Q A bone density test has revealed that I have signs of osteoporosis. My doctor has offered me drug treatment together with calcium and vitamin D, but I am very reluctant to take drugs because of the side-effects, and calcium makes me constipated.
I am on a vegetarian diet to control irritable bowel problems, so can you recommend a vegetarian diet I can follow to combat osteoporosis? - EC, Isle of Wight
A Women are more likely than men to develop osteoporosis, a disease that involves the loss of protein matrix tissue from the bone, causing it to become brittle. It's often associated with the menopause because that's when the ovaries stop producing oestrogen hormones, which help maintain bone mass.
But osteoporosis is just as likely to be a lifestyle disease, linked to our modern, protein-rich diets. We eat up to five times the protein our bodies actually need, and it's the acid byproducts of protein that leach calcium and other minerals from our bones. This suggests that even young women (and men) eating a high-fat diet could be unwittingly weakening their bones. We begin to lose more bone than we make at around age 30, and the menopause may only be accelerating an already established pattern unless we have made efforts to reduce our protein intake.
It is simplistic to suggest that calcium on its own - either as a supplement or from dairy products - will reverse or even prevent osteoporosis. Eskimos have the highest intake of calcium in the world, with a daily consumption of 2000 mg per person mainly from fish bones, and yet they also have the highest rate of osteoporosis in the world. Fish, along with meat and eggs, are the most acid-forming foods - and the ones that cause the greatest loss of calcium.
In contrast, the Chinese eat only half the daily amounts of calcium consumed in the West every day - and that mainly from vegetables - yet osteoporosis is rarely seen.
>From this, it's not surprising to learn that vegetarians often have a higher bone density than carnivores. Research involving 1600 women, roughly half vegetarian and half meat-eaters, found that the average meat-eater had lost 35 per cent of her bone density by the time she reached age 80, whereas a vegetarian of at least 20 years' standing would have lost, on average, only 18 per cent of her bone density (Am J Clin Nutr, 1988; 47: 1022-4).
Your being a vegetarian suggests that you've already taken the biggest step to slow the progress of your osteoporosis. It is important, nonetheless, to have a varied diet to combat the disease, and the best foods for this include the green leafy vegetables, alfalfa, kelp and cabbage, and all vegetables that are rich in boron, a mineral that reduces the excretion of calcium, and improves calcium and magnesium uptake. Nuts (especially almonds, hazelnuts and peanuts), avocados, and kidney and borlotti beans are also good sources of boron.
Fruits that are rich in vitamin C, such as blackberries, strawberries, raspberries, blackcurrants, citrus, kiwi, peaches and apples can slow osteoporosis, as can dried figs, apricots and dates.
Nuts and seeds are a great source of omega-3 essential fatty acids. Eat unsalted nuts, such as walnuts and brazil nuts, and sunflower, linseed and pumpkin seeds. Of the pulses and grains, try soybeans, wheatgerm, lentils, chickpeas and brown rice.
Your doctor is right to suggest vitamin D, as this helps the body absorb calcium, but the best source comes from the sun itself. The next best non-vegetarian source is oily fish; otherwise, you will need to take supplements. Other supplements to consider include magnesium, vitamin C, zinc and boron, although much of what you need can be derived from your diet.
Things to avoid other than meat include sugar, alcohol, cigarettes, coffee and, to a lesser extent, ordinary tea - use green or herbal teas instead. Finally, keep your weight down to a reasonable level, and try to take some gentle exercise every day, even if it's just a walk to the shops and back.