Osteoporosis – What You Eat Affects Your Bones

The Hippocratic Oath

In the practice of medicine one basic principle stands out: What you eat
has a major influence on your health. That principle is so simple and so
logical that it is surprising the medical profession has had such a
difficult time grasping it. The average doctor, despite having taken the
Hippocratic oath, rejects the famous words proclaimed by Hippocrates: “Let
your food be your medicine and let your medicine be your food.” Had these
doctors only met my late Uncle Ruben, who, well into his nineties, was
still able to walk a brisk five miles every morning, they would have
understood why he believed that “health comes from the farm, not the
pharmacy.”

A theme that keeps recurring in nutritional medicine is that degenerative
diseases are caused, at least in part, by our modern diet, which contains
too much sugar, fat, salt, refined flour, caffeine, alcohol, processed
foods, and food additives. I routinely advise my patients, regardless of
their specific medical problems, to try to clean up” their diet; that is,
reduce their consumption of these junk foods” and to increase their intake
of whole grains, fruits, vegetables, nuts and seeds, beans, and other
unprocessed foods. The majority of people who follow that advice find that
their health improves in some way. Many individuals report an increase in
energy, less depression and anxiety, fewer headaches, better bowel and
bladder function, and less fluid retention. They often sleep better, their
joints do not hurt as much, and they are more alert and productive.
Laboratory reports, such as serum cholesterol,
triglycerides, liver enzymes, and uric acid also improve in many cases.

Specific medical conditions may also be relieved as a result of these
general dietary changes. Patients with asthma, irritable bowel syndrome,
peptic ulcer, gallbladder attacks, acne, psoriasis, high blood pressure,
diabetes, angina, or other problems frequently find that their symptoms are better when they eat a healthier diet. Part of the appeal of improving
your diet is that, even if it does not help, it rarely causes harm.

Diet and Bone Health

Considering that bone is living tissue, just like the rest of the body, it
is likely that what you put in your mouth will determine in part how strong your bones will be. Many people believe that, aside from its calcium content, diet has little to do with osteoporosis. However, that assumption ignores the fact that bone tissue has diverse nutritional needs and engages in complex interactions with the rest of the body. It is
improbable that our modem-day diet could be sparing our bones while damaging
the rest of our body. Although it is impossible to determine the precise
effect of diet
on bone health, there is at least circumstantial evidence that the typical
American diet
promotes the development of osteoporosis.

There are three reasons that our modem diet might not be good for our
bones. First,
many of us ingest too much sugar, caffeine, salt, and alcohol. Consumption
of each
of these substances is reportedly associated with an increased risk of
osteoporosis.
Second, because of the way our food is grown and refined, today’s diet
probably
contains much lower quantities of various vitamins and minerals than it
used to. As
you will learn later, some of these vitamins and minerals play a key role in
maintaining healthy bones. Third, some of the processing techniques used by
the
food industry cause chemical changes in our food that may adversely affect the
health of the tissues in our bodies, including bone. The possible
influences of diet on
bone health are reviewed next.

Sugar

In the early part of the nineteenth century, sugar was considered a
condiment, rather
than a major component of the diet. Back then, the average per capita
intake of sugar
was only about 10 to 12 pounds per year. Today, according to some
statistics, the
average American ingests approximately 139 pounds of refined sugar each year.
That enormous quantity translates to about 41 teaspoons of sugar per day,
or 19%
of all of the calories we consume. Since refined sugar contains virtually
no vitamins
or minerals at all, it dilutes our nutrient intake, resulting in an
across-the-board 19%
reduction in all vitamins and minerals in our diet. Thus, because of our
high intake
of sugar we are getting less magnesium, folic acid, vitamin B6, zinc, copper,
manganese, and other nutrients that play a role in maintaining healthy
bones.

Ingesting sugar may also deplete our bodies of calcium. In one study,
administering
100 grams (about 25 teaspoons) of sugar (sucrose) to healthy volunteers
caused a
significant increase in the urinary excretion of calcium. When the same
amount of
sugar was given to people with a history of calcium oxalate kidney stones
or to their
relatives, the increase in calcium excretion was even greater.) Since 99%
of the
total-body calcium is in our bones, this increase in calcium excretion most
likely
reflects a leaching of calcium from bone. This study suggests that a
high-sugar diet
may reduce the calcium content of bone, and that people with kidney stones
or their
relatives are especially susceptible to the adverse effects of sugar. Thus,
the extent to
which dietary sugar affects calcium metabolism is in part genetically
determined,
just as there is a hereditary component to osteoporosis risk. It is
interesting to note
that individuals with a history of kidney stones are at increased risk for
developing
osteoporosis.2 Researchers have also suggested that consumption of refined
sugar
is one of the factors that promotes kidney stones. Perhaps what people with
kidney
stones and osteoporosis have in common is an increased sensitivity to
refined sugar.

Ingestion of large amounts of sugar has another effect on the body that may
promote osteoporosis. Dr. John Yudkin, a British physician, has been
studying the
effects of dietary sugar for more than thirty years. Yudkin found that
ingesting large
amounts of sucrose by healthy volunteers causes a significant increase in
the fasting
serum cortisol level. Cortisol is the primary corticosteroid l
(cortisonelike hormone)
secreted by the adrenal gland. Although corticosteroids have important
biological
functions, an excess of these hormones can cause osteoporosis. Indeed,
doctors are
reluctant to prescribe corticosteroids precisely because they can cause
severe bone
loss. Yudkin’s work demonstrated that eating too much sugar is in a way
analogous
to taking a small amount of cortisone, which could cause your bones to become
thinner. This possibility is supported by a study on hamsters, in which
feeding a diet
containing 56% sucrose caused osteoporosis, despite adequate intake of
calcium.3

Refined Grains and Flour

Another significant dietary change occurring during the past century is an
increase in
the consumption of refined grains, such as white bread instead of whole wheat
bread, and white rice instead of brown rice. During the refining of grains
and flour
the nutrient-rich germ and bran portions are removed, resulting in a
significant loss
of vitamins and minerals. For example, when whole wheat is refined to white
flour
the following percentages of selected vitamins and minerals are lost:
vitamin B6
(72%), folic acid (67%), calcium (60%), magnesium (85%), manganese (86%),
copper (68%), zinc (78%).4 Since grains make up about 30% of the average diet,
consumption of refined grains would have a substantial impact on the total
daily
intake of micronutrients (vitamins and minerals). Because nearly 50% of the
typical
American diet is composed of nutrient-depleted sugar and refined grains,
the intake
of many important micronutrients is probably much lower than it was during the
previous century

Caffeine

Caffeine is found in coffee, tea, cola beverages, and certain pain
medications.
Substances similar to caffeine are also present in chocolate. Caffeine has
certain
pharmacologic (druglike) effects in the human body and is known primarily as a
stimulant of the central nervous system. Tens of millions of people depend on
caffeine to help them wake up in the morning and to stay alert during the day.
Athletes sometimes use caffeine to enhance their performance.

Although the dangers of caffeine have long been a topic of debate, it is
well known
that caffeine is an addictive substance. Withdrawal from caffeine after
prolonged use
usually results in severe headaches, which can last several days. It is
also well
known that excessive caffeine use is a cause of anxiety and insomnia.

Nutrition-oriented practitioners and some conventional doctors believe that
caffeine
can also cause certain other problems in susceptible individuals. Problems
attributed
wholly or in part to caffeine include fibrocystic breast disease, cardiac
arrhythmias
(heart rhythm disturbances), diarrhea, constipation, abdominal pain,
elevated serum
cholesterol or blood sugar, high blood pressure, and chronic migraines or
other
headaches. There is evidence that caffeine may also promote heart disease and
cancer, although the studies in this area are conflicting.

It should not be surprising that a substance that appears to cause problems
in so
many different systems of the body would also adversely affect bone tissue.
Most
of the evidence is circumstantial, but studies do suggest that caffeine
ingestion may
contribute to bone loss. In one study, thirty-one women ingested a cup of
decaffeinated coffee on three different occasions. In two of the cups,
caffeine was
added at concentrations of 3 mg/kg and 6 mg/kg of body weight,
respectively. The
excretion of calcium in the urine during the next three hours was
significantly
greater after caffeine ingestion than after decaffeinated coffee. The
increases in
calcium excretion were 50% and 69%, respectively, after low and high doses of
caffeine.5 These results demonstrate that ingestion of caffeine causes
excess calcium
loss from the body in the short term.

Another study suggests that this effect of caffeine is not just limited to
the short
term. Calcium balance, a measure of the amount of calcium retained in the
body,
was assessed in 168 women between the ages of 35 and 45. The results showed
that
calcium balance decreased with increasing dietary intake of caffeine. In
other words,
women who habitually ingested a great deal of caffeine retained less
calcium than
did those who used little caffeine. Women who consumed 50% more caffeine than
average had an estimated; reduction in calcium balance of 6 mg/day.6
Although 6
mg/day might seem like a small amount, a loss of that much calcium every
day for
years would add up to a significant degree of bone loss.

The potential consequences of caffeine ingestion on bone health was
assessed in a
study of 84,484 women the ages of 34 and 59. In 1980, each of the women
completed a questionnaire pertaining to their intake of various foods and
beverages.
During the ensuing six years, there was a positive association between
caffeine
intake and the risk of sustaining a hip fracture. That is, the risk of a
hip fracture
increased with increasing levels of caffeine intake. Women who consumed the
most
caffeine (above the 80th percentile) had nearly three times as many hip
fractures as
women who consumed the least caffeine (below the 20th percentile).7 One
possible
confounding factor in this study is that women who use caffeine also tend
to smoke
cigarettes, which are known to contribute to the risk of osteoporosis. It
is possible
that some of the risk attributed to caffeine intake was actually due to
tobacco.
However, the weight of evidence suggests that anyone interested in maintaining
healthy bones should avoid excessive caffeine intake.

Alcohol

Consumption of excessive amounts of alcohol is a known risk factor for
osteoporosis. In a study of ninety-six male chronic alcoholics): ages 24 to
62, 47%
had osteoporosis. Among those under the age of 40, 31% had osteoporosis.8
Although a similar study has not been done on women, it is likely that
drinking too
much alcohol would also promote osteoporosis in women. The effect of moderate
alcohol consumption on bone health is not known.

Protein, Phosphorus, and Sodium

The American diet tends to contain too much, rather than too little
protein. Studies
have shown that excessive dietary protein may promote bone loss. With
increasing
protein intake, the urinary excretion of calcium also rises, because
calcium is
mobilized to buffer the acidic breakdown products of protein. In addition,
the amino
acid methionine is converted to a substance called homocysteine, which is also
apparently capable of causing bone loss.

Animal studies have shown that excessive intake of phosphorus can cause
osteoporosis, as well. The effect of dietary protein on osteoporosis might be
explained in part by the phosphorus content of many high-protein foods
because phosphorus does appear to have an adverse effect on bone health.
High-phosphorus beverages such as colas (which also contain a lot of sugar
and caffeine) are among the worst foods imaginable for someone trying to
prevent osteoporosis.

Several studies have shown that individuals who consume a vegetarian diet
have stronger bones later in life than those who eat animal flesh.9,10
However, other studies have failed to find a difference in bone mass
between vegetarians and meat eaters.

A substantial minority of human beings also appears to be Susceptible to
the effects
of high-sodium intake. When these individuals ingest moderate amounts of salt,
their urinary excretion of calcium increases markedly.” In people with this
sodium-dependent hypercalciuria, ingestion of too much salt probably
increases the
risk of both kidney stones and osteoporosis. In today’s fast paced society,
great
emphasis is placed on readily available, easily prepared food, which can be
stored
on the shelf for prolonged periods of time. The food technology industry has
developed many ways to achieve these goals. Unfortunately, the nutritional
quality
of processed, adulterated food is far inferior to that of fresh, perishable
foods.
Modern food is bleached, radiated, extracted with organic solvents,
subjected to
enormous temperatures and extremes of acidity or alkalinity, and
contaminated with
thousands of chemicals designed to preserve, texturize, color, or otherwise
modify
the food so that it will look, feel, and taste like the real thing.

Hundreds of articles have been written about how these harsh processing
techniques
can affect the nutritional value of food. One I example is the possibility
that food
processing can promote lysine deficiency. Lysine is one of the eight
essential amino
acids from which protein molecules are synthesized in the body. Studies have
shown that when proteins are subjected to alkali treatment (as in the
production of
isolated soy protein or textured vegetable protein), a substantial amount
of the lysine
is destroyed.l2 Exposure of lysine to temperatures of 250¡C for one hour also
caused significant losses of lysine.l3 Heating proteins even at moderate
temperatures in the presence of sugars such as lactose, glucose, or sucrose
can also
destroy significant amounts of lysine.14 Thus, in the baking of pies, cookies,
breads, and other grain products, where flour and sugar are heated together,
substantial amounts of lysine may be lost.

You might assume that, with all of the protein in the American diet, it
would be
difficult to develop a deficiency of an amino acid. The problem is,
however, that
amino acid imbalance can be just as damaging as amino acid deficiency. Animal
studies have shown that the ratios of essential amino acids in the diet are as
important as the absolute amount of each. If a single amino acid, such as
lysine, is
being systematically destroyed by food processing, then ingesting more of
all of the
amino acids will not correct a relative lack of lysine.

It is therefore possible that millions of Americans are marginally
deficient in Iysine,
even if their diet is high in protein. The modern epidemic of herpes simplex
infections is certainly consistent with that possibility. Lysine is known
to inhibit the
growth of herpes viruses and oral supplementation with Iysine has been
shown to
prevent recurrences of herpes simplex outbreaks in susceptible
individuals.15, l6
Since the doses of lysine that were effective against herpes infections
(312 to 3,000
mg/day) are similar to the amounts obtainable in the diet, it is possible
that dietary
lysine deficiency is a factor in the increased incidence of herpes simplex
infections.

It is also possible that lysine deficiency contributes to the development of
osteoporosis. Individuals with a rare genetic condition known as lysinuric
protein
intolerance develop osteoporosis during childhood. In lysinuric protein
intolerance, a
defect in the kidneys causes large amounts of lysine to be lost in the
urine. Scientists
have suggested that lysine deficiency is the cause of osteoporosis in
individuals with
this disorder.17 Although the typical American diet would not result in Iysine
deficiency that severe, it is possible that prolonged, subtle lysine
deficiency caused
by harsh food processing techniques could have an adverse effect on bones.

Soil Factors

The reduction in vitamin and mineral intake resulting from refining of
foods can be
made even worse by farming techniques that deplete the soil of essential
minerals.
Traditional methods of farming include using manure and compost to increase
the
trace mineral content of the soil. In modern times, however, with the
emphasis on
producing higher crop yields per acre, farmers use large amounts of inorganic
fertilizers, which are often deficient in important trace minerals and
which may
disturb soil mineral balance. For example, the use of ammonia as a
fertilizer causes
essential minerals such as magnesium’ manganese, zinc, and copper to be
leached
from the soil.18 Repeated application of inorganic fertilizers, which are
low in
essential trace minerals, can further reduce the soil concentration of
these trace
minerals. Many scientists and nutritionists are unaware of the effect the
depleted soil
can have on the mineral content of edible plants i Indeed, nutrition
textbooks often
contend that mineral-deficient soil will reduce crop yield, but will not
adversely
affect the nutritional quality of crops that do grow. However, the facts
indicate
otherwise. The presence of a “goiter belt” in the midwestern United States
attests to
the fact that foods grown on iodine-deficient soil can cause iodine
deficiency. The
relationship between mineral concentrations in soil and food is also
underscored by
the epidemics of selenium deficiency that have occurred in cattle grazing
in low
selenium areas of the country. As another example, dairy cattle an horses are
sometimes stricken by a condition known as grass staggers, characterized by
unsteady gait and twitching and spasm of the muscles. This disorder can be
cured
either by supplementing the diet with magnesium or by adding magnesium to the
soil.19 It appears that overuse of nitrates, phosphates, and potassium
salts as
fertilizers depletes the soil of magnesium and causes a deficiency of this
mineral in
grazing animals. In the Florida Everglades the soil is low in copper. Domestic
animals grazing in this area develop copper deficiency which makes them
unusually
susceptible to sus~ taining bone fractures. But, when copper is added to
their diet
fractures no longer occur.20 In another study, the manganese content of
turnips was
directly related to the manganese content of -the soil. Addition of calcium
carbonate
to the soil (a common practice by modern farmers) decreased the
accumulation of
manganese by turnips.

Conclusion

These studies indicate that modern farming practices deplete the soil of
essential
minerals, resulting in lower levels of these minerals in our food. The
vitamin and
mineral content of our diet is further reduced by overconsumption of
nutrient-depleted foods, such as sugar and white flour. The net result is
that the food
we consume today contains far less of many vitamins and minerals than it
did in the
past. One of the major theses of this book is that chronic, low level
deficiencies of
a wide range of micronutrients may increase the risk of developing
osteoporosis.

In summary, many factors related to the modern American diet may promote
not only osteoporosis, but other chronic diseases, as well. A health-promoting
diet is one that emphasizes fresh, unprocessed foods, such as whole grains,
fruits and vegetables, nuts and seeds, and legumes Animal foods, dairy
products, and salt should be used in moderation, and sweets, caffeine, refined
flours, and chemical food additives should be avoided as much as possible.
While some studies suggest that moderate alcohol intake improves health,
others have shown that even small amounts of alcohol are not good for you.
Certainly, excessive alcohol intake can cause many different problems,
including osteoporosis. The human body is remarkably resilient and is
capable of withstanding numerous stresses, but it is also true that the more
closely you follow the principles of good eating, the healthier you will be.




Notes


1. Lemann, J., Jr., W. F. Piering, and E. J. Lennon. 1969. Possible role of
carbohydrate-induced calciuria in calcium oxalate kidney-stone formation.
No Engl J Med 280:232-237.

2. Lawoyin, S., et al. 1979. Bone mineral content in patients with calcium
urolithiasis. Metabolism 28:1250-1254.

3. Yudkin, J., Dr. 1973. Sweet and dangerous. New York: Bantam Books,
112. Saffar, J. L, et al. 1981. Osteoporotic effect of a high-carbohydrate
diet
(Keyes 2000) in golden hamsters. Arch Oral Biol 26:393-397.

4. Schroeder, H. A. 1971. Losses of vitamins and trace minerals resulting
from processing and preservation of foods. Am J Clin Nutr 24: 562-573.

5. Hollingbery, P. W., E. A. Bergman, and L K Massey. 1985. Effect of
dietary caffeine and aspirin on urinary calcium and hydroxyproline excretion
in pre and postmenopausal women. Fed Proc 44:1149.

6. Heaney, R P., and R R Recker. 1982. Effects of nitrogen, phosphorus, and
caffeine on calcium balance in women. J Lab Clin Med 99:46-55.

7. Hernandez-Avila, M., et al. 1991. Caffeine, moderate alcohol intake, and
risk of fractures of the hip and forearm in middle-aged women. Am J Clin
Nutr 54:
157-163.

8. Spencer’ H., et al. 1985. Alcohol-osteoporosis. Am J Clin Nutr 41:847.

9. Marsh, A. G., et al. 1980. Cortical bone density of adult
lacto-ovo-vegetarian an omnivorous women. J Am Diet Assoc 76:148-151.

10. Marsh, A. G., et al. 1983. Bone mineral mass in adult
lacto-ovo-vegetarian an omnivorous males. Am J Clin Nutr 37:453-456.

11. Silver,J., et al. 1983. Sodium-dependent idiopathic hypercalciuria in
renal-stor formers. Lancet 2:484-486.

12. de Groot, A P., and P. Slump. 1%9. Effects of severe alkali treatment of
prose on amino acid composition and nutritive value. J Nutr 98:45-56.

13. Breitbart, D. J., and W. W. Nawar. 1979. Thermal decomposition of
Iysine. J Agric Food Chem 27:511-514.

14. Hurrell, R. F., and K J. Carpenter. 1977. Mechanisms of heat damage in
prose

8. The role of sucrose in the susceptibility of protein foods to heat
damage Br
J Nutr 38:285-297.

15. Griffith, R S., A. L Norins, and C. Kagan. 1978. A multicentered study
of Iysine therapy in herpes simplex infection. Dermatologica 156:257-267.

16. Griffith, R S., et al. 1987. Success of L-lysine therapy in frequently
recurrence herpes simplex infection. Dermatologica 175:183-190.

17. Carpenter, T. O., et al. 1985. Lysinuric protein intolerance presenting as
child hood osteoporosis. N Engl J Med 312:290-294.

18. Hall, R. H. 1981. The agri-business view of soil and life. J Holistic Med
3:15 166.

19. Ebeling, W. 1981. The relation of soil quality to the nutritional value of
plant crops. J Appl Nutr 33(1):19-34.

20. Rose, E. F. 1968. The effects of soil and diet on disease. Cancer Res
28:2390 2392.

21. Hopkins, H. T., E. H. Stevenson, and P. L Harris. 1966. Soil factors and
food composition. Am J Clin Nutr 18:390-395.

Avatar Written by Alan R. Gaby MD

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