1. Food gives our bodies more than just energy.
It also provides our bodies with vitamins and minerals. Many vitamins and minerals have been studied and we know if we don’t get enough of them – the result can be ill health. This is referred to as a vitamin or mineral deficiency.
Some deficiencies are more common than others and today we will be talking about:
Vitamin D and the minerals calcium and iron
What happens if we don’t enough of these important vitamins and minerals
Which foods are the best sources of iron and calcium
Some everyday tips to increase and maintain your levels of these vitamins and minerals
We are focussing on these three nutrients today because:
One in two women (half) and one in three men (a third) aged over 60 years - living in Australia - will have a bone fracture due to osteoporosis
Getting enough calcium and vitamin D is one key way to reduce the risk of developing osteoporosis
In Australia it is estimated that one in three women of childbearing age are iron deficient by the age of years.
Women are a group who need to take extra care to ensure they are getting enough iron otherwise they can become iron deficient and eventually anaemic, which can mean they get sick more often and take longer to recover.

2. Calcium and Osteoporosis
Let’s start with calcium. Why is calcium important?
Every time you move a muscle or your heart beats, calcium is being used. It is also needed to build strong teeth and bones. It is such an important mineral that the body needs to keep a constant level of calcium in the blood stream at all times.
What happens if we don’t get enough calcium?
Our bones act as a storage bank for calcium. If the calcium level drops in the blood, the body takes some calcium from the bones – to keep the level constant in the blood. Over time, if more calcium is taken from the bones than deposited - then the bones become weak and osteoporosis may develop. As well as eating enough calcium, getting regular exercise is also important for bone health and strength.
Prevention of osteoporosis
Your bones are the strongest they will be (called peak bone density) by the age of 30 however most of your bone strength develops when you are a teenager. So the best way to prevent osteoporosis and make sure you have enough calcium ‘in the bank for your later years’ is to start young. This is why it is particularly important for children to get enough calcium and to get out and be active every day.
After the age of 30, calcium starts to be lost from the bones, but you can slow it down by:
Eating foods that contain calcium every day
Getting out and being active on most days of the week.
and make sure that you address other things that can harm your bones and make them weak:
stop smoking – studies show that people who smoke have a higher risk of having a bone fracture
too much salt – as excess salt is processed through the kidneys it takes some calcium with it
don’t have excessive amounts of caffeine (strong tea, coffee or soft drinks containing caffeine or guarana). Drinking too much caffeine can have a diuretic effect – and flush calcium out of the body. Studies have also found that teenagers who drink soft drinks have softer bones than those teenagers who don’t drink soft drinks (including diet drinks)
if you choose to drink alcohol, drink in moderation (no more than two standard drinks a day) alcohol interferes with calcium absorption

3. Calcium and Osteoporosis
Some people are more at risk of developing osteoporosis than others:
It is estimated that more than 60% of Australian women do not get enough calcium
Post-menopausal women - over the life span women will lose more calcium from their bones than men. This is because when the female hormone oestrogen drops around menopause the calcium losses speed up for about 5-10 years
Lack of sunlight - Vitamin D is produced when our skin is exposed to the sun. It works with calcium to
strengthen bones and increase the amount of calcium ‘stored’ in the bones. So people who do not get enough sunlight on their bare skin may also be at risk of developing osteoporosis (this will be discussed more in the vitamin D section).
Where do you get calcium from?
There are only a few foods that contain large amounts of calcium, and smaller amounts are found in a variety of other everyday foods such as green leafy vegetables, nuts and fish with edible bones, such as sardines and salmon (the bones contain the calcium – so if you’re not eating the bones, you’re not getting the calcium)
Dairy foods (milk, yoghurt and cheese) are the best source of calcium. The calcium from these foods is easily absorbed by the body
If people drink an alternative like soy milk make sure calcium has been added (fortified). Look for a milk that has 100 mg of calcium per 100 grams – this information is on the Nutrition Information Panel on the label
Adults need 2 ½ - 3 serves of dairy foods (or alternatives like calcium fortified soy milk) a day. This will provide the majority of the calcium needed. If a good variety of other foods such as, breads, cereals, fruits and vegetables are included as well – this will make up the rest of the recommended daily intake of calcium.
The best way to get calcium is through food, however some people need to take supplements. Take them at night as your body will absorb them better and don’t take them at the same time as any iron supplements as the iron may prevent some of the calcium being absorbed.
Older adults should aim for 3½ - 4 serves of dairy foods or alternatives per day, especially women, to compensate for a greater loss of calcium from the bones around menopause.
NOTE: if anyone in the group is concerned about their calcium intake, they should seek advice from a doctor or registered dietitian

4. Iron and anaemia Why is iron important?
Iron helps to keep our immune system working properly which helps to fight illness. However, the most important function of iron is to make healthy red blood cells. When blood cells are healthy they take oxygen around the body – so without enough iron - you can start to feel very tired.
We do store some iron in our body – but we also lose some every day through sweat, shedding cells in the stomach and during menstruation, so iron stores need to be replaced daily with iron from food – a similar story to calcium.
Health consequences of not getting enough iron
Over time, if iron stores drop too low, and aren’t replaced, your muscles won’t get enough oxygen, which can lead to iron depletion, iron deficiency and in extreme cases - anaemia. The symptoms of anaemia include:
excessive tiredness or fatigue
low immunity (you may get sick more often and take longer to recover)
feeling the cold more
an inability to concentrate
People most at risk of developing iron deficiency or anaemia
Iron deficiency is the most common nutritional deficiency in the world and effects mostly women. In Australia it is estimated 8% of the population are iron deficient
Women who are menstruating are most at risk of iron deficiency, especially if monthly blood losses are heavy
A high number of pregnancies also increases the risk of iron deficiency because you need more iron during pregnancy to support the growth of the baby and blood losses can be quite high during delivery
Young children under the age of 2 – babies are born with enough iron stores to last six months, after this they must eat iron rich food to maintain sufficient levels.
Vegetarians need to pay special attention to their iron intake – we’ll discuss this in the next section.

5. Food sources of iron Food sources of iron
There are two types of iron in food:
Animal sources (haem iron)
 Found in red meat, chicken and seafood. This type of iron is easily absorbed by the body
Non-animal sources (non-haem iron)
Found in legumes, wholegrains, fortified breakfast cereals and bread, dark green leafy vegetables (broccoli), nuts, seeds, eggs, dried fruit, dried beans and peas. This type of iron is not so easily absorbed – and this means people who don’t eat meat need to be careful to include enough non-animal sources of iron in their diet.
How can you help your body to absorb more of the iron in food?
Non-haem iron is absorbed better if some haem iron is eaten at the same meal or a food containing vitamin C is eaten at the same meal.
Haem iron – (red meat, chicken or seafood) – the redder the meat, the more iron it contains (so chicken and fish don’t contain as much iron as red meat)
A food containing vitamin C - Vitamin C is found in a wide variety of fruits and vegetables and is another great reason to include fruit and vegetables at each meal
…also
Cut back on tea and coffee at meal times as the tannins found in these drinks stop your body from absorbing iron.
Note: Vegetarians also need to ensure they are getting enough B12 in their diet.
B12 is important in the formation of red blood cells, nerve cells and DNA material
Deficiency can result in a type of anaemia call pernicious anaemia
Only animal products contain B12 that can be absorbed by the body (meat, milk, eggs, cheese , yoghurt). Vegans need to eat foods fortified with B12 (e.g. soy milk) or take a supplement
Other food sources (seaweed, tempeh, miso, spirulina) also contain B12 but it is not in a form the body can use.
NOTE: if anyone in the group is concerned about their iron intake, they should seek advice from a doctor or registered dietitian. Iron supplements should only be taken under a doctor’s supervision.

6. Why is vitamin D important?
Vitamin D combines with calcium to build strong bones as well as being essential for general good health.
What happens if you have low levels of vitamin D?
If a person does not have adequate vitamin D levels, they may be at risk of developing osteoporosis later in life. Vitamin D deficiency can also lead to bone pain, muscle weakness and rickets (soft bones that do not from properly) in children.
People most at risk of low vitamin D levels:
Dark skinned people (especially if veiled)
dark skin is not as good at making vitamin D as fair skin
Older people and people who are housebound
this group of people is not as likely to be outdoors and the ability to produce vitamin D gets less with age
Little or no sun exposure
if people work indoors or need to cover up for religious or cultural reasons their exposure to sunlight may not be enough to produce adequate amounts of vitamin D
Breastfed babies whose mothers have low vitamin D stores
breast milk is the best first food for babies, however babies are not born with vitamin D stores and so they rely on the small amounts found in breast milk. If the mother is low in vitamin D, then the baby is also unlikely to get enough vitamin D.

7. Sources of vitamin D
The average person will not be able to get enough vitamin D from food alone, so it is important to get adequate
exposure to sunlight and take supplements to restore levels, if they are low. Foods that contain small amounts of vitamin D include:
Oily fish, dairy products, fortified products (e.g. some margarines) and eggs
Maintenance of vitamin D levels
To maintain vitamin D levels for a person living in South Australia during summer you should expose your face, arms and hands (or the equivalent skin area) before 11am and after 3pm on most days of the week for 5-7 minutes. During summer the sun can be very harsh. Common sense is needed to balance the risk of skin cancer with the health benefits of getting enough vitamin D
During winter (May to August) two to three hours a week of sun exposure is needed to maintain vitamin D levels. Expose arms (or legs) face and hands to the sun for 20 minutes on most days of the week
Recaps the main points from the session:
Eat three serves of mostly reduced-fat dairy (or alternatives) every day and get regular exercise each day to prevent osteoporosis
Eat fruit or vegetables with each meal to help your body to absorb iron
Sun exposure and not food is the best way to maintain vitamin D levels
If you are concerned about levels of iron, calcium or vitamin D you should consult your GP or a registered dietitian
Never take supplements without consulting your GP – and get your levels checked regularly so you know when you can stop taking supplements

8. Distribute the ‘Vitamins and minerals for health’ activity sheet
Explain the activity to participants:
Read each of the four questions and circle the correct answer
Give participants 3 minutes to complete the activity
Discuss the answers as a group
Note: you may have to read questions to participants if they English skills are limited

9. Answers – click to reveal the answers one by one
Sunlight – You won’t get enough vitamin D from food alone. Expose your face, hands and arms (or legs) most days of the week to the sun. If you are worried about your vitamin D levels see your doctor
20 minutes – Expose face, hands and arms (or legs) for 20 minutes most days of the week in winter time. In summer time the sun can be very strong. Stay out of the sun between 11am and 3pm and reduce the time to 5-7 minutes.
All of these foods provide some calcium. The best sources are cheese, milk, yoghurt, sardines (as long as you eat the bones). Eat three serves of dairy each day (or alternatives like soy milk, fortified with calcium) and a good variety of other foods to get enough calcium.
Older adults should aim for 3½ - 4 serves of dairy foods or alternatives per day, especially women, to compensate for a greater loss of calcium from the bones around menopause.
The vitamin C in fruits and vegetables help to absorb the iron in haem and non-haem foods. Include fruit or vegetables at every meal.

10. What did you think of today’s session?
What do you remember most from today?
Do you think you know more about how to get enough vitamin D, calcium and iron?
What are you going to do differently?
Group discussion – these questions may need to be asked differently depending on your participants
What will you take away from the session?
Do you feel more confident about the ways in which you can get more vitamin D, calcium and iron than you did before the session?
What changes, if any, do you plan to make as a result of todays’ session?

11. Developed by HELPP,
Funded by SA Health, and managed by
Nutrition & Dietetics, Flinders University
Contact: Food Safety and Nutrition Branch, SA Health Tel:
or Nutrition & Dietetics, Flinders University Tel