Bone Health: How to Feed Your Skeleton with Julia Zumpano, RD

Podcast Transcript

John Horton:

Hey there, and welcome to another Health Essentials Podcast. I'm John Horton, your host.

Bones give our body structure, and those pieces-parts are incredibly strong. In fact, ounce for ounce, bone is stronger than steel. Don't be fooled by that tough-sounding truth. Bones need our help to stay sturdy. What you eat can affect your bone health and prevent or limit the development of osteoporosis.

What food should be on your plate to boost your bones? That's what we are going to find out today from registered dietitian and podcast regular, Julia Zumpano. She is one of the many experts at Cleveland Clinic who pop into our weekly show to help us make healthier decisions. Now, let's see what we can do to keep our bones as strong as we need them to be. Welcome back to the podcast, Julia. I always know we're in for a great chat when you stop by.

Julia Zumpano:

Thank you so much for having me.

John Horton:

Bones just seem like such a solid piece of personal hardware. It's hard to believe we can damage them just with what's on our fork.

Julia Zumpano:

Well, we can, of course, because our bones are just like any other body part, and we grow them and build them and support them by the food that we eat. We can damage them by the food we eat. Certainly, can go both ways.

John Horton:

With everything, you got to be careful of what you pick out, and what you eat, I guess, has consequences.

Julia Zumpano:

Absolutely.

John Horton:

Since we're going to talk about setting a menu for bones, before we get there, let's spend a little time talking about bones in general, starting with the fact that they're actually living tissue, and constantly growing and changing throughout our life.

Julia Zumpano:

That's exactly right, John. It's fascinating that we have a little over 200 bones in our body. Their job is to give our body its shape, to protect our internal organs. They help us do every movement we do every day. Bones are, as you said, strong, hard tissue. They're constantly growing, and they're typically self-sufficient, although, certain health conditions such as osteoporosis, certain diseases, can cause our bones to be more brittle and break easier.

John Horton:

Well, and our bones do just change over time, don't they? I'm getting up there a little bit, and I'm feeling like mine are. Is that just kind of a reality we all live with?

Julia Zumpano:

Absolutely, yes. Your bone density does decrease as you age. Women specifically, during menopause and after, because of the drop in estrogen, their bone density also decreases. Something we need to be very mindful of, and our bones are not going anywhere, so we need to take really good care of them.

John Horton:

You do only get one set, so you want to keep it there for as long as you possibly can. Big picture, what do our bones need from us in order to be their best as long as we need them?

Julia Zumpano:

Many nutrients play a role in bone health such as calcium, vitamin K2, protein, magnesium, phosphorus, potassium. They all do play a role. There's some bigger hitters than others, but really maximizing all of your nutrients is important.

John Horton:

All these nutrients — what do they do specifically? You mentioned a few of them, like calcium. I think we all know that's kind of a big ... does it just add strength? Does it just help the bones be … what does it do?

Julia Zumpano:

Calcium supports bone growth, so supports the growth of the bone and the integrity of it. Vitamin K2 helps activate a certain protein that binds with calcium to build bones, so that makes vitamin K essential for bone health.

John Horton:

Now, we were talking earlier and you had mentioned that there was a lot of new development stuff with vitamin K2 and how important it is.

Julia Zumpano:

Yeah, so vitamin K is something we've always known about, and normally, we've known it more in the form of K1, but now we're finding more about vitamin K2, and its essential role in the body and specifically, with bone health. It works synergistically with vitamin D and calcium, so it's really very essential.

John Horton:

Now, you had also mentioned protein as something that's important. How does that benefit our bones?

Julia Zumpano:

We need protein to build collagen … and tissues and organs and bones. It's really the building blocks and growth of our entire system. It supports bone growth and health, and the strength of the bones as well.

John Horton:

It's amazing all of this is going on inside us, and we have no idea it's happening.

Julia Zumpano:

Yeah, it's completely fascinating how much is going on. We have a lot of influence on it, though, by what we eat, so that's really such a blessing to have, is really being able to take ownership and control of steering your health one way or another.

John Horton:

Well, and you had mentioned the food, and that's what we're going to get into next here because we kind of talked about the nutrients a little bit, but I know when I'm at the grocery store, I don't see vitamin D and vitamin K2 on those helpful little signs above the aisles. Let's help us get a shopping list together. You want to start with vitamin D that you had mentioned as being so important?

Julia Zumpano:

Sure. Vitamin D is abundantly found in fish, so more of those fattier cold-water fish, such as salmon, trout, herring, sardines, tuna. That's one of the best sources. It's also found in some dairy products and dairy alternatives because it's fortified. Dark chocolate even has some vitamin D.

John Horton:

I like the idea of that. Anything that calls for more dark chocolate in my diet, I think I can get behind.

Julia Zumpano:

Now, the darker, the better with that. You want to go higher percentage of cocoa to maximize that.

John Horton:

All right. Now, you had said, too, that vitamin K2 is kind of really linked with vitamin D.

Julia Zumpano:

Yeah, so vitamin K2 is just important, they work synergistically, so they work well together. K2 is found in natto, which is fermented soybeans. It's found in Gouda cheese and blue cheese and also in egg yolks. Some foods we may eat more than others, but a lot of those foods, we're not eating on a regular daily basis.

You may want to talk to your healthcare provider if you need a vitamin K2 supplement — that could be something you discuss in the future based on your bone health outcomes.

John Horton:

All right. Now, what about moving through some of calcium, which I feel like we all know the good spots to get those, but we may miss some, too?

Julia Zumpano:

Sure. We know that calcium is found in dairy, and then non-dairy fortified foods, like orange juice, milk alternates, tofu, some grains and almonds, salmon with the bones. Those are all sources of calcium.

John Horton:

What if you're lactose-intolerant? If dairy is one of the things that you should really be hitting, that could become an issue. Are there substitutes you can have in there?

Julia Zumpano:

Yeah. Probably one of the best substitutes to kind of match the amount you get in dairy would be a dairy alternative. It would be a nut or oat milk, or any of those milk alternatives … rice. Most of them are fortified with calcium. You always want to check and be sure they're fortified with calcium and vitamin D if possible, but that's probably the best alternative when it comes to the amount of calcium you gain. You can get it from greens and tofu. Those are other ways … some orange juices can be calcium-fortified as well.

John Horton:

You had mentioned protein, too, and I always feel like when you hear that, you think meat, or maybe I just think meat because I like my grill too much. How do you balance out getting the protein you need for your bone health, with not getting too much in, and you start worrying about those other issues?

Julia Zumpano:

Meat is a source of protein, of course, but there are so many other sources of protein. We just spoke on vitamin D and which foods are high there. Fish is a phenomenal source of protein, as well as the vitamin D. You're kind of gaining both benefits there. Third benefit to fish is that it's high in omega-3 fatty acids, specifically the fish that we talked about that are high in vitamin D, those fatty, oilier fish can provide omega-3, which we know helps with inflammation.

We have fish as a source of protein, and then, we're talking about bones, and calcium and dairy products are a great source of protein, and calcium and vitamin D. Things like Greek yogurt, like a low-fat Greek yogurt or cottage cheese — those are great sources of protein.

John Horton:

If you want to hit the red meat, is that still OK?

Julia Zumpano:

Yeah, occasionally. Yeah, you can still have some red meat. We know that varying your protein is ideal. Red meat a couple times a week, once or twice a week, is absolutely fine.

John Horton:

Just don't make it one of those two-pound burgers, right?

Julia Zumpano:

Exactly. Exactly. If you want to try to do a meatless and a dairy-free meal, tofu is another great choice for protein, and calcium, and in some cases, it's also fortified with vitamin D.

John Horton:

There were three other nutrients that you had mentioned when we talked earlier, and that was phosphorus, magnesium and potassium. Are those just things that you find in a bunch of different foods, or are there some specific things we should be having to make sure we get that in?

Julia Zumpano:

Sure, so each of them has specific foods, but in general, you're really going to gain those from things like nuts and seeds, fruits and veggies. Magnesium specifically, nuts and seeds are a great source of magnesium. Legumes, dairy can also provide some magnesium. Phosphorus is found in meat, so meats and organ meats, seafood and dairy, again, and then some seeds, and then potassium, also found in some meat, but greens, beans, bananas, black seeds, potatoes.

A lot of crossover with these foods, as you see. The theme here is that we can eat a lot of fatty, oily fish, a lot of low-fat dairy products, a lot of nuts and seeds and beans and greens, and we're going to pretty much hit most of these nutrients — and a little egg yolk here and there for the vitamin K.

John Horton:

Everything you just said reminds me of the wisdom you gave us in a previous podcast, which is to shop the perimeter of the store, which is where it sounds like all of these products are.

Julia Zumpano:

Absolutely. That is 100% accurate, and I would definitely still advise that, and especially in this case.

John Horton:

See, I listened to you when you talk, Julia, and it's making me a healthier person, so I appreciate all of your advice.

We're talking about eating the right food, but I know there's also, you need to avoid the wrong food. Is there some particular things you should try to stay away from if you want to keep your bones good?

Julia Zumpano:

Sure, yeah. No surprise with the things you should stay away from. They're the same things that we should stay away from for general health, but specifically, things like salt and sodium. Salt and sodium can cause the body to lose calcium. We definitely don't want that. Most Americans eat way more sodium than we need to, and most of it's coming from processed food, not necessarily adding salt to whole foods. That's another category that we want to avoid, processed foods.

Again, because they can decrease your absorption of calcium, and have things like phosphates that, again, compete with calcium. That's the reason we want to avoid those. Sugars, of course, we all know that sugar is not necessarily good for us, but to kind of take it a step further, sugar may actually cause the excretion of calcium.

You really want to limit sugars and sugar-containing beverages specifically, like colas and things that may even have caffeine in them, because caffeine has also been shown to decrease that absorption of certain nutrients, and calcium being one of them.

John Horton:

Wow. It's amazing to me that this calcium can just kind of be sucked out of your bones by eating the wrong foods.

Julia Zumpano:

Yeah. One thing I failed to mention was alcohol. Again, this, again, can inhibit the absorption of certain nutrients such as calcium. Just general foods and rules that we would follow for general health apply strongly here is really trying to keep sodium, sugar, caffeine and alcohol and processed foods to a minimum.

John Horton:

Well, and I know we've talked about that so many times when you're on, this concept of moderation, which I feel like is where a lot of people get into trouble with their diet.

Julia Zumpano:

Right. Moderation is key. Anything of those five things I've listed that if you can't moderate, it's OK not to have at all, actually. If you have the self-control, they're not giving you any nutrition or benefit. Sugar isn't, processed foods isn't, alcohol, caffeine — none of those are necessarily providing you strong benefit.

Now, certain ingredients or nutrients that have caffeine, like green tea and coffee, they've been shown to have some health benefits, but this is talking about excessively caffeinated beverages, or specifically things like sodas that have caffeine and sugar and phosphate. They're all very negative for bone health.

John Horton:

Instead of having a pot of coffee, just make sure you've limited it to a cup or two?

Julia Zumpano:

Right, exactly. Exactly.

John Horton:

Now, you've kind of given us a game plan to help our bones … but if somebody has not really been following that sort of plan for a while, can you reverse any bone mass losses by changing your habits at some point later?

Julia Zumpano:

Sure. We know that bone mass can be improved, and the rate of bone loss can be slowed. There's certainly impacts you can make, even if you're a little in the game.

John Horton:

If you're dealing with osteoporosis, it sounds like if you make some of these changes, it's not going to turn you into a teenager again with your bone strength, but it's going to prevent you from sliding back and having maybe additional problems.

Julia Zumpano:

Absolutely. One thing I failed to mention was that strength training can really help support bone health. It's never too late to start some light resistance training, and really, the heavier you go, you put some of that pressure on those bones, that can really help support them and help build those bones, too.

John Horton:

Well, and that seems to get to the point where whenever we talk, it's never just one thing you do that fixes or helps anything. It's kind of a combination of everything going on in your life.

Julia Zumpano:

Absolutely. It's a whole systems approach. Our body is so vast and complex that one thing is not necessarily going to treat and cure the problem. All the parts of our bodies and all the nutrients are really intertwined and interrelated, and they work together. It's very important to remember that.

It's really the whole picture, but in the end, it's what we advise for general good health is to eat a whole foods, heavy plant-based diet, maintain a good source of protein and calcium, and move, and get some activity. If you can, some resistance and strength training in there, too.

John Horton:

This is all information that makes me feel good to my bones, Julia. But before we say goodbye, is there anything else you'd like to add about what we should be eating for our bone health?

Julia Zumpano:

I think just reinforcing the key of the variety of nutrients, and really looking at all those different nutrients we spoke about today, and all the different food sources, and making a plan as to how you're going to get those into your diet on a regular daily basis. Maybe even setting up your grocery list, where you make sure you're kind of hitting all these nutrients, and really giving yourself the fuel and the needs to support bone health.

John Horton:

Julia, I always love when you come on. You make us all think a little bit more about what we eat and how it affects us. Thank you very much for coming in.

Julia Zumpano:

Thank you so much for having me.

John Horton:

Your bones are amazingly strong, but they need your help to stay that way. Eating bone-healthy food, such as calcium-rich dairy products, nutrient-dense fish and even a bit of dark chocolate can help keep your skeleton in tip-top shape.

If you liked what you heard today, please hit the subscribe button and leave a comment to share your thoughts. Till next time, be well.

Speaker 3:

Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit ClevelandClinic.org/hepodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.