Q:I understand that heart disease begins in childhood; you have said pediatricians can prevent heart attacks later in life. But is it true that weak bones later in life also have roots in childhood?
A: It has been said that a child's habits can literally make or break their bones. The bottom line is that what a child does in childhood, in terms of lifestyle, can make a huge difference later in life. One such an example is building strong bones.
Bones are living tissue where there is a constant turnover of bone formation. By age 18, for girls, 90% of the bone mass is laid down. The strength of our bones peaks in the late twenties. However, the more we do earlier in life, the more we are off to a good start. For example, by avoiding cigarette smoking, excessive amounts of soda pop, maintaining an ideal weight, taking Vitamin D, consuming foods rich in calcium, and engaging in weigh bearing exercises, we can invest in our future and avoid troubles later in life.
A shocking statistic surfaced recently about the consequences of osteoporosis in Canadian men and women over the age of 50. Osteoporosis is a condition where the bones are weak and where fractures easily occur. In a Canadian Medical Association publication, researchers from McMaster studied over 8000 patients above the age of 50. They discovered that close to one in six females suffered from hip fractures. The shocking part is that close to 24% of these females were dead five years later.
At a time when we are focused on slaying the ever-growing beast of healthcare expenses, the researchers calculated that the annual cost of osteoporosis runs close to $1.3 billion. That is a huge bill for taxpayers to cover, and it is frankly frustrating when one considers that more attention to prevention can avoid needless expenses.
With an increase in childhood obesity there is also an increase in weaker bones. Numerous studies have shown that some children are more likely to consume soda pop than milk. This leads to not only more calories being taken in, but it also affects the calcium deposits in bones. In fact, think of it as the chemicals in pop "squeezing" calcium out of bones or opening the door for calcium to escape and leave bones like flimsy scaffolds.
Patients with anorexia are also very prone to having weak bones. The thinking is that the disturbance in their estrogen metabolism contributes to weak bones (Girls who menstruate early have a lower risk of osteoporosis; girls with irregular menses are at a higher risk).
In the pediatric weight clinic (www.pediatricweightclinic.com) we see a number of former swimmers who are overweight. These patients are often low in calcium and Vitamin D due to their obesity as well as being indoors a lot and not engaging in enough weight bearing activities. I used to joke with my patients by saying, "Take the dog for a walk - even if you don't have one". But now I mean it seriously. The point is that weight bearing activities are critical. Examples of these regular "musts" include walking, running, tennis, hiking, skiing. For those who want to stay indoors try rope jumping, weight training, or hula hoops.
One of the best known sources of calcium is milk. One glass of milk (8 oz or 240 ml) provides approximately 300 mg of calcium. This is equivalent to ¾ of the daily requirement for a child and ¼ of the daily needs for a teenager. However, some people do not like the taste of milk or they may be intolerant or allergic to diary products. For these patients sources of calcium can be green leafy vegetables such as collard, turnip, spinach, and kale. Other sources are broccoli, almonds, sesame seeds, soybeans, sardines, and pink salmon. Although some juices are fortified with calcium, the concern is that while it delivers more calcium, patients may be set up for consuming extra calories.
The normal calcium requirements for children are as follows: 1 to 3 years, 500 mg per day; 4 to 8 years, 800 mg per day; and 9 to 18 years, 1300 mg per day. More than 85% of girls and 60% of boys ages 9 to 18 years fail to get the recommended 1,300 mg of calcium per day. (For more detailed information on the actual milligrams of calcium in various foods, see www.kidsnutrition.org)
Living above the 33rd parallel means we cannot depend on the sun for Vitamin D. Some doctors have done a great job of scaring patients from exposure to healthy amounts of sunshine causing these patients to become low in Vitamin D. The recommended intake for Vitamin D supplements under age 18 is 400-800 IU per day; after 18 it is 1,000 IU per day. When taking Vitamin D try to use it in a drop form and be sure it is Vitamin D3 and not Vitamin D2, which is about a third as strong as D3. (See www.healthykids.ca for more data on Vitamin D)
For those interested in taking calcium supplements, the suggested intake per dose is 500 mg. But healthy nutrition and exercise are more ideal and natural - it is also better as a long-term lifestyle choice. Besides, taking the dog for a walk will allow you and your family to meet interesting people in the neighborhood, in addition to preventing osteoporosis and even premature death later in life.
Access www.healthykids.ca for a terrific new resource in helping families raise healthy children - HealthyKids with Dr. Nieman will optimize your child's complete health.
An informed parent is ... an empowered parent.