How To Keep Your Bones Healthy On A Paleo Diet | Chris Kresser
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How To Keep Your Bones Healthy On A Paleo Diet

by Chris Kresser

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Contrary to what some nutritionists have claimed, a Paleo diet isn’t dangerous for your bones. Read on to learn how to keep your bones healthy and strong without dairy products, grains, or calcium supplements.

This is a guest post by Laura Schoenfeld, a Registered Dietitian with a Master’s degree in Public Health, and staff nutritionist for ChrisKresser.com. Click here to learn more about her nutrition consulting services.

One of the most common concerns of those starting a Paleo diet is that the diet is low in calcium. In fact, this is one of the biggest complaints from conventional medical professionals and dietitians: that by excluding dairy and grains, that we won’t be able to get adequate nutrients like calcium and vitamin D, and thus our bone health will suffer.

The illogical nature of this concern should be obvious –  there are many cultures around the world who do not consume dairy products and yet are able to maintain healthy, strong bones for the duration of their lifetime. (1a, 1b)

In this article, I’ll use the latest research, anthropological data, and even some common sense to help you design your diet and lifestyle to protect your bones and keep them strong as you age.

Learn how to keep your bones strong naturally with #Paleo diet and lifestyle tips by @AncestralizeMe.

What is Osteoporosis?

Before I talk about how to prevent osteoporosis and other bone disorders with diet and lifestyle, I’ll briefly explain the bone mineralization process in order to give some context to my recommendations. Our bones are constantly under a process of breakdown and rebuilding called bone remodeling, and the process has various physiological functions.

As children’s bones grow, the remodeling process allows them to elongate and change shape to fit the needs of the adult body. When new forces and stresses are applied to a bone, remodeling is used to add new bone tissue where necessary and strengthen the bones to handle the new stresses.

Our bones are also our biggest storage organ for calcium, which is kept in a tight homeostatic range in our blood stream in order to provide appropriate calcium for important functions like nerve signaling, blood clotting, and muscle contractions. When our serum calcium drops, cells called osteoclasts break down the bone tissue to release calcium into the blood. When serum calcium is elevated, a healthy, well nourished body will use its osteoblasts to return that calcium to the bone reservoir.

Watch this short video for an excellent overview of the bone remodeling process:

Now that you understand how bone grows and changes, let’s talk about what can go wrong with this process. Osteoporosis, one of the most common bone density issues as we age, is when bone becomes more porous and thus more brittle as we age. Osteopenia is a precursor to osteoporosis, and both are diagnosed using bone mineral density scanning using a DEXA machine. Osteomalacia is a softening of the bones due to vitamin D deficiency, and is another cause of bone fractures.

Bone disorders are a scarily common issue: approximately one in two women and up to one in four men age 50 and older will break a bone due to osteoporosis. (1) And these fractures significantly increase mortality risk for older adults, even doubling or tripling a person’s risk of death in some cases. (2) Women are at especially high risk due to the role that estrogen plays in maintaining their bone mass; estrogen declines with age and is affected by many factors including diet, exercise, and stress. (3)

So now that we understand the physiology of bone growth, as well as its importance, let’s talk about how we can keep our bones strong using simple diet and lifestyle changes.

Calcium

Calcium is a surprisingly controversial nutrient. The government’s guidelines for calcium intake range from 1,000 to 1,300 mg daily for adults, but some experts suggest that we only really need about 600-800 mg of calcium daily for healthy bones. (4, 5) Still others argue that the bioavailability of calcium from different foods will affect how much calcium you actually need to eat in order to get what you need on a daily basis. (6, 7)

While the science on calcium is controversial and far from decided, I generally recommend my clients get a minimum of 600 mg of calcium daily from their food, and ideally above 800 mg. Here’s a list of whole foods and their calcium content, starting with the best sources:

calciumchartpreviewAs you can see, many of the highest calcium sources in our diet do not come from dairy, and you can get plenty of calcium on a daily basis by eating lots of leafy green vegetables, or by eating bone-in fish. If you had two cups of leafy greens and a can of bone-in sardines in one day, you’d already have eaten around 840 mg of calcium. Add in some herbs and spices, and 2 ounces of almonds, and you’d be at the 1,000 mg mark easily.

(PS – Share this chart with any of your friends or family members who ask you where you get your calcium from on Paleo!)

Vitamins D, A and K2

If you’ve been following a Paleo diet for some time now, no doubt you’ve already learned about the role of the fat soluble vitamins A, D, and K2 in promoting bone health and ensuring proper absorption and utilization of the calcium we eat. But if you’re new to Paleo, you may have no idea why these nutrients are so essential, and you may not have even heard of Vitamin K2!

To keep things short and sweet, I’m not going to go into detail about these nutrients, as that would warrant its own blog post. Instead, for further information on the topic, I’ll recommend Dr. Kate Rheume-Bleue’s book Vitamin K2 and the Calcium Paradox, along with Chris Masterjohn’s article on how vitamin A does not cause osteoporosis when balanced appropriately with vitamin D. Both of these resources explain in detail the evidence that demonstrates the crucial need for a balanced intake of these three fat soluble vitamins in serum calcium balance and overall bone health.

Vitamin D should ideally come from appropriate sun exposure, and good blood levels to aim for year round are between 30-50 ng/dL. Some people need to supplement with vitamin D3 if they have dark skin and/or live far from the equator, or cannot spend adequate time outdoors to maintain appropriate levels.

Vitamin A in its preformed state primarily comes from liver, and you can eat 1/4 pound of liver per week or supplement with 1 tsp cod liver oil daily to get adequate intake. Egg yolks are also a good source of preformed vitamin A.

For vitamin K2, you can eat grass fed dairy fat like ghee and butter, goose and other poultry livers, fermented vegetables like sauerkraut, or natto, a traditionally fermented soybean product.

There are supplements that can help boost your intake of these three vitamins. Extra Virgin Cod Liver Oil from Rosita as my preferred cod liver oil product. For those who can’t tolerate that supplement, another supplement I frequently recommend is Nutricology’s Vitamin D3 Complete, which is a better choice for people with dairy intolerance or sensitivity to fermented foods.

Magnesium

Magnesium is another mineral that is essential for bone health, yet the conventional nutrition world rarely discusses its importance. Magnesium is one of the key minerals that makes up the structure of the bone matrix, and it will be pulled from the bones if blood magnesium levels drop. Magnesium deficiency is a known risk factor for osteoporosis. (8)

Since magnesium is needed for an astonishing number of physiological functions in our body (more than 300!), and many of our modern behaviors deplete magnesium more rapidly, it’s imperative that we make an effort to keep our magnesium intake high: Chris and I recommend a minimum of 400 mg daily, and up to 800 mg for those with higher needs.

Magnesium is one of the few nutrients that we recommend supplementing with regularly. My favorite supplements are magnesium glycinate and magnesium malate, which are generally well tolerated and cause the least digestive side effects. (Please note: Magnesium supplementation is not appropriate for everyone. See these precautions and talk to your doctor or a dietitian before starting any supplements.)

Inflammation

Another largely unknown influence on bone health and the risk of osteoporosis is inflammation. Several different inflammatory cytokines have been implicated in the development of osteoporosis, and chronic inflammation is believed to be a major risk factor for the disease. (9)

Inflammation has many causes, but there are many diet and lifestyle factors that can influence the inflammatory process. Examples of this include a low omega-3 to omega-6 ratio in the diet, high consumption of refined cereal grains and sugar, and low intake of antioxidant rich plant foods. Fortunately, a Paleo diet is highly anti-inflammatory, especially when there is a strong focus on eating fatty fish and grassfed meats, copious amounts of plant foods, and generally avoiding refined grains, seed oils, and sugar.

Gluten

For people who have an immune response to gluten, including those with celiac disease, strictly avoiding gluten is essential for preventing osteoporosis. As I just mentioned, inflammation is a significant factor leading to the development of osteoporosis, and whenever we eat foods that we have a strong immune response to, we are increasing the overall inflammatory state of our bodies. (10) For people with celiac disease and confirmed gluten intolerance, every time they eat gluten they are stimulating an immune response leading to systemic inflammation.

So it should come as no surprise that a decrease in bone density is one of the first symptoms of celiac disease, even in otherwise asymptomatic patients. (11) And the good news is that those who have reduced bone mineral density from previously undiagnosed and untreated celiac disease can significantly improve their bone strength simply by following a gluten-free diet. (12, 13)

Dairy As Tolerated

Like calcium, dairy is another hotly contested topic when it comes to promoting bone health. Our government recommends three servings of dairy per day for adequate calcium intake, while many plant-based diet advocates suggest that a high dairy intake actually causes osteoporosis. These two recommendations couldn’t be more polar opposite, and it’s no wonder people are confused about the role of dairy in a healthy, bone building diet.

Chris wrote an excellent article on dairy and osteoporosis, and explained that the majority of the evidence suggests that dairy is generally positive when it comes to its effects on bone health. As I discussed earlier, you certainly don’t need dairy to get adequate calcium and vitamin D to build healthy bones, but some amount of full fat, organic dairy intake can potentially make your bones stronger.

That said, much like gluten, there are many people whose bodies mount an immune response to the proteins in dairy like whey and casein. I’ve seen many people in my dietetics practice who have tested positive for immunogenic activity against dairy proteins, and these people should definitely avoid dairy for better bone health.

Ultimately, the role of dairy in bone health is highly individual. If you’re not sure if dairy is an appropriate food for you, consider working with a nutritionist who can help you determine your personal tolerance to high quality dairy foods.

Collagen

What many people forget about the structure of bones is that around 25-30% of the dry weight of bone is made of collagen proteins. Evidence suggests that the strength of our bones is highly dependent on the quality of the collagen matrix, particularly the cross-linking of collagen, thus it would make sense that supporting collagen formation would be important in keeping bones strong as we age. (14, 15)

In order to have good collagen formation, you need amino acids glycine, proline and lysine, along with adequate amounts of vitamin C for the hydroxylation of these amino acids. While our bodies can produce glycine, proline and lysine from any dietary protein, there is some evidence that these amino acids can be considered “conditionally essential” and thus we would benefit from consuming them in our diets. (16)

This means eating lots of bones, joints, tendons, and skin from animals, either by making bone broth regularly, consuming gelatin frequently, and following a nose-to-tail eating pattern that our ancestors would have done regularly to receive all those bone broth benefits. Also, getting plenty of vitamin C from fresh fruits and vegetables will help ensure proper collagen formation. If you can’t eat a lot of plant foods for some reason, supplementing with vitamin C may be helpful. Iron and copper are two minerals that are required for collagen production, and you can get both of those nutrients in liver.

Read this article for more information about how nutrition can affect collagen production.

Calories

This is another topic that could be a whole blog post in itself, and mainly applies to women who are overtraining and undereating. There is a common syndrome in female athletes called the Female Athlete Triad, and it can affect any woman who is training hard and not fueling herself with an appropriate amount of calories. We discussed this condition on a recent podcast, and I believe it’s an enormously under-recognized issue in the Paleo community, where there are many women on low carb and/or low calorie diets while simultaneously participating in high intensity training programs like CrossFit or running long distances.

This threefold condition is defined as disordered eating, menstrual dysfunction or amenorrhea, and premature osteoporosis; the latter symptoms caused by a drop in estrogen production. And while osteoporosis is typically an older person’s disease, it’s scary to see 20-30 year old women developing osteoporosis due to an unhealthy focus on “healthy” eating (read: dieting) and exercise leading to a drop in estrogen. If you’re concerned you have this condition, I strongly recommend working with a nutritionist to help you ensure you’re eating an appropriate amount of food and helping you regain a normal menstrual cycle if you’ve lost yours.

Acid Load

Some people are concerned that a high intake of animal protein on a Paleo diet will cause acidification of the body, leading to bone demineralization. However, observational studies have not found a correlation between dietary acid load and bone mineral density (BMD) or fracture risk. And while high protein diets are associated with increased calcium in the urine, there’s no evidence of a net negative impact on calcium status from a high protein intake. In fact, animal protein, the most acid-forming food of all, has been associated with better bone health. Chris has covered this topic extensively in his series on the Acid-Alkaline Myth, and I strongly recommend reading those posts if you’re at all concerned with the effect of meat consumption on bone health.

Exercise

Diet isn’t the only factor that influences bone strength. Doing the right type and amount of physical activity on a regular basis is just as important to maintaining healthy bone density. The best type of exercise for bone strength is weight bearing exercise, the best of these being strength training with relatively heavy weights. The stress put on your bones during the exercise stimulates the remodeling process described in the beginning of this article. Doing moderate weight lifting exercises a few times per week has been shown to significantly increase bone density, particularly in postmenopausal women. (17, 18, 19)

Running is often touted as another way to build bone density, with a recent study suggesting that it may be even more effective for building bone mass than weight lifting. (20) On the flip side, other studies have shown that long distance runners actually have lower bone mineral density than those who are sedentary. (21, 22) I believe this has more to do with the increased inflammation from catabolic exercise combined with the hormonal effects of overtraining, particularly in women. Running shorter distances and ensuring proper nutrition is key, and mixing endurance exercise with resistance exercise is likely the best way to promote bone health.

Sleep

Sleeping well is not only important for general health and wellness, but it actually directly impacts bone density through the hormonal effects of melatonin, the primary hormone secreted during sleep. (23) Melatonin affects the actions of osteoblasts and osteoclasts, interacts with other hormones like estrogen to augment bone remodeling, and functions as a potent antioxidant, protecting bone cells from oxidative stress and inflammation.

The most important way to keep melatonin secretion functioning optimally is to get your circadian rhythms entrained onto an appropriate 24-hour cycle. The best way to do that is to limit your exposure to artificial light at night, and to ensure you get adequate daylight during the day. Committing to 8 hours of high quality sleep in a cool, dark room also helps boost melatonin. And here are several ways your diet can improve your sleep.

Our new 14Four program also covers concise recommendations for improving sleep, so join us if you’re interested in learning more.

Stress

Stress is another factor of good health that generally gets ignored by those more focused on diet and exercise. And like sleep, stress levels can directly impact your bone health. It’s well known that the long term use of corticosteroid medications causes bone loss and can lead to osteoporosis. (24, 25) However, high cortisol from stress could potentially lead to similar effects on bone density. Cortisol indirectly acts on bone by blocking calcium absorption which decreases bone cell growth, and even a short bout of elevated cortisol may cause a decrease in bone mass. (26) Several studies suggest that high cortisol may lead to decreased bone density. (27, 28, 29, 30)

Since cortisol is the primary stress hormone, the best way to keep cortisol levels in an appropriate range is to practice regular stress management. Recommended techniques include yoga, meditation, deep breathing, and positive social interaction. We’ve dedicated a significant amount of the new 14Four program to stress management, so I recommend signing up if you’re interested in learning how to make stress management a regular, committed practice.

Tobacco and Excess Alcohol

I’m probably preaching to the choir here, but it’s important to remember that both cigarette smoking and excess alcohol consumption have been linked to reduced bone density. (31, 32) So if you are smoking or regularly drinking in excess, stopping those habits as soon as possible should be a priority for keeping your bones healthy.

What About Calcium Supplements?

Though calcium supplementation is a common recommendation by conventional doctors and dietitians for patients with reduced bone density, there is a lot of evidence to suggest that this is inappropriate and potentially unsafe advice. Chris wrote a comprehensive review of the dangers of calcium supplementation, which will likely do more harm than good for most people. There are very few people who should even consider calcium supplementation, and the majority of the population should have no trouble getting adequate calcium intake through food, as I explained how to do at the beginning of this post.

Conclusion: Paleo IS a Bone Building Way of Life!

The concerns over a Paleo diet and bone health are completely unfounded, as I’ve shown many times throughout this article. A nutrient dense Paleo diet, full of vitamin-rich fats and calcium-rich vegetables, plus the associated lifestyle factors promoted in this community including good sleep, stress management, and regular appropriate exercise, is the perfect combination for promoting good bone health.

So the next time a friend, relative, or even medical professional expresses concerns over your bone health with your dairy-free, grain-free Paleo diet, send them this article!

Now I’d like to hear from you. Do you implement all of these recommendations for keeping your bones healthy? Have any of you experienced an increase in bone mass after switching to a nutritious ancestral diet? Share your story in the comments below!

View More: http://em-grey.pass.us/laura-s-head-shots-web-optimizedAbout Laura: Laura uses her knowledge of traditional and biologically appropriate diets to improve her clients’ health. Growing up with a family that practices Weston A. Price principles of nutrition, she understands the foods and cooking practices that make up a nutrient dense diet.

With her strong educational background in biochemistry, clinical nutrition, and research translation, she blends current scientific evidence with traditional food practices to help her clients determine their ideal diet.

You can find her at AncestralizeMe.com, on Facebook, and Twitter!

81 Comments

Join the conversation

  1. Hi Chris,

    If my Bone Mass is quite much higher than the standard, what does it mean? Is it good or bad?

    Thanks
    Sa
    2017-6-2

  2. I have been tracking my calcium for one month and I can’t get near to RDA. I eat little dairy, no cheese or nuts. Paul Jaminet says that if you are on a Paleo diet you might be a little short of calcium and 400mg would resolve. I would say this dosage isn’t that much of a problem if you are supplementing K2 and D3. Most multis have 200 or so…

  3. I thoroughly enjoy reading Chris’s articles and try to follow his recommendations; however, being English, living in Britain, it can be hard to source some suggested foods and supplements. Another problem is the American measurement of ‘cups’ in recipes. According to how finely chopped an ingredient (such as spinach) is made, can vary the amount in a cup. Measuring food by weight is simple and more accurate. Can you help to clarify these issues for us poor Brits on the other side of the pond?

  4. Thank you so much, this article has been so informative. I’ve just started a paler diet and calcium has been my main concern as my mum has osteoporosis. You have now given me the info I need to make sure my diet is rich in these nutrients. Your awesome!

  5. I am wondering if the calcium in collard greens is still there depending on how much time you cook them-is it possible to overcook the calcium out? is it better to get it from fresh veggies?

  6. Hey Chris!

    Thanks for the info as always…

    I am doing several things dietarily that may deplete magnesium and have signs of apparent deficiency. (For example I consume coffee, high levels of A and D daily, and foods high in calcium and potassium, all of which I’ve heard rumors can deplete magnesium…and cramps and other issues.)

    I also have a condition that’s often associated with magnesium deficiency (and issues with other electrolytes), as well as all the symptoms.

    However, I have a bad reaction to any grains, including gluten-free grains and “seed grains,” and have this same reaction to almost every supplement I take. Therefore aside from upping my intake of mineral-rich foods I am hoping that one of these days I will run into a strictly paleo magnesium supplement in highly absorbable form.

    If you know of one at this time, please share!!

    Thank you:)

  7. Just recently trying to change my eating habits. My daughter and son-in-law are following the paleo mostly.
    In April I stopped eating cheeses, except for parmasen grated cheese. My fingernails have been splitting ever since. It all started because I used some nail dry directly onto my nails in April, but by now I hoped they would be growing in properly, but they are splitting so much.
    I’m trying to take in more high calcium based foods, but wondering if I should have a cup of full fat greek yogurt again.
    Thanks. I look forward to your advice.

  8. Excellent articles…Regular exercise is key to keeping some health issues at bay, and bone health is no exception. In fact, living a sedentary lifestyle is considered a risk factor for osteoporosis. One study comparing bone density in college women with various body weights and activity levels found that athletes with low body weight had the highest bone density of any group in the study, showing exercise (and low body weight) can have a positive effect on bone density. for more info
    1. https://www.healthclues.net/blog/en/osteoporosis-rising-trends-in-asia/
    2. https://www.healthclues.net/blog/en/poor-mans-rich-calcium-diet/

  9. Despite bracing, my son’s scoliosis progressed to the point of needing surgery. We are trying to ensure that his bones are strong enough to hold the screws used in a procedure that is much less invasive than the traditional surgery. If his bones are too soft, they will have to do a more invasive procedure. Any advice? We buy raw milk and make our own kefir and kombucha. We use grass-fed dairy products when available. I have bone broth simmering as I type. Any advice regarding supplements? Thanks in advance.

  10. Hi Chris,
    I am planning to do your 30 day reset. I am intolerant to salicylates and histamines and have to follow a low fodmaps diet. I don’t know where I can get calcium from if I eliminate dairy, as I seem to be able to tolerate small amounts of dairy.
    All the non dairy foods high in calcium such as sesame seeds, almonds, leafy greens, sardines,tinned salmon with bones are also high in salicylates or amines. Raw dairy seems to irritate, whereas organic pasteurised A2 milk seems ok. I am in Australia where it is easy to get A2 milk.
    thanks,
    Veronika

  11. I’m glad I came across this article. My wife and I have both been taking calcium supplements based on our doctors recommendations. The fact that calcium contributes to hardening of the arteries to the extent it does means we need to reconsider the advice we’ve been given.

  12. Hi Laura,

    Thanks for the article! I really enjoyed it. I have one comment though: the serving size for milk is almost always 8 oz. It seems like the serving size is being doctored a little to make a point against dairy.

    Best,

    Ty

  13. Paleo diet didn’t prevent my osteopenia (-2.1) from progressing to osteoporosis (-2.5). I followed the diet pretty rigorously for two years, no dairy beans or grains, and got calcium mostly from canned mackerel with bones, greens, tahini, and lately Life Extension vitamin K2 that contains some calcium. I go to the gym pretty much daily. Lately I’ve been making and taking bone broth from (conventionally raised) chickens. Wish I could continue being a Paleo enthusiast because I really like eating this way.

  14. Thanks for this article, Laura. Do you think that rebounding on a mini tramp gives enough resistance for bone building? Rebounding ‘gurus’ claim this to be true. Some of them also claim that every bone benefits from rebounding. Low impact and bone building – sounds almost too good.

  15. Great, great info! I have a question, though. Would you map out what getting enough calcium from the table above looks like on a daily basis for a family of four without dairy? It is too expensive for us all to eat canned salmon/sardines every day, and the amount of greens needed is also very impractical. (And, I have teens that will eat about anything I give them, but they just can’t stomach sardines.) Please, please help us by laying it out for a week. I think you will find as I did that it just does not add up without breaking the bank, or having the same greens repeated too often. Thank you!

    • We have a huge problem on our hands, we adulterate (refine) our vegetable oils to make products (cooking oil or margarine) last on the shelves. This means the fats can’t oxidize (go rancid), therefore they cannot absorb oxygen. These fats (mostly Omega-6) are then incorporated into cell membranes and impair the ability of that cell membrane to transport oxygen. This leads to increased anaerobic metabolism, causing the cell to become inflamed (acidic), leading to heart disease and cancer over a long enough period of time. To reverse this you have to consume lots of unadulterated Omega-6 (raw) fats. There are very few of these kind of supplements available, but in my patients who take them, you get some astounding results.

  16. The Omega story is much more complex than just ratios. It is the amount of highly dangerous, adulterated Omega-6 in our diet which causes much of the inflammation we see. In my patients that go on plant based Omega-6 supplementation, they don’t break bones any longer!

  17. Hey Laura, fantastic breakdown of the many factors involved in bone health. I always find it interesting that, when you strip all the academic-speak and scientific terminology away, you’re left with the fundamentals: eat well, sleep well, move, reduce stress.

    I have two quick thoughts:

    The first is to make abundantly clear that uniformly referring to “dairy” is misleading, because in my experience the difference between store-bought, hyper pasteurized dairy and local raw milk is night and day, both in terms of nutrition and potential allergic reactions. There’s no comparison.

    In addition, I’ve heard that drinking demineralized water (i.e. bottled water, water that’s been treated via reverse osmosis etc). can actually leach minerals out of the bones over time. I’m interested in hearing your thoughts on this, here’s the link to the World Health Organization study I’ve seen referenced:

    http://www.who.int/water_sanitation_health/dwq/nutrientschap12.pdf

    Anyways, thanks again for the epic article. I’m continually impressed by your depth of knowledge and ability to distill information into an easily digestible format.

    • Wow, that’s very interesting! I didn’t realize that the water could leach out minerals regardless of the mineral content of the food one was eating.

      I guess mineral water should be on my list of recommendations! Thanks for sharing.

  18. Wow, probably the best article I have read on Calcium intake on a Paleo nutrition plan!
    We have all of our Client’s on Paleo(ish) eating regimen’s along with HIIT programs and achieve outstanding, healthy, sustained results. One of the first questions they and their family member’s ask is “What about Calcium if I’m having none/reduced Dairy?”.
    I’ll just get them to read this!
    Great work Laura, thank you!
    🙂

  19. I don’t see chia seeds listed in calcium food list? Doesn’t it have enough calcium? Is there any truth behind calling it a super food?

  20. Something that should concern people more than acidity is the PHOSPHORUS intake with every soda consumed. Since we don’t consume sodas but DO consume plenty of alkalinizing plant matter along with our meat, and have lower sugar intake than the average SAD diet eater, acidity becomes a non-issue.

  21. Hi Laura,

    As usual, another excellent article from you! I’ve shared it enthusiastically and enjoyed reading it…twice!

    The only 2 comments I would add are
    1. discuss bio-identical hormone replacement therapy with your physician: I use estrogen/progesterone/testosterone/DHEA with women and testosterone/DHEA with men, monitored and individually tailored, with good results at maintaining or even restoring bone density.
    2. I just learned, here’s a good link http://naturalmedicinejournal.com/journal/2012-07/prunes-may-prevent-and-reverse-osteoporotic-bone-loss
    that there has been a string of research interest in the observation that prunes (!!!???) prevent bone resorption and are a useful tool… taken at night, their potassium can also help induce sleep, a double benefit!

    Thanks again, keep writing!

    Deborah

  22. I’ve been on an ancestral diet -Paleo for a few years now. I started this because my niece recommended it for my hyper-thyroidism including lesions on my gland and exzema, sleeplessness and acid reflux. I was a healthy eater before then – all organic and plenty of whole grains. All the above conditions are resolved – no more quarterly blood work, scans or fine needle aspirations. I’m 50 just had a bone scan and was told my bones look like a 20yr old’s! This is a great article and I see where I might make further improvements to my diet.

  23. Hi Laura,

    Thank you for writing such a great article, I for one have found it very informative and thought provoking.

    What are your thoughts with regards to the mineral content of water? Do you think that drinking mineral rich water is a viable way to increase our consumption of calcium and magnesium? Is it possible that mineral rich water may have represented a significant proportion of our ancestors’ intake of these minerals?

    I look forward to hearing your thoughts on the matter, thank you again for the article and for doing what you do!

    • I definitely think mineral-rich water contributed to our ancestor’s mineral status, though possibly it was more important for trace minerals than macro minerals like calcium or magnesium. But I’m not familiar with the levels of those nutrients in natural water sources. Mineral water is a great addition to an ancestral diet, though!

  24. I also have a question about natto. I’ve heard that you can make it with other beans than soy. I’m not a fan of soy. What other beans do you recommend and will the end product have the same amount of vitamin K2?

  25. I have Celiac Disease and was diagnosed with osteoporosis at age 40. I have been eating mostly paleo since. My second bone density (after 2.5 years paleo) revealed a slight improvement in bone density. The doctors say it’s not considered significant since there is a margin of error in the test, however to me it is significant since I would expect that it would otherwise have continued to decline.

  26. Thank you, that was informative and reassuring.
    I still get asked how I get calcium and iron, being on a no grain no meat but for fish and no sugar of any kind diet.

    Regards,
    Carla

  27. Thank you for the informative article. I wanted to point out that your vitamin D recommendation is low. While 30 is currently the medically established number, the vitamin D Council recommends a low of 50 with an ideal range of 80-100.

  28. I am another one who thinks that list the gross amount of a mineral in a food item is misleading. The bioavailability of the mineral is very important and can vary widely. So can the amount of the mineral.

    Here is a listing of calcium availability in various foods. Also notice that the amount of gross calcium in sesame seeds is about 8 times less that listed on the article.

    http://www.dairynutrition.ca/nutrients-in-milk-products/calcium/calcium-and-bioavailability

  29. Investigate Magnesium Taurate – I am finding that at 65 I need a Mg supplement but not a Ca and the taurate form offers extra heart protection.

    Oddly enough, my Vitamin D levels soared once I switched to grass fed beef – only dietary change…wow! No more supplements for this Northwest climate.

  30. You left out one of the greatest sources of CA++…Seaweed! 1/2 oz of wakame has the around 1000 mg of CA++ plus it is very alkaline, allowing for good uptake!

  31. I drink a mixture of water and about 1 tsp. calcium bentonite clay several days per week. The purpose is for gentle detoxification, increased mineral consumption, and to increase bone density. It seems to blend very well with my paleo lifestyle. I think it is good to eat a little dirt! Do you have any advice as to whether this is a good practice or not?

    • I also take some bentonite clay or sometimes called Redmond clay for general intestinal health…it’s like a miracle cure for dog digestive ailments as well. It is one of the key components in my tooth powder recipe as it aids in re-mineralizing teeth.

  32. Great article. Please tell me how much natto to eat each day to get a good dose of Vit K2. I make my own, have come to like it, and eat about 1 TB with breakfast…. Is this enough?

  33. Hi Laura,

    Thanks for that video; I love this kind of stuff! Thanks, too, for all the info. on the additional factors that affect calcium production and absorption.

    I have a few comments and questions about your article. You state that “There are many cultures around the world who do not consume dairy products and yet are able to maintain healthy, strong bones for the duration of their lifetime.” If there are so many, can you name some and the means by which their bones were assessed across time?

    “Still others argue that the bioavailability of calcium from different foods will affect how much calcium you actually need to eat in order to get what you need on a daily basis. (6, 7)”

    Citation #6 appears to focus on estrogen rather than food.

    Citation #7: the controversy stems from biochemical individuality, i.e., a person’s ability to assimilate calcium from food, and the fact that calcium content of foods isn’t static. Calcium content in plants is limited by the calcium content in the soil. This will vary from year to year and depends primarily on whether agribusiness adds calcium back to the soil/growing mediums they use. There might also be a small issue with where in the plant the calcium is measured and the sensitvity of the technology used to measure the calcium in plants, especially since many of the values for calcium content were measured long ago with tools that weren’t as sophisticated as those available today.

    Regarding your chart, it ignores bioavailability completely. I would have rather seen a chart ordered by net calcium available as measured by analytical testing in the chart on Paleo Leap that you linked to. Also, as members of the founding group of 14Four members have seen, even if they’re not expressly allergic to dairy, many experienced better breathing when avoiding dairy due to decreased mucus production.

    In addition, your dairy recommendation doesn’t address the issue of toxins from cows raised in CAFO (Concentrated Animal Feeding Operations) conditions. I believe that you’ve said on previous occasions that their fat contains toxins from the antibiotic metabolites, byproducts of incomplete digestion of grains.

    • Save those egg shells. I put mine in the grain grinder part of my Vitamix and whirl until powdered. That gets liberally scattered in any soi wherel I plant vegetables,ensuring good calcium availability for plants. If you just stop short of powder and want shards….scatter those for slug repellent – they hate the sharp stuff.

  34. Good article and covers the territory well. Can’t help feeling that the tacit conclusion might be a little wrong: that it’s trivial be get adequate calcium without dairy. The chart provided more or less makes that clear to my mind.

    Firstly there are a number of dairy choices in the top items: if we remove those, the top 10 are mostly things many people, especially kids, may not be able to eat (multiple veggie greens; fish with bones etc.). Even if this weren’t an issue, and it is, one has to eat multiple items, half a dozen or so,from this strange list every single day! Believe me, I’m not advocating that it’s impossible and I remove regular or even all dairy from clients’ diets every day, but the reality is that in the absence of dairy, it takes both education and continued commitment to make the calcium quota each day. In short possible, possible yes but not trivial by any means.

    The 2 groups I see who are quitting dairy most commonly are “women of a certain age”, and, not by their own choice of course, young kids. These are precisely the same 2 groups most at risk from calcium deficiency.

    And finally, while I’m on, the evidence that Paleolithic man didn’t consume dairy is questionable. Lactase persistence studies don’t apply if the dairy being consumed back in the Stone Age was typically clabbered/fermented and therefore pretty well lactose free. Also the “technology” required to milk an animal is far less than that required to slay one. Remind me: why do we believe animal milking is such a modern phenomenon?

    • The eHRAF files are an excellent source of information on traditional diets of non-agricultural peoples as well as subsistence farming peoples. There is a very large corpus of research in the form of papers written by anthropologists and archaeologists, if you’re interested in questions of bone health across time. I recommend Clare Cassidy and Smith & Smith.

      Milking of ruminant animals is primarily a trait of Eurasian peoples, perhaps because few suitable animals were available in the New World. Then there are cultural norms to take into account – some peoples are genuinely revolted by the notion of drinking milk.

      You’re correct that milking and clabbering may well have started way before the Holocene; currently, evidence for milk use comes from the fats trapped in ancient pottery sherds. Richard Evershed is the guy to read on this, e.g. http://news.nationalgeographic.com/news/2008/08/080806-prehistoric-dairy.html. In Europe, the genes for lactose-tolerance appear only ~7,500 years ago.

      Of course, milk could have been clabbered earlier on in bags made of treated hides (just as wine was fermented and water carried), or in watertight baskets made of fine grass stems. These don’t preserve in the archaeological record. However, the ~70% incidence of lactose-intolerance has been well shown to be linked with non-pastoral societies in which dairying didn’t occur – there is an extensive literature on this subject alone.

      Bone health of ancient populations over time is a matter of absorbing interest to bioarchaeologists and palaeopathologists, so there’s a humungous literature available.

  35. Chris, why don’t you mention silica (Si) and its importance for bones and collagen production?
    As far as I know 90% of people are deficient in this nutrient.

  36. No matter the number of times one repeats the BS it does not make it any more true.

    The Paleo Diet is unhealthy and likely bad for the bones but it is not because one does not get enough calcium if skipping the dairy. It is because the diet includes too much animal protein…

    It is true that there are cultures that have strong bones without consuming much dairy, for example the old Okinawan people. But they consumed over 80% of their calories from whole plant-based foods and seldom consumed meat.

    • Hi Richard,

      I was following the Australian pyramid food guidelines until recently. Having moved to a Paleo lifestyle over the last 12 months i have actually decreased my animal protein intake! Its amazing what eating healthy fats does for you. I have also dramatically increased my vegetable intake as i am no longer eating grains which are extremely low density calories.

      My recovery from racing road cycling events has never been better and i am eating less carbs and protein than i was a couple of years back! And enjoying every meal i make.

      Its no surprise the Okinawan people live so long. They love their Natto! (Vitamin K2)

    • Richard,
      The biggest misconception about Paleo is that we walk around gnawing on slabs of meat all day. Like Julian said, I eat less meat than ever on this diet because it makes fats acceptable. It actually emphasizes eating plant foods in the form of veggies and fruit, and lots of them. I feel sluggish if I eat more than about 3 ounces of meat at a meal, and make some of my meals “vegetarian” with just eggs or raw cultured dairy. I do feel better including animal protein, but it is not in any great quantity.

      Also, Paleo has evolved, so to speak. The original emphasis was on lean meats only. We now understand it is important to include the whole animal, fat, bones and organs as well as meat. I feel a thousand times better at 51 than I did at 40 when I was consuming the whole grains diet recommended by the USDA. Goodbye to blood sugar crashes and inflammation.

    • then don’t eat Paleo, my triglycerides are now 78 despite “all that meat”, I eat less meat now than ever before, I eat more vegetables than ever before and LIKE THEM, so don’t change your diet, eat ALL the grains you want and eat mine too because I won’t. When the doctor xrayed my arm after a fall (from over-exuberant exercise) he says “by the way you have the bones of a 30 year old”- I am 64 years old. Oh yeah, quit reading about Paleo, it’s just upsetting you.

      • How did you derive the opinion that I consume a lot of grains? Also, I did not say that the Paleo Diet is bad for the bones, although it could be…Unhealthy includes arteries…
        I am not trying to change your diet and I appreciate your permission to continue with mine.
        I would be one of the last persons to say that we do not need much more nutritional research but till we do have better information I have little animal products on a daily basis and get my protein from beans, vegetables, grains, seeds and nuts….twice a week two ounces of wild salmon.

  37. Hi Chris,
    I enjoyed reading your article. Recently, I saw my Primary care doctor and he told me that I would start on fosamax because my t score is-2. He said that I got worse. I did not see my last results but I got scared. I do not want to take this medication. I started eating a Paleo diet last October and I love my food. I never want to go off the way I eat. I need to find someone who has treated osteoporosis and is successful. Do you know of anyone in San Antonio Texas? Please help and thank-you,
    Maria Zeitz, San Antonio Texas (cell: 210-860-4702)

    • Hi Maria, my bone density has gone from -5 up to -4. I can still fracture very easily. Wish I had your a score like your -2 ! That’s not very low. You have plenty of time to rebuild bone. You first need to rule out any causes such as parathyroid/thyroid/celiac/gluten sensitivity/medications/Cit D deficiency etc. Then there is much you can do for yourself. You’ll find loads of helpful information on http://www.inspire.com/groups/national-osteoporosis-foundation/
      Best of luck.

    • A friend of mine was in your position, but luckily her GP lost the letter requiring her to go onto medication. Instead, she ate paleo, took a lot of D3, Magnesium – and yes, in her case, extra Calcium. 18 mths later, the hospital recalled her for another scan – panic at the GP’s as they found the original letter – but – her bones were completely healed. No longer even any osteopenia. She had had me urging her, and her Chinese Doctor – who worked out the supplement quantities for her. So get some help, try it, and barter at least a 6 mths trial.

  38. Thank you Laura for a well researched article. I’d like to add my experience with dairy. I avoided dairy for about 30 years largely because it gave me very bad mucus problems. A few years ago in my mid sixties my vertebrae started collapsing like dominoes. DEXA scans revealed bone density so low it was off the bottom of the chart. I began to delve into the diets of my recent ancestors. In my family, as far back as I can go, everyone used dairy liberally. Parents, grandparents, going right back to 1840, when they arrived in this country bringing their cattle along with them. I remembered that the oldies of my childhood piled lashings of butter and cream on their food. They were all robust and vigorous and their bones didn’t collapse in old age.
    So, I sought out the raw milk of my childhood and began to consume at least a quart a day. No mucus problems, and a DEXA scan that revealed over 20% increase in bone density within 2 years !!
    I think you’ll understand that’s considered medically impossible.
    I’ve read estimates from Paleo researchers that humans have not consumed dairy for more than about 10,000 years. I think it is quite possible that humans used the milk of small, easily caught animals like sheep and goats in much earlier times. Why wouldn’t they ? I wonder if many of us, coming from dairying cultures, have come to depend over the millenia, on milk for a large part of our Calcium intake. It’s possible that our ancestors may have lost the ability to extract the Calcium from plants as effectively as people in cultures that didn’t ever use dairy. If my hypothesis has validity then the ramifications could be far-reaching.
    My milk comes from cows that live outdoors on a pasture of herbs and grasses. We collect it fresh from the cowshed. It’s not pasteurized / homogenized / standardized / UHT / factory- farmed etc. I believe that it’s not milk per se that is the problem for so many people today, it’s what is done to the milk.
    Ross made a good point about bioavailability. The charts are misleading. Dr. Robert Heaney discusses this and also the acid/alkaline and protein myth in his You Tube talks and on his blog: http://blogs.creighton.edu/heaney/
    His latest posting is entitled ‘The Paradox of Osteoporosis Irreversibility.’ I think I may have proved him right.
    And Weston A. Price also dispelled the protein myth about 80 years ago.
    ‘Real milk’ certainly wasn’t bad for my bones. It’s a shame that article on milk consumption received so much publicity when it’s results were inconclusive.

  39. With all due respect Laura your article may have mentioned the importance of progesterone to the building of strong bones. This seems more important than estrogen according to Dr John Lee.

    The anovulatory nature of the peri- menopausal, menopausal, elite training, amennorheic female with her resultant lack of progesterone is related to osteopenia, osteoporotic bones.

    Certainly at 49 years I have only added progesterone to my milieu and moved out of this danger zone ( Dx with DEXA) using Dr Lee’s advice on progesterone for bone health.

    Lack of estrogen is not normally the problem.

  40. Hi there

    Thanks for a great article .

    I am guessing you mean unhulled tahini vs hulled regarding calcium content or is that a myth?

    Is 600mg of Ca enough for toddlers?

    And you mentioned an immunological response to dairy, is there a specific blood test you can do to see if you react to dairy?

    Thanks so much!

  41. Hi Laura,

    Superb article. This is the sort of information that can really help people, so kudos to you.

    My question concerns the chart you provided. Sesame seeds, for example, are listed as having significantly more calcium tham dairy, but this doesn’t take bioavailability into account. As a result, some people might go for a cup of spinach over a cup of dairy kefir (if tolerated). Is it simply, therefore, a case of making sure that if you go the plant route you eat always eat them with fat in order to liberate the minerals?

    Thank you!

  42. There is some interesting new research showing those consuming 3 cups or more of milk a day = higher mortality and osteoporosis. However this was not true for Yogurt and aged cheese. I might start supplementing some magnesium though.

  43. Wow, so for a Mom whose children don’t tolerate dairy, and won’t eat bone-in fish, getting enough Ca could be tough. We put greens in our smoothie in the morning and try to have some other greens at dinner, but I guess this is not enough. Back to the drawing board… Thanks for the article!

  44. For those who would like a scientific but very understandable explanation of weight bearing exercise and osteoporosis, I suggest reading Katy Bowman at katysays.com. You can start here.

    • I was about to link to Katy Bowman but I see Erin has already done that. I think that the “exercise” portion of this article could be strengthened– it’s not just the movements we do, but the WAY we do them. Also, any exercise will only strengthen the bones that it “uses,” so if you have osteoporosis in your ribs then running isn’t necessarily going to help you. Bone density is not consistent skeleton-wide; getting enough of the right nutrients will ensure that bones *can* stay mineralized, but they *won’t* if they’re not receiving the mechanical stimulus. Even just standing is a bone-building endeavor, but only if it’s done in a way that maximizes the force of gravity on our skeleton. Wearing heels is one way to encourage osteoporosis of the hip!

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