Paleo vs Osteoporosis

43 Comments

Charla posted the following question:

Robb,

Another question if you don’t mind. My mom was also told she has pre-Osteoporoses she was tested and put in the chart right on the edge of yellow and red. Later, she went gluten free. She went back to the DR.’s he said he had never seen some one get stronger. She is now in the yellow close to the green being good. The Dr. says he didn’t know how she was doing it neither did my mom. I was talking to her last night and said mom what if it is that you are gluten free … everything started to click for her. I know you mentioned this in the lecture but…what is the relationship between Osteoporosis and gluten?

Fantastic question and and interesting answer. When we are thinking about osteoporosis there are two things to consider: How much bone matrix are we taking in, how much bone matrix are we excreting. To some degree Dr.’s and dietitians get this (kinda) and this is why they recommend calcium supplements (increase the amount of building blocks) or drugs like Fosamax (improve mineral retention). The ONLY problem with this scenario is calcium supps do not work and although Fosamax improves bone density it does little to nothing for bone strength!! Bones are a pretty amazing engineering project with a calcium based crystal lattice that is reinforced with protein. Think re-bar+ concrete. The complex is amazingly strong, flexible and resilient. Fosamax simply stuffs calcium in the bones in an amorphous manner that does nothing to improve bone strength or prevent fractures. Bummer. What about the calcium supplements? Well, if we can not absorb it OR if we exrete more than we take in, it does not matter how much calcium we take in…other than high dose calcium can precipitate a heart attack or stroke!

Well Frack-my-fanny!! What the hell should we do with grandma!? Fosamax does not work and has crappy side-effects, calcium supplements don’t work and increase heart attack/stroke risk!!! Where should we look for an ANSWER!!?!?

In the immortal words of my grandfather from Arkansas: “Well, shit son, let’s start at the beginning.” I know some folks out there “just don’t buy into” the notion of evolutionary biology…but when it keeps delivering the goods…, aw shucks, who wants to really UNDERSTAND what’s at play here! If we just deal with outcomes it can be like magic! This way we never need to understand anything! We can just navigate the world via trial and error! We can live via superstition instead of a system of understanding! It’ll be as much fun as the dark ages! Ok…I’ve been drinking a lot of coffee today, but I think y’all get my point. Let’s use a little Evolutionary Medicine to figure out what’s happening here. When we are thinking about bone health, we need to consider absorption and retention/excretion. Let’s look at each of those.

You Will be Assimilated!

Believe it or not, the intestines are a rip-roaring place of excrement and adventure! It is the interface between “us” and the outside world…it’s where you absorb all the raw materials to make YOU. Mineral absorption happens in the small intestine and it is dependant upon an intact gut lining, vit d status and a few other factors. If our gut lining is irritated…from pesky neolithic foods for instance…you can not absorb minerals efficiently. Calcium, magnesium, zinc, copper, iron…they all just schwoosh right out your pooper and you never get to turn them into bone, hemoglobin, or super-oxide dismutase! Osteoporosis is sky-high among celiacs…oh, and among folks with autoimmune diseases. All those folks have irritated gut lining. Hmmm. When people adopt a paleo diet the gut heals and minerals get absorbed. We also tend to eat more protein on a paleo diet and although the vegetardians like Mcdougal think the acid load at the kidneys removes calcium from the bones, it turns out we actually absorb and retain MORE calcium due to hormonal shifts from a high protein diet. From the Protein Debate:

A similar experiment confirmed that elevated dietary protein enhances calcium absorption and thereby counters the increased urinary excretion of calcium (110). Furthermore, a series of recent dietary interventions in humans has shown that high protein, meat based diets do not cause loss of calcium from the skeleton, but actually have a favorable effect upon it by lowering bone resorption (105, 107, 111, 112) and may actually increase bone formation by dietary protein induced increases in IGF-1 (105).

Interesting, no? a compensatory mechanism of increased calcium absorption that supercedes excretions…oh, and the increase of anabolic hormones that improve bone health like Igf-1!

Retentive Much?

Retention and excretion are largely acid base issues and Prof. Cordain (again) has the goods on this. 

I don’t want to re-invent the wheel on that, so I’ll just say that a paleo diet is a net alkalanizing diet. You only need ~20% of your cals to come from fruit and veggies to accomplish this. 

So, the short-hand reasons why a paleo diet is beneficial for osteoporosis is that absorption is improved by healing the gut lining + improved hormonal state from increased protein intake. Retention is improved by a net-alkaline diet. Perhaps most importantly, it works.

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  1. M@
    March 19, 2009 at 7:27 pm

    Great post! I’m curious to know why you didn’t mention phytates? Anyone who is going gluten-free will likely consume a lot less of these compounds, which should improve the absorption of calcium, magnesium, zinc, and iron. I understand that the lining of the GI tract must be healthy in order for adequate absorption to occur but it seems like the phytates could be playing a secondary role in this situation.

  2. Chechi
    March 19, 2009 at 8:25 pm

    Robb,

    thanks for all the FREE info and being such a great asset to the community and myself I had the pleasure of attending your nut. cert in Chico last year & it literally changed my life and those around me. My Q is, I have a mother who is about 72 that lives about an hour away from ya she has adopted a full paleo diet since I attended your cert. last year She’s doing awesome but her Dr. Is a freackin moron she’s had High BP and has been on a cpl meds for the past 30+ yrs, she is very hesitant to get off them without the recomendation of a Dr but her weenie Dr. views her as just another # and doesn’t understand the idea of people changing for the better and not having to rely on big pharm…The doc actually suggested oatmeal instead of brocc for breakfast!! So do you have any recommendations of any Dr’s in the area(or as clients) that see more eye to eye with our way living, eating and moving our bodies…anything would help …thanks again

    Chechi

  3. Monica
    March 19, 2009 at 9:14 pm

    Great post. My thought is that calcium assimilation would likely also be higher in those with adequate vitamin D intake. The body’s requirements, I believe, will differ based on diet, with higher requirements for a grain-based diet. Of course, a natural, mostly whole foods paleo diet would probably be much better in vitamin D intake than the standard American diet.

    • robbwolf
      March 24, 2009 at 5:36 pm

      Monica-
      Something to keep in mind: If the gut lining is damaged we absorb neither vit-d nor minerals efficiently. Cordain has a paper on this describing the north/south variation in skin pigmentation of europeans and how this was an adaptation to encroaching agriculture.

  4. gios
    March 19, 2009 at 10:32 pm

    Brother Robb!!!
    Once again preaching and I’m absorbing it! Keep at it, stay on the box longer for the more you preach the more I absorb and learn and then pass onto my clients and parents.

    Thank you humbly for a great lesson. Just when I thought I knew just enough to shed some light on the subject at hand, I get handed a hefty dosage of humble pie. I love it.

    G

  5. Ben W
    March 19, 2009 at 10:47 pm

    From what i’ve read it seems that hyperinsulinemia plays a HUGE role in the development of osteoporosis.

    “There are two major causes, one is a high carbohydrate diet which causes hyperinsulinemia. People walking around with hyperinsulinemia can take all the calcium they want by mouth and it’s all going to go out in their urine.”

    “You take a bunch of calcium. The medical profession just assumes that it has a homing device and it knows to go into your bone. What happens if you high levels of insulin and you take a bunch of calcium. Number one, most of it is just going to go out in your urine. You would be lucky if that were the case because that part which doesn’t does not have the instructions to go to your bone because the anabolic hormones aren’t working.”

    “This is first of all because of insulin, then because of the IGF’s from growth hormone, also testosterone and progesterone, they are all controlled by insulin and when they are insulin resistant they can’t listen to any of the anabolic hormones. So your body doesn’t know how to build tissue anymore, so some of the calcium may end up in your bone, but a good deal of it will end up everywhere else.”

    This is all from an article about insulin and its metabolic effects by Ron Rosedale and can be found here: http://drbass.com/rosedale2.html

  6. M@
    March 20, 2009 at 2:49 am

    No prob bro. I think the acid/base load to the kidneys and the health of the GI tract you mentioned are probably more important but I was curious to know if you thought the phytates could play a role in this case.

  7. ec
    March 20, 2009 at 1:40 pm

    love the tie-in with hormonal response! i had been curious how the acid-load from “high-protein”/meat diet tied into this.

  8. Charla Lang
    March 20, 2009 at 7:58 pm

    thanks…I’ll give the info to my mom and her DR. :)

  9. JoAnne Andersen
    March 20, 2009 at 8:59 pm

    I am Charla’s Mom. I gradually started removing gluten from my diet about a year and a half ago. Before that I had a very difficult time eating most vegetables. Of course the fact that my entire colon was removed in 2001 has a lot to do with it. Since I have gone to staying away from gluten I am finding my gut tolerates vegetables more readily. I still can only do very small amounts of high fiber vegetables, and imagine that will not totally change, but I am experiencing a better energy level being gluten free and of course my spine is definitely feeling better. I told Charla the other day I feel taller, like the middle of my back has been freed up! Amazing isnt it!!! I am obviously very sensitive to gluten as I also have had rhuematoid arthritis for almost 30 years. Years of using/failing virtually every prescriptive drug for arthritis greatly contributed to the decline of my gut as well. Its baffles me how little the medical community has contributed to my “well” being. Oddly enough the arthritis improved with the removal of my colon, ( its a horrible thing to live without however) but I am thinking if I would have known about my intolerance to gluten ages ago I likely would not have ANY of these chronic issues to deal with. I take a prescribed Vit D gel cap now, but most tablet type vitamins reek havoc with me. I have found a liquid multi-vitam/mineral supplement called Seasilver, which I can tolerate about every other day. I am hoping as my gut continues to heal I will feel continually better and have the ability to introduce more fresh fruits and vegetables into my diet. Gluten free is long over do ,and would drastically change the health of our nation. Dr’s removed my colon, but very few have anything to offer as far as how do I live without it. Thank God I am finally on the right path. If you have any suggestions I would greatly appreciate your input.

    • robbwolf
      March 24, 2009 at 5:28 pm

      JoAnne-
      First, thank you for sharing all this. You are an inspiration! I have never been able to affect the level of change you have tackled in my own mother…it heartens me to know some folks are giving this wacky stuff a shot and benefiting from it.

      All I would recommend is trying a simple digestive aid like Nowfoods:Super enzymes. Start with 1 cap per meal, see how you feel. It contains betaine HCl so it increases stomach acid. That considered you need to take it with meals that have protein like chicken, fish etc (this should be all your meal anyway!). This should help with the veggies digestion, you can also steam your veggies pretty thoroughly to help the digestion. Keep us posted!

  10. Scott Jones
    March 20, 2009 at 10:00 pm

    Robb,

    You are an incredibly generous human being. What great information, and I really appreciate your concision. Rather than going off on all kinds of scientific tangents, you get to the point and provide practical application advice.

    These issues become more and more important to me and my wife as we grow more. . . seasoned (ahem) at this life-gig.

    • robbwolf
      March 24, 2009 at 5:22 pm

      Thanks Scott! Very kind words. Rutman calls the affliction you described as “owe, ell, dee” (old). It sucks!

  11. Geoff Else
    March 21, 2009 at 1:43 am

    Rob,

    Just started following your blog and I am really impressed with the quality. I like to dork it up once in a while and appreciate your commitment to the collective.

    This post raised a few questions for me. You made a comment and linked to a study/secondary analysis that Ca+ supplementation leads to cardiovascular issues. A little do diligence and I’ve come to the conclusion that all good scientists come to; further research is needed. Seems like a small study (~1500), nearly half the women bailed, and the researchers admit its not conclusive. I was able to find some other larger studies drawing opposite conclusions (although in unhealthy individuals). I am curious if your aware of any other research to support link to adverse events? Don’t get me wrong, I am not trying to call you out. I’ll be the first one to line up and advocate getting my Ca+ from whole food sources! I love my greens! I just want to have a solid foundation to recommend people stop taking their supplements when I know they aren’t willing to change the diet enough.

    Thanks!

    • robbwolf
      March 24, 2009 at 5:21 pm

      Geoff-
      I might have this in the appendix of the book…I have a ream of research on the topic…not able to unearth it right now. Keep digging, you will likely find the same stuff I did. Best I can offer for now!

  12. me
    March 22, 2009 at 1:27 am

    robb, why are there so many differences between different acid/alkaline tables all over the place. depending where you look them up (online), the same food is measured as having a different acidity content (google acid/base tables and see for yourself…not 2 of them are the same). i trust dr cordain’s table but i’m going simply on faith, and would like a more detailed reason on how those things are calculated.
    many thanks

    • robbwolf
      March 22, 2009 at 6:25 pm

      No clue on the variability…oddly enough, science is not an “exact science”!!

      • Greg
        January 17, 2011 at 2:16 am

        Hi Robb, I’ve been doing some looking into this and I have an answer to this question.

        There are two main varieties of acid/alkaline lists of foods.

        Dr Codain uses PRAL method to measure and assess whether a food is acid or alkaline and so does all of the published research I’ve found.

        The other variant comes from Dr Robert Young who wrote and published “The pH Miracle”. He says the PRAL method is insufficient because it fails to take into account the sugar content of food. His opinion is that sugar of all sorts is acidifying which is why most fruits are listed as acidic. He bases all of this on his live and dry blood analysis although I’ve not been able to find anything on this in the peer reviewed literature.

        Dr Young’s list is widely available on the net because it’s advocated by Energise For Life.

        I’ve been looking into it for a while now and can’t decide whether it’s legit or not so I run with the PRAL method until I see something that convinces me otherwise.

        Hope this helps!

  13. Simontly Fellows
    March 22, 2009 at 4:57 am

    Squire Hi..Do you ascribe to the notion that a more evol correct exercise profile..less linearity as it were might somehow facilitate the using of more nutrients and fat stores than say rote repeticious anaerobic exercise please ?

    Senor Taubes suggested some of his pals believed this.

    You know all this kinda stuff…any ideas please ?

    Also any rough idea when you’re in Vancouver please ?
    I know this place that serves very wonderful lamb and reasonably priced despite the owner having a temperament better suited to being in charge of a CIA torture facility.

    All good things lad.

    x(manly, not Greek up the chuff..ok ok maybe just a tadge !)

    • robbwolf
      March 24, 2009 at 5:19 pm

      Fellows-
      Exercise is interesting in that the endocrine response to specific activities and intensities decreases rapidly. Someone brand new to rowing will see very high hGH levels with 500m row repeats. In a few weeks, this response is greatly blunted. This IS much of the power of CrossFit, that things are constantly varied and this variance allows for a solid endocrine response.

      Now, all that said, there are things like the olympic lifts that produce a heck of an endocrine response, but require some repetitious effort to attain some mastery…but simply changing work/rest intervals, loading etc will keep that scene fresh. What this means for our physiques is a better running metabolism, more muscle building, less muscle wasting, more fat used as fuel. In theory!

  14. Warren Nichols
    March 22, 2009 at 12:42 pm

    “swoosh out your pooper” thats funny!

  15. mike
    March 22, 2009 at 11:24 pm

    Although I agree with you from the diet sense I think you are a bit off regarding the treatment of osteoporosis. Fosamax and other bisphosphonates don’t “stuff calcium” into the bones but slow down how quickly the bones are broken down. There are several high-quality trials that show using bisphosphonates in people who have osteoporosis decreases fractures. At the end of the day, it doesn’t matter what the bone matrix looks like as long as people are less likely to break something when they fall down. Yes science and medicine are not exact, but lets not throw the baby out with the bathwater because they haven’t gotten on board with the paleo/gluten-free movement yet.

    • robbwolf
      March 23, 2009 at 7:33 pm

      Mike-
      Read Grace’s comment (animal pharm) she is a practicing pHD pharmacist and seems to buy what I’m saying.

  16. M@
    March 23, 2009 at 2:28 am

    Robb, Me,

    The differences in the numbers are due to many factors such as the method employed (direct, indirect, acid-ash diet calculation), the quantity of food that was used to make the measurement (100g or 300Kcal), and whether or not the bioavailability of nutrients were taken into account. The numbers found on Dr. Cordain’s site come from a 1995 study that directly measured net acid excretion via titration of urine samples. As a result, the numbers are a little better than what can be obtained using other methods. I say “a little better” because there are a number of approximations and assumptions that are involved in these calculations.

  17. animal pharm
    March 23, 2009 at 2:52 am

    Gosh darn it Robb… u r SOOO good…!!!! :)

    Our bones are like life — the strongest are CROSSLINKED… connected…

    Fosamax yea may increase density (but who wants ‘dense’ as you said it so well during your CF nutri cert… small/dense LDL-chol particles are NOT desired… and neither are ‘dense’ skeletal structures)… bones actually will become more brittle in one direction v. another without cross-connections (and yes — fosamax taken >5-10yrs is now being observed to do indeed i-n-c-r-e-a-s-e fractures). Maximal bone strength derives from multi-direction-strengthening, extended-enforcements (eg, earthquake-proofing), multi-rebarred linking formed by the factors that Paleo H-G man consumed…and weight-beared via work/ HIT-hunting/ foraging/ fishing/ etc…
    –fat soluble vitamins ADEK (u and Nicki doing the ‘D’ right oh?)
    –vitamin K2 from fermented foods — like the Probiotics u like :)
    –omega-3’s EPA DHA GLA and ALA — yes studies are showing Sears is right on — long chain omega’s are vitally important for BONE REMODELLING
    –other fats, CLA, saturated fats (caprylic acid, MCTs, etc like coconut oil, grassfed meat, wild fowl/seafood… Lisbona F. Int J Vitam Nutr Res. 1989;59(3):255-61.), etc
    –adequate protein (bone marrow excellent — for stem cells and growth factors)
    –iron Fe and other minerals Magnesium, Boron, Selenium, etc…

    Crossfit to me… is like the ultimate CROSSLINKING for l-i-f-e :)

    *haa* And Patrone’s doesn’t hurt…right?

    Thanks!! G

  18. Scott Kustes - Life Spotlight
    March 23, 2009 at 1:56 pm

    Great post Robb! The whole calcium, no-dairy thing is one I have to explain to a lot of people. The dairy lobby has done an excellent job of making the connection between dairy = calcium = bone strength. It’s an unquestionable “truth”! It seems to be one of the more common questions people have…”where do I get my calcium?”

    One other thing the dairy advertisers aren’t telling us is that magnesium and vitamin D are at least as important as calcium in building bone. And since most of us are vitamin D deficient…

    Cheers Robb
    Scott Kustes
    Life Spotlight

  19. Randy Buttocks
    March 25, 2009 at 4:46 pm

    Robb you are a gent.

    Thanks yr time and yr knowledge

  20. jgirl
    March 31, 2009 at 4:50 pm

    Robb,
    Awesome info. Time and time again. Thank you :-) ~j

  21. Ken
    June 15, 2009 at 1:27 pm

    I’ve read it speculated that strontium has an effect on bones.

    M@ is well informed – mentioned “phytates? ”
    The amount of vitamin d that can be obtained from food is tiny. (halibut liver oil is hardly Paleo).

    What were vitamin D levels in the Paleolithic ? Mad dogs and ….

  22. Olivia
    March 2, 2011 at 9:02 am

    I’m eating Paleo, but I’m still worried. The link below does suggest more meat more osteoporosis

    http://healthrecipes.com/osteoporosis.htm

  23. Alexandra
    August 29, 2014 at 4:24 pm

    Just wondering where are the references for this? There are a bunch of numbers in brackets that seem to refer to evidence/research. Are they available?
    Thanks

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