Most of us believe that if we get enough calcium and vitamin D we will maintain healthy bones as we age. In this country, a woman over 50 or a man over 70 is told to get at least 1200 mg of calcium a day from diet and/or supplements to prevent bone thinning. Women on certain types of breast cancer treatments take 1000 mg of calcium and 400 units of vitamin D to prevent drug-induced osteoporosis. Younger people are also told to get at least 1000 mg of calcium daily.
In my TQI Diet class, however, we review an ever-increasing number of studies that indicate that our approach to osteoporosis is wrong. These studies strongly suggest that the recommended amounts of calcium do not protect against osteoporosis but instead increase the incidence of hip fractures, kidney stones, and serious heart problems.
Despite decades of advice to get plenty of calcium, osteoporosis is common in the Western world and hip fractures in postmenopausal women is expected to rise over 50% by the year 2025. This is referred to as the calcium paradox: Hip fractures are higher in countries where calcium intake is higher. At least 40% of women and 15-30% of men in these countries will sustain one or more fragility fractures in their remaining lifetime.
The biggest problem facing those with osteoporosis, however, is not bone breaks. Instead the real risk of osteoporosis is that it increases your odds of dying from heart disease. It appears that the more calcium you get, the worse for your heart.
I recently came across this prophetic warning from a 1997 study: “Since we now know that most deaths in people with osteoporosis relate not to the bone but to the cardiovascular system . . . measures simply directed to improving overall calcium status without ensuring that calcification is taking place in bone and not in arteries or kidneys have the potential to do more harm than good.”
It turns out that when we focus on calcium rather than on a healthy diet, we end up absorbing less calcium and end up excreting more calcium than expected – none of which is good for bone health. And then much of the calcium that gets absorbed ends up in our arteries and kidneys instead of in our bones. Today research that began in the 1930s is gaining prominence: To improve both our heart and our bone health, we must get adequate amounts of essential fats. And most Americans need to work on getting their essential fats for many other reasons as well. It’s an area that we do poorly in.
Essential fats come in two groups: Omega 6s and omega 3s. Both are critical components of our diet and should be eaten in balance. The typical American, however, gets too many 6s and does not get enough omega 3s. This imbalance results in inflammation that damages health. So, we need to change our diet to increase the presence of omega 3s.
Foods with a natural, inherently good ratio of omega 3 fats are wild fish, leafy green and cruciferous vegetables, most green herbs (basil, sage, etc.), most berries, walnuts, flax, chia, and hemp along with their oils. A recent study compared a standard American diet with a diet richer in healthy omega 6s and another diet richer in healthy omega 3s. The omega 3 diet (rich in walnuts, walnut oil, and flax) significantly reduced measures of bone destruction. This study was important because it was well designed and also because it strongly suggests that we can protect our bones with a diet rich in plant omega 3s, something that has long been questioned.
In addition to eating a balanced diet rich in omega-3s, we need to quit doing things that weaken our ability to process our omega 3s: This involves limiting alcohol, avoiding too many saturated fats especially combined with too many simple sugars, avoiding transfats, corticosteroids, eating a diet that reduces or eliminates the need for acid reflux medications, and not smoking. Add enough weight bearing exercise and vitamin D and it appears that osteoporosis would be a thing of the past.
Ultimately, bone health is complicated and is made much more complicated by the number of studies that compare apples with oranges. Few compare healthy diets with other healthy diets. Instead, for instance, a study on the effect of saturated fats on bone did not compare diets high in cholesterol with healthy diets low in cholesterol, even though cholesterol is our most common form of saturated fat. Instead, they fed roosters palmitic acid (a saturated plant fat) and compared them to roosters fed alpha floc cellulose, not something most humans eat. As a result many questions pertaining to bone health remain unanswered.
Ultimately, no one has an unassailable, evidence-based calcium recommendation for us. Instead, while waiting for these important issues to get sorted out, we should eat a balanced diet filled with leafy greens, pestos made with walnut oil, berries, and some wild fish for those so inclined.
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brilliant as usual…xoxox
thanks for this – I’m horrified by how many women are taking lots of Vitamin D and Calcium supplements these days thinking they’re doing a good thing for their body, many because their Doctors told them they should, as opposed to making sure their diet and lifestyle is in good shape. Not only does this apply to older women like my mother but my daughters grew up thinking they needed extra calcium too.
The Better Bones Blog by Dr. Susan Brown, and the National Osteoporosis Foundation both encourage women with osteoporosis to consume enough of both kinds of Vitamin K, which apparently ensures that the calcium we take does not end up in our arteries.
While both types of vitamin K (the one found in plant foods and the one produced by our beneficial flora) are essential to bone health (and general health as well), there are no definitive studies showing that the negative effects seen in some studies from calcium supplementation are overcome by adequate vitamin K.