Healthy eating for strong bones

Give your child a head start by building bones during pregnancy. Building healthy bones actually starts in the womb. If you are pregnant, you should avoid smoking and drinking alcohol. Make sure you have a healthy, balanced diet with adequate protein and calcium as well as enough vitamin D to ensure you are doing the very best you can for your baby’s developing skeleton.

Children need a well-balanced diet and higher intakes of calcium and protein are required during adolescence. Throughout life, it’s the balance of healthy foods that is essential. Setting a pattern for healthy eating provides a role model for children that they are likely to adopt in later life.

Aim for a healthy body weight throughout your life. If you are trying to lose weight, the lowfat versions of dairy foods provide equivalent amounts of calcium – in fact, they may have slightly more as the calcium is in the non-fat part of dairy products.

For women, menopause is a time to reevaluate eating habits and make healthy choices. You don’t need extra calcium or other nutrients at this time but it’s a good opportunity to make sure you are eating healthily.

If you are older and frailer, make sure you eat small ‘eatwell plates’ (see image below) if you can’t eat larger meals – try and keep the same proportions but in smaller amounts. Have enough protein too – low levels of protein seem to increase the risk of hip fracture.

UK government advice has recently changed. See the revised Eatwell Guide here. (If you are using assisted technology, email publications@phe.gov.uk for an accessible version)

What is a mixed, well-balanced diet?

Aim to eat meals that incorporate a wide variety of foods from the four main groups. These are fruit and vegetables; carbohydrates such as bread, potatoes, pasta and cereals; milk and dairy products; and proteins such as meat, fish, eggs, pulses, nuts and seeds.

This will help to provide you with all the vitamins, minerals and energy you need to live life to the full and reduce the risk of other chronic diseases too.

The ‘eatwell’ plate shows the proportion of different foods that make up well-balanced, healthy eating. It’s not essential to get a perfect balance every day but make sure you eat these proportions of the different food groups over about a week to ensure you get all the nutrients for good health, including what your bones need to stay strong. Having a mixture of foods within each food group will also ensure you consume a range of different nutrients.

Check your body mass index (BMI) to make sure you have a healthy body weight see the healthy body weight section.

Healthy eating tips

Eating for your bones needn’t be boring – there are lots of delicious meals and snacks packed full of the vitamins and minerals you need, and they don’t have to be fattening.

  • Eat plenty of whole-grain foods such as brown rice and pulses for more minerals, vitamins and fibre.
  • Eat more fruit and vegetables, at least five portions a day. (A portion is about the amount in a handful.) Choose lots of different coloured fruit and vegetables to ensure you get the range of essential nutrients you need, including some calcium.
  • Eat more fish. Try for two portions a week and remember oily fish, such as mackerel, are also a good source of vitamin D.
  • Cut down on saturated fats and sugar. Check out the food labels: 5g or more of saturated fat per 100g and 10g or more of sugars per 100g is a lot.
  • Try to cut down on the amount of salt you eat. Again, check out the food labels and remember that 0.5g or more of sodium per 100g is high.
  • Don’t skip food early in the morning. If you don’t feel hungry when you wake up, start with a healthy snack and have regular meals throughout the day to maintain your health and wellbeing.

Find out more by visiting www.nhs.uk/Livewell/healthy-eating. If you are concerned about your eating habits, you could also speak to the practise nurse at your local GP surgery.

Calcium and bones

Calcium is vital for teeth and bones because it gives them strength and rigidity.

Our bodies contain about 1kg of this important mineral and 99% of it is found in our bones. Most people should be able to get enough calcium through healthy eating.

How much calcium is recommended?

Age 
 

Reference nutrient
intake (RNI)

0–12 months(non-breastfed infants only) 525mg
1–3 years 350mg
4–6 years 450mg
7–10 years 550mg
11–18 years boys/girls 1,000 / 800mg
19+ years 700mg
Pregnant women 700mg
Breastfeeding women 700mg + 550mg
If you are taking osteoporosis drug treatments you may benefit from a higher daily calcium intake of around 1,000mg a day.

 

Reference nutrient intake

The government’s advisers on nutrition set recommended daily levels of intake of nutrients, called the reference nutrient intake (RNI). 700mg of calcium is sufficient to meet the daily requirements of most of the adult population (97.5%). These advisers also recommend that an intake of calcium below 400mg is likely to be insufficient. This amount is called the lower reference nutrient intake (LRNI) and is the lowest amount of calcium required to maintain a healthy adult skeleton. Do not worry if your calcium intake does not quite reach the RNI of 700mg a day; it is the average daily amount that is important. A low calcium intake on one day, when most days you achieve the right amount, will not have a detrimental effect on your bone strength

I am a vegan. Will this cause problems for my bones?

If you don’t eat dairy products, you will need to include lots of other calcium-rich foods such as green leafy vegetables, almonds, sesame seeds, dried fruit, pulses, fortified soya drinks and soya protein (tofu) in your diet. A vegetarian diet is not a risk factor for osteoporosis and vegetarians and vegans do not appear to have poorer bone health than the rest of the population. For more information contact the Vegan Society or the Vegetarian Society.

I am lactose intolerant. How can I get more calcium into my diet?

Some people cannot tolerate lactose, the natural sugar found in milk, because they don’t produce enough lactase, the enzyme needed to digest lactose. When undigested lactose passes through the system unabsorbed, it will ferment in the large intestine, causing stomach cramps, bloating, flatulence and diarrhoea. Some people find they can tolerate small amounts. Lactose intolerance affects 5–10% of North Europeans and North Americans of European origin. This figure may be as high as 90% in some Asian, African and Caribbean populations. If you are lactose intolerant, make sure you enjoy plenty of non-dairy calcium-rich foods such as pilchards, sardines, curly kale, watercress, sesame seeds and tahini (sesame seed spread). You could also choose fortified foods, such as water, soya milk or bread with added calcium as seen below

Can eating fortified foods help?

Supermarket shelves are increasingly filled with supplemented foods that claim to be good for you because they are fortified with vitamins and minerals. They may prove a convenient way of improving your intake of specific nutrients such as vitamin D. But remember, it’s a well-balanced diet that provides a range of nutrients to keep bones strong, not just one added mineral or vitamin.

Calcium-rich food chooser:

Use our food chooser to get the required calcium you need.

Foods providing around 50mg of calcium per average portion

Plain yoghurt 1 tablespoon (40g)
Fortified fromage frais 1 ‘mini’ pot (47g)
Muesli Swiss style 1 portion (50g)
Bread (white) 1 medium slice (36g)
Bread (wholemeal) 1 thick slice (44g)
Green or French beans 1 portion (90g)
Green cabbage 1 portion (95g)
White cabbage (raw) 1 portion (90g)
Broccoli (steamed) 1 large portions (110g)
Watercress 1 small bag (40g)
Fried onion 1 medium sized (150g)
Tinned tomatoes 1 tin (400g)
Red kidney beans 2 tablespoons (70g)
Vegetable casserole 1 portion (260g)
Veggie burger 1 (56g)
Vegetable samosa 1 (75g)
Pasta (dried, boiled) 1 portion (230g cooked Weight)
Rice (basmati, boiled) 10 heaped tablespoons
Dairy or non-dairy ice cream 1 scoop (60g)
Dried apricots 8 (64g) 8(64g)
Orange / easy-peel citrus (e.g. tangerines, satsumas) 1 large orange (50g) / 3 medium easy-peelers (210g)
Almonds 10 Whole Nuts (22g)
Brazil Nuts 9 Whole Nuts (30g)

Foods providing around 300mg of calcium per average portion

Edam / Gouda 1 portion (40g)
Paneer cheese 1 portion (60g)
Parmesan cheese 1 portion (30g)
Cheese omelette 1 portion (120g)
Quiche (cheese and egg) 1 portion (140g)
Macaroni cheese 1 portion (220g)

Foods providing around 100mg of calcium per average portion

Cottage cheese 2 tablespoon (80g)
Camembert 1 portion (40g = 1/6th of whole)
White pitta bread 1 small (75g)
Plain naan bread 1/3 (43g)
Baked beans 1 small tin (200g)
Cornish pasty 1 medium size (155g)
Sausages (pork or vegetarian) 2 (80g)
Tahini (sesame paste) 1 heaped teaspoon (19g)
Sesame seeds 1 tablespoons (12g)
Tinned pink salmon 1 small tin (105g)
Grilled herring 1 (119g)
Custard (ready made) 1 portion (120g)
Dried figs 2 (40g)

Foods providing around 200mg of calcium per average portion

Milk or milk drink e.g. hot chocolate (skimmed/ semi-skimmed/whole) 1 tumbler or mug (200ml)
Soya milk (calcium boosted) 1 tumbler or mug (200ml)
Cheddar cheese & low-fat hard cheese Small matchbox size (30g)
Yoghurt (low-fat fruit, plain & calcium boosted soya) 1 pot (125g)
Porridge (made with semi-skimmed milk) 1 bowl (160g – weight with milk)
Halloumi 2 thin slices (35g)
Cauliflower cheese 1 portion (200g)
Lasagne (meal for one, vegetable or meat) 1 portion (290g)
Pizza 12”(cheese & tomato, vegetarian or meat topping) ¼ of the whole
Tofu (steamed or fried) 1 portion (120g)
Sardines (canned) 1 portion (50g)
Rice pudding 1 portion (200g)

You can also use this calcium calculator

 Calcium Calculator

Tip: Choose a wide variety of foods to make sure you get all the other nutrients your bones need.

Other nutrients for bones

There are many other vitamins (such as B, C and K) and minerals (such as magnesium) that may play a part in keeping bones strong, but more research is needed in this area to fully understand their role. These nutrients are all readily available through a balanced diet and, as long as a wide range of foods from all the main food groups are obtained, it is likely that you will be getting enough and do not need to take supplements. Fore more information see our Further food facts and bone – Beyond calcium and vitamin D factsheet

Related Links

Your Questions: Healthy Eating

Do I need to take a calcium supplement?

Most people should be able to get enough nutrients through their food without needing to take a calcium supplement. Eating a good, balanced diet will also ensure you get other vital bone building vitamins and minerals. Many people will be surprised to see it is not just dairy products that contain calcium. Green leafy vegetables, bony fish and dried fruit all contain useful quantities of the mineral. Dairy products are often recommended as they are a rich source of calcium that is easily absorbed and generally make up a significant proportion of most Western diets.

How much calcium do I need if I have osteoporosis?

If you have been diagnosed with osteoporosis and are taking a drug treatment, you may need to boost your calcium intake up to around 1000mg a day and consequently may be given a calcium supplement with your osteoporosis medicine. In the research trials that have shown bisphosphonates (one type of osteoporosis drug treatment) to reduce fracture risk, all participants had an adequate calcium intake either by diet or supplements.

Is high calcium intake a guarantee against osteoporosis? 

Although calcium is a vital mineral for bone health, eating lots of it does not automatically result in a high bone density or prevent broken bones. There are some groups of people who have a low calcium intake but also have few broken bones because of osteoporosis. However, it is not clear exactly why this is. It may be because of other lifestyle factors, such as being more physically active or getting more exposure to the sun and having good levels of vitamin D. Alternatively, there may be genetic reasons or body size differences.

Can I have too much calcium?

Having more than the upper safe limit of 2,000 to 2,500mg of calcium a day on a regular basis could lead to medical problems including a high level of calcium in the blood, known as milk alkali syndrome. It may also interfere with the absorption of other minerals such as iron and magnesium. For more information about calcium supplements see our leaflet Drug Treatments for Osteoporosis

I am lactose intolerant, how can I get more calcium into my diet?

Some people cannot tolerate lactose, the natural sugar found in milk, because they don’t produce enough lactase, the enzyme needed to digest lactose. When undigested lactose passes through the system unabsorbed, it will ferment in the large intestine causing stomach cramps, bloating, flatulence and diarrhoea. Lactose intolerance affects 5-10% of North Europeans and North Americans of European origin. This figure may be as high as 90% in some Asian, African and Caribbean populations. If you are lactose intolerant, make sure you enjoy plenty of non-dairy calcium rich foods like pilchards, sardines, curly kale, watercress, sesame seeds and tahini (sesame seed spread). You could also choose fortified foods, such as soya milk which includes added calcium.

Can eating fortified foods help?

Supermarket shelves are increasingly filled with supplemented foods that claim to be good for you because they are fortified with vitamins and minerals. They may prove a convenient way of improving the nutritional value of your diet. But remember, it’s a well balanced diet that provides a range of nutrients to keep bones strong, not just one added mineral or vitamin.

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