The further a society drifts from the truth, the more it will hate those who speak it. ... In a time of deceit, telling the truth is a revolutionary act. George Orwell

Saturday, July 23, 2011

Animal protein and osteoporosis myth

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This is a compilation of my past discussions (2007). Since this issue comes back so often, I decided to re-post it here, as the reference [or just to annoy] 8-:) . 

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Myth 1: "Populations which consume a very high amount of dairy get more hip fractures than those which don't."

and

Myth 2: "It isn't only the calcium that comes in which is important but the calcium which is leached out due to high animal protein diets.

I am sorry to disappoint the true believers, but it is just the opposite! People who avoid animal protein believing that they are saving their bones are in fact increasing the risk of osteoporosis.

The following study found that women who consumed the most animal protein (+43%) had only one-fifth risk of hip fractures:

"Prospective study of dietary protein intake and risk of hip fracture in postmenopausal women"
by Ronald G Munger, James R Cerhan, and Brian C-H Chiu Am J Clin Nutr 1999;69:147-52.



Results: Forty-four cases of incident hip fractures were included in the analyses of 104 338 person-years (the number of subjects studied times the number of years of follow-up) of follow-up data. The risk of hip fracture was not related to intake of calcium or vitamin D, but was negatively associated with total protein intake. Animal rather than vegetable sources of protein appeared to account for this association. In a multivariate model with inclusion of age, body size, parity, smoking, alcohol intake, estrogen use, and physical activity, the relative risks of hip fracture decreased across increasing quartiles of intake of animal protein as follows: 1.00 (reference), 0.59 (95% CI: 0.26, 1.34), 0.63 (0.28, 1.42), and 0.31 (0.10, 0.93); P for trend = 0.037.

Conclusion: Intake of dietary protein, especially from animal sources, may be associated with a reduced incidence of hip fractures in postmenopausal women.

Table 4 of the study shows some really interesting data on the risk of hip fractures (from 6-th column). Namely, in addition to much lower (factor of 0.31) risk for the 43% higher consumption of animal protein, they found 1.9 times HIGHER risk associated with the 31% higher consumption of VEGETABLE protein!

Carbohydrate consumption turned out to have been a much bigger factor, perhaps the biggest factor:

23% higher consumption of carbohydrates was associated with 3 times higher rate of fractures!

If we recalculate (normalize) those risk factors per 100% (i.e. per doubling) increase of the consumption of each: total protein, animal protein, veg protein and carbohydrates, then we obtain the following:

Hip fracture risk correlation:

  • Total protein: - risk reduction 3.6 times
  • Animal protein:- risk reduction 4.5 times
  • Vegetable protein:- risk INCREASE 2.9 times
  • Carbohydrate:- risk INCREASE 4.9 times

In addition, women who experienced hip fractures (as opposed to those who didn't) consumed less animal fat, less saturated fat, less alcohol, had lower body mass index, had fewer pregnancies, smoked less, consumed more calcium, more vegetable fat and more vit D.

Heretic

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REFERENCES

Papers:

"Controlled High Meat Diets Do Not Affect Calcium Retention or Indices of Bone Status in Healthy Postmenopausal Women"

"Protein intake: effects on bone mineral density and the rate of bone loss in elderly women"

"Effect of Dietary Protein on Bone Loss in Elderly Men and Women: The Framingham Osteoporosis Study"

"Factors associated with calcium absorption efficiency in pre- and perimenopausal women"

Quote: "Women in the lowest tertile of the ratio of dietary fat to fiber had 19% lower fractional calcium absorption values than did women in the highest tertile of ratio of dietary fat to fiber"

Articles:

"Protein Saves Bone in Elders"

"New Data on Dietary Protein and Bone"

------ More references, update 1-Aug-2001 ---------------------------------------

This is based on the most recent blog article by Denise Minger quoting various peer-reviewed publications using China Study data. This is a MUST READ!

Some of the papers were co-authored by the well known expert vegan scientist Dr. T.Colin Campbell but unlike in his popular book, those papers are based on individual rather than county-averaged data. They also state completely opposite conclusion regarding heart disease, cancer and bone health which is quite remarkable for a senior mainstream academic scientist! The same man but two opposite views! Now to the subject of osteoporosis, bone density, calcium and diet:


* Dietary calcium and bone density among middle-aged and elderly women in China" by Ji-Fan Hu, Xi-He Zhao, Jian-Bin Jia, Banoo Parpia, and T. Colin Campbell.

Quote:
However, decline in bone mass after menopause for women in county WA (higher dairy calcium) was at a somewhat slower rate than for women in the nonpastoral areas (without dairy calcium).
...

Thus. differences in the rate of bone loss between these areas may be related to differences in dairy calcium intake, given that 34.6% ofealcium in county WA and none in the other nonpastoral areas was from milk. Indeed, dairy calcium was found to be more significantly correlated with bone mass than was nondairy calcium (Table 7), even though these analyses only included women with dairy food intake in counties YA and WA (n= 253). Nondairy calcium. in contrast, showed no association with bone variables after age and/or body weight were adjusted for (Table 7).



BMC and BMD at the distal and midradius were positively associated with consumption of milk (r = 0. 1 5-0.26, P [less than] 0.003) and with consumption of hard cheese and other dairy foods (r = 0.22-0.29, P [less than] 0.01) (data not shown). These results agree with those reported in other cross-sectional studies (35, 37). A similar association between daily milk intake and bone density was also reported by Yano et al (10) in Hawaiian Japanese males and females and by Shiehita (23) in 85 healthy Japanese males and females, whose calcium intakes were as low as in our study. Increasing calcium intake with calcium-rich foods (milk and cheese) was found to reduce bone loss in adolescent (34), osteoporotic (38), premenopausal (14), and lactating (39) women.

* Veganism and osteoporosis: A review of the current literature. "The findings gathered consistently support the hypothesis that vegans do have lower bone mineral density than their non-vegan counterparts."

* A Comparison of Bone Mass Measurements of Vegetarians and Omnivores. "In this review of 9 cross-sectional and 1 longitudinal study, little statistical significance between bone density and bone content was found between vegetarians and omnivores."

* Effect of vegetarian diets on bone mineral density: a Bayesian meta-analysis. "The results suggest that vegetarian diets, particularly vegan diets, are associated with lower BMD, but the magnitude of the association is clinically insignificant."

* Long-Term Vegetarian Diet and Bone Mineral Density in Postmenopausal Taiwanese Women. "Long-term practitioners of vegan vegetarian were found to be at a higher risk of exceeding lumbar spine fracture threshold … and of being classified as having osteopenia of the femoral neck."

The rest of Denise article quotes more papers co-authored by T.C.Campbell, that conclude a positive protective role of dairy, meat and fish rich diets against cancer, heart disease and other disease in China. Read it all!

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13 comments :

JC said...

If this data holds up then why don't the folks at McDougall and other low fat vegan groups report problems with their bone density,falling, etc?I see them on Dr Oz and other shows promoting a low fat vegan diet as bone healthy,heart healthy, as well as anti-cancer.It appears that, despite what they say, the verdict is not in just yet.

JC said...

Ths data does appear to be mixed.

http://www.pcrm.org/news/release090702.html

Malibu said...

what about saving it when you already have it? i developed osteoporosis(25 yrs old) when i developed anorexia(7 yrs ago). my diet is very protein heavy now and for the past 4 or so years. i doont handle dairy but get lots of animal protein and gelatin and fats. out in the sun all the time i can be, and do weight bearing exercise 1 x a week(deadlift). anything else i can do? i have knee problems and often my joints ache

Stan (Heretic) said...

JC,

It is mixed if you believe it is. I stopped reading your pcrm link when it said that saturated fat clogs arteries.

8-D

Malibu,

The key to combat osteoporosis using low carb nutrition is not high protein consumption but high animal fat consumption!

Excessive consumption of protein with insufficient fat increases the risk, as you can see in the data I posted. above. That's why consumption of plant protein in that study was proved detrimental - not because of "plants" but because it is not balanced by sufficient amounts and types of necessary fatty acids. That's why a consumption of animal protein was found protective and healthy. Not because of "animal" but because such protein is almost always accompanied by the right amount and good mix of fats (except shellfish which is too lean, but good for other reasons - especially B12 and omega 3).

Reqards,
H.

JC said...

Don't quit reading!...You would be guilty of being as close minded as the McDougall group who quit reading when its suggested fat may not be harmful.

And yes ultimately everything does come down to beliefs even the laws of the material universe.But operating within those laws it may help to figure out why the data appears mixed....and which side is "right"...and thats a loaded statement.

Something we all can agree with:

http://www.ajcn.org/content/94/2/479.abstract?etoc

H. said...

Stan, thanks very much for this. :) I appreciate your taking the time to post about the benefits of eating animal foods and especially about animal fats.

Every bit more I find out about eating a VLC Ancestral diet gives me more confidence that I am doing what I can to assure being as healthy as possible.

Am now at the one year mark on my VLC adventure. I started at 30-35g/CHO/d, and after some months found 15-20g to be optimal.

I very much enjoy your blog and your comments.

Best wishes. :)

Stan (Heretic) said...

Hi H, thank you for your appreciation, I am glad that you find this material helpful, feel free to post more comments when you have some observations regarding your very low carb nutrition experiment. For me, an optimal amount of carbs used to be also 15-25g/d up until the second year. Afterwards I could increase it if I wanted to 50g (100g if in form of vegetables and fruit) without problems. Now I consume about 50g that seems to work best for me.

Hi JC,

The data appears mixed fifty-fifty only for those who want to see it mixed fifty fifty.

I do not perceive it as such, for me logic and experimental facts have very large objectivity contents, although I admit it is never 100%. Nothing is 100%. Thus for me data is not "mixed" 50-50 - for me data is definitely pointing in one direction, more like 95-5, though the opposite direction towards a 5% veganism, I admit is not a "brick wall" or a firbidden place, just a small tiny alternative path not taken by most of us.

There were many such lifestyle alternatives (BTW - I am now rereading Seth, including his earlier sessions. you may find this interesting.). Veganism is but one such. You/we ought to ask a different question: why is veganism and environmentalism such a big issue among large number of people?! Where does their fanaticism come from and what is the true reason of them being so upset when challenged?

Regards,
Stan

JC said...

I always enjoy our conversations Stan.I showed your post to a friend of mine and asked him to comment.He had some counters:



"Myth 1: "Populations which consume a very high amount of dairy get more hip fractures than those which don't."

and

Myth 2: "It isn't only the calcium that comes in which is important but the calcium which is leached out due to high animal protein diets.

I am sorry to disappoint the true believers, but it is just the opposite! People who avoid animal protein believing that they are saving their bones are in fact increasing the risk of osteoporosis.

False.

The following study found that women who consumed the most animal protein (+43%) had only one-fifth risk of hip fractures:

"Prospective study of dietary protein intake and risk of hip fracture in postmenopausal women"
by Ronald G Munger, James R Cerhan, and Brian C-H Chiu Am J Clin Nutr 1999;69:147-52.


The "study" is highly flawed. Here is a link to the study:

http://www.ajcn.org/content/69/1/147.short

We have to pay attention to this statement:

"Design: Nutrient intake was assessed with a food-frequency questionnaire in a cohort of Iowa women aged 55–69 y at baseline in 1986. Incident hip fractures were ascertained through follow-up questionnaires mailed to participants in 1987 and 1989 and verified by physician reports."

So why is this flawed? Simple. Incident of hip fracture is not an indicator of bone density.

In addition, there are so many factors that were not stated such as types of protein specifically. Excessive consumption of red meats can cause bone loss as where other animal proteins such as fish are not a big factor. Dairy also increases bone loss for the same reason. Why? Because red meats and dairy are high in phosphorus, which increases the ratio of phosphorus to calcium. In response the parathyroid glands release parathyroid hormone to break bones down releasing calcium in to the bloodstream and resulting in bone loss.

But the study was not controlled where the researchers could really follow the diet of the participants. instead they relied on questionnaires that could have left out many factors such as how much soda did they drink, especially colas since they are also phosphorus rich.

Other factors include hormones, cancers, exercise levels, medications being taken, smoking, etc., etc., etc. Supposedly they factored some of these in, but without seeing exactly how they supposedly did this it still leaves a lot of questions as to accuracy.

But the biggest problem I see still goes back to the basis of their claim being based on the incidence of hip fracture, which means nothing. How many of those hip fractures occurred from auto accidents? How many from falling down stairs? Or being thrown from a horse?....... Point is that just because someone suffers a hip fracture this does not mean they have low bone density.

And why did they base their findings on 44 cases of hip fracture out of 104,338 participants?! That is totally ridiculous. Let's say that the out of all the test subjects that all but the 10 had a high vegetable protein diet. So only 10 of the 44 participants that actually developed a hip fracture had a high animal protein diet. If it were presented this way then the fact that over 104,000 of the high plant protein diets did not develop hip fractures would make the high animal protein diet look extremely dangerous. Since only 44 out of 104,338 participants were looked at though there is no way to tell what the real results would have been if the actual bone density was looked at among all the particpants.

In short this "study" is so heavily flawed that the American Journal of Clinical Nutrition should have been completely embarrassed to even think about possibly publishing it. This is akin to taking a 2 year old child's crayon drawing and trying to sell it in a major art gallery as a masterpiece!

JC said...

continued


There are actually numerous studies readily available that show an increased in bone density from the ingestion of plant based proteins sources. Particularly soy, which is high in bone strengthening phytoestrogens. For example these:

http://www.ncbi.nlm.nih.gov/pubmed/18063230

http://www.ncbi.nlm.nih.gov/pubmed/17392695

http://www.ncbi.nlm.nih.gov/pubmed/20199985

Here is an article on the subject:

http://www.news.cornell.edu/chronicle/96/11.14.96/osteoporosis.html


We also know that silica is one of the most important nutrients for strong bones, much more important than calcium. And the primary source of silica for humans is plants.

Boron is also extremely important for bone strength. Even though boron is found in trace amounts in meats the best sources again are plant sources. Especially nuts, which are also high protein.

JC said...

I disagree with him on what I consider an important point.I don't really care so much about bone density as much as I care about avoiding fracture.If the fracture rate is lower on animal foods shouldn't that be all that really matters?

DePuy Pinnacle Lawsuit said...

This is something that we have to look into the effectiveness of an animal protein.

Anonymous said...

Stan, thanks very much for your kind words. I have now passed the two-year mark, and have found that I can eat a few more carbs, as long as they are slow-acting ones (per Dr. Richard Bernstein's list, in his book, The Diabetes Solution).

I am now waiting to see if, at the two-year mark, of eating low PUFA, that I notice other improvements.

I really enjoy reading your blog. Thank you for taking the time and making the effort to write.

H.

Stan (Heretic) said...

Hi H. and thanks for your kind comments.

Would you like to tell us more about your experience, do you have a blog or a web page with more information about your story, that I could link to? I am thinking that many people with similar medical condition (was it diabetes?) might benefit out of your experience.

Regards,
Stan (Heretic)