Healthy eating on a plate: eating for health made simple
Module 5: Nutrients at Risk
Healthy eating on a plate: eating for health made simple
Module 5 – Nutrients at Risk, June 2013
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Healthy eating on a plate: eating for health made simple
Contents
Module 5: Nutrients at Risk ................................................................................................................ 1
Learning Outcomes ............................................................................................................................. 1
Key Messages ...................................................................................................................................... 1
Checklist for session ............................................................................................................................ 1
Session outline: Nutrients at Risk ....................................................................................................... 2
Presenter notes for Module 5: Nutrients at Risk ................................................................................ 3
Calcium................................................................................................................................................ 3
Iron ...................................................................................................................................................... 5
Vitamin D ............................................................................................................................................ 6
Group discussion ................................................................................................................................. 8
Some things to consider when presenting this module ..................................................................... 8
Website resources .............................................................................................................................. 9
Appendix A – Resources…………………………………………………………………………………………………………10
Activity Sheet – ‘Vitamins and minerals for health’
Activity Sheet - Answers – ‘Vitamins and minerals for health’
Appendix B – Script and flashcards……………………………………………………………………………………..13
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Healthy eating on a plate: eating for health made simple
Module 5: Nutrients at Risk
In Australia, people in the community may be instructed by their doctor to take supplements from
time to time. It is important that supplements are only taken under supervision and that people
know how to maintain nutrient levels through diet and other means once supplements are no longer
necessary. This module looks at simple strategies to address iron, calcium and vitamin D
deficiencies.
Learning Outcomes: By the end of the session participants will be able to:
 Identify which foods are the best sources of iron and calcium
 Implement simple strategies to address key nutrient deficiencies
 Understand that adequate exposure to sunlight and not diet is the best way to gain sufficient
vitamin D
Key Messages:



Eat three serves of reduced-fat dairy (or alternatives) each day
Eat fruit or vegetables with each meal to enhance iron absorption
Sun exposure and not food is the best way to maintain vitamin D levels
Checklist for session:




Script and flashcard set for Module 5: Key nutrients
Activity Sheet – ‘Vitamins and minerals for health’
Activity Sheet - Answers – ‘Vitamins and minerals for health’
Pens
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Healthy eating on a plate: eating for health made simple
Session outline: Nutrients at Risk
Time
2 mins
5 mins
5 mins
5 mins
3 mins
10 mins
Activity
Introduction and overview of the session
 Understanding why our bodies need calcium, iron and Vitamin D
 Health consequences of inadequate intake of these nutrients
 Best sources of these important nutrients
Calcium
Discussion Points:
 Why is iron important?
 Health consequences of not getting enough calcium
 Prevention of osteoporosis
 People at risk
 Food sources of calcium
Iron
Discussion Points:
 Why is iron important?
 Health consequences of not getting enough iron
 People at risk
 Types of iron (haem and non-haem)
 Food sources of iron
 Help your body to absorb more of the iron in food
Vitamin D
Discussion Points:
 Why is vitamin D important?
 Health consequences of not getting enough vitamin D
 People at risk
 Sources of vitamin D
 Maintaining vitamin D levels
Recap of main points
Resources required
In-class activity
 Participants will complete the activity sheet ‘ Vitamins and minerals
in food’
 Discuss answers as a group.
Group discussion
 Discuss what participants have learnt, confidence and intention to
change
Activity sheet ‘Vitamins and
minerals for health’
Answer sheet ‘Vitamins and
minerals for health’
Module 5 – Nutrients at Risk, June 2013
Flashcard: ‘Calcium
and osteoporosis’
Flashcards: ‘Iron
and anaemia’ and
‘Food sources of
iron’
Flashcards:
‘Vitamin D and
osteoporosis’
‘Vitamin D’
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Presenter notes for Module 5: Nutrients at Risk
Give an overview of what participants can expect to learn during the session
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. Today we are going to
focus on three of the most common deficiencies in Australia and discuss:



Why we need calcium, iron and vitamin D
The health consequences of not getting enough of these important vitamins and minerals
The best sources of these vitamins and minerals
Display ‘Calcium and Osteoporosis’ flashcard
Calcium
Why is calcium important?
Calcium is needed to carry out many important roles in the body
including maintaining the normal functions of the muscular and
nervous systems. It is such an important mineral that the body
needs to keep a constant level of calcium in the blood stream at all
times.
Osteoporosis means ‘bones with
holes’. The condition itself will
not cause pain or illness;
however as bones lose calcium,
they lose strength and are easily
broken (fractured).
The most common breaks occur
in the spine, upper arm, wrist,
ribs, forearm, pelvis and hip.
Bones can break even with a
minor fall or knock.
Health consequences of not getting enough calcium
A person may show no signs of
Our bones act as a storage deposit for calcium. If the calcium level
osteoporosis until a fall occurs
drops in the blood, the body will withdraw some calcium from the
which results in a fracture or
bones to make up the shortfall. Over time, if more calcium is
break.
withdrawn 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 the bone strengthening occurs during early adolescent when the growth rate is highest. So the
best way to prevent osteoporosis is to start young. This is why it is particularly important for children
to get enough calcium and to be physically active every day.
After the age of 30, you can slow down the rate at which calcium is lost from the bones by making
sure you eat enough calcium every day and get regular exercise. You may also like to consider other
things that may be harming your bone health such as:





Smoking – studies show that smokers have an increased risk of bone fractures
Too much salt – when excess salt is processed through the kidneys it takes some calcium with it
Excessive amounts of caffeine (strong tea, coffee, caffeinated soft drinks). Drinking too much
caffeine can have a diuretic effect – and flush calcium out of the body.
o this includes products that contain guarana, which is a form of caffeine
Excessive soft drinks - studies have found that teenagers who drink soft drinks (including diet
drinks) have softer bones than those teenagers who don’t drink soft drinks
Excessive alcohol consumption – interferes with calcium absorption
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People most at risk of developing osteoporosis
According to the latest Nutrition Survey very few people in Australia are getting enough calcium
through the food they eat. Osteoporosis affects women more than men. In Australia 1 in 2 women
(half) and 1 in 3 men (a third) over the age of 60 will have a fracture due to osteoporosis.
Post-menopausal women
Both men and women lose calcium from their skeleton with age, however losses are generally
greater in women, especially around menopause when changes in hormone levels speed up the loss
of calcium from the bones. In Australia, the average age for a women to go through menopause is
51 years of age. Woman may go through menopause earlier or have menopause induced due to
medical conditions or surgery.
Lack of sunlight
Vitamin D is produced when our skin is exposed to the sun and works with calcium to strengthen
bones and increase calcium stores. For this reason, people who do not get adequate exposure to
the sun may also be at risk of developing osteoporosis (more information in the Vitamin D section).
Food sources of calcium
There are only a few foods that
Average amount of calcium (mg) in standard serve sizes
Food
Serve size
Calcium (mg)*
contain large amounts of calcium
Milk
250 ml glass
300-500 mg
with smaller amounts found in a
Yoghurt
200 g tub
300-400 mg
variety of other everyday foods.
Sardines (with the bones)
100g
400 mg
Dairy foods are the best source of
Cheese
40 g (2 slices)
300 mg
calcium. It is readily available and the
Salmon (with the bones)
100g
200 mg
Soya beans
100 g
200 mg
calcium in milk is easily absorbed by
Almonds
30
g
80 mg
the body. For those people who do
Bread (2 slices)
70 g
55 mg
not drink milk, make sure alternative
Orange
150 g
45 mg
products (e.g. soy milk) are fortified
Broccoli (cooked)
75 g
30 mg
with calcium (100mg per 100 mls).
*Adults need approximately 1000-1300 mg calcium per day
Adapted from FoodWorks 7 (Xyris 2012)
Eating 2½ serves of dairy foods
(cheese, milk, yoghurt) or alternatives fortified with calcium every day, along with a good variety of
breads, cereals, fruit, vegetables, nuts and seeds should be enough to get a good intake of calcium
for most people.
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.
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Display ‘Iron and anaemia’ flashcard
Iron
Why is iron important?
Iron plays a role in the proper functioning of the immune system and the
production of enzymes that help cells to function efficiently. However,
the most important function of iron is to form haemoglobin in red blood
cells and myoglobin in muscles. Oxygen attaches to the haemoglobin and
is then transported throughout the body to be used for energy in daily
life. The oxygen stored in myoglobin is released during strenuous
exercise.
Even though some iron is stored in the body, we lose iron every day through
sweat, shedding cells in the intestine and menstruation, so iron stores need
to be replaced daily with iron from food.
Health consequences of not getting enough iron
Over time, if iron stores drop, and aren’t replaced, this means that not
enough oxygen is able to be delivered to the body, 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
Anaemia develops when
there is not enough
haemoglobin or red blood
cells to carry oxygen around
the body.
This means the heart has to
pump harder to get oxygen
to the cells resulting in
feelings of exhaustion.
A person who eats a
mixed diet that
includes meat will
absorb about 18% of
the iron they eat.
A vegetarian/vegan
will absorb only 10%.
Vegetarian: does not
eat meat, but may eat
fish and other animal
products e.g. milk,
cheese, yoghurt
People most at risk of developing iron deficiency or anaemia
Vegan: does not eat
 Women who are menstruating are most at risk of iron deficiency,
any animal products
especially if monthly blood losses are heavy
 Pregnant women. The risk increases with each pregnancy due to the
greater demand for iron during pregnancy and breastfeeding and the blood losses that can occur
when giving birth
 Vegetarians need to pay special attention to their iron intake. They will need almost twice the
amount of iron as those people who include meat in their diets to get the same benefit (see
haem and non-haem sources of iron below)
 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.
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.
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Display ‘Food sources of iron’ flashcard
Food sources of iron
There are two types of iron present in food:
Haem iron
 Found in red meat, chicken and seafood. This type of iron is
easily absorbed by the body. The redder the meat the more iron
it contains ( chicken and fish do not have as much iron as red
meat)
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 by the body
Iron supplements
should only be
taken under the
supervision of a
doctor.
Help your body to absorb more of the iron in food
Non- haem iron is absorbed better if one or both of the following is included at the same meal:
 Haem iron (from red meat, chicken or seafood)
 A food containing vitamin C - most fruit and vegetables contain some level of vitamin C 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 interfere with the
absorption of iron.
Display ‘Vitamin D and osteoporosis’ flashcard
Vitamin D
Why is vitamin D important?
Liver is a good source of
iron; but it contains high
levels of vitamin A,
which can be toxic.
Pregnant women should
avoid eating liver for
this reason.
Vitamin D combines with calcium to build strong bones as well as
being essential for general good health.
Health consequences of 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 in children.
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People most at risk of low vitamin D levels
 Dark skinned people (especially if veiled)
o dark skin is not as good at making vitamin D as fair skin
Rickets affects babies and
 Older people and people who are housebound
young children who do not
o this group of people is not as likely to be outdoors and
get enough vitamin D.
the ability to produce vitamin D gets less with age
 Little or no sun exposure
Symptoms include soft,
o if people work indoors or need to cover up for
painful bones, fractures
religious or cultural reasons their exposure to sunlight
and bone deformities.
may not be enough to produce adequate amounts of
vitamin D
 Breastfed babies whose mothers have low vitamin D stores
o 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
Display ‘Vitamin D’ flashcard
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
 Mushrooms that have been exposed to UV light are also a good source of Vitamin D, however
this only applies to mushrooms specifically labelled as Vitamin D
mushrooms.
Get your vitamin D
Maintenance of vitamin D levels
levels checked by a GP.
 To maintain vitamin D levels for a person living in South Australia during
A blood test will show if
summer expose face, arms and hands (or the equivalent skin area) before
supplements are
11am and after 3pm on most days of the week for 5-7 minutes. During
needed.
summer the Australian sun can be very harsh. Common sense is needed to
Once vitamin D levels
balance the risk of skin cancer with the health benefits of getting enough
are restored,
vitamin D
supplements can be
 During winter (May to August) two to three hours a week of sun exposure
stopped, however
is needed to maintain vitamin D levels. Expose arms (or legs) face and
adequate measures to
hands to the sun for 20 minutes on most days of the week.
maintain vitamin D
levels should be in
Recaps the main points from the session:
place before stopping
 Eat three serves of dairy foods (or alternatives) and get regular exercise
each day to prevent osteoporosis (4 serves for women 50+ years and men 70+ years)
 Eat fruit or vegetables with each meal to enhance iron absorption
 Sun exposure and not food is the best way to maintain vitamin D levels
 If participants are concerned about their intake of any of these nutrients they should consult
their GP or a registered dietitian
 Never take supplements without consulting your GP
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Distribute ‘Vitamins and minerals for health’ activity sheet to participants
Give participants enough time to fill in the activity sheet and then go through the
answers. Clarify any points and collect the sheets. Make a note of how many
participants complete the activity sheet correctly.
Group discussion
Group discussion and evaluation


What will you take away from today’s session?
How confident are you that you can choose foods that will enable you to increase or maintain
your level of these important nutrients?
 What changes, if any, do you plan to make as a result of today’s session?
Make notes of comments throughout the session and questions asked when filling out the activity
sheet . An overall evaluation will be conducted at the end of the sessions.
Some things to consider when presenting this module






Taking a wide range of supplements can be concerning for many people. Emphasise the need to
consult a GP and have the use of supplements monitored
Muslim women may choose not to bare their arms in public. Finding a private place to expose
their skin to sunlight may be difficult
Refugees may have become accustomed to not eating meat due to scarcity or cost. This could
lead to B12 deficiency.
Non-vegetarians should be encouraged to eat meat (particularly red meat) 3-4 times per week
Vegetarians (no meat in the diet) and vegans (no animal products in the diet) should eat food
fortified with B12 or take supplements
Breastfed babies of vegetarian/vegan mothers are at particular risk of B12 deficiency. If the
mother’s B12 stores are low, the baby is unlikely to have any stores.
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Website resources
Assisting Torture and Trauma Survivors (ASeTTS) http://goodfood.asetts.org.au/is an organisation
set up in Western Australia in 2001 to improve the access to nutrition information available to new
arrivals. Good Food for New Arrivals is a website which includes resources and background
information on the health needs of new arrivals.
Calcium
Osteoporosis Australia http://www.osteoporosis.org.au/news/latest-news/clarifying-the-issuescalcium-vitamin-d-and-supplements/,
Calcium. Preventing osteoporosis is a major health concern in Australia. This website provides easy
to read information about the importance of calcium in preventing osteoporosis.
The Better Health Channel, Calcium,
http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Calcium
This website is funded by the State Government of Victoria and provides easy to understand
factsheets on a wide range of health issues. This fact sheet summarises the causes and treatment of
calcium deficiency in adults.
Iron
The Better Health Channel, Iron deficiency – adults
http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Iron_deficiency_adults
This website is funded by the State Government of Victoria and provides easy to understand
factsheets on a wide range of health issues. This fact sheet summarises the causes and treatment of
iron deficiency anaemia in adults.
Vitamin D
Bureau of Meteorology (BOM) http://www.bom.gov.au/uv/index.shtml the national weather,
climate and water agency. This website provides information on UV ratings and sun protection.
Cancer Council Australia, http://www.cancer.org.au/cancersmartlifestyle/sunsmart/vitaminD.htm,
Vitamin D is very important for bone health, and the best source is exposure to the sun, however in
Australia sun exposure needs to be carefully balance against the risk of skin cancer. This webpage
give practical advice on how to stay safe in the sun and still get enough vitamin D.
Vegetarian eating
The Better Health Channel, Vegetarian eating. Adopting a vegetarian eating style is more than
simply leaving meat off the plate. This webpage explains some of the things vegetarians and vegans
must take into account to eat a healthy diet.
http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Vegetarian_eating
eatforhealth.gov.au, Simple Vegetarian Recipes, http://www.eatforhealth.gov.au/eatingwell/healthy-recipes/simple-vegetarian-recipes. This webpage gives some simple tips on how to
ensure vegetarian/vegan eating includes all the minerals and vitamins needed for good health.
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Appendix A
Resources
Module 5: Nutrients at Risk
Module 5 – Nutrients at Risk, June 2013
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Activity sheet: Vitamins and minerals for health
Circle the best source of vitamin D:
Circle the correct answer.
During winter in South Australia – how many minutes of
sunlight do you need on your face, hands and arms (or legs)
most days of the week?




10 minutes
15 minutes
20 minutes
60 minutes
Circle the best foods for calcium:
Circle the foods you should eat every day to help your body absorb
more iron.
ANSWERS - Activity sheet: Vitamins and minerals for health
Circle the best source of vitamin D:
Answer: 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 (see the
chart for times in winter and summer). If you are worried about your
vitamin D levels see your doctor.
Circle the correct answer.
During winter in South Australia – how many minutes of sunlight do you need
on your face, hands and arms (or legs) most days of the week?
Circle the best foods for calcium:
Answer: All these foods provide some calcium. The best sources are cheese, milk,
yoghurt and 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.
Circle the foods you should eat every day to help your body absorb
more iron.
10 minutes
15 minutes
20 minutes
60 minutes
Answer: 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.
Answer: 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.
Appendix B
Script & flashcards
Module 5: Nutrients at Risk
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Script for Module5: Nutrients at Risk
Module 5
Nutrients at Risk
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
o 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 45-50 years.
o 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.
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Module 5
Nutrients at risk
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Script for Module5: Nutrients at Risk
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
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Calcium and Osteoporosis
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Script for Module5: Nutrients at Risk
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
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Calcium and Osteoporosis
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Script for Module5: Nutrients at Risk
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.
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Iron and anaemia
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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)
Note: Vegetarians also need to ensure
they are getting enough B12 in their diet.
 Found in legumes, wholegrains, fortified breakfast cereals and bread, dark green
 B12 is important in the formation of red
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
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.
 Cut back on tea and coffee at meal times as the tannins found in these drinks stop
your body from absorbing iron.
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.
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Food sources of iron
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Script for Module5: Nutrients at Risk
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)
o dark skin is not as good at making vitamin D as fair skin
 Older people and people who are housebound
o 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
o 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
o 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.
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Vitamin D and Osteoporosis
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Vitamin D
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
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Vitamin D
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Vitamin D
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Script for Module5: Nutrients at Risk
Distribute the ‘Vitamins and minerals for
health’ activity sheet
Explain activity to participants
 There are four questions looking at
iron, bone health and vitamin D.
Participants need to circle the
correct answer.
 Give participants about 3 minutes
to complete the activity and then
discuss the answers as a group (as
per answer sheet)
Group discussion
What will you take away from today’s
session?
How confident are you that you can
choose foods that will enable you to
increase or maintain your levels of
these important nutrients?
What changes, if any, do you plan to
make as a result of today’s session?
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Script for Module5: Nutrients at Risk
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