In our last blog, Dr. Doyle-Lucas discussed the importance of getting enough protein in your diet to support proper post-surgical healing. Next we will discuss the key vitamins and minerals essential for healthy bones. The first is CALCIUM. Calcium is a mineral essential to our skeleton; our bones make up 99% of our body’s calcium store,however most of us fail to meet the recommended daily allowance.  Interestingly, calcium has been observed to act synergistically with protein on bone formation.  Good food sources include diary, fortified foods like tofu or rice milk, seeds, dark leafy greens such as kale and spinach, broccoli, and beans like navy, soy, pinto, garbanzo, and Lima. Make sure you are getting about 1200 mg of calcium daily.  To obtain this in a day, you could eat one cup cooked spinach (245 mg), one ounce cheddar cheese (212 mg), one cup raw broccoli (45 mg), one cup low fat yogurt (415 mg), and one 100g serving of tofu (300 mg). What key vitamin works with calcium to promote bone health?  The answer is VITAMIN D.  Adequate levels of vitamin D are necessary for the absorption of calcium.  If your intake of calcium is sufficient, but your vitamin D levels are low, calcium will not be utilized efficiently.  Osteoporosis and poor bone health is often the result.  Also, because Vitamin D is a hormone, it plays a significant role in many other aspects of our health.  Vitamin D deficiency has been linked to multiple sclerosis, rheumatoid arthritis, irritable bowel disease, cancer, and heart disease.  Vitamin D deficiency rates are extremely high, with 1 billion people worldwide and almost half of the U.S. population testing in at insufficient levels.  The best source of vitamin D comes from the sun, however, our ability to make vitamin D depends on where we live, the time of year, and the time of day.  Cloud cover alone can reduce vitamin D3 synthesis by 50-75%!  In cloudy Ohio, we make no vitamin D during the months of November to February, and none in the early morning or late afternoon during any time of the year.  If we wear a sunscreen with a SPF of 15 or more, vitamin D production decreases by 99%.   As the summer approaches try to spend 10 to 15 minutes in the sun between 10am and 3pm, 2 to 3 times per week without sunscreen.  Individuals with darker skin need even more time in the sun.  Getting enough vitamin D from food sources alone is almost impossible.  Nevertheless, eating fatty fish like salmon, mackerel, and tuna will help you reach your goal.  A small amount of vitamin D is also found in egg yolks, cheese, and fortified milk. VITAMIN C is another nutrient of focus.  Because of its antioxidant properties, this vitamin has the ability to neutralize the effects of free radicals that are known to promote disease. Vitamin C therefore, plays an integral part in wound healing and immune function.  Adequate levels have even been associated with faster healing time following fracture and/or surgery.  Vitamin C also aids in collagen synthesis, a necessity for normal bone development and maintenance of bone mass.  Although findings are conflicting, there is some evidence that vitamin C prevents the post-operative complication of regional pain syndrome in foot and ankle surgery.   The recommended daily allowance for vitamin C is 90 mg for men and 75 mg for women, however during periods of healing the body requires more with suggested intakes of 500 mg.  Fruits and vegetables that are orange, yellow, red, and green are usually good sources.  Here are a few common foods with their vitamin C content:  medium orange (70 mg), kiwi (64 mg), strawberries (1/2 cup; 49 mg), cantaloupe (1/2 cup; 29 mg), broccoli (1/2 cup; 39 mg), Brussels sprouts (1/2 cup; 48 mg), bell peppers (1/2 cup; 95 mg), and strawberries (1/2 cup; 49 grams). ZINC has been shown to work synergistically with both vitamin C and protein on bone health.  Zinc, like vitamin C, promotes wound healing, is essential for collagen synthesis, unites bone fractures, and prevents osteoporosis.  Zinc deficiency is linked to poor bone health.  Oysters happen to be the best source of zinc, but beef, dark poultry meat, pork, and crab also have moderate amounts.  Fortified cereals, dairy, beans, and nuts also provide a small amount of zinc.  By eating 3 ounces of dark meat chicken, one ounce of cashews, one cup milk, and 2 ounces of roast beef you would consume your recommended allowance. A quick mention of OMEGA-3 fatty acids will round out our discussion on the key building blocks of a surgical recovery diet.  These fatty acids, specifically DHA and EPA, have been found to have a positive effect on bone formation and may protect against bone loss.  Their anti-inflammatory properties, that have been well-documented for improving heart health, are newly associated with protective mechanisms against disease causing agents of the bone.  Most individuals do not consume ideal levels of Omega-3 fatty acids, so be sure to keep tabs on your own intake.  Consuming cold-water fatty fish like salmon, tuna, and/or halibut twice per week is a good idea.  Flax seeds, walnuts, canola, and tofu provide moderate amounts as well.  Cod liver oil is one if the best sources of omega-3 fatty acids and can be taken in supplement form. In general, eating a diet high in fruits, vegetables, lean meats, and healthy fats while reducing processed foods and added sugars is imperative to your overall health.  Focusing on adding foods associated with the aforementioned bone healthy nutrients into your diet should also aid in a speedy recovery.  Stay tuned as more information will be provided on eating for optimal bone health within the following weeks.