A SIMPLE, SENSIBLE, SCIENTIFICALLY CREDIBLE
APPROACH TO PREVENTING OSTEOPOROSIS…
…THAT ALSO REDUCES RISK OF HEART DISEASE, CANCER, STROKE, DIABETES, AND OBESITY
Everyone knows how to prevent osteoporosis, right? Drink milk. Eat cheese and yogurt. And take a calcium supplement. This is the familiar “calcium theory of osteoporosis”—endorsed by the nation’s leading health experts.
Only it’s simply not true.
That’s right. Amy Lanou, Ph.D., an assistant professor of health and wellness at the University of North Carolina, Asheville, and noted medical journalist Michael Castleman reviewed 1,200 studies dealing with risk factors for osteoporosis to write Building Bone Vitality, a book that proves the calcium theory wrong and presents a more sensible, scientifically credible explanation of what causes osteoporosis and how to prevent it.
THE COUNTRIES THAT CONSUME THE MOST CALCIUM
HAVE THE HIGHEST RATES OF HIP FRACTURE
If milk, dairy foods, and calcium supplements prevent osteoporosis and its most catastrophic result, hip fractures, the countries that consume the most calcium should have the lowest hip fracture rates. But they don’t. They have the world’s highest rates.
Four worldwide epidemiological surveys conducted by different research teams over twenty years agree that the countries that consume the most calcium (the U.S., Western Europe, Australia, and New Zealand) have the highest rates of hip fracture. Meanwhile, countries that consume little or no milk, dairy, and calcium supplements (much of Asia and Africa) have fracture rates 50 to 70 percent lower than those in the U.S.
MILK, DAIRY FOODS, AND CALCIUM SUPPLEMENTS
BY THEMSELVES OR IN ANY COMBINATION
DO NOT PREVENT FRACTURES
In addition to the four epidemiological surveys, the human experimental studies (clinical trials) also show that the calcium theory is wrong. Since 1975, when the medical literature became easily searchable by computer, 140 clinical trials have explored calcium’s effects on osteoporotic fracture risk. One-third of these studies (47 trials) show that as calcium consumption increases, hip fracture risk decreases. But two-thirds (93 trials) show no benefit from high calcium intake (even with added vitamin D). Several of the negative studies are huge—40,000 to 60,000 women followed for 10 to 20 years. If calcium prevents osteoporosis, shouldn’t such enormous, extended trials show at least some benefit? But they don’t. Overall, the clinical trials dealing with fracture prevention run two-to-one against calcium.
Unfortunately, the minority of studies showing fracture reductions with calcium have garnered just about all of the publicity. That’s a big reason why the calcium theory is still accepted. Only one study showing no benefit from calcium has ever made headlines—a 2006 Harvard trial. As a result, most of the news about osteoporosis prevention supports calcium even though the weight of the evidence runs two-to-one against it.
A HIGH-CALCIUM DIET DURING CHILDHOOD
DOES NOT PREVENT FRACTURES
While the news media continued to endorse the calcium theory, the osteoporosis research community began to question it. After all, two-thirds of studies refuted it. But defenders of the calcium theory clung to their explanation—with one modification. They said: Adulthood is too late to start eating a high-calcium diet. Milk and dairy foods are most important during childhood when bones are growing.
But the evidence shows otherwise.
Since 1975, 13 studies have explored the effects of childhood milk, dairy, and calcium consumption on fractures throughout life. Six of them (46 percent) show that a high childhood calcium intake reduces later fracture risk. But seven (54 percent) show no benefit. The research makes no compelling case in favor of childhood calcium intake for prevention of osteoporotic fractures. In fact, the trials tilt against it.
THE DIETARY KEY TO OSTEOPOROSIS PREVENTION:
If calcium doesn’t prevent fractures, what does? A diet high in fruits and vegetables and low in high-protein foods: meats, poultry, fish, milk, and dairy.
Why? Strange as this may sound, osteoporosis prevention begins in the bloodstream. Blood chemistry is very complicated. But for good health, the blood must maintain its pH (relative acidity or alkalinity) within a very narrow range.
Protein is composed of amino acids. As the body digests high-protein foods, amino acids flood the bloodstream, and the blood becomes more acidic. People who eat a high-protein Western diet—lots of meats, poultry, fish, milk, and dairy foods—have blood that’s too acidic for the body to function properly. The excess acid must be neutralized quickly to avoid life-threatening problems.
Have you ever taken Tums for acid indigestion? Its active ingredient is highly alkaline, which neutralizes excess stomach acid. The alkaline ingredient in Tums is calcium carbonate.
The body does something similar to neutralize excess acid in the bloodstream. It draws on the body’s reservoir of alkaline material, the calcium compounds in bone. Neutralizing excess blood acidity releases calcium, which eventually leaves the body in urine. Dozens of studies show that as protein in the diet increases, so does the amount of calcium in urine. A high-protein Western diet draws so much calcium from bone that a diet high in milk, dairy foods, and calcium supplements can't replace it. In other words, a high-protein diet—a typical American diet—sucks calcium from bone and eventually causes osteoporosis.
In the words of researchers at the University of California, San Francisco Medical Center: “The high incidence of hip fracture in Western countries is caused by the cumulative effects on bone of the body’s chronic high acid load. This high acid load is the result of disproportionate consumption of animal (acid) foods relative to vegetable (alkaline) foods. The body adapts through dissolution of bone. Over decades, blood that is chronically too acidic induces osteoporosis.”
Now, fruits and vegetables also contain protein—enough protein for good health (without eating any animal foods). But fruits and vegetables contain much less protein than animal foods, so they introduce much less acid into the bloodstream.
In addition, fruits and vegetables also contain a great deal of alkaline material, fiber and minerals such as potassium and magnesium. When you eat fruits and vegetables, a small amount of acid enters the bloodstream along with a great deal of alkaline material, which neutralizes the acid. The body does not have to draw calcium compounds out of bone. But meats, fish, poultry, milk, yogurt, and cheese contain much more protein—five to 10 times as much per serving—and very little alkaline material. High-protein foods acidify the blood much more than fruits and vegetables, and contain very little alkaline material to buffer it. To neutralize all the acid, the body must draw calcium from bone.
The low-acid theory neatly explains why the countries that consume the most calcium have the highest fracture rates. About two-thirds of the calcium in the Western diet comes from animal foods (milk, cheese, etc.). These foods are high in protein and low in alkaline material. The protein in milk and dairy foods sucks more calcium from bone than the calcium in them replaces. In addition, the countries with a high calcium diet are also the countries that consume the most other high-protein foods: meats, poultry, and fish.
One of the worldwide epidemiological surveys correlated hip fracture rates with the amount of animal and vegetable protein the various countries consume. As animal protein intake increases, so does the rate of hip fracture. At first glance the dots seem disparate. But using standard statistical tools, they form a straight line, a hallmark of a cause-and-effect relationship:
Results are highly statistically significant: p = < 0.001. Source: Frassetto, L.A. et al. “Worldwide Incidence of Hip Fracture in Elderly Women: Relation to Consumption of Animal and Vegetable Foods,” Journal of Gerontology: Medical Sciences (2000) 55:M585.
Meanwhile, as consumption of protein from fruits and vegetables rises, the rate of hip fracture falls:
Results are statistically significant: p = < 0.04. Source: Frassetto, L.A. et al. “Worldwide Incidence of Hip Fracture in Elderly Women: Relation to Consumption of Animal and Vegetable Foods,” Journal of Gerontology: Medical Sciences (2000) 55:M585.
The more animal foods, the higher the hip fracture rate. The more fruits and vegetables, the lower the fracture rate.
Our health experts tell us that osteoporosis is caused by calcium deficiency—hence their exhortations to consume more of the mineral. In fact, osteoporosis is caused by a calcium imbalance. The typical Western diet is too high in animal protein and too low in fruits and vegetables. As a result, the blood becomes chronically acidic, and the body draws calcium from bone to neutralize it, which eventually weakens bone and causes osteoporosis.
THE BEST WAY TO IMPROVE BONE MINERAL DENSITY:
A DIET HIGH IN FRUITS AND VEGETABLES
By a margin of two-to-one, the fracture studies show that a diet high in calcium does not prevent fractures. But fracture studies are very expensive. It’s cheaper to study bone mineral density (BMD), the amount of calcium and other minerals in bone.
Since 1975, there have been more than 300 studies of calcium’s impact on BMD. Fifty-two percent show that calcium improves BMD. Many of these studies have been publicized, reinforcing belief in the calcium theory. But we already know that two-thirds of studies show that calcium does not reduce fracture risk. How can a majority of studies—albeit a slim majority—show that calcium improves BMD while two-thirds of trials show that it doesn’t reduce fractures?
Because bones are composed of much more than calcium. Strong, healthy, fracture-resistant bones require 17 nutrients. Consuming lots of calcium without enough of the other 16 nutrients is like building a brick wall with no mortar. Where are these other 16 nutrients found? The richest sources are fruits and vegetables. While calcium improves BMD in 52 percent of studies, fruits and vegetables improve BMD in 85 percent of trials. In other words, the best way to improve bone mineral density is to eat a diet based on fruits and vegetables—which makes sense because the same diet is the key to preventing fractures.
HIDING IN PLAIN SIGHT FOR 40 YEARS
This low-acid theory of osteoporosis may sound new, but it isn’t. It was first articulated more than 40 years ago in 1968 in an article in the prestigious medical journal, The Lancet. It neatly explained why gorging on calcium does not strengthen bone or reduce fracture risk. The low-acid explanation intrigued many researchers, who, over the past four decades, have conducted the studies demonstrating that the acid-alkaline approach explains osteoporosis much better than the calcium theory. But none of these researchers seemed interested in explaining the low-acid theory to the general public. We got tired of waiting.
A PLANT-BASED DIET PROVIDES ENOUGH CALCIUM AND PROTEIN FOR GOOD HEALTH
Many Americans believe that it’s impossible to get enough calcium without milk, cheese, yogurt, and supplements. It isn’t. Many Asian cuisines use no milk and no dairy (Chinese, Japanese, Thai, Vietnamese) yet they have osteoporotic fracture rates much lower than those in the West.
Many Americans also believe that it’s impossible to get enough protein without eating animal foods. It isn’t. Nutritionists agree that vegetarians get more than enough protein for good health. In fact, the diseases that kill most Americans (heart disease, cancer, stroke, diabetes, obesity) are all closely linked to a diet that’s too high in animal foods.
To eat a low-acid diet, you don’t have to become a vegetarian, but for optimal bone health, don’t eat more than one serving a day of high-protein foods (meat, fish, poultry, milk, and cheese). At the same time, be sure to eating more fruits and vegetables—two servings per meal plus fruit snacks, for a total of six to nine servings a day.
DAILY WEIGHT-BEARING EXERCISE
Beyond a diet based on fruits and vegetables, one other thing is also vital for fracture prevention, daily weight-bearing exercise—walking or equivalent exercise (dancing, tennis, gardening, etc.) for 30 to 60 minutes a day.
HOW TO PREVENT OSTEOPOROSIS
Of course, Building Bone Vitality contains a great deal more information than this synopsis. The book:
* Delves deeper into the critique of the calcium theory and the evidence in favor of low-acid eating.
* Discusses why the low-acid approach has not been well publicized.
* Lists more than 100 common foods and rates how acid-forming or alkaline they are. (The most alkaline foods may surprise you.)
* Suggests easy ways to evolve your diet toward low-acid eating.
* Offers quick, tasty recipes to help make the transition.
* Explains how many other risk factors relate to fracture risk: diabetes, frailty, salt, caffeine, alcohol, smoking, depression, and prescription drugs.
* Discusses all the osteoporosis drugs and the role they can play in fracture prevention.
* Reveals how the pharmaceutical companies have exaggerated the drugs’ effectiveness.
* And explains how low-acid eating helps stop global warming and contributes to the health of the planet.
Bottom line: The calcium theory is bankrupt. It just doesn’t explain what causes—and prevents—osteoporosis. The best approach to osteoporosis prevention, the only one that makes scientific sense, is a diet low in animal foods and high in fruits and vegetables, combined with walking or equivalent exercise for 30 to 60 minutes a day, every day. That’s the safe, simple, scientific prescription for osteoporosis prevention—and for optimal health and longevity.