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What Ten Dried Plums (Prunes) a Day Can Do for Your Bones - The Florida State University Study - Understanding the Science Behind the Prune's Effect Upon Bone Health

 

 

 

 “Over my career, I have tested numerous fruits, including figs, dates, strawberries and raisins, and none of them come anywhere close to having the effect on bone density that dried plums, or prunes, have.  All fruits and vegetables have a positive effect on nutrition, but in terms of bone health, this particular food is exceptional.

Dried plum(s) significantly increased bone mineral density of the ulna & spine in comparison with dried apples.

In comparison with corresponding baseline values, only dried plum(s) significantly decreased serum levels of bone turnover markers, including bone-specific alkaline phosphatase and tartrate-resistant acid phosphatase-5b. 

The findings of this present study confirm the ability of dried plums(s) in improving bone mineral density in postmenopausal women in part due to suppressing the rate of of bone turnover and bone resorption."

 

-Bahram H. Arjmandi, Florida State’s Margaret A. Sitton Professor and chairman of the Department of Nutrition, Food and Exercise Sciences in the College of Human Sciences.  

Hooshmand, S et al   "Comparative effects of dried plum and dried apple on bone in postmenopausal women,"  British Journal of Nutrition 106(6):923-30, September, 2011.   Epub 2011 May 31.

 

 

First it was calcium.  Then it was weight-bearing exercise.  Then it was vitamin D.  And yes,  it's still all of these (though less calcium lately)--but now there's a new kid on the bone mineral density block.   

Now, consider the dried plum (formerly known as "the prune") for a boost in your bone health!

Yes, there's always that "back-up plan" of drug options--the bisphosphonates & raloxifene, if all else fails. 

But, now there's a serious suggestion by the FDA of a five-year limit on drug therapy--or at least taking a recommended "drug holiday".   Stay tuned for revised drug labeling in November 2011.  Read more here.

According to the FDA, between 5.1 million and 5.7 million patients in the United States have received prescriptions for the drugs for each of the years 2005 through 2009.

Earlier this month (September 2011) an FDA staff report said there was no advantage of taking the popular bone drugs of Boniva, Actonel, and Fosamax for more than five years. 

 

“These results suggest no significant advantage of continuing drug therapy beyond 5 years,” according to agency’s 45-page review of scientific evidence.

As for side effects, the report said, there is no solid evidence the drugs, called bisphosphonates, cause unusual breaks of the femur bone, a jaw injury called osteonecrosis, or esophageal cancer. At the same time, the agency said, those rare but dangerous outcomes cannot be ruled out because it has been so difficult to study them for various reasons.

“The safety of long-term bisphosphonate therapy continues to be unclear as study results are conflicting,” according to the F.D.A. report.    Duff Wilson, "FDA Staff:  5 Years May Be Enough for Bone Drugs,"   New York Times, September 7, 2011.

 

If you received this post via email, click here to get to the web version with all the links & a video.

 

Meet the Dried Plum! 

Looks like perfect timing to consider adding prunes to your diet and take a careful look at Hooshmand's & Arjmandi's new research.

I couldn't wait to look at this study--and I admit that I'm a rank amateur--but, I'm impressed with the results of their well-designed study.  These researchers have been analyzing the effects of dried plums on bone strength for years in their lab--first in animals, and then in humans. 

In 2002 they even ran a short-term 3 month prune study on women, which had positive outcomes.  (click here)  And they've also pored over years of published research by other scientists on the effects of nutrients & prunes on bones.

Best of all--they provide detailed explanations of how it is possible for the lowly prune to physiologically make bones stronger.  Now even I get it!

 

The Florida State & Oklahoma State University Postmenopausal Bone Study Explained - Dried Plums Face-off Against Dried Apples

 

Who was in this study?

 

100 postmenopausal women completed the study over a period of 12 months.  No one was on bone medications, anabolic agents, steroids, or any drugs that can alter bone or calcium metabolism. Women with metabolic bone disease, other chronic diseases, or heavy smokers were excluded.   Anyone who regularly ate prunes or prune juice could not participate.  No one had a BMD t-score at any site below 2.5 sd of the mean.

 

What did the participants have to eat?

 

Fifty-five women were in a treatment group (and completed the study) that was assigned to consume 100 grams of prunes a day--that's about 10 prunes--for 12 months.  "Because of the known laxative properties of dried plums, the participants were asked to gradually incorporate the plums into their diet."  

 

Note:  One HHLL reader took an early test-drive of the prune regimen, but made the mistake of eating 10 prunes all at once--and suffered the consequences.  Her physician recently told her to go off of Fosamax--since she'd been on it for over 5 years.  She was highly motivated to keep her bones strong, and eating prunes seemed like a good plan, so, after her initial "faux pas" she figured out an easy way to consume the 10 prunes--just space them out--eating about one an hour works well for her, and she loves the taste!

 

Forty-five women were in a second treatment group (and completed the study) that was assigned to consume 75 grams of dried apples--which have an equivalent amount of calories, carbohydrates, fat, and fiber--as the dried plums.

Both groups also took 500 mg of calcium, plus 400 IUs of vitamin D.

Compliance was high--at 82%--the same for the apple & dried plum groups.  The women liked the prunes. 

 

How was the study designed?  What did the researchers measure?

 

Physical measurements: At the study's start everyone had medical, nutritional, & physical activity histories taken.   Height & weight was measued at the start, and at 3, 6, and 12 months.

BMD measurements:  Bone density was measured at the start--and at the end of the treatment with dual-energy x-ray absorptiometry--and the whole-body, lumbar spine, hip & forearm BMD's were all measured.

Bone marker measurements:  Blood samples to measure biomarkers of bone turnover were taken from everyone at the start, and at 3, 6, and 12 months.   Here's what the researchers looked at: 

• The markers of bone turnover:  bone-specific alkaline phosphatase (BALP), osteocalcin (OC)
• The markers of bone resorption:  tartarate-resistant acid phosphatase-5b (TRAP5b)
• The marker of inflammation: C-reactive protein (CRP) was taken to determine the potential anti-inflammatory role of dried plums in modulating bone metabolism

 

Who won?  The Apples or the Plums?  And, the envelope, please!!

• Both fruits were palatable, and the "dosage" was easy to adhere to.
• Both groups were still eating the same amount of food at the start of the study, as they were throughout the study, yet, remarkably, no one gained weight, in spite of the additional calories.
• Both dried fruit groups experienced bone-protective effects based on the positive changes from baseline in the ulna, spine, femoral neck, total hip, and whole-body BMD.
• The dried prune group had more significant increases in the BMD of the ulna & spine--compared to the dried apple group.
• The dried plum group had a significant reduction in the markers of bone turnover (a good thing!), compared to the dried apple group.  The reduction in these markers helps to explain how dried plums improve the BMD of post-menopausal women, in part, due to slowing down the rate of bone turnover.
• The dried plum group had a significant decrease in the marker of bone resorption (a good thing!) at 3 months and it remained the same through the end of the study.  The dried apple group didn't change much over the course of the study--but it increased at the 12 month mark (not a good thing!)
• The inflammation marker (CRP) decreased (a good thing!) in the plum group after 3 months--and remained the same until the end of the study.  In the apple group, the CRP was the same after 3 months, and decreased thereafter--ending up insignificantly higher than the plum group. 

 

What Ten Prunes a Day Can Do for Your Bones and the Reasons Why It Works

 

• Bone density increased.  Ten dried plums a day (100 grams) eaten daily for 12 months showed increases over baseline in the bone mineral density of the ulna, spine, femoral neck, total hip, and whole-body.   Both the prune & dried apple groups showed similar bone density improvements in the neck of the femur and the total hip.
• Ulna & spine.  The dried plum group showed significant increases of the ulna (long bone of the forearm) & spine compared to the dried apple group.  According to the authors, "These findings suggest that dried plum is particularly effective in reducing the risk of fracture in the ulna & spine as indicated by the higher BMD in these sites."
• No bone loss.  None of the women in the study lost any bone--whether they were eating dried apples or prunes.
• The earlier animal studies.  Earlier animal studies strongly suggest that dried plums have a potent effect on preventing & reversing bone loss as "evident by the higher bone densities, [higher] mineral contents, [increased] percentage of the trabecular bone area (this is the all-important lattice-like network of struts that supports our bones & women can lose up to 50% of this type of bone-read more here), and the tendency to reduce marrow space in the long bones in rats."
• Bone biomarker improvements.  Bone mineral density biomarkers found in the blood also showed improvement after 12 months.  According to Arjmandi, this is due in part to the ability of dried plums to suppress the rate of bone resorption, or the breakdown of bone, which tends to exceed the rate of new bone growth as people age.
• No weight gain.  Although the women consumed about 200 calories worth of prunes a day, neither their weight nor BMI increased--perhaps due to the increased fiber content of the prunes--about 6-7.1 grams of fiber.
• The vitamin C, K, boron, & phytochemical connection to bone health.   Prunes are high in the antioxidant compounds of neochlorogenic and chlorogenic acids (click here) that scavenge potentially damaging free radicals. Previous studies have shown this action helps to prevent bone loss. Click here & here.  Prunes have higher amounts of boron than most fruits--and "boron modulates bone and calcium metabolism, and plays an important role in preserving BMD."  Click here.  And prunes have high amounts of vitamin K which influences bone health by improving calcium balance & promoting normal bone mineralization.
• Dried plums may improve bone mass by slowing down the rate of bone turnover.  The authors speculate that dried plums may improve bone health by suppressing  the rate of bone resorption more so than the rate of bone formation.  However, this can only be shown through bone biopsies.
• Dried plums reduce inflammation--perhaps another reason why they improve bone.  The dried plums in this study significantly reduced the C-Reactive Protein (CRP) levels (a measure of inflammation) after 3 months--and this improved level was maintained, thereafter.  A high CRP is linked to a number of chronic diseases, including osteoporosis.  Click here.

Full Disclosure & Author Acknowledgements:  This study was supported by the National Research Initiative of the USDA Cooperative State Research, Education & Extension Services, grant #2005-35200-17053.  The California Dried Plum Board provided the dried plums, & Bayer Healthcare supplied the calcium & vitamin D supplements.  There are no conflicts of interest.

 

Nutritional Data for a Ten-Prune Serving

Nutrition Facts Prunes
Serving Size: 10 prunes
Amount Per Serving
Calories	200
Total Fat	0.3g
Saturated Fat	0.1g
Trans Fat	0g
Cholesterol	0mg
Sodium	2mg
Carbohydrate	53.7g
Dietary Fiber	6g
Sugars	32g
Protein	1.8g
Vitamin A 13% Vitamin C 1% Calcium    4% Iron 4%

Potassium:  732 mg

Boron:  3 mg

Magnesium:  41 mg

Vitamin K:  59.5 mdg

 

Dr. Bahram H. Arjmandi and a Study Participant Discuss the Study (1:46 minutes)

Please click here if you don't see the video.

 

 

Want Even More Evidence of the Benefits of Dried Plums?  

 

First off--just take a look at Dr. Arjmandi's extensive bibliography!

These highlights come for Pamela Durkin, a registered nutritional consultant and freelance journalist living in Victoria, Australia.  Source: Alive Magazine  #342, April 2011   A HHLL sent it to me.

• Prunes are a natural laxative because they're high in insoluble fiber, which helps them to absorb water.  They also contain "a compound called dihydroxyphenyl isatin, which stimulates the intestine, causing it to contract."   Good reason NOT TO EAT 10 prunes at one time!!!
• Prunes also contain soluble fiber which helps to lower cholesterol.
• It's loaded with potassium which helps to lower blood pressure.
• It contain phenolic compounds (neochlorogenic and chlorogenic acids) that help to inhibit the oxidation of LDL cholesterol.
• It's high in boron which helps to regulate mineral metabolism, optimize estrogen levels, & increase calcium absorption.
• Boron helps to convert vitamin D to its active form, which helps the osteoblasts utilize calcium for bone formation.
• Prunes are loaded with disease-fighting carotenoids like beta-carotene, lutein, & zeaxanthin, as well as anthocyanins, proanthocyanins, and phenols.  No surprise that they have a higher ORAC (measure of antioxidant activity) than blueberries---clocking in at 8,059 for a 100 gram serving--which is exactly the 10 prunes that Dr. Arjmandi is recommending.  The blueberry measures in at 4,669.

Learn more from Pamela Durkin by following the link to her article.

 

It's not often we see such a provocative study about a functional food.  I've never considered eating prunes before reading this study--but I'm definitely going to give them a try!  Full disclosure:  I haven't started yet.

HHLL reader "Teacher Fan" gives them a big thumbs up.   Just take her advice--space them out over the day.  She now keeps a bag in her purse to munch on throughout the school day.

 

For more on the ongoing controversies about bone health, osteopenia, and prescription bone meds, see below:

What's the Best Way to Treat Osteopenia? Diet, Vitamin D, Calcium, Drugs Like Bisphosphonates, or Weight Training? Check Your Fracture Risk with the W.H.O. FRAX Tool to Help You Decide

 

NPR's Award-winning broadcast:  How A Bone Disease Grew To Fit The Prescription, (a must read!) by Alix Spiegel 

 

Reconsidering Calcium Supplements - What the Experts Say about Bone Health, Calcium Requirements, Dairy, and Strength Training

 

And, HOT OFF THE PRESS, from HHLL reader, Tom.  Wall Street Journal, September 20, 2011, "Yes, You Are Getting Shorter,"  by Melinda Beck   One more good reason to add dried plums to the menu!

 

 OK, HHLL readers, please weigh in with your opinions!  Does this sound too good to be true---or worth a try?

 

Reconsidering Calcium Supplements - What the Experts Say about Bone Health, Calcium Requirements, Dairy, and Strength Training

"If you care about your bone health and preventing fractures, don't drink the milk, but take your cow for a walk!  The bones that are the strongest are the ones we put stress on. 

Calcium and dairy are definitely not the solution to osteoporosis. Countries consuming  the most calcium have the highest rates of fracture.  Looking at the Nurses' Health Study & the Health Professions Follow-up Study, there was no relationship in the amount of calcium or milk consumed by women and men and their risk of fractures. 

It's true we do need some calcium in our diet--it's absolutely essential for bone health, but 500-700 mg of calcium a day is probaby right. (Note: the DRI for calcium for people age 50+ is 1200 mg; ages 19-50 is 1000 mg) Most people are already getting enough and just adding more isn't going to be helpful."

-Walter Willett, MD, DrPH, is Chairman of the Department of Nutrition and the Frederick John Stare Professor of Epidemiology and Nutrition at Harvard University's School of Public Health.  Click here for source of quotes-

 

If you received this post via email, click here to get to the web version with all the links.

OK, I admit it--this post is ridiculously long.  I apologize!

 

Bone health and calcium have definitely been on my radar screen this week.  Here's why:

• Can calcium supplements increase cardiovasuclar events?  I know, it doesn't seem plausible--for years we've been told to dutifully take our calcium supplements!  But the authors of this article think there are good reasons to seriously reconsider the widespread use of calcium supplements.  "Effect of calcium supplements on risk of myocardial infarction and cardiovascular events:  meta-analysis,"  Bolland, MJ, Reid, IR et al.  BMJ 2010 Jul 29;341:c3691. doi: 10.1136/bmj.c3691  Click here for article. 

This provocative New Zealand  "meta-analysis of trials looked at studies totalling 12,000 people who took calcium supplements (without vitamin d) and found they increased the risk of myocardial infarction by 30%.  Given the modest benefits of calcium supplements on bone density and fracture prevention, a reassessment of the role of calcium supplements in the management of osteoporosis is warranted,"  the authors write.  What could be the cause? The proposed mechanisms for the higher risk include increased blood coagulability and decreased blood vessel compliance due to calcium buildup in the arterial wall.

• If the BMJ article is correct, & calcium supplements do have risks, what should physicians advise their patients?  From Medscape's Internal Medicine Stay Well series, published 10/25/10, "Rethinking Calcium: Bone Health or Heartache?" by Dr. Sandra A. Fryhofer, Clinical Associate Professor of Medicine, Emory University School of Medicine, American College of Physicians Past President.  As a result of the BMJ study Fryhofer is rethinking calcium supplementation.  Although previous studies have shown them to be safe, they may be problematic from a cardiovascular standpoint.  She's recommending her patients look primarily  to dietary sources of calcium in order to get 1000 mg of calcium a day; she's discouraging the use of calcium supplements & advising their use only for patients who can't get enough dietary calcium--and advising they take 1000 IU of vitamin D daily.  She's also recommending non-dairy sources of calcium like vegetables, fruits, nuts, and fish; and encouraging adequate intake of vitamin D.
• Hot Off the Press! Even calcium supplements with vitamin D may also increase the risk of myocardial infarctions.  As soon as I finished writing this post I received a press release of Dr. Ian Reid's (he's the BMJ primary author of the calcium supplement article) recent presentation to the Annual Meeting of the American Society for Bone and Mineral Research.  It turns out that Reid recently looked at a subgroup of 16,000 women in the Women's Health Initiative (WHI), half of whom took  500 mg of calcium + D a day, and half of whom took a placebo.  According to Reid, the calcium group had a significant 22% relative increased MI rate, compared to the placebo group.  "We calculate that for every 1,000 people treated with calcium for 5 years, it will lead to four additional myocardial infarctions, four additional strokes, and two additional deaths, while preventing three fractures," Dr. Ian R. Reid said.  Click here for the press release.

According to Reid, a professor of medicine at the University of Auckland, New Zealand:

"I don’t prescribe calcium supplements to anyone anymore for preventing bone fractures. People should get calcium from their diet.  We believe there is a fundamental difference between dietary calcium and supplemental calcium."  He speculated that a calcium supplement, even at a relatively modest dose of 500 mg, produces a "borderline hypercalcemia" that persists for several hours and raises the risk for MI or stroke, the same way that people in the highest quartile for normal blood calcium levels have an increased risk for cardiovascular disease events.

Full Disclosure: The researchers who ran the Women’s Health Initiative (WHI) study questioned the legitimacy of the new analysis beyond a hypothesis-generating exercise.  Stay tuned. This new analysis is not without its critics.

• This weekend I'm traveling to Columbus, Ohio to hear Dr. Amy Lanou speak on "Building Bone Vitality".  I'm interested to hear what she has to add to this discussion. I've posted about her book and research previously, in: "Preventing Bone Loss & Osteoporosis Through a Plant-Based Diet & Weight-Bearing Exercise--Dr. Amy Lanou & Michael Castleman's Research-Backed Case for Building Bone Vitality".

 

I Used to Take Calcium Supplements & Drink Milk with Double the Calcium - Not Anymore!

 

Three years ago I was following my doctor's orders to get 1500 mg of calcium a day, in divided doses.  I drank a glass of Lactaid milk with 500 mg of calcium per 8 oz. serving every day.  I took 2 Citracal calcium supplements a day to get 630 mg of calcium, and topped off my tank with 220 mg of calcium from a Centrum multiple vitamin. 

Grand total:  1350 mg, and I figured I picked up another 150 mg a day from other calcium-containing foods.

Taking a calcium supplement is something I only do occasionally--and now I'm going to seriously rethink that practice.  I take care of my bones by ditching animal protein--in favor of a diet high in dietary calcium in the form of kale, broccoli, arugula chard, other greens, beans, calcium-enriched non-dairy milk, tofu, dried fruits, kiwi, and soy yogurt. 

I strengthen my bones with a regular yoga practice (click here to find out how yoga benefits bones), twice a week weight-training, and lots of walking.

 

What We Eat Affects Bone Quality - Is There a Connection Between Animal Protein & Bone Loss?

 

I first learned about how animal protein adversely affects bone in March 2008, when Dr. T. Colin Campbell spoke at a Wellness Grand Rounds at the medical center where I work.  Yes, I was skeptical at first.  But, when I read a research study in the Journal of Clinical Endocrinology & Metabolism (JCEM), authored by Dr. Bess Dawson-Hughes, the past president of the National Osteoporosis Foundation, it started to sound more plausible. 

• Higher intake of animal protein (dairy/milk) = a higher rate of bone fractures. Cornell University nutrition professor emeritus Dr. T. Colin Campbell explains this counter-intuitive situation best.  An animal protein diet creates an acidosis state in the body that diminishes vitamin D, which is needed to build strong bones.  In addition, when acidosis exists, the body pulls out calcium from the bones in an attempt to neutralize the acid state.
• Dr. Bess Dawson-Hughes, a former President of the National Osteoporosis Foundation, Professor of Medicine at Tufts University and Director of the Bone Metabolism Laboratory at the Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging at Tufts University explains that when older adults eat diets high in protein & grain, acid is produced, and as we age our bodies are less able to excrete this acid.  Read more here.

"One way the body may counteract the acid from our diets is through bone resorption, a process by which bones are broken down to release minerals such as calcium, phosphates, and alkaline (basic) salts into the blood.  Unfortunately, increased bone resorption leads to declines in bone mass and increases in fracture risk."

 

Exercise - Strength-Training Has a Profound Effect of Strengthening Bones

 

This comes from Randy Raugh, MPT, the author of Prime for Life - Functional Fitness for Ageless Living.  Raugh is a physical therapist and the fitness director of Canyon Ranch.  The prevention of osteoporosis through exercise is a chief concern of his.

The BEST Study of Bone Density

The BEST Study (which stands for Bone Estrogen Strength Training study) was conducted in Arizona betwen 1995 and 2001 and is considered to be a seminal study in osteoporosis.  The study looked at 266 sedentary postmenopausal women, ages 44-66, all in relatively good health.  The subjects were all nonsmokers.  About half of them were on hormone replacement therapy, the others were not.  Every participant took a daily calcium supplement--making an equal playing field.  The subjects' bone density was measured prior to the test using the Bone Mineral Density (BMD) test.

Participants in the BEST study were divided into two groups, half taking hormone replacement therapy and half not.  The object of the study was to determine what effect weight-bearing exercise had on bone mineral density (BMD) when the only variable was exercise.  So one group on each team (those taking hormones, and those not) undertook a strength-training program, while the others had no regular strength training at all. 

Exercisers performed supervised aerobic, weight-bearing, and weight-lifting exercises, three times per week in community-based exercise facilities.  To encourage and maintain interest in exercise for one year, the women in the strength-training group participated in social support programs resulting in a high level of adherence.

The findings were startling. The participants in both groups who exercised--whether they were taking hormones or not--had markedly improved bone density in their hips and low backs, the areas of focus for the study.  (The hormone-raking group showed a slightly higher, but not significant, level of improvement.)

Among non-exercisers, the hormone-taking group showed a slight increase in bone density while the other group showed no improvement at all--or, even worse, showed a decrease in bone density.

The study powerfully showed that a dramatic increase in bone density and strength can occur with regular, weight-bearing exercises.

 

The BMJ Study Explained - The Effect of Calcium Supplements on the Risk of Myocardial Infarction and Cardiovascular Events: A Meta-Analysis

From Dr. Sandra A. Fryhofer's article for Medscape, 'Rethinking Calcium: Bone Health or Heartache?'  What the BMJ study discovered about calcium supplements.

"In the past, calcium concerns have focused on bone health and on how to get enough calcium. Adequate calcium intake recommendations developed by the Food and Nutrition Board at the Institute of Medicine say that children and teens 18 years of age or younger need 1300 mg daily, and adult men and women 19 to 50 years of age need 1000 mg daily. After age 50 years, the Institute of Medicine recommends even more calcium, and daily adequate intake increases to 1200 mg.  Now, a study in BMJ raises concern that supplemental calcium may have an inadvertent adverse outcome: It could hurt your heart.

Calcium and Heart Woes

In this meta-analysis of 15 randomized blinded placebo-controlled trials. Dr. Mark Bolland (and Dr. Ian Reid) from the University of Auckland in New Zealand and colleagues evaluated calcium supplement use (at least 500 mg daily) in more than 12,000 patients older than 40 years of age. The findings were surprising: The pooled results linked calcium supplement intake to a significant 30% increased risk for heart attack. A tendency to increased risk for stroke and sudden death was also seen, but this result was not significant. Of note, cardiovascular outcomes were not a primary endpoint in any of the individual trials. Proposed mechanisms for the higher risk include increased blood coagulability and decreased blood vessel compliance due to calcium buildup in the arterial wall. On the basis of these findings, the authors postulate that treating 1000 people with calcium for 5 years would prevent 26 fractures but cause an additional 14 heart attacks.

This is not the first time that Dr. Bolland has studied calcium intake and cardiovascular outcomes. Two years ago, results of a randomized placebo-controlled study of 1471 postmenopausal women were published that linked calcium supplements with greater cardiovascular risk. That 2008 study by Bolland and colleagues was included in their 2010 meta-analysis.

No Trials of Calcium Plus Vitamin D Were Included

The type of calcium supplement did not seem to matter, but the current meta-analysis looked at calcium supplements alone. Researchers did not include any trials looking at calcium plus vitamin D.  (Note: Since Fryhofer's article, the BMJ authors have looked at 16,000 participants in the WHI who took calcium with vitamin D & also found an increased risk of myocardial infarction.)

An accompanying BMJ editorial questions the role of calcium in bone health in reducing fractures. It even goes so far as to say that only patients with osteoporosis who are also taking medication for it should take calcium supplements, alone or with vitamin D, and calls for further research on calcium supplement safety and efficacy.

The Women's Health Initiative evaluation of combined calcium and vitamin D found no effect on heart attack and stroke. A recent systematic review in the Annals of Internal Medicine suggests that moderate to high doses of vitamin D may reduce cardiovascular risk, whereas calcium alone had no significant effect. (Note: the BMJ authors recently looked at a subgroup of the Women's Health Initiative (WHI) who had not taken calcium with D prior to the start of the WHI study.  They felt analysis of this group would provide a more accurate measure of the risk or lack of risk of calcium supplements.  When they looked at this group they found a 22% relative increased myocardial infarction rate, as compared to the placebo group.)

 

Q & A with Dr. Walter Willett on Bone Health & Calcium

When I heard Dr. Walter Willett's interview about bone health on Joe and Terry Graedon's People's Pharmacy he turned my view about calcium & bone strength upside down.  Willett is one of the country's most-esteemed and cited nutrition experts.  He leans on the conservative side nutritionally, so to hear him say that calcium isn't a big player in bone health--and that the U.S. recommendations for calcium intake are based on poor science--was shocking to me.

Back in May 2010 Dr. Mark Hyman also weighed in on dairy, and presented a good case for looking to other sources to get our calcium.  Dr. WiIlett was also his go-to expert when it came to rethinking dairy as a key player in bone health.  It's worth taking a look at, and he references his claims.  Among Hyman's reasons to avoid dairy:  it's linked to prostate cancer, it aggravates irritable bowel syndrome, digestive disorders from lactose intolerance and more.  Click here to read more.

If you just increase your calcium intake and eat more dairy will you keep your bones strong?

Calcium and dairy are definitely not the solution to preventing osteoporosis.  It's true we do need some calcium in our diet--it's absolutely an essential for both bone health and other physiological requirements.  But how much--and are there many people in the U.S. who are deficient, is the real question. From many lines of research over the past 10 years have made it clear that not very many people will benefit by getting more calcium in their diets.  Consumed the wrong way, it's even possible to be harmful.  There is even risk of fracture from too much calcium intake.

Please explain this.  It's so embedded in our thinking that we need calcium to avoid fractures.

 Several decades ago Dr. D. Mark Hegsted looked at the fracture rates & calcium intake around the world and he found that the countries consuming the most calcium & drinking the most milk had the highest rates of fracture.  This doesn't prove that calcium & milk cause fractures--but it certainly questions whether calcium is strongly protective. To read his eye-opening article in the Am J Clin Nutr, "Fracture, Calcium, and the Modern Diet" click here.

Looking at the Nurses Health Study--and the Health Professionals Follow-Up Study--it found there was really no relationship in the amount of calcium or milk consumed by women & men, and their risk of fracture.

Most people are probably already getting enough calcium, and just adding more isn't going to be helpful.

How did this happen?  Most women over 40 or 50 are told that getting calcium is good for their bones--and many of them are  taking 1500 mg of calcium supplements over what they're getting from their diet.

Adding supplements to a diet puts many men & women over 2000 mg of calcium a day.  Part of this is driven by the DRI (daily reference intake) that said women & men over 50 need 1200 mg of calcium a day for adequate bone health.

But there's a BIG PROBLEM with this recommendation!  It was based on some very short-term studies that looked at how much calcium you can force into the bone temporarily.  Unfortunately, these studies only lasted just a few days or weeks--and that doesn't reflect what goes on over the long-term.

If you really up the calcium dose, you can only increase the calcium in the bones by 2%.  And that's not much when measured by bone mineral density.  But, the  researchers erroneously thought, "Great!  2%/year X 10 years, and you'll increase the bone density by 20%."  Sure, that would have been a good thing, but it was an incorrect assumption.  Bone absorption just doesn't work that way. 

If you maintain that high a dose (1200 mg a day) you don't continue to get increases in calcium in the bone!  It's just a one time 2% increase that doesn't continue to accumulate--and then if you reduce that high intake you even lose that small 2% increase in a matter of months. 

So, this short-term study on which we've based our RDAs or DRIs was very misleading.  In the UK, experts looked at this and they came up with 700 mg of calcium/day as being adequate.

A committee for the World Health Organization looked at this and they came up with 500 mg of calcium/day as adequate.

Bottom Line:  500-700 mg of calcium a day is probably about right & you can get that with a decent diet & just one serving of dairy, or soy, or almond milk a day--which is much less than is being recommended.  If there is any benefit of higher calcium intake it's very small.

What role do nutrients besides calcium play in bone health?

We need a whole orchestra of minerals & vitamins to maintain healthy bone.   The question is, which one's are most of us deficient in?  The evidence is strong that many of us are way below adequate levels of Vitamin D.

How much Vitamin D should someone be taking to prevent osteoporosis?

Two-thirds of us have inadequate vitamin D levels because we're so cut-off from the sun.  For most of us to get up to adequate levels we would need to supplement at around 3000-4000 IUs of Vitamin D.  (my comment: the only way to know for certain  your vitamin D level is to be tested with the 25-hydroxyvitamin D test, and although one needs a minimum level 32 ng/mL to absorb calcium, most vitamin D experts recommend reaching levels of 40-50 ng/mL.

What kind of a diet is best for building strong bones?

Clearly, eating plenty of vegetables and moderate amounts of fruit is going to be beneficial.  People who aren't eating enough green leafy vegetables aren't getting enough vitamin K--which is needed for bone health.  And the green leafy vegetables provide calcium, as well.   We do need some calcium, so if you eat a vegetarian diet, it is possible come up on the short side of calcium.  But, we don't have the fine detail yet to know exactly where you swing into the short side.  The question of whether or not too much animal protein can have a deleterious effect on bone is another interesting question, but not one I'm able to answer. 

Dairy is not essential, but we do need some calcium.  I think it's fine to have 1 or 2 servings of dairy a day, but with higher amounts, I think are going to start outweighing the benefits.

Vegetables	Acorn squash (1 cup): 90 mg Arugula (1 cup): 125 mg Broccoli (1 cup): 180 mg Chard or okra (1 cup): 100 mg Kale, raw (1 cup ): 55 mg Spinach, cooked (1 cup): 240 mg
Fruits	Figs, dried uncooked (1 cup): 300 mg Calcium-fortified orange juice (1 cup [8 oz]): 400 m

 

Source:  USCF Medical Center.  Calcium content of selected foods. 

What about physical exercise?  How important is it?

Physical activity is profoundly beneficial for bone health.  Every study that has looked at that has seen a much lower risk of fractures among people who are physically active.  The bones that are stressed the most are the strongest.

Walking is good for hip fractures, but it won't do a thing for wrist fractures, so we need exercises to keep the upper body bones strong, too. 

What exercises do you suggest for all-around bone strength?

Variety!  Just plain walking at a moderate to brisk pace will benefit your heart, prevent diabetes, stroke, and hip fractures.  But, the bones that are strengthened are only the ones we put stress on--a few minutes 2-3 times a week with free weights is need to strengthen upper extremities.

So there you have it! 

• Reconsider calcium supplements
• Get 500-700 mg of dietary calcium a day
• Be sure to get adequate Vitamin D--consider a supplement--get your level tested.
• Definitely strengthen your bones with yoga, weight-training, and/or walking
• Consider the effects of animal protein on bone quality & density.

 

 

 

 

10-Minute Quick-to-Fix Vegan Dinner. The Healthy Librarian's Arugula Pear "Steak" Salad with Dried Cranberries and Walnuts

Super Fast Arugula Pear "Steak" Salad with Walnuts and Cranberries

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Back when I was eating meat, a favorite quick-to-fix dinner was sliced grilled flank steak with roasted vegetables over mesclun greens--with a little sprinkle of chopped nuts, and maybe some goat cheese.  But that was almost 2 years ago.

Last Saturday night Joyce and Ron whipped up an "Arugula and Pear Salad with Maple Vinaigrette" in about 10 minutes.  It was fabulous, and I became an instant arugula fan. 

On Sunday I stopped at Trader Joe's and picked up 2 bags of organic arugula--where they had purchased theirs.  I brought an arugula salad to work on Monday, and made this one for dinner on Tuesday night.

Good-bye mesclun greens.  Hello arugula.  I always thought of it as a seasonal snooty fancy shmancy salad green.  But there it was at Trader Joe's, reasonably priced, organic, and looking beautiful. 

Now that I know it's in that super-healthy family of chicory greens it's got even more credibility.  Don't forget about the 3-new-to-me super foods I wrote about last week:  black raspberries, broccoli sprouts, & chicory-family greens!  Click here if you want a refresher.

Why Does Shari Lieberman, Ph.D., D.N.S, F.A.C.N. Have Arugula on Her Top Ten List of Favorite Foods?

• It's loaded with minerals and antioxidants
• It's a delicious cruciferous vegetable that helps to protect us against toxins like xenohormones--the hormone disruptors in pesticides, plastics, and pollution.
• It protects against cancer because its loaded with the anticarcinogenic indole-3-carbinol. (click here for: Sarkar, FH, Li, Y. "Harnessing the fruits of nature for the development of multi-targeted cancer therapeutics"  Cancer Treatment Reviews, 2009 Nov;35(7):597-607. Epub 2009 Aug 5---just one of many articles on the benefits of the indole-3-carbinols.

Why Does Jonny Bowden Ph.D., C.N.S. Have Arugula on His List of the 150 Healthiest Foods on Earth?

• For only 5 calories a cup you get a generous amount of eye-healthy carotenoids, like lutein and zeaxanthin, plus folate, and vitamin A.
• It's also loaded with calcium and Vitamin K--essential for building strong bones--and 1 cup of arugula has 62 mcg of vitamin K.  The recommended daily intake is: 90 mcg for women and 120 mcg for men.
• What's the calcium/vitamin K connection?  Vitamin K helps the body transport calcium and metabolize it into our bones.  Several studies (including the very large Nurses' Health Study) have found that high intake of Vitamin K (at least 110 mcg a day) boosts bone mineral density in postmenopausal women and reduces hip fractures by 30%.  Click here and here to read more.
• It has glucosinolates--the same cancer-fighter as found in broccoli sprouts--that neutralizes cancer cells, and also inhibits cancer cell growth.

Dr. Joel Fuhrman ranks arugula 11th on his ANDI Scale (aggregate nutrient density index)--right under greens like kale, watercress, Swiss Chard, and broccoli sprouts.

 

Super Fast Arugula Pear "Steak" Salad with Walnuts and Cranberries

You'll have this on the the table in less than 10 minutes!

Serving size: 1 salad 

Ingredients:

2 cups of arugula

1/3 thinly sliced pear

1 TBS. chopped walnuts or pecans

1 TBS. dried cranberries

9 slices of either Trader Joe's Beef-Less Strips (aka Gardein)  If you don't have a Trader Joe's nearby,  use Morningstar Farms "Beef" Meal-Starters found in your grocer's freezer.  Note: *TJ's Beef-Less Strips come in 3 serving packages.

A couple of shakes of Durkee Grill Creations Kansas City Style Steak Seasoning

I drizzled this on as salad dressing:

1 tsp. Olive Tap Blood Orange Fusion Olive Oil  click here 

2 tsp. Olive Tap Tangerine Balsamic Vinegar  click here

Directions:

Quickly brown 1 Package of Trader Joe's Beef-Less Strips in a frying pan.  Sprinkle strips with the Grill Creations Steak Seasoning.  One package of strips makes 3 servings. 

Rinse arugula.  Pile a dinner plate with the greens.  Top with the olive oil and flavored vinegar--or the dressing of your choice--see Joyce & Ron's Maple Vinaigrette below.

Top with the sliced pears.  Sprinkle on the chopped nuts & cranberries, and enjoy.

Save the left-over strips--one package contains enough for 3 salads.  Note:  Tal Ronnen uses these strips for a "Steak Sandwich" served on a ciabatta or focaccia square, layered with watercress, red pepper, sliced red onion, and horseradish mayo.

NOTE: Want to cut calories & fat?  1 TBS. of walnuts=4.8 g of fat/52 calories; 1 tsp. olive oil=4.6 g of fat/40 calories.   Cut 92 calories & 9.4 gr of fat when you leave them out!

Nutrition Facts Healthy Librarian's Arugula, Pear, "Steak" Salad wt Cranberries & Walnuts
Serving Size: 1 recipe
Amount Per Serving
Calories	345
Total Fat	11.5g
Saturated Fat	1.2g
Trans Fat	0g
Cholesterol	0mg
Sodium	346mg
Carbohydrate	37.9g
Dietary Fiber	5.4g
Sugars	26.5g
Protein	23.3g
Vitamin A 42% Vitamin C 26% Calcium    20% Iron 38%

What's in Trader Joe's Beef-Less Strips?

These are vegan, but, alas, not gluten free.  I don't like to use faux meats very often--but occasionally--why not?

Ingredients: water, vital wheat gluten, isolated soy protein, natural flavors, barley malt, expeller pressed canola oil, garlic powder, yeast extract, onion powder, organic evaporated cane juice, red bell pepper flakes, sea salt, citric acid, spices, pea protein, carrot fiber, organic beet root fiber, sunflower oil.

Nutritional info for 9 strips.  Calories: 120; Total Fat 2g;  Sat Fat & Trans Fat 0g; Cholesterol 0g; Sodium 310 mg; Total Carbs 5 g; Fiber 1g; Sugars 1g; Protein 20g.

Joyce & Ron's Arugula and Pear Salad with Maple Vinaigrette  (from Real Simple Magazine)

Serves 4

Hands-on Time: 20 minutes.  (they made the dressing ahead of time, and it took 10 minutes to assemble)
Total Time: 20 minutes

Ingredients
    •    1 tablespoon maple syrup
    •    1 teaspoon Dijon mustard
    •    1 tablespoon red wine vinegar
    •    1/4 teaspoon kosher salt
    •    1/8 teaspoon black pepper
    •    2 tablespoons extra-virgin olive oil  (consider lowering this amount to 4 tsp.)
    •    8 cups arugula leaves
    •    1  pear, unpeeled, thinly sliced
    •    1/2 cup (3 ounces) blue cheese, crumbled  (optional--leave out for the vegan version)

Directions

1. In a small bowl, whisk together the maple syrup, mustard, vinegar, salt, and pepper. Whisking constantly, slowly add the oil; set aside.
2. Arrange the arugula on individual plates and top with the pear and cheese. Drizzle with the vinaigrette.

Tip

For a warm salad, heat the vinaigrette in a small saucepan over medium heat for 1 minute, and substitute spinach for the arugula.

Nutritional Information
Calcium 185.47mg; Calories 183.58; Calories From Fat 65%; Carbohydrate 11.91g; Cholesterol 15.95mg; Fat 13.3g; Fiber 1.96g; Iron 0.88mg; Protein 5.83mg; Sat Sat Fat 4.92g; Sodium 410.06mg

NOTE: The higher fat and sat fat in this recipe is from the blue cheese and olive oil.

*Source of information about Shari Lieberman & Jonny Bowden:  The 150 Healthiest Foods on Earth.  by Jonny Bowden.  Gloucester, MA:  Fair Winds Press, 2007.