Do I need to eat dairy products in order to prevent osteoporosis?

Osteoporosis, a condition in which minerals and other substances are lost from the bones causing
them to become thinner, more porous, and more easily broken, affects about 20-25 million
Americans, primarily older women. While many people believe that consuming dairy products is
a required nutritional strategy for preventing osteoporosis, the truth is that this is not necessarily
true. There are many plant foods that not only contain calcium but other valuable bone-health
promoting nutrients that can play a valuable role in a diet aimed at preventing osteoporosis.
The role of calcium in osteoporosis
Inadequate calcium intake definitely increases risk of osteoporosis. Too little calcium causes the
parathyroid hormone to stimulate certain bone cells, called osteoclasts, into breaking down bone
in order to raise calcium levels in the blood. Just as calcium deficiency increases risk of
osteoporosis, calcium supplementation has been shown to help prevent it by increasing bone
density. For example, studies have shown that supplementing with calcium increases bone
density in perimenopausal women and slows bone degeneration in postmenopausal women by an
average of 30-50%. These effects translate into a significant reduction in hip fractures.
Because a glass of cow's milk contains about 300 milligrams of calcium, (and the Adequate
Intake level for a middle-aged adult is 1,000 milligrams), cow's milk has traditionally been
marketed as a high-calcium, osteoporosis-preventing food. However, calcium is not the only
nutrient involved with osteoporosis risk. Many nutrients are involved in the determination of a
person's risk of osteoporosis.
The relationship between protein intake and osteoporosis
The relationship between protein intake and osteoporosis is the subject of ongoing debate in
scientific studies. However, it appears that under certain circumstances and at least in certain
age-related groups, excess protein intake can increase a person's risk of bone mineral loss. This
relationship appears to hold true particularly under circumstances in which a higher level of
sulfur-containing amino acids are included in the dietary protein and when this type of diet is
being consumed by older individuals. The connection between dietary protein and bone mineral
loss involves pH levels in the bone tissue and sensitivity of bone cells and bone cell enzymes to
changes in pH (degree of acidity).
The bone cells that help remodel bone by removing its core minerals are called osteoclasts. The
activity of these cells is switched on as acidity increases. When acidity has decreased all the way
to a pH level of 7.4, the removal of mineral from bone by osteoclasts can sometimes be shut
down entirely. The reverse is true for osteoblasts-cells that deposit more minerals into the bone
matrix and help to form new bone. In very low pH environments (highly acidic), these bone-
forming cells are greatly inhibited in their activities. For both of these reasons-altered osteoclast
and osteoblast activity-higher pH environments (slightly alkaline) favor retention of bone mass.
The exact way in which high-protein diets can change pH levels in different body tissues has yet
to be clarified in research studies. What has been shown in numerous studies is the tendency of a
high-protein diet to increase excretion of acids in the urine along with excretion of calcium.
Since increased elimination of acid typically corresponds to some form of acid excess in the
body, and since acid excess (low pH) in bone tissue favors loss of calcium from bone, a
connection between higher protein diets, pH changes in bone tissue, and potentially unwanted
loss of calcium from the bone seems likely.
Some clinical research studies can be used to help give us a sense of how this connection might
work in practical terms. For example, in one study, an increase in daily protein intake from 47 to
142 grams was found to double the excretion of calcium in the urine. What might this level of
protein intake look like in terms of food choices? One glass of cow's milk contains about 8
grams of protein. Three glasses of cow's milk, which would provide very close to a day's worth
of calcium, would also provide 24 grams of protein. By itself, this amount would not be enough
to cause problematic amounts of calcium to be removed from bone. However, in combination
with other protein sources, for example, an 8-ounce chicken breast, which would contain about
56 grams of protein, and a quarter-pound hamburger (which would add another 28 grams), the
day's total would be about 108 grams-much closer to the amount in the research study that
doubled calcium excretion in the urine and increased risk of osteoporosis.
The relationship between magnesium intake and osteoporosis
Another example of a nutrient that plays a role in osteoporosis is magnesium, a mineral that
appears to be nearly as important as calcium in preventing problems associated with this
condition. Women with osteoporosis have low bone magnesium content and other signs of
magnesium deficiency, and a two-year study of magnesium supplementation in postmenopausal
women has found that those receiving magnesium had a slight improvement in bone density
while those receiving the placebo lost some of their bone density.
Inadequate consumption of magnesium has also been shown to decrease blood concentrations of
the most active form of vitamin D (called D3). In clinical research studies, vitamin D3 has been
shown to stimulate the absorption of calcium, increase bone mineral density, and reduce the risk
of hip fracture. Magnesium is also required to regulate the body's levels of parathyroid hormone
and calcitonin, two hormones that maintain the proper concentration of calcium in the blood.
Yet, cow's milk, which is a very good source of calcium, is not a very good source of
magnesium. One cup of cow's milk only provides about 33 milligrams or about 10% of the daily
requirement for a middle-aged woman.
Other nutrients important for bone health
We could add a long list of nutrients to calcium, protein, and magnesium that influence the risk
of osteoporosis. Other bone-health promoting nutrients include vitamin D, boron, vitamin K,
vitamin C, ipriflavone, silicon, and vitamins B6, B12, and folate. Not only is cow's milk less
than ideal as food source of these nutrients, but in some cases (like vitamin C) it is nearly devoid
of the nutrient altogether.
Could you get enough of all nutrients - including calcium - without consuming cow's milk, or
cow's milk yogurt, or cow's milk cheese? The answer is definitely "yes." In fact, most women in
the world as a whole who do not develop osteoporosis also do not consume dairy products. The
foods they eat, including the World's Healthiest Foods, are concentrated in calcium and other of
the bone-health promoting nutrients noted above. Just how could you get enough calcium
without consuming dairy products? Consider the example below involving a dairy-free salad.
Plant foods as sources of calcium
As previously described, calcium is a mineral found in a wide variety of foods besides dairy
products. Virtually all greens contain calcium. By "greens," we mean all the dark green leafy
vegetables like spinach, chard, mustard greens and collard greens, as well as lettuces, like
romaine. Shredded cabbage is also a source of calcium.
Virtually all nuts and seeds - and especially sesame seeds - contain calcium. So do most beans,
including navy, pinto, kidney, and black are all calcium-containing foods. Additionally, tofu can
also be an important source of calcium, particularly when the tofu has been calcium-precipitated
(meaning that calcium was used to help convert the soy milk into tofu) it can provide a
significant amount of calcium.
Enjoy a delicious salad and support your bone health
Although none of the above non-dairy foods, all by itself, will provide a large percent of your
total day's calcium, when these foods are combined, the total calcium they provide is actually
higher than the amount in an 8-ounce glass of cow's milk. Let's take a salad as our example.
Romaine lettuce contains 20 milligrams of calcium per cup. Using 2 cups of romaine as our
salad base, we start off with 40 milligrams of calcium. A half-cup of chard leaves would bump
us up another 25 milligrams, to 65 total. Adding one-half cup of soybeans we jump up 87
milligrams to 152 while sprinkling on 2 tablespoons of sesame seeds brings us up to 237
milligrams. To top it off, add one-third of a cup of kidney beans and we have a salad that
provides a substantial 277 milligrams of calcium.
How does this amount compare to a glass of 2% cow's milk? In terms of total calcium, it's very
similar! A glass of 2% has about 285-300 milligrams. And while it is true that our salad contains
nearly twice as many calories as an 8-ounce glass of 2% cow's milk, it also contains a much
wider variety of nutrients. These nutrients include fiber, which is absent in the cow's milk
altogether, and vitamin C, which is over 10 times more plentiful in the romaine lettuce alone
than in a cup of 2% milk.
Practical tips
As the salad above highlights, since many of the World's Healthiest Foods contain calcium and
other important bone-promoting nutrients, we feel that meal plans concentrated in these foods
may help reduce risk of osteoporosis as effectively, or even more effectively, than cow's milk.
While Table 1 below gives details on the calcium content of some of the World's Healthiest
Foods, the article on our website about Osteoporosis goes into more detail about the condition
itself as well as nutrients necessary for promoting bone health. It gives detailed examples of
foods other than dairy products as well as recommended dietary suggestions that can help you to
promote bone health.
Table 1
Some Calcium-Rich World's Healthiest Foods
Food Serving Calcium (mg) % DV Density Quality
Sesame seeds 0.25 cup 351.0 35.1 3.1 Good
Collard greens, boiled 1.0 cup 226.1 22.6 8.2 Excellent
Turnip greens, cooked 1.0 cup 197.3 19.7 12.3 Excellent
Soybeans, cooked 1.0 cup 175.4 17.5 1.1 -
Navy beans, cooked 1.0 cup 127.4 12.7 0.9 -
Mustard greens, boiled 1.0 cup 103.6 10.4 8.9 -
Chard, boiled 1.0 cup 101.5 10.2 5.2 Very good
Kale, fresh, boiled 1.0 cup 93.6 9.4 4.6 Very good
Almonds 0.25 cup 91.8 9.2 0.8 -
Tofu, raw 4.0 oz-wt 86.2 10.0 2.1 Good
Pinto beans, cooked 1.0 cup 82.1 8.2 0.6 -
Garbanzo beans, cooked 1.0 cup 80.4 8.0 0.5 -
Green snap/string beans, boiled 1.0 cup 57.5 5.8 2.4 Good
Celery, raw 1.0 cup 48.0 4.8 4.5 Good
Black beans, boiled 1.0 cup 46.4 4.6 0.4 -
Cabbage, raw 1.0 cup 41.8 4.2 2.5 Good
Lettuce, romaine 2.0 cup 40.3 4.0 4.6 Good
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