building strong bones and preventing bone loss

In addition to adding calcium-rich foods to your diet, there are a few other important things you can do to strengthen your bones and keep them that way. You can also minimize the amount of calcium you lose by reducing your intake of certain kinds of foods and other substances that

For lifelong bone health, exercise is key
When it comes to building and maintaining strong bones, exercise is essential. Studies show that the risk of osteoporosis is lower for people who are active, especially for those who do weight-bearing activities at least three times a week. Exercise also increases your muscle strength and coordination, which helps you avoid falls and other situations that cause fractures.

There are many different ways to include weight-bearing exercises in your life. Some examples are walking, dancing, jogging, weightlifting, stair climbing, racquet sports, and hiking. Find something that you enjoy doing and make it a regular activity.

See Making Exercise Fun: Finding a Fitness Plan that Works for You.
Minimize calcium-leeching culprits
There are a number of foods and substances that, when consumed in excess, leech calcium you’re your bones and deplete your body’s calcium stores.

Caffeine – Drinking more than 2 cups of coffee a day can lead to calcium loss. The amount lost can have a significant impact on older people with already low calcium levels. You can buffer the effects to an extent by drinking coffee with milk.

Animal protein – Protein is a vital part of your diet, but getting too much protein from animal sources can lead to calcium loss. To avoid weakening your bone’s calcium stores, limit yourself to 4 ounces of meat per day.

Alcohol – Alcohol inhibits calcium absorption and disrupts your body’s calcium balance in a number of ways. Try to keep your alcohol consumption to no more than 7 drinks per week.

Salt – Eating too much salt can contribute to calcium loss and bone breakdown. What you can do: taste your food before adding more salt and reduce processed foods, which are often high in sodium.

Soft drinks – It’s best to avoid drinking soft drinks regularly. In order to balance the phosphates in soft drinks, your body draws calcium from your bones, which is then excreted.

Calcium supplements and vitamin pills: What you need to know

While food is the best source of calcium, supplements are another option. But it matters what type of calcium you take and how you take it.

Calcium citrate is a highly absorbable calcium compound. Calcium citrate can be taken at any time, but absorption is best when taken with a meal.

Calcium ascorbate and calcium carbonate are not as easily absorbed as calcium citrate. Absorption is better when taken with food or soon after a meal.

Be smart about calcium supplements

Don’t take more than 500 mg at a time. Your body can only absorb a limited amount of calcium at one time, so it is best to consume calcium in small doses throughout the day.

Take your calcium supplement with food. All supplemental forms of calcium are best absorbed when taken with food. If it’s not possible to take your supplement with food, choose calcium citrate.

Purity is important. It’s best to choose calcium supplements with labels that state "purified" or have the USP (United States Pharmacopeia) symbol. Avoid supplements made from unrefined oyster shell, bone meal, or dolomite that don't have the USP symbol because they may contain high levels of lead or other toxic metals.

Be aware of side effects. Some people do not tolerate calcium supplements as well as others and experience side effects such as acid rebound, gas, and constipation. For acid rebound, switch from calcium carbonate to calcium citrate. For gas or constipation, try increasing your intake of fluids and high-fiber foods.

Check for possible drug interactions. Calcium supplements can interfere with other medications and vitamins you’re taking. Talk with your doctor or pharmacist about possible interactions. Any medications that you take on an empty stomach should NOT be taken with calcium.

EASY TIPS (P7)

Healthy eating tip 10: Plan quick and easy meals ahead


Healthy eating starts with great planning. You will have won half the healthy diet battle if you have a well-stocked kitchen, a stash of quick and easy recipes, and plenty of healthy snacks.

Plan your meals by the week or even the month
One of the best ways to have a healthy diet is to prepare your own food and eat in regularly. Pick a few healthy recipes that you and your family like and build a meal schedule around them. If you have three or four meals planned per week and eat leftovers on the other nights, you will be much farther ahead than if you are eating out or having frozen dinners most nights.

Shop the perimeter of the grocery store
In general, healthy eating ingredients are found around the outer edges of most grocery stores—fresh fruits and vegetables, fish and poultry, whole grain breads and dairy products. The centers of many grocery stores are filled with overpriced, processed foods that aren’t good for you. Shop the perimeter of the store for most of your groceries (fresh items), add a few things from the freezer section (frozen fruits and vegetables), and the aisles with spices, oils, and whole grains (like rolled oats, brown rice, whole wheat pasta).

Cook when you can
Try to cook one or both weekend days or on a weekday evening and make extra to freeze or set aside for another night. Cooking ahead saves time and money, and it is gratifying to know that you have a home cooked meal waiting to be eaten.

Have an emergency dinner or two ready to go
Challenge yourself to come up with two or three dinners that can be put together without going to the store—utilizing things in your pantry, freezer and spice rack. A delicious dinner of whole grain pasta with a quick tomato sauce or a quick and easy black bean quesadilla on a whole wheat flour tortilla (among endless other recipes) could act as your go-to meal when you are just too busy to shop or cook.

Stock your kitchen to be meal ready
Try to keep your kitchen stocked with recipe basics:
Fresh and frozen fruits and vegetables.
Recipe and soup starters such as garlic, onions, carrots, and celery.
Healthy staples like brown rice, white Basmati rice, whole-wheat pasta, quinoa, and wild rice.
Whole wheat bread and tortillas for healthy sandwiches and wraps.
Beans such as lentils, black beans, chickpeas, black-eyed peas, kidney beans, fava beans, and lima beans.
Frozen corn, peas, and other vegetables to add to recipes or for a quick vegetable side dish.
Frozen fruit and berries to make smoothies or frozen desserts.
Dark greens for salads, plus salad add-ins like dried fruit, nuts, beans, and seeds.
Fresh and dried herbs and spices.
Healthy fats and oils for cooking, such as olive oil and canola oil. You can also try specialty oils like peanut, sesame, or truffle oil for adding flavor.
Unsalted nuts for snacking, like almonds, walnuts, cashews, peanuts, and pistachios.
Vinegars, such as balsamic, red wine, and rice vinegar for salads and veggies.
Strong cheeses, like aged Parmesan or blue cheese for intense flavor in salads, pasta, and soups.

EASY TIPS (P6)

Healthy eating tip 8: Add calcium & vitamin D for strong bones

Calcium and vitamin D are essential for strong, healthy bones—vitamin D is essential for optimum calcium absorption in the small intestine. Recommended calcium levels are 1000 mg per day, 1200 mg if you are over 50 years old. Take a vitamin D and calcium supplement if you don’t get enough of these nutrients from your diet.

Great sources of calcium include:
Dairy products, which come already fortified with vitamin D.
Dark green, leafy vegetables, such as kale and collard greens
Dried beans and legumes

About calcium, you could read more here


Healthy eating tip 9: Limit sugar, salt, and refined grains

If you succeed in planning your diet around fiber-rich fruits, vegetables, whole grains, lean protein, and good fats, you may find yourself naturally cutting back on foods that can get in the way of your healthy diet—sugar, salt and refined starches.

Sugar and refined starches
It is okay to enjoy sweets in moderation, but try to cut down on sugar. Sugar causes energy ups and downs and adds to health problems like arthritis, diabetes, osteoporosis, headaches, and depression.

Give recipes a makeover. Often recipes taste just as good with less sugar.
Avoid sugary drinks. One 12-oz soda has about 10 teaspoons of sugar in it! Try sparkling water with lemon or a splash of fruit juice.

Eliminate processed foods. Processed foods and foods made with white flour and white sugar cause your blood sugar to go up and down leaving you tired and sapped of energy.

Salt
Salt itself is not bad, but most of us consume too much salt in our diets.
Limit sodium to 2,300 mg per day, the equivalent to one teaspoon of salt. Most of us consume far more than one teaspoon of salt per day.
Avoid processed, packaged, restaurant and fast food. Processed foods like canned soups or frozen meals contain hidden sodium that quickly surpasses the recommended teaspoon a day.

EASY TIPS (P5)

Healthy eating tip 6: Enjoy healthy fats & avoid unhealthy fats

Good sources of healthy fat are needed to nourish your brain, heart and cells, as well as your hair, skin, and nails. Foods rich in certain omega-3 fats called EPA and DHA are particularly important and can reduce cardiovascular disease, improve your mood and help prevent dementia.

Add to your healthy diet:

Monounsaturated fats, from plant oils like canola oil, peanut oil, and olive oil, as well as avocados, nuts (like almonds, hazelnuts, and pecans) and seeds (such as pumpkin, sesame).

Polyunsaturated fats, including Omega-3 and Omega-6 fatty acids, found in fatty fish such as salmon, herring, mackerel, anchovies, sardines, and some cold water fish oil supplements. Other sources of polyunsaturated fats are unheated sunflower, corn, soybean, and flaxseed oils, and walnuts.

Reduce or eliminate from your diet:

Saturated fats, found primarily in animal sources including red meat and whole milk dairy products.

Trans fats, found in vegetable shortenings, some margarines, crackers, candies, cookies, snack foods, fried foods, baked goods, and other processed foods made with partially hydrogenated vegetable oils.


Healthy eating tip 7: Put protein in perspective

Protein gives us the energy to get up and go—and keep going. Protein in food is broken down into the 20 amino acids that are the body’s basic building blocks for growth and energy, and essential for maintaining cells, tissues and organs. A lack of protein in our diet can slow growth, reduce muscle mass, lower immunity, and weaken the heart and respiratory system. Protein is particularly important for children, whose bodies are growing and changing daily.

Here are some guidelines for including protein in your healthy diet:

Try different types of protein. Whether or not you are a vegetarian, trying different protein sources—such as beans, nuts, seeds, peas, tofu and soy products—will open up new options for healthy mealtimes.

Beans: Black beans, navy beans, garbanzos, and lentils are good options.
Nuts: Almonds, walnuts, pistachios and pecans are great choices.
Soy products: Try tofu, soy milk, tempeh and veggie burgers for a change.
Avoid salted or sugary nuts and refried beans.

Downsize your portions of protein. Most people in the U.S. eat too much protein. Try to move away from protein being the center of your meal. Focus on equal servings of protein, whole grains, and vegetables.

Focus on quality sources of protein, like fresh fish, chicken or turkey, tofu, eggs, beans or nuts. When you are having meat, chicken, or turkey, buy meat that is free of hormones and antibiotics.

Complete, incomplete and complementary proteins

A complete protein source—from animal proteins such as meat, poultry, fish, milk, cheese and eggs—provides all of the essential amino acids.

An incomplete protein—from vegetable proteins like grains, legumes, nuts, seeds and beans—is low in one or more essential amino acids.

Complementary proteins are two or more incomplete protein sources that together provide all of the essential amino acids your body needs. For example, rice and dry beans are each incomplete proteins, but together they provide all of the essential amino acids.

Do complementary proteins need to be eaten in the same meal? Research shows that your body can combine complementary proteins that are eaten within the same day.
Why are complete and complementary proteins important? Complete and complementary proteins that provide all of the essential amino acids will fill you up longer than carbohydrates because they break down more slowly in the digestive process.

EASY TIPS (P4)

Healthy eating tip 5: Eat more healthy carbs and whole grains

Choose healthy carbohydrates and fiber sources, especially whole grains, for long lasting energy. In addition to being delicious and satisfying, whole grains are rich in phytochemicals and antioxidants, which help to protect against coronary heart disease, certain cancers, and diabetes. Studies have shown people who eat more whole grains tend to have a healthier heart.

A quick definition of healthy carbs and unhealthy carbs
Healthy carbs (sometimes known as good carbs) include whole grains, beans, fruits, and vegetables. Healthy carbs are digested slowly, helping you feel full longer and keeping blood sugar and insulin levels stable.
Unhealthy carbs (or bad carbs) are foods such as white flour, refined sugar and white rice that have been stripped of all bran, fiber and nutrients. Unhealthy carbs digest quickly and cause spikes in blood sugar levels and energy.
Include a variety of whole grains in your healthy diet, including whole wheat, brown rice, millet, quinoa, and barley. Experiment with different grains to find your favorites.
Make sure you're really getting whole grains. Be aware that the words stone-ground, multi-grain, 100% wheat, or bran, don’t necessarily mean that a product is whole grain. Look for the new Whole Grain Stamp. If there is no stamp look for the words “whole grain” or “100% whole wheat,” and check the ingredients.
Try mixing grains as a first step to switching to whole grains. If whole grains, like brown rice and whole wheat pasta, don’t sound good at first, start by mixing what you normally use with the whole grains. You can gradually increase the whole grain to 100%.

Avoid: Refined grains such as breads, pastas, and breakfast cereals that are not whole grain.

Fiber: An essential component of a healthy diet
Dietary fiber, found in plant foods (fruit, vegetables and whole grains) is essential for maintaining a healthy digestive system. Fiber helps support a healthy diet by helping you feel full faster and for a longer amount of time, and keeping your blood sugar stable. A healthy diet contains approximately 20-30 grams of fiber a day, but most of us only get about half that amount.

The two types of fiber are soluble and insoluble.

Soluble fiber can dissolve in water and can also help to lower blood fats and maintain blood sugar. Primary sources are beans, fruit and oat products.
Insoluble fiber cannot dissolve in water, so it passes directly through the digestive system. It’s found in whole grain products and vegetables.