Q: I am now 50 years old and my periods stopped in July of last year. I wondered how I would know if I had brittle bones, which I hear mentioned in the newspapers quite a lot nowadays. I smoke about 15 cigarettes a day and wondered whether this could have an effect on my bones and I know I am not exercising as much as I should.

A: Osteoporosis affects 1 in 2 women over the age of 50 in the UK. And osteoporosis isn’t just a matter of brittle bones. It can kill. In fact it is a bigger female killer than ovarian, cervical and uterine cancers combined.

But the biggest problem is that osteoporosis is so often a ‘silent disease’, bone loss happens gradually over time, without any symptoms. Osteoporosis, at the moment, remains woefully unrecognised and yet it is preventable and treatable.

There are a number of risk factors for osteoporosis and these include: family history of osteoporosis, yo-yo dieting or an eating disorder such as anorexia or bulimia, irregular menstrual cycles or long gaps between periods when younger, certain medications – steroids, heparin, anticonvulsants, diuretics, long-term laxatives or antacids, low level of physical activity and smoking. Smoking not only reduces bone density (by up to 25%) but also increases the risk of hip fractures so you need to think about stopping.

The gold standard for testing for osteoporosis is a DEXA scan but unfortunately is hard to get on the NHS nowadays. In the clinic in Tunbridge Wells I use an ultrasound machine which passes sound through the heel bone. Recent research has shown that ultrasound scans can predict those patients who subsequently go on to have a fracture as well as DEXA scans.

Another way of assessing bone health is to do a Bone Turnover test which measures biochemical markers in urine that show the rate of bone breakdown. Higher levels of these bone resorption markers, indicating higher bone turnover and higher bone loss, have been found to be associated with a two fold increased risk of osteoporotic fracture. This is an easy test to do and can be done by post.

Once you have found out the condition of your bones there is a lot you can do nutritionally and with your lifestyle to improve your bone density. I have discussed the natural approach to osteoporosis in my book ‘Osteoporosis — the Silent Epidemic’).

As well as getting your nutrition right it is also important to take a good ‘bone’ supplement. The first nutrient that comes to mind is calcium. But many other nutrients are equally crucial for healthy bones, and these include magnesium, vitamin C, vitamin D, zinc and boron.

Magnesium helps to metabolise calcium and vitamin C and converts vitamin D to the active form necessary to ensure that calcium is efficiently absorbed. Vitamin C is vitally important in the manufacture of collagen, which is a sort of ‘cement’ that holds the bone matrix together (use an alkaline form of vitamin C like magnesium ascorbate not ascorbic acid).

Boron is an important mineral in relation to osteoporosis as it plays a crucial part in the conversion of vitamin D into its active form, which, in turn, is necessary for calcium absorption, and zinc is needed for the proper formation of bone cells. There are many good ‘bone’ supplements, the one I use in the clinic is called OsteoPlus and also contains digestive enzymes.

Q: I’ve heard of several studies that have shown caffeine to have a negative effect on health. Should I switch from regular coffee to decaf?

A: If you’re trying to kick the coffee habit, decaffeinated coffee is a good short-term substitute. But there are other non-caffeine substances in coffee that may have a negative effect on health as well. For example, Norwegian researchers who found that forgoing coffee for six weeks reduced total cholesterol levels believe that it’s not caffeine that raises cholesterol levels but compounds called terpenoids which are present in both caffeinated and decaf coffee.

There has also been evidence to support a link between coffee intake and fibrocystic breast disease. Again, the culprit is thought to be not caffeine but methylxanthines which are a family of substances that include caffeine, theophylline and theobromine. These methylxanthines are found in coffee, black tea, green tea, chocolate, cola and decaffeinated coffee, as well as in medications that contain caffeine, such as headache remedies. These upset the liver detoxification process and encourage cell proliferation.

If you’re worried about chemicals in your diet, bear in mind that the decaffeination process uses potent solvents that may end up in your mug. Instead, look for water-processed brands of decaf coffee that use only steam and carbon dioxide in the decaffeinating process. Or, have a cup of grain coffee or herbal tea instead.

Q: At 4 pm every afternoon my energy levels slump and I find myself reaching for chocolate. How can I stop this bad habit?

A: It seems to me that you have not been eating anything between lunch and 4 pm so your energy slump is most likely linked to a dip in blood sugar — the body’s main fuel- which causes you to become hungry.

To keep your blood sugar level stable make sure you lunch on slow releasing carbohydrates (brown rice, oatcakes and whole meal bread) and proteins (avocado, eggs, hummus, oily fish, lentils) that release energy steadily into the blood stream. I also suggest that you eat three meals a day and two snacks in between those meals to keep your blood sugar levels steady; pre-empt the energy crash by having a slow energy releasing snack (nuts, seeds, some fruit, including berries, cherries, grapefruit, pear and melon) just before 4 pm.

If you still crave sugar, a team at the US Department of Agriculture have recently found that introducing cinnamon into the diet can help — half a teaspoon a day can reduce blood sugar levels by up to 20 per cent and keep them steady through the day. Sprinkle cinnamon on porridge, a smoothie or in a hot drink.