Dear Doctor: Last fall at my annual checkup, my doctor ordered a bone density test. Besides talking to me about osteoporosis in general, she also suggested calcium supplements. I wonder if you have any advice about which supplements are best, and also about maintaining bone health.

Dear Reader: You’ve already taken the first step to protecting bone health by getting a bone density test. This is a simple scan that, as the name suggests, measures bone mineral density.

Although they seem static, our bones are metabolically active organs. They are in constant flux, with old bone being removed and new bone being made. Most of us reach peak bone mass in our late 20s to mid-30s. At that point, the balance of bone metabolism shifts. Bone loss gradually begins to exceed bone creation. Factors such as menopause, inactivity and certain medications can accelerate bone loss. A bone density test gives you an idea of where you are in the process. It does this via a score that compares your bone density to that of a young adult, measuring your bone health on a scale that ranges from normal through low bone mass and to established osteoporosis. It is recommended that all women age 65 and older and men age 70 and older should have a bone density test.

While calcium supplements have their place in keeping our bones strong and healthy as we age, they’re just one part of a broader strategy. To maintain skeletal health and integrity, we also need to focus on a nutritious diet that includes sources of not only adequate calcium, but also potassium, magnesium and vitamin D. That means eating from a wide range of fresh fruits, vegetables, leafy greens, lean meats, dairy products, healthful oils, seeds, beans and legumes.

To help meet their calcium needs, postmenopausal women may need to turn to supplements. Guidelines suggest getting from 1,000 to 1,200 milligrams of calcium daily, with at least half of that coming from dietary sources. Calcium carbonate, at 40% elemental calcium, and calcium citrate, at 21% elemental calcium, are the two main forms of supplements. Newer research has hinted at potential cardiovascular risks linked to the overuse of calcium supplements. With that in mind, we recommend meeting as much of your calcium need as possible through diet, and limiting daily supplements to a maximum of 500 mg per day.

The final piece of the bone-health puzzle is exercise. Specifically, strength training and weight-bearing exercises. Research shows that bone responds to load-bearing exercise by remodeling, which is the complex process that results in the formation of new bone. This includes exercises such as lifting weights, climbing stairs, skipping rope, dancing, running or playing tennis, to name just a few. Regular exercise also improves balance and coordination, which are important to prevent falls. It’s always important to check with your doctor about the type of physical activity that is appropriate for your unique situation. This is particularly true for anyone who is frail or has been diagnosed with thinning bone or osteoporosis.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: My big New Year’s resolution was to get my gut into better shape. I’m not talking about a flat stomach -- after having three kids, that ship has sailed -- but about the gut microbiome. Do I need to take probiotics?

Dear Reader: Considering the abundance of foods and drinks with which many of us celebrate the weeks between Thanksgiving and Jan. 1, the new year is a logical and appropriate time for a gut reset. And, yes, we’re talking about the gut microbiome here, which is the collection of trillions of microorganisms that call our digestive tracts home. These include the vast and varied colonies of bacteria, fungi, protozoa, friendly viruses and other microbes that interact with our bodies and, in many cases, help to keep us healthy. Research into the microbiome continues to uncover the many ways in which gut health plays a role in general health, including how it affects processes as varied as the immune system, blood sugar regulation, the cardiovascular system, cholesterol, weight and even mental health.

The good news is that, with several simple lifestyle choices, you can improve your gut health. To understand how, we should define two important terms -- the probiotics that you mention and another equally important piece of the gut microbiome puzzle, prebiotics. Probiotics is the word we use to describe the good microbes living in our guts. A wide variety of types and strains of probiotics are now available as dietary supplements, and in food sources such as yogurt, kefir and naturally fermented foods and drinks. The jury is still out as to whether or not probiotic supplements are actually helpful in achieving and maintaining gut health.

Perhaps more important are prebiotics. These are a type of indigestible carbohydrate that are found in fiber-rich foods, including fruits, vegetables, seeds, beans and legumes. Prebiotics pass through the digestive system and arrive in the colon largely intact. There, they provide a food supply for the all-important probiotics living in our gut. In order to support your microbiome, it’s important to eat a wide range of fresh fruit, vegetables and other prebiotics.

In addition to what you do eat, gut health depends on steering clear of certain foods. Unfortunately for those of us with a sweet tooth, recent studies have shown that a high intake of simple carbohydrates in the diet can tip the balance of gut bacteria to specific types of microbes associated with low-grade inflammation. That’s pretty much the opposite of what you’re trying to achieve. The occasional sweet treat won’t wreak havoc on the gut, but people who regularly eat a lot of sugar or highly processed foods need to rethink their diets.

Gut health isn’t all about food. Studies have found that, just like our hearts, bones, muscles and mood, the denizens of our gut microbiomes respond positively to exercise. A study published in 2017 found a link between exercise and the bacteria that support weight loss. Add in adequate sleep and managing stress, and you’re on your way to a healthier gut in 2021.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: Is it true that grief can make you get physically sick? My mom passed away just before Thanksgiving, and I’ve been struggling with my health. I’m having headaches, I’ve had an eczema flare and I caught the first cold I’ve had in three years.

Dear Reader: We have only to look to language to see how closely grief and bereavement are associated with physical pain. Heartsore, heartsick, heartache, brokenhearted -- each word draws a direct line between the emotion of grief and its profound effect on the human body. People who are grieving talk about feeling empty and numb, of being sick with grief. And small wonder. Research shows that, in addition to being an emotional challenge, grief and grieving can indeed take a physical toll on the human body. The sense of loss and longing that are a part of grief often manifest themselves as physical sensations, including a tightness in the throat and chest; a hollow feeling in the solar plexus; physical weakness; aches and pains; lack of energy; and changes to appetite and sleep patterns.

Research into the physical effects of grief suggests that the immune system gets involved by mounting an inflammatory response. A study of older adults who were grieving found the effectiveness of certain white blood cells, which fight off infection, to be measurably reduced. A different study, published in the journal Circulation, found that the day after a significant death, a grieving survivor’s risk of having a heart attack was 21 times higher than normal. A week later, the risk was 6 times as great. The psychological pain of grief can put your physical health in jeopardy.

Another reason grief can be so difficult to endure is that, in addition to being a state of body and of mind, it also is a process. The famous “five stages of grief” theory, which includes denial, anger, bargaining, depression and acceptance, suggests an orderly and linear progression. However, reality is far more complex. People can find themselves experiencing multiple stages of grief at one time and revisit them repeatedly.

Grief is classified into two distinct types, acute and persistent. Most people experience the former, which lasts about a year and gradually resolves. In persistent grief, the feelings and symptoms last far longer. Although there’s no quick way out of the physical and emotional pain of mourning a loss, research suggests specific steps can help make it bearable. First, do your best to maintain a healthy diet and get adequate sleep. Physical exercise, including mind-body practices such as yoga, tai chi and qi gong, is important. It can be hard to get motivated, so consider joining an exercise group or taking regular classes.

Be sure to reach out to your social circle. Grief is an isolating experience, and even one social interaction per day can lift your spirits. And consider a support group. The participants will understand what you’re going through. A support group can both show you a way forward and give you a chance to lend someone else a hand when you are able.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)