I heard from six people, all vegan, who have improved their bone mineral density (BMD). Three of them used strontium and I will have more to say about strontium tomorrow ̶ assuming no other nutrition or other crisis!
It should be strongly noted, this is only anecdotal evidence and I am not recommending anyone do anything based on these results without first talking to their doctor.
Here are the results:
A 72-year old woman whose BMD has gone up since age 50 on a regimen of:
a) Increasing calcium to recommended levels
b) Doing an hour of weight bearing exercise most days (about 6 days a week)
c) Vitamin D
A woman who improved her osteopenia on a regimen of:
a) Weight bearing exercise
b) Calcium
c) Magnesium
d) Strontium
e) Vitamin K2
f) Vitamin D3
g) Increased a variety of foods, you can read more by clicking here
A woman who improved her osteoporosis to osteopenia since 2005 with less than a year of drugs and then:
a) Strontium
b) Weight lifting
A woman whose bone mineral density improved after almost a year of:
a) Strontium citrate
A 41-year old man diagnosed with vitamin D deficiency and osteopenia improved bone mineral density after a year of:
a) Vitamin D
b) Calcium
A woman who improved her BMD while taking Fosamex and whose BMD “plummeted” when she went off it.
A note on strontium and BMD scans from WebMd: “[I]t’s important to note that while strontium may increase bone density, improvements seen on bone density testing may appear more impressive than they really are… you should let the radiologist know before you have the bone mineral density test.”
[Thank you for all the responses to my request for information on increasing bone mineral density! I received a lot of responses and am still working my way through them.]
Because I’m planning to write a more reader-friendly version of VeganHealth.org’s Bones, Vitamin D, and Calcium, I decided to check in on the research on protein and bone health. In so doing, I found a 2012 review from a group of researchers in France who declared having no conflicts of interest (1).
There has been an enormous amount of research on protein and bone health and their review had almost 4 pages of references. I will hit the highlights of what they found:
– Many clinical trials show that adding purified proteins to the diet increases calcium excretion through the urine.
– Phosphorus, in which meat and dairy are rich, counteracts the increase of calcium in the urine between 40 and 65%.
– Findings that older people in Western countries have higher hip fracture rates are confounded by the fact that people in Western countries live longer, protein intakes were not estimated for individuals, and there are ethnic differences in bone structure and lifestyles.
– High protein diets increase acid excretion in the urine, but this can be handled by the body’s acid buffer system without the need for calcium.
– Studies measuring whole-body calcium balance (as distinct from excretion) in relation to high protein diets have been mixed, but this might partly be due to the difficulty in measuring calcium balance and because high protein diets might reduce calcium balance when calcium intakes are particularly low.
– In low-calcium, but not high-calcium diets, higher protein intakes probably increase calcium absorption from the digestive tract causing an increase in calcium excretion in the urine.
– Fruits and vegetables are beneficial to bone health, probably due to their high potassium and magnesium content. This could cause confounding in protein studies because diets high in protein are often low in fruits and vegetables.
– As I describe in my post Protein Intake and Bone Health, Darling et al. (2009) found that a large majority of the cross-sectional surveys and cohort studies have reported either no association or a beneficial association between protein and bone mineral density.
– There is some evidence that a beneficial effect of protein on bones is only seen when calcium intake and vitamin D status is adequate.
– Maintenance of adequate bone strength and density with aging is dependent on adequate muscle mass which is dependent on adequate intake of protein.
– An increase in IGF-1 is most likely the mechanism for increased bone health with higher protein intakes.
They conclude, “Although HP [high protein] diets induce an increase in net acid and urinary calcium excretion, they do not seem to be linked to impaired calcium balance and no clinical data support the hypothesis of a detrimental effect of HP diet on bone health, except in the context of inadequate calcium supply.”
Reference
1. Calvez J, Poupin N, Chesneau C, Lassale C, Tomé D. Protein intake, calcium balance and health consequences. Eur J Clin Nutr. 2012 Mar;66(3):281-95. | link
It’s been a long time since I posted something not related to nutrition. And as exciting as nutrition is, once in awhile I can use a break!
There is an animal advocacy-related issue that has been sticking in my craw for the last few years. I listen to a number of NPR shows on my iPod while exercising, driving, and doing house chores, and for the most part I really enjoy them – that is, except for the lack of sensitivity and sophistication with which they treat animal issues.
On the one hand, you have Terry Gross on Fresh Air who does stories on how intelligent some animals are, and then doesn’t blink when a researcher talks about invasive research on them. Similar experiences can be had listening to Radiolab and This American Life. But they are much better than the Planet Money crew who consider farmed animals inanimate objects at best and worthy of contempt at worst.
These are programs that show a great deal of sensitivity to most progressive issues. And while I have a pretty high tolerance for our meat-centered, animal-unfriendly culture, it really burns me to hear these otherwise-enlightened people talk so insensitively. At the very least, they could care about offending their audience, which has many animal advocates.
Much worse than being personally offended, I am concerned that millions and millions of progressive listeners who might otherwise care about animal issues are listening to intelligent, sophisticated radio show hosts and guests dismiss animals’ suffering as unworthy of concern on a daily basis. It cannot be good for what we are trying to accomplish.
After hearing This American Life’s episode “Animal Sacrifice” I reached the tipping point and decided to write them. Below is my email. I am posting it here in hopes that it will help bring some awareness to what I think is a significant, though very subtle problem for our promotion of animal liberation.
This American Life:
I am a longtime listener to This American Life and an occasional donor. I absolutely love the show and am amazed at how you can produce such interesting content week after week.
I know you probably get a lot of feedback any time you mention animals and so I hesitate to write you about this, but your website says that you pass the email around and take comments seriously, so I thought I’d give it a shot.
I have been disappointed in how NPR shows, in general, treat the subject of animals. I realize that NPR is not made up of animal rights advocates, but for a network of people who are so progressive and forward-thinking on so many other issues, the views on animals are not enlightened. The Animal Sacrifice episode (which I listened to weeks ago and have been contemplating writing about ever since then) underlined this point for me. The way animal issues are dealt with on NPR must offend a large portion of the audience in ways that NPR would never be willing to do with any other issue.
I would like to give the entire network a sensitivity training on the subject, but, obviously, that is not realistic. What might be realistic would be for TAL to do a program with some serious thinkers on the issue, such as Peter Singer of Princeton University or Wayne Pacelle of the Humane Society of the United States. I hope you will consider it.
And thank you again for all the great stories you continue to provide!
Are there any vegans out there who have been diagnosed with osteopenia or osteoporosis and have successfully increased their bone mineral density (confirmed by measurements by a doctor)?
If you prefer to email me privately, please send me a note through my contact form (click here).
In my continuing review of the literature of the glutathione and antioxidant status of vegetarians, today’s episode is a 2007 cross-sectional study from Ireland (1).
The study included 31 vegetarians (including 6 vegans) and 58 omnivores. The results were adjusted for age, gender, and body mass index (which did not significantly differ between the two groups). Antioxidant supplements were allowed and results were examined both for the entire group and for non-supplement users.
There were no significant differences between the groups for glutathione or any antioxidant enzymes. The only differences between the two groups of note were:
• Vegetarians had higher levels of carotenoids, associated with a higher vegetable intake.
• Among those not taking antioxidant supplements, the omnivores had a higher total antioxidant status (known as FRAP). This was due to higher uric acid levels (which is an antioxidant) in the omnivores, which was probably due to meat intake.
The authors say, “The results of this study indicate that there were no differences between vegetarians and omnivores in the level of cellular endogenous antioxidants…and in the plasma levels [of] antioxidant nutrients (vitamin C, retinol and a-tocopherol) despite the increased dietary intakes of these antioxidants by the vegetarian group. The reason for the lack of difference in the antioxidant vitamin status between the two groups might partly be due to homeostasis…” In other words, once you have reached a certain threshold of antioxidants in your system, adding more might not do much.
Regarding the uric acid and total antioxidant capacity, this study was interesting, and could possibly indicate that lacto-ovo vegetarians are at a disadvantage. As we saw from my recent post Higher Uric Acid Levels in Vegans, vegans would not be at a disadvantage.
In terms of glutathione levels, we now have a cross-sectional study (1) and a clinical trial (2) indicating that vegetarians have similar glutathione levels as omnivores.
As an aside, one other measure of interest was that plasma zinc levels did not differ between the two groups.
They found what they thought was active vitamin B12 in the following mushrooms (per 100 g of dry weight):
2.9 – 3.9 µg in black trumpet (Craterellus cornucopioides)
1.3 – 2.1 µg in golden chanterelle (Cantharellus cibarius)
1.3 µg in parasol (Macrolepiota procera)
.3 – .4 µg in porcini (Boletus spp.)
.2 µg in oyster (Pleurotus ostreatus)
.1 µg in black morels (Morchella conica)
The authors noted that 100 g of dry weight was the equivalent of about 1 kg of fresh mushrooms. They said that a moderate intake of black trumpet or golden chanterelle “may contribute slightly to the prevention of severe B12 deficiency in vegetarians.” They did not know why the mushrooms contained B12 and also did not test the mushrooms in humans to determine their ability to lower methylmalonic acid (MMA) levels.
As always, I will add a word of caution that vegans should not rely on any plant food for vitamin B12 until a number of batches have consistently lowered MMA levels in humans.
The reason this is relevant to glutathione is that in assessing selenium status, the researchers measured a protein that requires selenium, mentioned in the earlier posts, glutathione peroxidase.
Selenium is considered an antioxidant because it is needed for the production of glutathione peroxidase which, in turn, neutralizes reactive oxygens species by “coupling their reduction with the oxidation of glutathione (2).”
Because animals require selenium to live, non-vegans should be able to get selenium from animal products. Plants can absorb selenium from the soil, but it has to be in the soil. The US soil typically has decent levels of selenium, but the German soil is low in selenium.
The study found that vegetarians had only 71% of the selenium storage protein, selenoprotein P (SEPP), as did the meat-eaters. However, they had the same levels of glutathione peroxidase. When the vegans were separated from the lacto-ovo vegetarians, it did not change the findings for either group.
The authors state, “Whether the differences in SEPP or total serum Se concentrations are important for health issues and disease risk or for the course of pathologies remains to be demonstrated.”
However, this study, as the previous two I blogged about, provides some evidence that the glutathione status, via glutathione peroxidase levels, of vegetarians is similar to meat-eaters.
Kiefer, you are now 0 for 3. To quote Yogi Berra, “It’s getting late early.” As a Sacramento Kings fan, I can identify.
I’m going to take a brief break from the antioxidant discussion to report on a cross-sectional study just released from EPIC that shows vegans to have higher levels of uric acid than lacto-ovo and pesco-vegetarians (people who eat no meat other than fish).
To quote the authors, “Uric acid is the end product of purine metabolism, generated from the breakdown of DNA, RNA and ATP… High circulating concentrations of uric acid can lead to gout, a common form of arthritis, and have also been linked to chronic kidney disease, cardiovascular disease and cancer.”
In the model adjusted for age and alcohol intake (but not body mass index), the results were (µmol/l):
In our correspondence, author Paul Appleby told me that the differences between the vegans and the pesco/lacto-ovo groups were statistically significant for both genders, and the differences between the vegans and meat-eaters were statistically significant for men only.
How could this be?! Apparently, dairy products have been shown to lower uric acid levels. And in this study, there was a significant positive correlation between uric acid and soy protein intake in men.
The good news is that these levels are still within the normal range which is 202-416 µmol/l for men and 143-357 µmol/l for women (2). And even though the differences were statistically significant, they were not huge (about 11% in men and 8.5% in women).
These levels do not appear to be associated with an increased risk of kidney disease (3) or cardiovascular disease (4). One study found an increase in risk of stroke for uric acid levels above 297 µmol/l, but another did not find a statistically significant difference for levels above 410 µmol/l (4).
Uric acid is an antioxidant and has been studied for its potential to prevent cancer, but the findings have not been in that direction. One study found an increased risk for cancer above the normal levels (5), while another found an association of cancer in men (women were not in the study) in the range of the vegans in the EPIC study (6). The authors (6) noted that vitamin B12 deficiency can increase uric acid levels and also stated, “we hypothesize that elevated [serum uric acid] acts as a valuable, long-term, surrogate parameter, indicative for a life-style which is at increased risk for the development of cancer, but does not function as an independent risk factor or even carcinogenic substance by itself.”
Given all the above, I do not think there is much to worry about, though it would be interesting to see if cancer deaths are related to uric acid levels among vegans in EPIC (if there are enough participants to determine this).
It’s been 3 weeks since my last plea to support JackNorrisRD.com. I got a great response from that plea, too, which was very exciting.
In the meantime, I have made a bunch of posts that I hope will help my readers be more informed on issues – it is amazing how many issues get raised in vegan nutrition.
In those three weeks, I’ve picked up about 50 new subscribers bringing the total to 1,500 (via Feedburner anyway). That is good news, but our movement needs many more people knowledgeable about vegan nutrition. I’ve been seeing some things lately showing that the scientific research is not getting through to all animal advocates!
Every post I make has a Facebook “Like” button at the top (you have to click through to the website). If you have a second to like the post, that would go a long way to getting more attention for the blog.
And see below for other ways you can support the site.
Okay, that’s my spiel for this week. Thank you for continuing to read the posts!
A 2012 study from Korea compared the antioxidant status of 45 vegetarians (10 vegans and 35 lacto-ovo vegetarians) to 30 omnivores (1). The vegetarians had to have been vegetarian for at least 10 years and they were mostly Seventh-day Adventists. The vegetarians consumed animal products only occasionally. They had to be without chronic disease and not taking antioxidant supplements, could not be smokers, and could not drink one or more alcoholic beverages per week.
The vegetarians ate a diet of 66% carbohydrate, 19% protein, and 15% fat (versus 60%, 17%, and 25%, respectively, for omnivores). The vegetarians ate about the same amount of calories as omnivores (1,832 vs. 1,790). There was no iron-deficiency anemia. The groups were similar in weight, height, body mass index, and blood pressure but the vegetarians had a lower body fat percentage. Vegetarians had average cholesterol levels of 174 mg/dl, compared to 193 mg/dl for omnivores.
Antioxidant status findings: Vegetarians had significantly lower amounts of diacron reactive oxygen metabolites, which is a reflection of oxidative stress. From what I can tell, by “oxidative stress” they mean “oxidative damage.”
Despite the difference in oxidative stress, both groups had the same levels of biological antioxidant potential. They measured a number of other antioxidant enzymes, including glutathione peroxidase, and found them to be the same in both groups. The authors suggest that the reason for the lack of differences in antioxidant capacity between diet groups could be a tendency to maintain homeostasis.
Body fat, total cholesterol, and LDL cholesterol were significantly and positively associated with reactive oxygen metabolites level.
In this study, vegetarians suffered less oxidative stress (or damage). So far, Kiefer appears to be 0 for 2.
Reference
1. Kim MK, Cho SW, Park YK. Long-term vegetarians have low oxidative stress, body fat, and cholesterol levels. Nutr Res Pract. 2012 Apr;6(2):155-61. Epub 2012 Apr 30. | link
