1. June 20081 Disease / Deficiency

2. Bones are living organs Calcium is deposited and withdrawn from bones daily. Bones continue to deposit more bone than loss until about age 30. We need to build up a healthy bone account while young and continue to make deposits with age.

3. Lawrence Riggs, MD, Surgeon General’s Workshop Osteoporosis Prevention

4. June 2008 4 Osteoporosis Osteoporosis causes weak bones Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealthhttp://www.surgeongeneral.gov/library/bonehealth Normal Bone Bone with Osteoporosis

5. June 2008 5 Bone Density Factors Over Time National Academy of Sciences, Institute of Medicine (1997) Copyright Robert P. Heaney, M.D., 2003. Used with permission

6. After mid-30’s, slowly lose bone mass Faster bone loss after menopause Bones can weaken early in life without a healthy diet and the right kinds of physical activity. Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealthhttp://www.surgeongeneral.gov/library/bonehealth

7. June 2008 7 Risk Factors for Osteoporosis Genetics 60% to 80% n Gender n Ethnicity n Age n Hormonal status n Body frame & weight n Medications n Disease States Environmental 20% to 40% n Cigarette Smoking n Alcohol n Caffeine n Diet (low calcium intake) n Exercise

8. Four prevention steps … Enjoy a diet rich in calcium Engage in regular weight-bearing exercise. Avoid smoking and excessive alcohol. Talk to your doctor about bone health. Have a bone density test and take medication when appropriate.

9. Low Bone Mass = Increased Osteoporosis Risk Shortfalls contribute to risk for osteoporosis and future hip fractures Osteoporosis: A pediatric disease with geriatric consequences

10. June 2008 10 Lactose Intolerance Choose Dairy First to Enhance Diet Quality Try These Tips for Tolerance rink milk with meals. ged cheeses like Cheddar and Swiss are naturally low in lactose. ntroduce dairy slowly. Gradually increase the amount. educe it. Enjoy lactose-free milk and milk products. ogurt with live active cultures helps to digest lactose.

11. DASH Defined Dietary Approaches Stop Hypertension

12. Hypertension Facts & Figures 50 million Americans with hypertension 1 in 4 adults One-third unaware Increased risk for heart disease, stroke, cardiac/kidney failure $32 billion in healthcare costs

13. June 2008 13 Public Health Priority Healthy People 2010 Goal:  blood pressure from 28% to 16% of adults. - US Department of Health and Human Services

14. June 2008 14 Lifestyle Changes to Control/Prevent High Blood Pressure Lose weight Increase physical activity Limit alcohol Stop smoking Reduce sodium, saturated fat, cholesterol Consume adequate calcium, potassium, magnesium - 6 th Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

15. The DASH Trial N = 459 adults – 49% women – 60% African Americans Systolic < 160 mm Hg Diastolic 80 – 95 mm Hg - Appel, et al., N Engl J Med, 336:1117, 1997

16. Combination “DASH” Diet Lowered Blood Pressure Most Effectively

17. June 2008 17 DASH Diet Benefits Quick and lasting results Results rival medications Potential to reduce disease risk and healthcare costs

18. Who DASH Diet Benefits Most Hypertensives:  11.4/5.5 mm Hg African Americans: Systolic  6.8 mm Hg vs.  3.0 mm Hg in whites

19. June 2008 19 The DASH-Sodium Trial

20. June 2008 20 The DASH-Sodium Trial N = 412 adults –57% women –57% African Americans Control Diet vs. DASH Diet Sodium level (30 days each) –High (3,300 mg) –Medium (2,400 mg) –Low (1,500 mg) - Sacks, et al., N Engl J Med, 344:3, 2001

21. DASH II Sodium

22. Why Does the DASH Diet Lower Blood Pressure? Mineral Mix Calcium Potassium Magnesium

23. June 2008 23 Milk’s Mineral Mix Also Reduces Stroke Risk Calcium, potassium, magnesium in Milk Group foods reduce risk factors for stroke. All three minerals work in concert. Naturally found in milk, yogurt, cheese. - Massey, J Nutr, 131:1875, 2001

24. June 2008 24 Beyond Blood Pressure: DASH Reduces Heart Disease Risk Factors

25. June 2008 25 DASH Reduces Cholesterol Subjects following DASH diet:  Total cholesterol 13.7 mg/dL  LDL cholesterol 10.7 mg/dL  HDL cholesterol 3.7 mg/dL Obarzanek, et al Am J Clin Nutr, 74:80, 2001

26. Health Professional Groups Advocate DASH 6 th Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure - National Heart, Lung and Blood Institute

27. American Heart Association 2000 Dietary Guidelines 4 2-4 servings lowfat dairy foods; 5-9 servings fruits/vegetables recommended 4 Calcium, potassium, magnesium from foods such as milk, yogurt, cheese Krauss, et al, Circulation, vol. 102:2284, 2000

28. June 2008 28 More DASH Resources National Heart, Lung and Blood Institute: www.nhlbi.nih.gov American Heart Association: www.americanheart.org American Dietetic Association: www.eatright.org