Jane Clarke: I hate milk - but fear for my bones

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Every Tuesday, Britain's leading nutritionist explains how to eat your way to health. This week Jane tackles milk, osteoporosis and the risks of tripe...

I have not had milk for more than eight years - it never really agreed with me, causing indigestion and bloating. I do, however, eat small amounts of hard cheese. My concern is that now I'm approaching 50, am I asking for trouble as regards bone density problems and osteoporosis.


Are there any other good sources of readily absorbed calcium other than dairy products, or should I consider supplements? Colin Briggs, Southend-on-Sea, Essex.


Jane says... You're right for wanting to be proactive about protecting your bones as osteoporosis is an increasingly common problem that we can go some way to prevent.

It causes brittle bones that can easily fracture - and can be terribly disabling. I'm pleased that you've written in because so often we associate bone concerns with women; but men can also get osteoporosis, although it is not as common.

For women, osteoporosis often occurs around the time of menopause. This is because our bones are protected by the hormone oestrogen (it reduces the amount of bone that breaks down). When levels of oestrogen drop at menopause, the loss of bone accelerates.

For men and women, the condition is increasingly likely if you suffer from eating disorders such as anorexia, arthritis or hypothyrodism (an underactive thyroid gland). It can even be a side-effect of some medication, such as steroids.

I suspect the reason osteoporosis has become more common - one in two women and one in five men over the age of 50 in Britain will fracture a bone because of it - is partly because of poor diet.

Increased smoking at an earlier age also causes bones to leach precious calcium.

Fortunately, thanks to extremely accurate and accessible bone scanners, we are getting better at its diagnosis. These scanners measure bone density, providing an important early warning if your bones are on the low-density side.

Generally, doctors will recommend testing after 50, but if there is a risk factor, such as family history or any of the other medical conditions listed, you can be tested earlier.

Bone-building occurs during the first 20 or so years of life. After that the rate of growth slows down. This means that if you don't eat or live well as a teenager, you could be setting yourself up for future problems.

But even then all is not lost. As you approach 50, it's still important to preserve as much of the bone you have left as possible, and calcium is the first key mineral to focus on.

Dairy produce, such as cheese, butter and milk, has always been highlighted as the best source of calcium. But some people, like you, simply can't tolerate milk.

However, it's not enough to have just cheese. Why not try soya mince, tofu and soya yoghurts, especially those fortified with calcium carbonate - a natural compound found in shells, such as eggshells, and one of the easiest forms of calcium to absorb. You can also buy bread and orange juice fortified with this.

Dark green leafy vegetables, such as kale and watercress, provide some calcium (not spinach, though, as it contains oxalic acid, which hinders your ability to absorb calcium), as do seeds such as sesame seeds.

Small-boned fish such as sardines are also a good source, although with anchovies you need to watch their salt content, as they can be preserved in brine.

Do you have a nutritional question?

Jane will answer a selection of readers' queries every week.

Write to Jane Clarke, Good Health, Daily Mail, 2 Derry Street, London W8 5TT, or e-mail jane.clarke@dailymail.co.uk.
Jane cannot enter into personal correspondence. Please include contact details.

Her replies cannot apply to individual cases and should be taken in a general context. Contact your GP with any health problems.

As you need around 1,000mg a day (this varies depending on age, see websites such as www. nutrition.org), you'll need an awful lot of these foods to attain that amount, so a daily supplement may be the way to go.

Magnesium increases bone density, so try to include this mineral - found in foods such as chickpeas, nuts, lentils, potatoes and oatmeal.

The recommended daily intake is 270mg for women and 300mg for men, which equates to 66g of brazil nuts or 100g of pine nuts (a lot again, so a supplement might be easier).

Finally, bones need vitamin D to help absorb calcium properly.

Fifteen minutes walking about in the sunshine, two or three times a week, ensures that your body manufactures enough, but if you can't do this, take a daily pill containing 200 to 400 international units of vitamin D if under 70, or 600 iu if you are over.

Vitamin D can also be found in foods such as oily fish (sardines, salmon, tuna), milk, fortified margarines and breakfast cereals, but, again, you would have to eat an awful lot of them to make up the required level.

Then there are oily fish, walnuts, walnut oils and hemp oil to help boost the essential fatty acids that build and maintain healthy bones, so include up to four 140g portions of oily fish a week (though women of childbearing age and girls should stick to two portions a week).

Remember, salt has a negative effect on bones, because it increases the amount of calcium you lose in your urine, so keep your intake down.

And finally, keep active with regular weight-bearing exercise. This not only stimulates the bones to manufacture cells, but also, if you're active, fit and supple, you're far less likely to fall badly if you trip.

Could you please advise if tripe is good or bad for you. Is it high in cholesterol? I'm fond of it, but am cautious about eating it in case it is bad for me. D. Greenwood, by e-mail.

Jane says...Rather you than me! Tripe is something of an acquired taste; it's mushroom-like in texture, bland and a little slimy.

The fact that it comes from the lining of the cow's stomach can also put off many people - illogical though that is, since meat from elsewhere in an animal's body is happily eaten.

Nevertheless, rather like kidney and liver, people can get a little funny about it.

In Italy and many other countries, tripe is popular. It is high in cholesterol, but like other offal, as well as seafood and eggs, this is not as bad as it sounds.

The cholesterol in tripe is dietary cholesterol, which does not have a big impact on blood cholesterol levels because the body breaks it down efficiently.

So long as you don't pan-fry it in butter, tripe can be a low-fat, high-protein meat.

It's also cheap, rich in iron (good for growth and healthy blood), zinc and B vitamins - therefore it's good for the immune system.

Pregnant women should avoid it, though, as it's high in vitamin A, which has been linked to an increased risk of developmental defects in unborn babies.

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