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Nutritional Aspects of Osteoporosis

PikaB
1 Recommendation

The 7th International Symposium on Nutritional Aspects of Osteoporosis will be held next month in Switzerland, where new research results will be presented. The abstracts are not yet online, but the presentation titles have been announced, and I will be particularly interested in reading abstracts for the following presentations when they are online:

"Alkalinity of mineral water alone does not inhibit bone resorption"
"Is there a correlation between oral calcium intake and bone density?"
"The importance of timing potassium bicarbonate supplementation to affect acid-base balance"
"Effectiveness of potassium bicarbonate administration to prevent sodium chloride-induced bone loss"
"Low calcium-to-phosphorus ratio in habitual diets interfere with calcium and bone metabolism in healthy pre-menopausal women with in a generally adequate calcium intake"
"Is salt sensitivity the link between hypertension and osteoporosis?"
"Dietary alkalinity and bone health - current controversies: future perspective"
"Which fruit and vegetables protect bones?"

Let's hope there will be some results with new practical applications for use in our efforts toward strong bones.

Explore topics in this discussion:

Exercise Heart disease Cancer Arthritis Falls Dementia Fractures Stroke Anemia Hypertension Memory Osteoporosis Estrogens Cortisol Stress

21 replies

linnyd531

thanks pika for all the links and info on the latest osteoporosis research. it's nice of you to take the time to keep us all updated.

juliemarie

Yes, thanks so very much for this notice. I hope we can get the information from the symposium. I am having a great deal of trouble with the acid/alkaline balance. Even though I have my list and try to keep to the low acid vegetables, I just don't make any headway. When I tried the potassium bicarbonateI have horrendous stomach problems and onstipation.

Has anyone had good results in getting less 'acid?'

rmchavin

Dear Pika B:
The acid-alkaline balance in our blood is the most important reason why eating more vegetables and eating less meat would reduce our rate of bone loss. However, there are two additional reasons. One is the benefit from getting plenty of phylloquinone (vitamin K1) which is abundant in green vegetables. Phylloquinone has been shown to reduce bone loss, fracture risk, and risk of ending up with a calcified aorta. The other is the benefit from getting plenty of phytoestrogens. Phytoestrogens, which are only one one-hundreth as potent as real estrogens, have been shown to prevent heart disease, stroke, cancer, bone loss, and fractures. The 2 best plant sources of phytoestrogens are soybean products (soymilk, tofu, edamame, soyburgers, natto, etc.) which are rich in the isoflavones genistein and daidzein, and flaxseed products (flaxmeal, flaxbread, etc.) which are rich in lignans. Lignans and isoflavones are the 2 most well-researched phytoestrogens for cardiovascular, cancer, and bone benefit to both humans and animals.

PikaB

I wouldn't be so hasty in unequivocally recommending non-fermented soybean products like soymilk, tofu, soyburgers, etc. The 2008 study "High tofu intake is associated with worse memory in elderly Indonesian men and women" found that tofu was associated with worse memory, but tempeh (which is fermented) was associated with better memory. The abstract also states "Estrogen (through which receptors phytoestrogens can exert effects) was found to increase dementia risk in women over 65 years of age. Tempe contains high levels of phytoestrogens, but (due to fermentation) also exhibits high folate levels which may exert protective effects."
http://www.ncbi.nlm.nih.gov/pubmed/18583909

SequoiaHealth

Hi PikaB:
I think you going to find that osteoporosis, just like heart disease and arthritis are connected to alkalinity and acidity. Another way to look at acid/base balance is through total body inflammation levels. They are closely related.

A healthy diet, consisting of 50% fruits and vegetables, is important in reducing inflammation. However, it cannot “cure” the added inflammation of a high stress lifestyle. Chemical stress, like inadequate vitamin D, and other non-osteoporosis medications can also affect inflammation levels.

From my experience, changes in lifestyle are very important and cannot be overlooked. I call the following lifestyle changes the “Big 5 for Bone Health.” These are:

1. A diet that contains 50% fruits and vegetables. Fruits and veggies contain
greater amounts of water and minerals with generally lesser amounts of
animal protein.
2. Adequate water intake for maximum hydration. Water is very important
in helping the kidneys regulate pH and detoxify the body.
3. Daily stress reduction activities. This helps lower cortisol and homocysteine levels reducing calcium loss.
4. Year round vitamin D3 levels in the 50-80 ng/mL (or 125-200 nM/L).
This should be confirmed by 25-hydroxyvitamin D testing.
5. Sufficient weight bearing exercise to stimulate balance and muscle growth which is essential for bone strengthening determined by regular full body strength testing.

As for soy products, the only recommendation is for fermented products. Lack of fermentation leaves high levels of phytate and oxalic acid in soy.

As always, no one change will give the results you seek. The body is too complicated and finely regulated for that the happen.

Woody McMahon
Reston/Herndon Osteoporosis Support Group Leader

rmchavin

Dear PikaB:

Here's what the Linus Pauling Institute at Oregon State University says about potassium: http://lpi.oregonstate.edu/infocenter/minerals/potassium/ Note that potassium bicarbonate supplementation and potassium citrate supplementation have both been used successfully by women in clinical studies to buffer the acid-in-your-blood problem caused by the unhealthy, meat-loving Western diet. Potassium pills could be used as a last resort for osteoporosis patients who simply cannot reduce their addiction to animal protein and increase their consumption of heart-friendly, cancer-preventing fruits and vegetables. Caution: People with impaired kidney function must greatly reduce their intake of both potassium and phosphorus.

PikaB

On the other hand, this study found no benefit to bones from potassium citrate:
http://www.ncbi.nlm.nih.gov/pubmed/18689384

rmchavin

Dear PikaB:

The Linus Pauling Institute at Oregon State University agrees with you that potassium citrate doesn't work, at least in that one scientific study you mentioned (involving 276 postmenopausal women). http://lpi.oregonstate.edu/infocenter/foods/fruitveg/index.html#osteo

PikaB

Some of the abstracts of the (now in progress) 7th International Symposium on Nutritional Aspects of Osteoporosis are now online, and can be browsed through the page at
http://registration.akm.ch/einsicht.php?XNKONGRESS_ID=93&XNSPRACHE_ID=2

If anything, they indicate that the nutritional aspects of osteoporosis are very complex, and not as simple as some people would have us believe. For example, believers in the acid-base theory of osteoporosis, should take a look at these abstracts:
http://registration.akm.ch/einsicht.php?XNABSTRACT_ID=90774&XNSPRACHE_ID=2& XNKONGRESS_ID=93&XNMASKEN_ID=900
http://registration.akm.ch/einsicht.php?XNABSTRACT_ID=91204&XNSPRACHE_ID=2& XNKONGRESS_ID=93&XNMASKEN_ID=900

rmchavin

Dear PikaB:

I remember you advised us recently to eat lots of onions because postmenopausal women who ate onions had much better bone health than postmenopausal women who didn't eat onions: http://www.inspire.com/groups/national-osteoporosis-foundation/discussion/c homp-those-onions/ What chemical or chemicals found in onions and other vegetables do you suspect are responsible for this bone-protecting benefit? (You seem to imply in this discussion that alkaline potassium compounds and alkaline magnesium compounds found in vegetables are not the reason for the better bone health observed in vegetarians and almost-vegetarians). Caution: Don't say that the vitamins and minerals in onions and other vegetables are responsible for protecting our bones. Why? Because beef, pork, poultry, eggs, and dairy products are just as rich in vitamins and minerals as vegetables (and people who eat too much meat have poor bone health). Also, green onions are very high in vitamin K but regular onions have very little vitamin K. So vitamin K was not the reason the onion-eating postmenopausal women had better bone health.

PikaB

The likely bone-helpful chemical in onions, according to the study at
http://www.ncbi.nlm.nih.gov/pubmed/15853380
is called gamma-L-glutamyl-trans-S-1-propenyl-L-cysteine sulfoxide (GPCS).

PikaB

rmchavin:

Regarding "the better bone health observed in vegetarians and almost-vegetarians", it is very misleading to compare different nations, because there can be so many variables. Some studies, which look national subset populations, have not found that benefit. For example the big UK study at
http://www.ncbi.nlm.nih.gov/pubmed/17299475
found fracture risk similar between meat eaters, fish eaters and vegetarians, with vegans having a higher fracture risk. The Taiwan study at
http://www.ncbi.nlm.nih.gov/pubmed/18364334
found the same BMD decline between vegetarians and non-vegetarians. The Chinese study at
http://www.ncbi.nlm.nih.gov/pubmed/9481534
found vegetarians and non-vegetarians had the same spine BMD, but the vegetarians had lower hip BMD.

rmchavin

Dear PikaB:

I've noticed something very strange. All of the PubMed web addresses that you have had to cite (as abstracts) on NOF Inspire had very short web addresses, while over 95% of the PubMed web addresses that I have had to cite (as abstracts) on NOF Inspire had extremely, extremely long web addresses. I wonder if this is just a fantastic coincidence or perhaps God views you more favorably than He views me? Anyhow, the research study you cited today on onions that successfully isolated one specific chemical responsible for preventing bone resorption helps me to explain why some vegetables work better than other vegetables at discouraging bone loss. (Each vegetable might have its own, unique chemical or chemicals that protect our bone health). In this study with rats, garlic worked even better than onions at preventing bone resorption: http://jn.nutrition.org/cgi/content/full/133/11/3592 http://jn.nutrition.org/cgi/content/full/133/11/3592/F2 On the other subject of vegetarians and bone mineral density (BMD), the last 2 studies you cited, one for Taiwan and the other for China, are not the rare exceptions to the majority of studies on vegetarians and osteoporosis. In fact, it is quite common for studies to indicate that vegetarians have slightly lower bone mineral density during much of their life when compared against people consuming some milk and dairy products among other things. What matters, of course, is bone health as measured by fracture risk in the late years, not BMD during the earlier years of life. Finally, the first of the 3 studies you cited (for U.K.) is a bit of a contradiction to the majority of studies that I've seen. In that U.K. study you cited today, vegans, but not vegetarians, had a higher risk of bone fractures than the other groups. (My guess is that pure vegans can have poor bone health if their calcium intake is extremely, extremely low). Of course, I base my osteoporosis prevention nutritional advice on the observation that Asians living in Asia have slightly lower bone densities during much of their life but much better bone health (less age-adjusted fractures per capita) than Asians who have emigrated to the U.S. and have started eating the typical American diet which is high in animal protein and cola drinks and low in soy and other vegetables. Perhaps this is not a contradiction to the U.K. study you cited because Asians in Asia are not really vegans. (If they were vegans, they would die of pernicious anemia, the deficiency of vitamin B12). Asians in Asia do get enough vitamin B12 from a variety of sources including fish. But the big picture is that most Asians in Asia cannot afford to eat animal meat on a regular basis. This was even more true in the past than it is today. Here are some of my bookmarks on vegetarians having superior bone health: http://www.ajcn.org/cgi/content/abstract/25/6/555 http://ukpmc.ac.uk/picrender.cgi?artid=885455&blobtype=pdf http://www.healthy.net/scr/article.asp?Id=3130 http://www.ctds.info/osteoporosis-diet.html http://community.livejournal.com/veganpeople/3604560.html http://www.tripanswers.org/answer.aspx?criteria=&tagtrail=%2Fdiet%2F&qid=50 61&src=0 http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermT oSearch=8610662&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_Resu ltsPanel.Pubmed_RVAbstractPlus http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermT oSearch=11124760&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_Res ultsPanel.Pubmed_RVAbstractPlus http://www.ajcn.org/cgi/reprint/59/6/1356 http://www.hacres.com/diet/research/HallelujahVegetariansandNutritionScienc e21.pdf http://delavan22.adventistchurchconnect.org/article.php?id=40 http://www.direct-ms.org/pdf/nutritionGeneral/Remer%20and%20Manz%20Acid%20B ase.pdf http://www.thevegetariansite.com/diet_stud.htm

rmchavin

Dear PikaB:

I forgot to include this one: http://www.eateco.org/PDF/OsteoporosisProtein.pdf I also have another web address which agrees with your U.K. study that vegans can have poor bone health: http://journals.cambridge.org/action/displayAbstract;jsessionid=C63F86284A4 79012EE716C265E423D7C.tomcat1?fromPage=online&aid=1874088 My best guess is that not all "vegetarians" eat enough healthy vegetables and fruits. Many vegetarians are so poor that they eat pretty much nothing more than grains such as rice or wheat. Thus, it is entirely possible for vegetarians to be malnourished, and malnourished vegetarians would have terrible bone health. If their calcium intake was extremely, extremely low, their bone health would benefit from supplementation. Even more likely, if their intake of vegetable protein was inadequate (as in this study), their bone health would benefit greatly from increasing the amount of vegetable protein in their diet. The essential amino acid methionine is the most likely to be deficient in malnourished vegetarians. The essential amino acid lysine is the second most likely to be deficient. The essential amino acid phenylalanine is the third most likely to be deficient.

PikaB

The garlic-is-even-better-onions study you cite also argues against the acid-base hypothesis: "We demonstrated, however, that at least in rats the effect on bone resorption of the 14 foodstuffs outlined above is not mediated by their base excess but possibly by pharmacologically active compounds. Because some vegetables, such as potatoes, carrots and soy, consumed at the same dosage, did not significantly inhibit bone resorption, it cannot be generally stated that the consumption of vegetables is beneficial to bone density."

The study did show garlic was much better than onions, based on fresh food weight. But onion contains 3.5 times more water than garlic. When I eat fresh garlic with a meal, the maximum comfortable amount for me is one bulb (about 2.3 ounces); when I eat fresh onion with a meal, the maximum comfortable amount is one onion (about 9.5 ounces). That brings the benefits of the two more closely in line.

Regarding the fact that some studies have shown vegetarians to have lower fracture risk, perhaps part of those results are explained by the fact that vegetarians have lower blood pressure and cholesterol, and thus are less likely to be prescribed medication which could have dizzying side effects, and lead to falls.

I do not reject the acid-base hypothesis; in fact I tend to eat as though it were true, because it doesn't take much additional effort on my part. But the evidence thus far is not universal, and I don't think that most people with osteoporosis can reverse it simply by making their diet more alkaline and exercising a little more.

In any event, I am looking forward to seeing the remaining abstracts from last week's Symposium, which includes several sessions devoted to acid-base, so that I can see what some of the new research results are.

PikaB

Several more abstracts from the Symposium are online, including one for the presentation:
"Which fruit and vegetables protect bones?"
at
http://registration.akm.ch/einsicht.php?XNABSTRACT_ID=90811&XNSPRACHE_ID=2& XNKONGRESS_ID=93&XNMASKEN_ID=900

28 fruits and vegetables were analyzed in a UK population-based study. The greatest positive effect on BMD was evidently associated with berries, apples and salad, and the greatest negative effect on BMD was associated with root vegetables.

Root vegetables negative? Arggghhhh! I eat more mini-carrots than any other single vegetable; I love them because they are so easy to eat, require no preparation, cost very little, are great for snacking, and are (were supposed to be) so good for you. I guess it just goes to prove the old saying, everything that's good for you is also bad for you. So now I have to choose between ignoring the study and waiting for confirmation from future studies, or reducing my carrot intake (currently about 8 oz. per day) and switching to something else.

My image is indicative of my mental state.

rmchavin

Dear PikaB:

Thanks for sharing this study with us. One sentence in this research report's conclusion says, "...intakes of tomatoes, salads, berries, capsicum peppers, and green vegetables were associated with greater...BMD." I want to caution everybody about eating capsicum peppers. Capsicum peppers have been linked to higher cancer rates in humans. (In fact, black pepper, white pepper, and salt have also been linked to higher cancer rates in humans). Here's what I have on red pepper causing cancer: http://www.journals.elsevierhealth.com/periodicals/ymehy/article/PIIS030698 7702001524/abstract http://aje.oxfordjournals.org/cgi/content/abstract/139/3/263 http://www.ncbi.nlm.nih.gov/pubmed/12800206 http://en.wikipedia.org/wiki/Capsaicin http://en.wikipedia.org/wiki/Chili_pepper http://lib.bioinfo.pl/auid:1690449 I still believe that sweet bell peppers of all colors are perfectly safe, in fact, quite beneficial to our overall health. However, this is just my educated guess and I don't have any research studies to back me up so I could be wrong. I would definitely avoid cayenne pepper powder, red pepper flakes, chili powder, and paprika because they may in some cases contain nitrosamines, ochratoxin A, and aflatoxin B1 in addition to capsaicin. I would also avoid fresh or pickled jalapeno peppers, serrano peppers, habanero peppers, Anaheim peppers, yellow banana peppers, and any other spicy-hot soup peppers of all colors because of the capsaicin. I personally eat high-fat fish almost every day without using any salt, red pepper, black pepper, or white pepper. I use things things like broccoli sprouts, radish sprouts, chopped green onions, sliced regular onions, and/or fresh garlic cloves to "pepper" my food. Catsup (contains lycopene) and yellow mustard (contains turmeric) are moderately healthy for you but I decided not to use them because they contain a small amount of salt.

rmchavin

Dear PikaB:

Please kindly tell us what other root vegetables besides carrots were detrimental to bone density in this study so that we can all remember to avoid them. I have a hunch that all starchy vegetables and grains are slightly detrimental to bone density. That would include potatoes, rice, wheat, corn, and peas (despite their green color). Green plants would normally be beneficial to bone health and this study seems to confirm that belief.

PikaB

I contacted the lead author of the study "Which fruit and vegetables protect bones?" at
http://registration.akm.ch/einsicht.php?XNABSTRACT_ID=90811&XNSPRACHE_ID=2& XNKONGRESS_ID=93&XNMASKEN_ID=900
for clarification on the "root vegetable" category. I received a response stating that carrots and potatoes were not included in that category (because they were separate survey questions).

In the survey, the "root vegetable" category was asked as a single question, which included rutabaga, parsnips, turnips, and beets.

So the study did not associate carrots and potatoes with bone loss.

RocknRoll

All this is just too much for me. I've got so many things to think about than what you are supposed to eat and not supposed to eat. And the studies change constantly. Coffee is bad for you, oh wait a minute, coffee is good for you. Dairy is good, no dairy is bad. It can drive a person crazy!! (Short trip for me. Ha!) How about just moderation in everything and forget all this crap and just live the best you can. You know what, sooner or later something is going to get ya. Life is too short to spend all this time on studies that usually turn out to be wrong anyway. I'm probably losing more bone by worring about what to eat or not to eat and what supplements to take and everything else. I'm glad this community is here and I'm sure a lot of people have been helped. I've learned a lot of things myself. I just know that everyone is different and something that works for one person may not work for another. What we know for sure if we have this condition is that our bodies are not regulating calcium properly and hopefully we will be able to find out the reason why and go from there. It should not be as complex as it's made out to be.

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