June 2008 1

Disease / Deficiency

Bones are living organs

• Calcium is deposited and withdrawn from bones daily.

• Bones continue to deposit more bone than loss until about age 30.

• We need to build up a healthy bone account while young and continue to make deposits with age.

Lawrence Riggs, MD, Surgeon General’s Workshop Osteoporosis Prevention

June 2008 4

Osteoporosis

Osteoporosis causes weak bones

Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealth

NormalBone

Bone withOsteoporosis

June 2008 5

Bone Density Factors Over Time

HEREDITY

ERRORS

STRUCTURAL

EXERCISE/LOADING

CALCIUM INTAKE

AGE0 10 20 30 40 50 60 70

BO

NE M

ASS

IntakeCalciumInadequate

IntakeCalciumAdequate Menopause

Fragility Zone

National Academy of Sciences, Institute of Medicine (1997)

Copyright Robert P. Heaney, M.D., 2003. Used with permission

• After mid-30’s, slowly lose bone mass

• Faster bone loss after menopause

• Bones can weaken early in life without a healthy diet and the right kinds of physical activity.

Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealth

June 2008 7

Risk Factors for Osteoporosis

Genetics

60% to 80% Gender Ethnicity Age Hormonal status Body frame & weight Medications Disease States

Environmental

20% to 40% Cigarette Smoking Alcohol Caffeine Diet (low calcium intake) Exercise

Four prevention steps …• Enjoy a diet rich in calcium

• Engage in regular weight-bearing exercise.

• Avoid smoking and excessive alcohol.

• Talk to your doctor about bone health.

• Have a bone density test and take medication when appropriate.

Low Bone Mass = Increased Osteoporosis Risk

• Shortfalls contribute to risk for osteoporosis and future hip fractures

• Osteoporosis: A pediatric disease with geriatric consequences

June 2008 10

Lactose Intolerance

Choose Dairy First to Enhance Diet Quality

Try These Tips for Tolerance

rink milk with meals.

ged cheeses like Cheddar and Swiss are naturally low in lactose.

ntroduce dairy slowly. Gradually increase the amount.

educe it. Enjoy lactose-free milk and milk products.

ogurt with live active cultures helps to digest lactose.

DASH Defined

• Dietary

• Approaches

• Stop

• Hypertension

Hypertension Facts & Figures

• 50 million Americans with hypertension

• 1 in 4 adults• One-third unaware• Increased risk for heart

disease, stroke, cardiac/kidney failure

• $32 billion in healthcare costs

June 2008 13

Public Health Priority

Healthy People 2010 Goal:

blood pressure from 28% to 16% of adults.

- US Department of Health and Human Services

June 2008 14

Lifestyle Changes to Control/Prevent High Blood Pressure

• Lose weight• Increase physical activity• Limit alcohol• Stop smoking• Reduce sodium, saturated fat, cholesterol• Consume adequate calcium, potassium,

magnesium - 6th Report of the Joint National Committee on

Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

The DASH Trial

• N = 459 adults – 49% women– 60% African Americans

• Systolic < 160 mm Hg

• Diastolic 80 – 95 mm Hg

- Appel, et al., N Engl J Med, 336:1117, 1997

Combination “DASH” Diet Lowered Blood Pressure Most

Effectively

June 2008 17

DASH Diet Benefits

• Quick and lasting results

• Results rival medications

• Potential to reduce disease risk and healthcare costs

Who DASH Diet Benefits Most

• Hypertensives: 11.4/5.5 mm Hg

• African Americans: Systolic 6.8 mm Hg vs. 3.0 mm Hg in whites

June 2008 19

The DASH-Sodium Trial

June 2008 20

The DASH-Sodium Trial

• N = 412 adults – 57% women– 57% African Americans

• Control Diet vs. DASH Diet• Sodium level (30 days each)

– High (3,300 mg)– Medium (2,400 mg) – Low (1,500 mg)

- Sacks, et al., N Engl J Med, 344:3, 2001

DASH II Sodium

Why Does the DASH Diet Lower Blood Pressure?

Mineral Mix

• Calcium

• Potassium

• Magnesium

June 2008 23

Milk’s Mineral Mix Also Reduces Stroke Risk

• Calcium, potassium, magnesium in Milk Group foods reduce risk factors for stroke.

• All three minerals work in concert.

• Naturally found in milk, yogurt, cheese.

- Massey, J Nutr, 131:1875, 2001

June 2008 24

Beyond Blood Pressure: DASH Reduces Heart Disease Risk

Factors

June 2008 25

DASH Reduces Cholesterol

Subjects following DASH diet:

Total cholesterol 13.7 mg/dL

LDL cholesterol 10.7 mg/dL

HDL cholesterol 3.7 mg/dL

Obarzanek, et al Am J Clin Nutr, 74:80, 2001

Health Professional Groups Advocate DASH

• 6th Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

- National Heart, Lung and Blood Institute

American Heart Association 2000 Dietary Guidelines

2-4 servings lowfat dairy foods; 5-9 servings fruits/vegetables recommended

Calcium, potassium, magnesium from foods such as milk, yogurt, cheese

• Krauss, et al, Circulation, vol. 102:2284, 2000

June 2008 28

More DASH Resources

National Heart, Lung and Blood Institute:

www.nhlbi.nih.gov

American Heart Association:

www.americanheart.org

American Dietetic Association:

www.eatright.org