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    Archive for the ‘osteoporosis’ Category

    There’s More to Osteoporosis than Calcium

    osteoporosis-illustratedThe majority of news articles on osteoporosis never fail to mention that calcium is a key nutrient in slowing down bone density loss.

    While that is an established fact, there are other nutrients and behaviors that are just as important in risk-reduction and management of osteoporosis.

    Here’s a handy cheat sheet:

    • Phosphorus: High intakes inhibit calcium absorption and bone metabolism.  Ironically, dairy products are quite high in phosphorus.  Yet another reason why calcium intake should come from a variety of foods (i.e.: leafy green vegetables, chickpeas, almonds), including dairy (if so desired).
    • Smoking: negatively affects bone metabolism and decreases bone density levels.
    • Sodium: Excessive amounts (not at all uncommon in the “Standard American Diet”) increase calcium losses in urine.
    • Vitamin D: Facilitates calcium absorption.  Note: current guidelines (400 International Units of Vitamin D per day) are too low.  Supplement 1,000 – 2,000 International Units every day.
    • Vitamin K: Helps bind calcium to the bone matrix.
    • Weight-bearing exercise.

    There are also preliminary studies which show that zinc, manganese, and even vitamin A may play important roles as well.


    In The News: Beer for Bones?

    2111The hot topic of the moment buzzed about by nutritionists and late-night comedians alike comes courtesy of a study conducted by the Department of Food Science & Technology at the University of California, Davis published in the Journal of the Science of Food and Agriculture.

    The study’s conclusion? “Beer is a significant source of dietary silicon, a key ingredient for increasing bone mineral density.”

    As someone who doesn’t drink alcohol, I have no strong feelings about the research.

    For the record — my lack of interest in alcoholic beverages is solely a matter of disliking alcohol’s flavor.  For whatever reason, when some people hear me say I don’t drink alcohol, they almost expect me to go on a 30-minute monologue about why everyone should avoid it if they are about their health or why my moral compass disagrees with such a substance.

    Back to the study.  The mainstream media — of course — had more fun with this than a housecat in a room full of mice.  Awkward puns graced headlines, practically anointing beer as a recommended beverage (“by scientists!”, no less) against osteoporosis.

    It is true that adequate intakes of silicon are necessary for bone growth and maintenance.  And, yes, beer is indeed a good source of silicon.

    However, everyone who eats a varied diet — especially one high in whole, unprocessed foods — is getting more than sufficient amounts of silicon.  Remember, too, that bone health involves many nutrients — mainly calcium, vitamin D, magnesium, and phosphorus.

    It is precisely those four nutrients that many people do not get enough of!  Having an extra beer every day isn’t going to do much good for your bones if your vitamin D and magnesium intake doesn’t meet the recommended amounts.

    The study is certainly interesting — and accurate — but “beer is good for osteoporosis” claims blindly jump from point A to point Z — and fall flat on their face halfway through.

    Remember: no one food is “good for” a condition.  It is general dietary patterns that provide you with a good amounts of various nutrients that are helpful.  I know, that line of thinking is not going to sell millions of books, but at least I’m being completely truthful.


    You Ask, I Answer: Caffeine & Calcium

    Is it true that coffee causes osteoporosis?

    — Linda (last name withheld)
    New York, NY

    Before I answer, allow me to get something off my chest.

    Statements like “[insert name of food here] causes [insert disease/condition here]” are tremendously inaccurate.

    If someone ever tells you that a food causes a particular disease, promise me your “BS” alarms will go off.

    Unless you are talking about foodborne illness issues, food as a whole does not cause disease.

    Rather, it is particular components in certain foods that, when consumed consistently over long periods of time, can elevate one’s risk of developing a certain condition.

    This reminds me of absurd statements like “ice cream makes you fat.”

    While a 600-calorie sundae every day after dinner will surely result in weight gain, a one-scoop ice cream cone every Saturday night is no cause for concern.

    “Ice cream makes you fat” wrongly categorizes 150 calories and 900 calories of the same food as nutritionally equal.

    Similarly, saying that “coffee causes osteoporosis” is too broad a statement. At the very least, whoever is making such a statement should identify what specific component in coffee is believed to affect bone mass.

    Which brings us to the question at hand.

    Since caffeine is a diuretic that results in a higher-than-normal excretion of calcium in urine and feces, some people jump to the conclusion that, therefore, caffeine intake is related to osteoporosis.

    However, studies have demonstrated that the average cup of coffee — 8 ounces and approximately 150 milligrams of caffeine — increases calcium excretion by a practically insignificant 5 milligrams (remember, you should be getting 1,000 milligrams a day).

    To balance this out, all you need to do is add a single teaspoon of milk to your coffee.

    Keep in mind that all the studies looking at caffeine’s effect on calcium levels assume people drink black coffee (an 8-ounce latte, meanwhile, contains two thirds of a cup of milk!).

    Another concern with caffeine is that it inhibits intestinal absorption of calcium. While true, our bodies are smart and make up for this by increasing calcium absorption at the next meal.


    Numbers Game: Answer

    92 to 98 percent of peak bone mass (the period by which all bone formation occurs) is achieved by age 20.

    High peak bone density is one factor that helps decrease the risk of osteoporosis and bone fractures later in life.

    This is precisely why having adequate intakes of calcium — as well as being physically active — during childhood and adolescence is crucial.

    The more “bone healthy” the diet is during childhood and adolescence (particularly by consuming sufficient amounts of calcium, vitamin K, vitamin D, phosphorus, and magnesium), the higher peak bone mass levels are.

    This is not simply a matter of having your child pop a Flintstones chewable vitamin, though. Whole foods containing these nutrients are far superior sources.


    Numbers Game: Critical Point

    ____ percent of peak bone mass (the period by which all bone formation occurs) is achieved by age 20.

    a) 73 – 79
    b) 92 – 98

    c) 81 – 87

    d) 100

    Leave your guess in the “comments” section and come back on Saturday for the answer (and to find out how this ties into osteoporosis and fracture risk).


    Another Dark Side of Lighting Up

    Many discussions on the health effects of cigarette smoking leave out a very important fact — it can speed up the development of osteoporosis.

    Several studies — here is one example — have found a link between cigarette consumption and decreased bone density.

    Although one could argue that it may be behaviors and lifestyle choices common in smokers (i.e.: lack of physical activity) and not cigarettes themselves that may be the actual cause, there is no denying that smoking in and itself has a detrimental effect on bone health.

    Nicotine, for example, inhibits calcitonin, a hormone that inhibits the dissolution of bone tissue.

    Additionally, the massive amounts of free radicals created by smoking decrease levels of estrogen, consequently accelerating bone loss in women.


    You Ask, I Answer: Vitamin K

    What does Vitamin K do? What foods is it in?

    — Name Withheld
    Brooklyn, NY

    You kind of have to feel sorry for Vitamin K. It appears to be the least popular vitamin, and many people don’t even appear interested in getting to know it better.

    If Vitamin D is the life of the party, Vitamin K is standing by the punchbowl, futilely attempting to make small talk with other guests.

    I would definitely suggest being familiar with it, though, since this nutrient plays a very important role in blood clotting and bone density.

    You may wonder why its blood clotting properties are perceived as beneficial, particularly when one of the outed benefits of Omega-3 fatty acids is their blood thinning properties.

    We come back to the ever-present ideal of balance.

    Over-thinning of the blood is problematic, as it increases the risk of internal bleeding.

    Additionally, without blood clotting factors, something a small cut could result in excessive blood loss.

    Vitamin K helps with bone density by regulating calcitonin, a protein that locks calcium in the bone matrix, thereby making it more difficult for cells known as osteoclasts from breaking it down.

    If osteoclasts are more active than osteoblasts (which help create new bone tissue), your risk of osteoporisis increases significantly.

    What’s interesting about this nutrient is that we get it two different ways.

    K2, the more biologically active form, is synthesized by beneficial bacteria in our intestinal tract.

    Since babies start off with bacteria-free intestines, they are given a Vitamin K shot within hours of being born.

    The plant form — K1 — is found abundantly in leafy green vegetables. Although our intestinal bacteria produce some Vitamin K, we still need to get some from our diet.

    A mere half cup of steamed kale, spinach, and collard greens each pack in six times the Daily Value!

    A single cup of raw romaine lettuce provides three quarters of a day’s worth.

    Anyone who has ever been on blood-thinning medication (i.e.: warfarin, more commonly known as Coumadin) has been told to be mindful of their Vitamin K intake so as to prevent unwanted drug-nutrient interactions.

    Here’s why.

    Warfarin, an anticoagulant, decreases clotting (this is why it is mostly prescribed to heart disease patients.)

    A lot of people inaccurately think that the best thing to do when put on warfarin is completely eliminate Vitamin K from the diet.

    Not so! The key is to keep vitamin K intake consistent.

    Suddenly increasing Vitamin K consumption renders Coumadin ineffective, whereas decreasing it too much in a short amount of time will overly thin the blood.

    Remember, too, that antibiotics kill all flora in the gut — the negative AND positive bacteria (this includes the one that produces Vitamin K.)

    Therefore, when on antibiotics, do not drastically alter your Vitamin K intake.

    A clinical dietitian I know at New York City’s Memorial Sloan Kettering Hospital recently told a most interesting anecdote about a patient who was put on coumadin.

    A dietary recall revealed that her diet was very high in Vitamin K. Not a problem, but definitely important in the scheme of things.

    Soon thereafter, she fell very ill, to the point where she stopped eating. Mind you, she was still on Coumadin.

    In other words, her vitamin K drastically decreased (from about 1200% of the Daily Value a day to absolutely nothing).

    To counteract the illness, she was given antibiotics (remember, she is still on Coumadin).

    The antiobiotics wiped out gut flora.

    So, she now had a high Coumadin dose (based on her standard Vitamin K intake) but no Vitamin K from her diet OR her intestinal tract.

    Not surprisingly, she bled internally and had to be rushed into surgery.


    In The News: Lopez Says…

    People magazine happily plunked down $6 million to feature Jennifer Lopez and Marc Anthony’s twins on its cover.

    As ridiculous as that may sound, Jennifer’s comments on breastfeeding left me even more puzzled:

    My mom didn’t breast feed and I think that was the thing for me. You read and figure out what’s the best thing for them.

    Can a baby be healthy and grow adequately without breastfeeding? Absolutely. I certainly do not side with breastfeeding fanatics who equate bottle feeding with bad parenting or negligence.

    I also understand that not every woman can — or wants to — breastfeed. Women have every right to choose, and I find it obnoxious when people criticize this very personal choice.

    What I have a problem with is Jennifer Lopez’s notion that she chose bottle feeding based on “what is best for her babies.” While bottle feeding is certainly not detrimental to a growing baby, it is inaccurate to claim it is identical to breastfeeding.

    Some studies have concluded that breastfed babies have stronger immune systems, decreased risks of developing ear infections and diarrhea, lower infant mortality rates, enhanced neurological development, better oral health (due to a different suckling motion than drinking from a bottle).

    Breast milk is not only tailored to fully meet a baby’s nutritional needs for the first six months, it also contains naturally tranquilizing hormones.

    Some studies are less enthusiastic about health benefits from breastfeeding, but that does not take away that breastmilk is always clean and at the right temperature.

    The American Academy of Pediatrics’ official position is that breast milk is the best source of nutrition for all babies.

    They recommend it as the sole source of food for the first six months of a baby’s life, and as a complementary source from six to twelve months of age.

    They are not alone.

    The World Health Organization, UNICEF, and The American College of Obstetricians and Gynecologists are just some of the organizations that hold the same position.

    Formula is okay, but undoubtedly second best.

    Part of the problem is that most hospitals in the United States do not really support breastfeeding.

    Many do not have lactation specialists on staff, and they immediately bombard mothers with baskets of formula.

    Once a woman feeds her baby formula, it is very hard to get her to commence breastfeeding.

    Breastfeeding is a technique and skill that needs to be learned. It is not innate.

    This is why it is crucial to have trained specialists on staff who can teach new mothers the right positions for breastfeeding and how to handle common problems like mastitis (inflammation of the breast) and sore nipples.

    In 1991, WHO and UNICEF launched the Baby-Friendly Hospital Initiative.

    The ten steps hospitals must follow to be an official baby-friendly one can be viewed here.

    Here’s a shockingly low figure – of the 5,810 hospitals in the United States, only 63 are baby-friendly.

    The full list can be viewed here. I was very shocked to discover that New York City doesn’t have any!

    Another huge barrier to low breastfeeding rates in the country? The ridiculous and undeserved taboo!

    Last April, ABC News reported that an astounding 57 percent of people in this country believe women do not have a right to breastfeed in public.

    What is so wrong about a woman feeding her baby in a natural and healthy way?

    Has our culture’s common practice of hypersexualizing women’s bodies completely screwed with our heads?

    Here’s an even more astounding figure – 72 percent of people surveyed believe it is “inappropriate” to show a woman nursing on television!

    So Jerry Springer (well, now his former security chief Steve Wilkos, who took over the show) can show people verbally and physically attacking each other before noon, and it’s considered perfectly okay to see someone get shot or stabbed on primetime television, but people choose to tear their hair in some ridiculous “moral” outrage over something as harmless as breastfeeding?

    Color me confused — and pretty disgusted.

    If anything, breastfeeding needs to stop being relegated to the “naughty” corner. It needs to be talked about, discussed, and out in the open.


    You Ask, I Answer: Osteoporosis

    I am a 56 year old woman diagnosed with osteoporosis.

    I would like to know the best way to incorporate calcium [in]to my diet.

    — Maria Barbosa

    Before I answer your specific question, let’s briefly discuss the larger issue.

    Osteoporosis — a condition in which bone tissue deteriorates and bone density decreases, thereby weakening the skeletal system (see accompanying illustration) — is especially prevalent among women.

    In the United States alone, it is estimated that approximately 10 million adults currently live with osteoporosis, and an astounding 75 percent of them are women.

    In case you are wondering about the difference between these two groups, a decline in estrogen at menopause is associated with decreased bone density.

    Men, meanwhile, are protected by testosterone. Although testosterone levels decrease with age, they are still at a sufficient range to guard against the onset of osteoporosis.

    Since osteoporosis is “symptom free” (you don’t feel weak, bloated, tired, or get headaches), it is completely feasible to develop it and be completely unaware of this for years.

    To discuss how osteoporosis starts – and how to make the necessary changes once diagnosed with it – let’s go back to the beginning.

    Our bones are a vast storage unit for a handful of minerals, especially calcium.

    It’s important to have a strong reserve of calcium because we lose it on a daily basis.

    All bodily excretions (sweat, urine, and feces) contain calcium, and our nails require it for production and growth.

    Calcium is also needed for a variety of bodily functions (i.e.: forming blood clots).

    Consume adequate amounts of this mineral every day and you easily replenish any losses.

    If calcium intake is insufficient, that’s where the problem begins.

    The body, desperate for calcium, doesn’t find any circulating in the blood and goes to the trusted storage unit for some.

    In turn, bones are demineralized and broken down.

    Imagine this happening on a daily basis for ten, twenty, even thirty years!

    By the time you hit the fifty or sixty year-old mark, your bones are — not surprisingly — quite fragile and acutely demineralized.

    Although many people automatically equate osteoporosis with calcium, there are other factors to keep in mind.

    A crucial one is Vitamin D, which helps our bodies absorb calcium (this is why you often see calcium supplements also containing Vitamin D).

    As I have explained before, Vitamin D is not found in many foods (the best source is actually the sun).

    If you live in an area of the world that does not receive much sunlight for five or so months of the year, or if your dermatologist has strongly recommended you always use UV-proof skin lotions, you run the risk of being significantly deficient.

    The solution? Reach for a daily supplement! Aim for 1,000 International Units a day.

    Protein also plays a role in preventing osteoporosis.

    Both sides of the spectrum – not getting enough or getting too much – are problematic.

    A lack of protein in the diet will hinder the body’s ability to repair and rebuild bone tissue.

    An excess, meanwhile, results in urine outputs with higher calcium levels than normal.

    Phosphoric acid is also worth paying attention to. Found in regular and diet sodas, it disturbs the body’s calcium balance mechanism, often resulting in calcium being leeched from bones.

    Sodium – a mineral the majority of people in the United States overconsume– also plays a role in osteoporosis.

    High sodium intakes increase calcium losses through the urine (a result of the body attempting to keep various mineral levels proportional).

    With all that in mind, how can you be proactive about lowering your risk of developing osteoporisis (and maintaing what bone mass you do have at the time you are diagnosed with it)?

    From a nutritional standpoint, make sure you get sufficient amounts of calcium and Vitamin D and that you do not surpass maximum recommendations for sodium and protein.

    Aim for 800 – 1,200 milligrams of calcium a day.

    To answer your question, all dairy products are a great source, as are tofu, almonds, oats, and any fortified products.

    Spinach, however, is one food that gets way too much credit.

    Although it offers substantial amounts of various nutrients, don’t put it in your osteoporosis defense kit.

    Spinach offers significant amounts of calcium, but also contains high levels of oxalate, a compound that binds to calcium and greatly reduces its absorbability in our gastrointestinal tract.

    The good news is that oxalates only affect calcium absorption of the food they are in.

    So, if you’re having a spinach and tofu stirfry, only the dark leafy green vegetable’s calcium will be practically rendered useless.

    Aside from nutrition, one of the best things you can do to minimize your risk of developing osteoporosis (and prevent further bone demineralization if you have already been diagnosed) is weight-bearing exercises.

    This does not mean you need to necessarily start lifting heavy weights or buildmuscles. It’s really just about performing physical activity in which the muscles have to resist weight.

    Remember, bone strengthens up when stressed. Hence, challenging it with weights on a regular basis helps to maintain — and even increase — its density.

    As you can see, there are helpful steps you can take at any stage of the game. There is no reason to give in to osteoporosis.


    You Ask, I Answer: Diet Soda

    I was debating [with a colleague] about whether diet soda is bad for you.

    I mentioned some folks believe the artificial sweeteners in them may be cancer-causing, but that it’s a step up from guzzling sugary sodas every day.

    She said something about the acid in the soda not being that bad for you, because our stomachs are already acidic.

    But I always thought the phosphoric acid in the soda wasn’t so good for the tum tum.

    What’s your verdict?

    — Judith (last name withheld)
    (location withheld)

    The problem with all soda — diet or not — is the phosphoric acid in it.

    Not so much because it’s bad for your stomach (it isn’t), but because of its effect on our calcium levels.

    Our bodies like to stay in balance (you might remember the term “homeostasis” from your high school biology class). Calcium and phosphate, in particular, are two minerals that are actually good buddies. In fact, they’re inseparable.

    If one’s level in our blood goes up, the other one wants to go up as well. So when you drink that can of diet soda, your body’s phosphate levels rise. Calcium sees this, and says, “Wait a second, I want to go up, too!”

    If you are like most people in the United States, your calcium intake isn’t as high as it needs to be, meaning you don’t have much available calcium floating around. So in order to up its levels, calcium, eager to join phosphate, starts leeching extra calcium from the first place where it can find it – our bones.

    Let me be very clear here – if your calcium intake is adequate, the occasional diet soda is not going to make you develop osteoporosis.

    But, in looking at teenagers, for instance (many of whom are already calcium deficient and on top of that are guzzling down two or three sodas a day) this is a huge problem.

    Phosphoric acid is also responsible for wearing away enamel (a protective layer) on our teeth, leading to an increased risk of tooth decay.

    I don’t see anything wrong with having a soda here or there as a treat (i.e.: once or twice a month), but definitely take issue with soda being someone’s main source of fluids on a daily — or almost-daily — basis.


    Quick Tricks: Getting Enough Calcium/Preventing Osteoporosis

    According to current estimates, 90% of adult females and 78% of adult males in the United States are not meeting their daily calcium requirement.

    Depending on your age and gender, you should get anywhere from 1,000 to 1,300 milligrams of this VIP mineral every day.

    From the ages of 9 to 18, calcium intake should be at approximately 1,300 milligrams.

    From 18 to 50, it lowers slightly to 1,000 milligrams.

    After age 51, males and females should aim for at least 1,300 milligrams, although 1,500 milligrams are recommended.

    Here are some ways to sneak more calcium into your day — and prevent it from leaching out:

    • Include steamed or sautéed greens in your diet. One cup of collard greens provides 360 milligrams, while the same amount of kale contributes 300!
    • Make quinoa one of your staple grains. One cup of this Incan wonder grain contains 106 milligrams of calcium.
    • Potassium helps prevent calcium loss, so be sure to have two of the following foods every day: oranges, bananas, avocados, raisins, wheat germ, potatoes, tomatoes, and sweet potatoes.
    • Watch your protein intake. Excess protein results in the excretion of calcium from our bones. To find out how much protein your body requires, take your weight in pounds and divide it by 2.2. Then, multiply that number by .8. Your protein intake should not exceed 200% of this value.
    • Grin and bear it. Weight-bearing exercises help maintain bone density and slow down bone loss.
    • If you drink milk (dairy or a calcium-fortified alternative), aim for 2 servings a day. Hate it by itself? Add it to your coffee, or have milk-based smoothies.
    • Limit your intake of sodas. The phosphoric acid in them leeches calcium from your bones. And, yes, this applies to dark AND light sodas.
    • Know your sources. The following foods are calcium all-stars: non-fat yogurt, non-fat milk, fortified cereals, fortified orange juice, fortified soy milk, mustard greens, and kale

    Lift Weights to… Lose Weight?

    Many adults looking to shed those last few pounds sign up for aerobics classes, go on daily jogs, or take their bikes out for a ride. Although these are by no means bad decisions (any exercise is a good thing), they are missing out on a crucial component to weight loss — weight-bearing exercises.

    As a general rule, the more muscle you have, the more calories your body burns to simply maintain it.

    One reason why we need less calories as we age — apart from our metabolism slowing down — is that we lose muscle mass with time. Thus, the body burns less calories on a daily basis.

    Many women fear that doing weight-bearing exercises will turn them into Arnold Schwarzenegger with breasts, which could not be more far from the truth.

    Rather than do a few repetitions of heavy weights, doing 15 to 20 repetitions of a bearable weight will help tone muscles and eventually help the body burn extra calories. As an added bonus, this will also help with bone density issues — a key component in the fight against osteoporosis!

    Even better, weight-bearing exercises help your metabolism burn calories efficiently for several hours after you’re done.

    To really help your body burn calories, follow weight-bearing physical activities with cardiovascular ones.

    Remember, watch out for sports/energy drinks that are basically giving you the same amount of — or more! — calories that you just burned off.


    You Ask, I Answer: Diet Soda

    What are your feelings towards diet soda, especially those that use aspartame as a sweetener?
    — Hektor Suhr

    Although I don’t advocate diet soda (I would never recommend it to someone who doesn’t drink or like it), I also am not about to throw a bucket of corn syrup on the next celebrity featured in Diet Coke’s latest ad campaign.

    As far as aspartame goes, the jury is still out as far as I am concerned. It is obviously legal to have in the food supply, but there haven’t been many long-term studies done with it. There is no reason to panic and completely avoid it, but I also wouldn’t feel 100% kosher downing 4 Diet Cokes a day, every day.

    My biggest issue with any soda (regular or diet) is the presence of phosphoric acid.

    See, our bodies like to stay in balance (you might remember the term “homeostasis” from your high school biology class). Calcium and phosphate, in particular, are two minerals that are actually good buddies.

    In fact, they’re inseparable. If one’s level in our blood goes up, the other one wants to go up as well. So when you drink that can of diet soda, your body’s phosphate levels rise. Calcium sees this, and says, “Wait a second, I want to go up, too!”

    If you are like most people in the United States, your calcium intake isn’t as high as it needs to be, meaning you don’t have much available calcium floating around. So, in order to up its levels, calcium — eager to join phosphate — starts leeching extra calcium from the first place where it can find it – our bones.

    Let me be very clear here – if your calcium intake is good, the occasional diet soda is not going to harm you or make you develop osteoporosis. But, in looking at teenagers, many of whom are already calcium deficient and on top of that are guzzling down two or three sodas a day, this is a problem.

    Although we don’t see the physical consequences of osteoporosis until middle age, this silent disease starts when we are young, especially if our body is constantly leeching calcium out of our bones! If you absolutely must have diet soda every day, you need to sure you are getting sufficient calcium to prevent your bones from losing this crucial mineral.

    My other issue with diet soda is that it usually triggers unhealthy cravings (potato chips, pretzels, buttery popcorn, hamburgers, French fries, etc). When was the last time you were jonesing for a fruit salad and a Diet Pepsi?


    Numbers Game: Answer

    The average adult in the United States takes in 35 % of his/her recommended daily calcium intake.

    No wonder 10 million Americans are living with osteoporosis (progressive bone loss that greatly increases the risk of fractures) and 18 million are currently at risk of developing it.


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