Eating the Right Foods


Strategic Nutrition for Healthy Bones

If you think calcium and bone health are joined at the hip, you’re right. Calcium is essential for building and maintaining healthy bones. However, no single nutrient works in isolation. As the science of nutrition has matured, we’ve learned a great deal about the interplay between a variety of nutritional factors, and we’ve begun to understand our bodies as complex biological systems.

The question is: How can we make bone-healthy choices based on that complex understanding? It all may sound like a lot of trouble, especially if you’re saddled with ulcerative colitis or Crohn’s disease. Between negotiating treatment regimens, fighting to achieve control of your symptoms, and dealing with the effects of your disease on your quality of life, you’ve probably got your hands full. The last thing you need is a complicated set of nutritional instructions for every body part. As far as your bones are concerned, a glass of milk and a daily calcium supplement should do it, right?

“Bone-healthy nutrition isn’t that simple,” says Leslie Bonci, a registered dietician at Pittsburgh Medical Center, “but it’s definitely doable. You don’t have to go out of your way or shop at a dozen different stores to stock up on bone-healthy foods.”

The first rule of thumb, she explains, is to make sure you’re taking in enough calories from the food you eat (plus liquid supplements, if necessary). Your body can only build and maintain bone tissue if you give it enough fuel to carry out its basic physiological functions. So do your best to keep those calories coming.

Beyond total calories, Bonci says, five specific nutrients play a larger-than-life role in protecting the integrity of your bones:

  1. Protein. In addition to providing the “scaffolding” for bone tissue, dietary protein stimulates the production of insulin-like growth factor-1 (IGF-1), which promotes new bone formation.
  2. Fats. You’ve probably heard of fat-soluble vitamins—a group that includes vitamins A, D, E, and K. Two of these, vitamins D and K, are crucially important for bone health. Without sufficient fats in your diet, your body won’t be able to absorb enough of these vital micronutrients. A low-fat diet is fine, but low-fat should never mean no-fat.
  3. Calcium. Required for bone formation and for maintaining adequate bone mass, calcium is necessary for bone health at every stage of life. In healthy adults, about 200 mg of calcium are removed from the skeleton and replaced each day. To make sure that balance doesn’t tip unfavorably toward bone loss, eat a variety of calcium-rich foods. Your doctor or nutritionist may also recommend a daily supplement.
  4. Vitamin D. You get it actively through food and passively through exposure to sunlight, and it’s even more important for healthy bones than previously believed. Without adequate vitamin D, your body won’t be able to absorb enough calcium. A vitamin D blood level can help determine the amount of supplementation that you need. You can boost your intake of vitamin D with 15 minutes of sunlight a day as well.
  5. Vitamin K. It cooperates with proteins that build and maintain bone, and its absorption depends on fats. In other words, vitamin K is a biochemical “team player” in bone metabolism. Dark green vegetables provide the lion’s share of this vitamin through food, with certain oils a distant second. Surprisingly, most people don’t get quite enough vitamin K—a good reason to make better friends with your veggies, if you can handle them.

Boning Up on Nutritious Foods

When you go down the list of bone-healthy nutrients and how to get more of them, you may notice that the same foods keep coming up over and over.

“Take peanut butter,” says Bonci. “It’s rich in protein, good fat, and magnesium—a mineral that helps your body absorb calcium—and it nourishes your bones while giving you energy to burn. Milk provides protein, calcium, and vitamin D, another three-for-one winner. Omega-3-enriched eggs, which are readily available in many supermarkets, are an excellent source of protein, fats, and vitamin D. Canned salmon is rich in protein, calcium, and omega-3 fatty acids, while dark green vegetables are packed with calcium and vitamin K.

“The point I want to make,” she concludes, “is that you can leverage a fairly short list of foods to give your bones the nourishment they need.”

Once you consult the following table, it’s clear that Bonci’s advice is spot on. Many of the foods listed contain not just one but two or even three key nutrients considered critical for building and maintaining healthy bones at every age.

Familiarize yourself with them, juggle and combine them, and see what kinds of bone-enhancing meal plans you can come up with!

Nutrient Best Sources 
Protein Complete Protein: Meat, poultry, fish, shellfish, soy products, eggs, and low-fat dairy foods
Incomplete Protein: Legumes, grains, nuts, seeds, and vegetables
Bone-Friendly Fats Fatty fish, walnuts, and flaxseed oil (all rich in omega-3 fatty acids), nuts and nut butters
Calcium Milk Dark green leafy vegetables (such as kale, mustard greens, and arugula), and calcium-fortified foods and beverages
Vitamin D Milk, egg yolk, liver, fortified cereals
Vitamin K Collard greens, spinach, broccoli, Brussels sprouts, cabbage, and plant oils


Bone Robbers

Protecting the health of your bones, says Arthur Heller, M.D, can be approached both positively and negatively.

Board-certified in both Nutrition and Gastroenterology, Dr. Heller concurs with Bonci’s dietary recommendations. He also adds regular exercise to the list of positive steps people with Crohn’s or colitis can take to prevent osteoporosis or slow its progress.

Then, there are the negatives. “There are a number of diet and lifestyle factors that thwart calcium absorption and worsen the risk of osteoporosis,” says Dr. Heller, who points to the following bone robbers:

  • Phytates: These phosphorus compounds are found mainly in cereal grains, legumes, and nuts. They bind with calcium, iron, and other minerals and interfere with their absorption in the body. To counter their effects, cook grains and legumes thoroughly; add milk to cereal; and choose whole grains instead of refined ones.
  • Alcohol: An unabashed calcium robber. Limit your alcohol consumption and your bones will thank you.
  • Smoking: It’s bad for just about every part of your body, including your bones, and it aggravates the symptoms of Crohn’s disease. There’s no compromise when it comes to smoking: just quit.
  • Tea and coffee: Both hinder calcium absorption, but the extent of their bone-robbing effects has not yet been determined. To stay on the safe side, limit yourself to a cup or two a day, and add milk for a little shot of calcium.
  • Cola: Recent research has indicated a possible link between cola and bone loss, especially among young people. For a calcium boost, replace that carbonated beverage with milk or calcium-fortified soy milk, and drink water when you’re thirsty.
  • Corticosteroid Medications: These literally wash calcium right out of your bones. If you’re on steroids, focus on calcium-rich foods, take supplements, and go for regular bone density testing.

“Inadequate vitamin D intake may be the most serious bone robber of all,” says Dr. Heller. “Sometimes, doctors treat osteoporosis with bisphosphonate drugs such as Actonel® or Fosamax® but fail to consider the possibility of vitamin D deficiency. Vitamin D supplementation is an important aspect of patient care that’s frequently overlooked.”

A final piece of advice from the doctor: Don’t go it alone. To develop a bone-friendly lifestyle and dietary strategy, see your doctor and discuss your options with a nutritionist.



For further information, call the Irwin M. and Suzanne R. Rosenthal IBD Resource Center (IBD Help Center): 888.MY.GUT.PAIN (888.694.8872).

The Crohn’s & Colitis Foundation of America provides information for educational purposes only. We encourage you to review this educational material with your health care professional. The Foundation does not provide medical or other health care opinions or services. The inclusion of another organization’s resources or referral to another organization does not represent an endorsement of a particular individual, group, company or product.

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Published: June 1, 2012