A fresh look at bone health

The quick answer:  The modern epidemic of osteoporosis, like coronary artery disease, is the natural result of an unnatural lifestyle—too much meat, sugar, and processed foods and too little use of the muscles. 

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American women worry about osteoporosis.  They should worry.  There’s nothing nice about stooped-over posture, the dowager’s hump, or a life-shortening broken hip.  Osteoporosis is a big problem and in the American way, treatment has become a big business.  Unfortunately the money spent on treatment—like calcium supplements and drugs—hasn’t solved the problem.  In this post we take a fresh look at bone health and talk about prevention.  Warning:  Most of what you've been told may be wrong. 

An Old Theory Revisited

The current calcium theory of osteoporosis calls for more calcium in the diet and this has carried over into government guidance.  Americans consume more calcium than any nation, yet we are advised to take more.  Problem is that while we consume more calcium, we still have one of the highest rates of osteoporosis.  This doesn’t make sense.  There’s another theory—call it the acid/alkaline theory—that’s been around since 1968 though largely ignored, perhaps because there’s no pill to sell. 

The Lancet, published in England, is a prestigious medical journal.  Over 40 years ago it carried a revolutionary article by two Harvard researchers, Amnon Wachman and Daniel Bernstein, titled “Diet and osteoporosis.”  The article offered evidence that osteoporosis was the natural result of the modern acid-producing diet, not of too little calcium. 

Another Harvard researcher, D. Mark Hedsted in a 2001 American Journal of Clinical Nutrition commentary “Fractures, calcium, and the modern diet” (you can read it here), made these points:

1. Questioning the guidance to eat more calcium, Hedsted asked:  “Why do populations with low-calcium diets have fewer fractures than do those with high intake?”
2. He further observed:  “the long-standing recommendations to increase calcium intakes [though this may increase bone density] appear to have had little or no effect on the prevalence of osteoporosis or fractures in the United States.”
3. Hedsted also noted the link between heart disease and osteoporosis—when one increases, the other follows.  This pattern is seen in country after country—what’s good for the heart is also good for the bones, and vice-versa. 

Acid/alkaline Theory

To better understand the acid/alkaline theory of osteoporosis, here are a few bone facts:

• Bones contain calcium, but it’s only about 3 lbs. in our 25 or so lbs. of bone. 
• Bones have other vital minerals, including phosphorous, and magnesium.
• Bones provide structure for the body, but they’re also a reservoir for minerals that the body taps as needed.
• For survival, the pH (a measure of acidity/alkalinity) of our blood must be controlled.  (Blood pH should be 7.4; if your pH is lower you have acidosis.)
• If our diet causes blood pH to be too acid, the body uses first sodium, then calcium from our bones to buffer and remove the excess acid.
• The peak rate of calcium removal (resorption) is greater than the ability of the body to add calcium (absorbtion).  This makes sense because survival depends on controlling pH.
• Because there are limits on the ability to restore calcium to the bones (we’ll discuss the factors later), it’s important to limit removal over the long term. 
• Some foods are alkali-producing when metabolized; others are acid-producing, which can be a problem. 
• Basically, plant foods are alkaline while animal products (and processed foods) are acidic. 
• It takes time, decades, but the modern diet will cause osteoporosis by dissolving bone to use the calcium for buffering excess acid.

Building strong bones:

How does the body build strong bones?  Our knowledge is incomplete, but here are some key factors:

• Mom: The quality of your mother’s diet during pregnancy is critical, then your diet, especially during puberty (when mom was doing the cooking).  In girls, bone formation at menarche can be five-fold greater than during adulthood.  As always, much depends on Mom.
• Mineral balance is critical.  Minerals make bones hard (a matrix of collagen makes bones flexible) but they are needed in balance.  Too much phosphorous, for example, inhibits the ability to absorb calcium (a calcium to phosphorous ratio of 2.5 to 1 is best).  One problem is processed foods, which contain fewer minerals but more added phosphorous.
• Vitamins, especially D and K2, are needed for bone building.  There is controversy about the best way to get vitamin D (whether by sunshine, the historic method, or pills) but many experts believe we’re getting too little.  Vitamin K is found in dark greens and other vegetables; the body converts this to the needed K2. 
• Estrogen plays a role for both men and women (yes, men produce a small amount).  The decline of estrogen after menopause is problematic for women.  Some foods stimulate estrogen production but this is not well understood.  What to do?  Until we know more, eat well and take care of your health. 
• Want stronger bones?  Build stronger muscles!  Exercise stimulates bone growth, especially if the normal load is slightly and repetitively exceeded.  Exercise also builds muscle, which partners to strengthen bones.
• Americans love sugar but sugar disrupts the calcium to phosphorous ratio, inhibits calcium absorption, and increases calcium resorption from bone. 
• Chronic stress can interfere with the building of strong bones.  We’ll address stress in a future post but pick your battles carefully and create islands in time where you have peace, order, and harmony.
• Calcium absorption is reduced by smoking, alcohol, excess caffeine and meat, and improved by eating whole grains, herbs and fruits.  All things considered, the Word of Wisdom is a remarkable recipe for good bone health. 

Summary:

Monitoring your bone health is like watching a glacier move, you need to take a long view.  There is much we don’t know and that likely won’t be known in our lifetime.  The best strategy then is to optimize bone formation and minimize the breakdown of bone to preserve blood pH.  Fortunately, the Word of Wisdom lifestyle works for both.

In the next post we'll discuss muscle-building exercises.  If you suffer from osteoporosis consult your doctor.  Be patient in adding exercises—try to avoid injury; see this as a marathon not a sprint. 

Budget Wisdom:  You don't need a fancy gym—gravity is free.  Jumping rope or climbing stairs is good for the legs.  Push-ups and pull-ups are good for the arms and shoulders.  A walker passed the house while I was working in the yard.  In conversation he said he does his age in push-ups.  I was impressed as he was in his 70s, though he looks younger.  Picking up small children counts too; as they get older you'll get stronger.  (They'll make you stop about the time they get to high school.)  The key is to incorporate into your daily life things that are harder than usual, and then do them for years and years. 

Comments:  Please share your experience with bone health.  What do your doctors recommend?  What works best for you?  What do you do to build and preserve muscle.

Need a reminder? Download our Healthy Change reminder card. Print and fold, then place in your kitchen or on your bathroom mirror to help you remember the Healthy Change of the week.

What Builds Bones?

The Quick Answer:  Calcium (essential for bone health) deficiency is a problem for adolescent girls, menopausal women, and older men.  There is growing evidence that getting calcium from whole foods works better than taking it in pill form.  The foods in this picture provide 700 mg.

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In 1939 Dr. Weston Price published a remarkable book, Nutrition and Physical Degeneration.  Price studied 13 indigenous civilizations from his expeditions, comparing dental decay in people eating traditional diets to their cousins who had moved to the cities and adopted the modern diet.   He concluded that it was possible to prevent dental cavities (or caries) through diet, and that prevention was better than repair.  His work was ignored, and the business model for modern dentistry was built on repair rather than prevention.  This is a repeating story in nutrition: repair, in our culture, makes a better business than prevention (which requires that so un-American behavior—self-restraint).

I intended to share more about Dr. Price until I discovered that May was National Osteoporosis Awareness & Prevention Month—I almost missed it.  Osteoporosis is a lot like dental cavities—repair makes a better business than prevention.  Here are a few facts:

•  Half of women over fifty will break a bone because of declining bone density; worse, there is the risk of “dowager’s hump.” 

•  For men the risk of age-related bone fracture is one in four. 

•  Risk factors for osteoporosis include: insufficient dietary calcium, vitamin D deficiency, excessive intake of protein, sodium, and caffeine, and lack of exercise.  (Smoking and heavy alcohol intake are causes also, but if you’re reading this blog you don’t likely have those problems.)

My beautiful wife was upset recently because the doctor gave her a stern lecture for not taking calcium and vitamin D pills.  I was puzzled because the doctor had not tested her to see if there was a deficiency, or made a diagnosis of bone loss.  He claimed the benefit was well proven; I thought it would be wise to see the proof.  My wife is caught between her doctor’s faith in pills, and our faith in wholesome food. 

This week the prestigious British Medical Journal reported on a major long-term study that addressed this question; the article was titled “Dietary calcium intake and risk of fracture and osteoporosis: prospective longitudinal cohort study.”  (An online digital version is available here.) 

The study tracked diet, supplements, and bone fractures in 61,400 postmenopausal Swedish women for nineteen years, starting after they turned fifty.  This is the most complete study of diet and bone health to date and the article made these surprising statements:

•  There is currently a wide range of daily calcium recommendations: The UK calls for 700 mg; Scandinavia, 800 mg; the U.S., 1200 mg; and 1300 mg in Australia and New Zealand.  (These values include dietary calcium and any taken in pill form.  Because no one knows how much calcium they get in their diet, these targets are not very helpful.)

•  Reviews of prior studies have found little or no benefit to taking calcium in pill form.  Eating calcium as part of a healthy diet seems to be best but the optimum amount had not been determined.

•  The study concluded that the optimum dietary intake of calcium for postmenopausal women was 700 mg daily.  Taking less resulted in more hip fractures; taking more also caused an increase in hip fractures, though at a reduced rate.  At lower levels of calcium intake, vitamin D intake was especially helpful.

•  Taking calcium in pill form as a supplement did NOT show a benefit.

Based on this major study, we should:

1. Eat more foods rich in calcium.  This is critical for adolescent girls, menopausal women, and older men.  The most recent data (NHANES 2002-6) showed older women averaging about 560 mg of calcium daily from food sources; men were getting a little more, about 650.  Because we already get 51% of our calcium from milk and dairy, getting more from plant sources seems wise as there are other reasons to eat more dark green vegetables, legumes, nuts and seeds. (Plant-sourced calcium also increases estrogen activity in women, and reduces the risk of kidney stones.)

2.  Discuss with your doctor the wisdom of taking calcium in pill form; he should be aware of other health considerations.  Getting sufficient calcium is a bigger challenge if you avoid milk or dairy.  (All this is a tough topic for doctors as they have been guided to push calcium supplements.)

Dietary Calcium

What does 700 mg of calcium from natural foods look like?  The picture above tells the story, but here are the details:

•  Breakfast of Post Grape Nuts and milk (1/2 cup each): 165 mg.

•  Morning snack of cheese (1/2 oz.) and whole wheat cracker: 100 mg.

•  Lunch of canned tuna on whole wheat store bread (wheat isn't a significant sourse of calcium; the bread shown is calcium fortified):  87 mg.

•  Afternoon snack of yogurt (2 oz.): 100 mg.

•  Dinner of spinach salad and a bean dish: 212 mg.

•  Evening snack of walnuts, Brazil nuts or sunflower seeds: 30-40 mg.

We’ll come back to bone health in a future post—it’s a complex subject that scientists are still unraveling.  Three parting thoughts:

1. Remember that besides dietary calcium, exercise, adequate vitamin D, and avoidance of excessive salt and caffeine are also important to bone health.

2. Strong bones go hand-in-hand with strong muscles.  Both peak in our youth; the key to health is to slow the decline.

3. Exercise builds muscles and most muscles are attached at each end to a bone.  So besides improving your appearance, exercising your muscles also strengthen your bones.

Please comment on your approach to calcium sufficiency, or your experience protecting bone strength.