Aging in Place: Brittle Bones on the Streets of Seoul Beg the Question of a Balanced Diet

My daughter "teacher Jess" and me at the old palace in Seoul

My family and I were recently in South Korea visiting my daughter Jessica who is teaching K-12 English in a private school outside of Seoul. In eight days Jess showed us what she’s discovered in the eight months she’s been there – from the high-tech towers, designer galleries, and uber-trendy coffee houses of this booming city, to it’s gorgeous ancient palaces and thousand-year-old temples.

We all slept and ate on the floor of a traditional Korean ‘hanok’ for seven nights, spent another in a hotel with our own private karaoke ‘singing room’,   explored the old villages, visited the Buddha in his temple late at night and drank plum tea in the ‘garden of morning calm.’  It was a trip.

But of the many images I came away with, one that stands out in my mind was the sight of so many older women on the sidewalks of Seoul hobbling hunch-backed over their canes. It seemed to me that nearly every one of them, old, and not so much older than me had bent spines, bowlegs or both! It was painful to watch these frail figures picking their way across the crowded streets and intersections: How is she going to make it to the other side??  OMG what a difference a few supplements could make!

Bent and bowlegged - my postmenopausal Asian counterpart

Evidently the traditional Korean diet of fish, rice, seaweed and fermented ‘kimchi’ cabbage of every sort

Calcium-free 'Kimchi'

though healthy in many respects (and I never saw an obese person the whole time I was there) has also been seriously lacking in a few basic nutrients: like calcium, magnesium, and Vitamin D for starters.  But as greater affluence creates greater awareness of healthy living the situation is improving.

Meanwhile, dismaying as it was to witness the stark effects of malnutrition  among my post-menopausal Asian counterparts, the ravages of osteoporosis are by no means a Korean problem; indeed it is still an all too common, and preventable, disease of aging in the US, not only in women (just the other day here in Portland, a friend’s mom, a woman in her mid-fifties, fell at the airport and broke her femur) but in men as well.  Roughly a third of hip fractures occur in midlife men (but I’ll leave that one for the MENopause blog)….

Candace and #2 daughter Ryan, with the emperors' food stores: keepers of the traditional diet of rice, fish, seaweed/greens and the famous 'kimchi'. Healthy in many ways, but not necessarily a balanced diet.

Blame it on  poor diet, sedentary living, chronic stress,  hormone imbalance, or menopause,  the cause of brittle bones on the streets of Seoul or at home in my own neighborhood boils down to a lack of the essential ingredients of balance. Take vitamin D-deficiency for example. Some experts say it’s epidemic especially in gray, rainy climates like the Pacific Northwest where I live, or for that matter anywhere people don’t get enough  sunlight. That’s significant because a lack of vitamin D is not  just about childhood rickets but is now known to be a major risk factor for obesity, heart disease, and breast cancer.

Apparently most people can’t get enough of this vital vitamin (which isn’t really a vitamin at all but a hormone made by the action of sunlight upon chemicals in the skin) either because we’re afraid of getting skin cancer

Wary of skin cancer: a billboard in Korea plugs sunglasses as big as your face, but covering up to the eyeballs against the sun can lead to vitamin D deficiency.

or, let’s face it,  because we  don’t get outside much – by some estimates we spend about 90% of our lives indoors. Fewer and fewer elementary or middle schools have recess or playgrounds anymore, and most of us work or play inside in front of  laptops, I-pads, I-pods, smart phones,  gameboys and Facebook. In the winter months the sun’s rays aren’t strong enough to provide sufficient D anyway, and even in the ‘sunshine state’ where the so-called sunshine vitamin should be readily available,  Florida physicians say patients are surprisingly deficient. Clearly it doesn’t matter where you live but how you live that makes the difference.

Turning awareness into action is a work in progress but progress is being made. I would be remiss not to mention that younger Koreans are undoubtedly taller and straighter-legged than their elders as food and supplemental sources of calcium, vitamin D and other necessary nutrients (though still pretty expensive) have become more widely available.

Balance begins early - younger generation Koreans know their nutrients

Balance starts early with 'Jess teacher" students

One woman I met even revealed  that her mother takes estrogen “for her bones”. That really pricked up my ears and I couldn’t resist asking if she was also taking natural progesterone…. but, alas, that question was met with a blank stare. Should I have been surprised? No, probably not. The concept of hormone balance vs. imbalance and the growing preference for bioidentical, natural hormones in this country only began to shift less than 10 years ago now when the Women’s Health Initiative reported its major findings in 2003 ( JAMA 2002 Jul 17;288(3):321-33.) about the definitive dangers of HRT.

High-tech buildings don't show signs of structural weakness like bones do

Pleasurable pursuits. Plum tea with the family in the garden of morning calm.

Sometimes we have to learn the slow, hard way from those who have gone before us – the women with the bent spines and flaking bones are the lesson – and we are learning from them. You can’t push the river, but you can learn to practice balance one day at a time.

If you are a woman in the menopause zone, your hormone levels are fluctuating and your nutritional needs are increasing with each passing day. Now is when the adrenal glands have to take over all hormone production from aging ovaries.  Now more than ever we need to practice the essentials of balance: adequate nutrition, exercise, sleep, stress relief (with emphasis upon the people, places, and pursuits that give us pleasure in life) and, last but not least, bio-identical hormones when and as needed. As the days get shorter and darker one of the first steps you can take is to test your vitamin D and hormone levels ( to detect and correct imbalances that impact not only the health of your bones but of your whole body, heart, and mind. Want to jump in and join the conversation? Please do, leave us a comment!

This is our number one essential truth: Hormones in harmony and living in balance is an attainable goal.

Balance in being in the garden of morning calm (



Filed under Bioidentical Hormones, Candace Burch, Menopause Symptoms, Women's Health & Happiness, Women's Work/Life Balance

11 responses to “Aging in Place: Brittle Bones on the Streets of Seoul Beg the Question of a Balanced Diet

  1. American DOES have talent! Well written! Thank you, Candace!

    • candacebwell

      Thanks for the positive response compadre, I appreciate your taking the time …it is certainly an issue that can be explored from more aspects, i.e. the hormone issues particularly estrogen and testosterone deficiencies in relation to bone loss…. CB

  2. Carol Gay

    So good to hear you are out & about, spreading the word about women’s health. I’m forwarding your blog to a friend here that will find it interesting. Come see us again when you’re in Savannah.

    • candacebwell

      Hi Carol…great to hear you got something out of the post and will pass it on… the daughter who’s living in Seoul responded that kimchi is actually rated as one of the world’s healthiest foods aiding in digestion and speeding up metabolism, (and it’s served at every meal); she also mentioned that they drink a ton of green tea which is known to significantly boost metabolism. So when it comes to the merits of the traditional diet in Korea at least, it’s a trade off between obesity and osteoporosis. Meanwhile, where in the world is the most balanced diet to be found? Great subject for another blog…but even if one found the most balanced diet in the world, does everyone in that place partake of it in the most balanced way?? I mean inn this country where every food group is in plentiful supply, we know that less than a quarter of the population eat enough fruit and veg every day…..and then there are those who refer to the Standard American Diet as SAD given our obesity, diabetes, heart disease and cancer stats ….anyone want to jump in here??

  3. Great post! Sounds like a fascinating trip on many fronts.

  4. candacebwell

    Fascinating is a good word to describe the dynamics of a country that has catapulted itself from ancient to modern in a matter of fifty years …you can really feel the pace of life hurtling you into the future when you’re there…they call the place a “modern miracle” which is why the sight of hunched over women seemed so medieval-like in contrast….of all that blur of images it is the freeze-frame in my health educators’ mind.

  5. Terrific blog Candace! It was a long time coming, I would say. Wil most certainly pass this along to my clients and colleagues. Your work to educate women and men on how they can be more proactive with their hormone health is so important- I am fortunate to have learned from you throughout the years. Regarding your comments about the most balanced diet, I have read that the traditional Asian and Mediterranean food pyramids are the healthiest diets around. Of course, we know that the modernized versions are highly westernized now, but if we can all go back to eating whole foods and keeping the allergenic, addictive, and inflammatory processed foods to a minimum, that would make for a healthy, “balanced” lifestyle.

    • candacebwell

      AMEN to whole foods which in their unrefined and natural state inherently minimize the allergenic, addictive and inflammatory aspects of the highly processed or so-called SAD (Standard American Diet) western diet. A truly balanced diet has to take into account not only the best of the traditional ways of eating but fill in the nutrient gaps caused by denatured soil or use of pesticides, herbicides, synthetic growth hormones and GMOs ….these replace all the goodness in food with toxins that disrupt our digestive, immune, and hormonal (endocrine) systems….to overcome this we need to boycott all the above and choose foods that are in season, organic, gmo-free and that have NOT been injected with antibiotics and synthetic growth hormones. The more we insist upon these choices the more choices there will be. Just look at the explosion of gluten-free foods on the market now (see article in NY Sunday Times, Nov. 27, 2011) – as demand grew so too did the available supply and now there are whole aisles of gluten free in health food stores when just a few years ago there was little if any choice that didn’t taste like cardboard. In Oregon we are health food store rich, but that is definitely not the picture in other parts of the country. So we have a lot more demanding to do. And educating – fewer than 25% of Americans eat enough fruit and veg every day – so we still have a lot of work to do if we are going to get back to truly balanced eating – the kind that lowers our health risks and lengthens the quality of our lives.

      • It is amazing how many people feel better when they stop eating gluten. I see it all the time in my practice in Portland, OR. I often hear, “I cannot lose weight no matter what I do: I am eating the same as I did when I was younger, but I keep getting belly fat and it’s just such a struggle!!” One suggestion I often make to these women is to try going “gluten-free” for 90 days and see what happens. For many women, the shift away from gluten has incredible effects, especially if gluten is causing inflammation in their bodies. If that IS the case, energy levels increase, digestive issues resolve and weight loss is a natural response to their new and improved digestive system(and less stress on their adrenals). Even if gluten is NOT your issue, eating whole foods is absolutely the best way to ensure you are getting the most nutrients that you can from your diet. Hippocrates said, “Food is medicine, medicine is food” over 2000 years ago and his words still ring true today. To be continued…..

  6. Elizabeth Jacobs

    Thanks Candace. I think another part of a really good blog is that it encourages further thinking. Which yours has done with me. I got to thinking more about Korea and the history of Korea which would have affected the people of S. Korea. Of course I thought about the Korean War but as I looked at the history on Wikepedia I found some other factors that could account for the frailness of the older population.
    1) The Japanese ruled Korea from 1910-1945. During the 2nd WW there was a lot of forced labor and of course food shortages.
    2) From 1945 to the 1960s the economy was in the tank: What would eventually be S. Korea was administered by the US after the war and was chaotic due to Japanese explotation, little knowledge by the US of the culture, language, or politics and waves of regugees. One could imagine that people born in this time period would be frail, and much older than their age. I would imagine there were food shortages and the government was very authoritarian. In June of 1949 there was land reform – “40% of farm households became land owners” But what about the other 60%?
    3) Then in 1950 the war started with the final stalemate achieved by July, 53.
    4) These 2 paragraphs from Wikipedia seem to encapsulate the good economic times… after 1960. However I imagine that was a little late for some of the older people you saw.
    “Since the 1960s, the country has developed from one of Asia’s poorest to one of the world’s wealthiest nations. Education, particularly at the tertiary level, has expanded dramatically. It is said to be one of the “Four Tigers” of rising Asian states along with Singapore, Taiwan and Hong Kong.[1][2]”
    “South Korea had one of the world’s fastest growing economies from the early 1960s to the late 1990s, and South Korea is still one of the fastest growing developed countries in the 2000s, along with Hong Kong, Singapore, and Taiwan, the other three members of Asian Tigers.[6] South Koreans refer to this growth as the Miracle on the Han River.[7] Having almost no natural resources and always suffering from overpopulation in its small territory, which deterred continued population growth and the formation of a large internal consumer market, South Korea adapted an export-oriented economic strategy to fuel its economy, and in 2010, South Korea was the seventh largest exporter and tenth largest importer in the world.”
    THANKS again for a powerful blog and the thought processes it generated. Fun looking up things and glad I had a good excuse.

    • candacebwell

      Thank you for widening the discussion Elizabeth…….I am with you that the food shortages and deprivation during the long years of occupation and ensuing poverty in Korea is the bottom line on brittle bones ….and yet from what I observed while there, the traditional/typical diet still appears to lack some of the essentials of balanced nutrition, particularly of the EFAs, calcium, magnesium, D and other micronutrients that build and maintain bone and structural strength….but having said that, osteoporosis is still a major issue in our own country where we have access to all the essential nutrients we need – the question is how many of us actually take the time to eat a balanced diet every day? We know that less than 25% of Americans eat enough fruit and vegetables and that over a third are overweight or obese…so its’ all relative. Getting to that place of balanced health, wherever we live is a challenge and a work in progress to be sure!

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