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Is Protein Bad to the Bone?

The best available science on protein intake and osteoporosis risk.

December 8, 2010 |
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Acknowledgements

Image thanks to Frank Kovalchek.

Transcript

Is protein “bad to the bone”? The thought is that dietary protein creates a metabolic acid load that has to be buffered by calcium from the bones, and so someone who eats a lot of protein—particularly animal protein, which has a higher acid-forming sulphur content—is basically peeing their bones down the toilet. Is this fact, or fiction?
We used to think it’s fact, but now we know the best science says it is fiction

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring watch the above video. This is just an approximation of the audio contributed by veganmontreal.

To help out on the site please email volunteer@nutritionfacts.org

Dr. Michael Greger

Doctor's Note

Due to popular demand I've greatly expanded on this topic in my new video Alkaline Diets, Animal Protein, & Calcium Loss--enjoy!

Please feel free to post any ask-the-doctor type questions here in the comments section and I’d be happy to try to answer them. Also, there are 1,686 other subjects covered in the rest of my videos--please feel free to explore them as well!

If you haven't yet, you can subscribe to my videos for free by clicking here.

  • http://nutritionfacts.org/members/jacknorrisrd/ JackNorrisRD

    Best 33 seconds of info on protein and bones I’ve seen in a long time!

    • http://nutritionfacts.org/members/mgreger/ Michael Greger M.D.

      Thanks–that means a lot coming from you.

  • http://nutritionfacts.org/members/eileenmcv/ eileenmcv

    Yikes! Just got DEXA backbone scan results of Osteoporosis…. upgrade from reports of osteopenia for previous scans.
    age 67…. grandparent history of Osteoporosis. I am a
    two year “smart… doing it the right way” vegetarian. ( no fish, eggs or dairy ) I need to reverse this diagnosis….. do you think I can ?
    I also do water aerobics three times per week.

    • http://nutritionfacts.org/members/thoram60/ ThoraM60

      I don’t think you can reverse this diagnosis…however there are many things that you can do to slow the progress…
      A strict vegetarian diet may lack essential nutrients
      Eat calcium-rich foods, for example

      • Dairy products such as milk, yogurt, and cheese (low-fat milk and skimmed milk contain less saturated fat and are healthier choices)

      • Seafood eaten with bones or shells, such as whitebait, dried silver fish and dried shrimps

      • Soya bean products such as tofu, fortified soy milk, soy chicken, beancurd stick and beancurd sheet

      • Dark green leafy vegetables, e.g. white cabbage, broccoli and Chinese flowering cabbage

      • Nuts, e.g. almond and sesame

      • Ensure adequate vitamin D intake, such as egg yolk and fortified milk

      Limit caffeine (coffee & tea )
      Limit Alcohol
      Perform weight-bearing exercises (Swimming …while it is certainly good for you…will not strengthen bones)
      Good Luck !!!

      • beccadoggie10

        Before I went vegan, as a result of a spinal injury, and to reduce pain and inflammation and avoid Cortisone
        steroid injections for the rest of my life, I ate vast amounts of dairy including skimmed milk, low fat cheese, and lots of yogurt. It did NOT prevent osteoporosis, which I was diagnosed with in 2006 after fracturing my hip.
        Nor did eating salmon or other cold water fish give me enough vitamin D. In fact, the old recommendations on vitamin D were inadequate and not protective.

        Since 1992, when our first computer was purchased, I moved inside to explore the worldwide web and received little sun to get vitamin D through my skin. At the same time, physicians were saying to stay out of the sun between the hours of 10-2 to prevent skin cancer.

        Now I’m learning that I should be in the sun during those hours to accumulate vitamin D3 through my skin, and that my skin needs to be pink to know that enough is achieved.

        Did I get osteoporosis from misinformation by the medical community and disinformation from industry propaganda?

        I now receive calcium from plants including oatmeal, mission figs, blackberries, and Mori-Nu organic silken tofu; collard greens, black organic soy and “white” Italian kidney beans and whole grains to balance amino acids. I’m careful not to ingest 5 servings of soy per day. But, I carefully look for plant foods that contain the most soy.

        Eating animal foods increases pain and inflammation immediately. Whereas eating a plant based diet eliminates the pain and inflammation and has reduced my bad cholesterol in my body by leaps and bounds.

        I am now a strong believer in a vegan diet to keep the calcium in my bones. I lost 66 pounds when eating vegan, but then I reached a plateau and am trying to get over the hurdle.

        I just need to learn how I can lose more weight now!

        I limit caffeine to one cup of green tea, don’t drink alcohol, and am adding weight bearing exercises including Pilates twice a week, and using pilates straps to increase muscle strength in my spine as well as limbs. Weight resistant exercise in the pool, and walking more. It is not easy with a fractured spine and my body screams when I do too much.

        Advice other than eating animal products is wanted. Eating cold water fish hurts excruciatingly!

  • http://nutritionfacts.org/members/toxins/ Toxins

    According to the FAQ page on Rip Essysltens Engine2 page, he claims that bone loss is due to high protein.
    http://engine2diet.com/about_e2/FAQ

    I guess it needs updating!

  • http://nutritionfacts.org/members/eileenmcv/ eileenmcv

    ThoraM60……. You valiated my instincts and I do so appreciate the time you took to make this response. I have so enjoyed the adventure of being a vegetarian….. almost vegan…. for the last two years.
    The cardio vascular benefits in particular are so obvious. I do intend to address this bone loss in the ways you mentioned, and added weightbearing exercise plus a Dr. reccommended supplement. I will retest in one year and I am certain I will see no further bone loss.

    • JJ

      eileenmcv: I am not in any way associated with the following book, but I recently purchased it for my mother. I thought you might be interested:

      Building Bone Vitality: A Revolutionary Diet Plan to Prevent Bone Loss and Reverse Osteoporosis–Without Dairy Foods, Calcium, Estrogen, or Drugs
      http://www.amazon.com/gp/product/0071600191

      One person wrote this review of the book on Amazon: “The authors offer their insights on osteoporosis after reviewing over 1,200 research articles on the topic. And they tell readers how to find that literature, or will actually send you copies of all of it for a fee that covers their expenses. This strengthens their positions that the commonly held beliefs to drink your milk, eat your dairy products or take a calcium supplement to prevent or treat osteoporosis are not based upon a preponderance of research findings. … ”

      and someone else wrote: “I’m a family practitioner in practice for over 20 years and I found this book refreshingly thought-provoking. I’m also a breast cancer survivor who was diagnosed with osteoporosis and put on prescription medication based solely on bone density studies. I like to think I keep up to date on the medical literature by reading journals and attending continuing education, but I was shocked and amazed by the sheer number of studies cited in this book (and rarely if ever mentioned in those journals and courses) that challenge the conventional wisdom on bone health. While the authors do not discount the usefulness of medication for some, their common sense advice on lifestyle as the key to “building bone vitality” is the most important news this decade for women, doctors and parents like me.”

      Plus, in an e-zine that I get, I found the following blurb from an article: “… Calcium is high in dairy products and some vegetables including pinto beans, red beans, white beans, bok choy, kale, broccoli, and spinach. However, eating calcium rich vegetables is rarely associated with increased risk of cancer while high intake of dairy products has…. Researchers at Oxford University reported that high intake of protein from dairy products produces high serum levels of insulin-like growth factors or IGF-1, linked with risk for both prostate cancer in men and breast cancer in women. …” The full article is here:
      http://www.foodconsumer.org/newsite/Nutrition/Food/calcium_and_dairy_products_boosts_prostate_cancer_0917110220.html

      Everything I’ve seen on this site and others point to the idea of adding dairy and egg yolks to ones diet is much more likely to cause health problems, not solve them. Plus, I haven’t seen anything to indicate that a whole-plant foods-based diet with B12 and D supplement would be lacking in any nutrients. The opposite appears to be true.

      I’m not a doctor or an expert, but I’ve been doing a lot of research on nutrition. You need to do what you think is right, but maybe before you change your diet, you might want to check out the above book??? Just a though.

    • JJ

      You may also want to check out the following videos on this website which are relevant to your posts:
      http://nutritionfacts.org/videos/long-term-vegan-bone-health/
      http://nutritionfacts.org/videos/omnivore-vs-vegan-nutrient-deficiencies-2/

  • http://nutritionfacts.org/members/thoram60/ ThoraM60

    I’m curious about the supplement ….as I have similiar issues…. and I know there are side effects associated with bone loss prevention drugs like Fosamax

  • http://nutritionfacts.org/members/eileenmcv/ eileenmcv

    JJ…. Partof the excitement of a plant based diet is the research and education. I will surely purchase that book and I have bookmarked the article. As far as Dr. Greger is concerned, I practically know all of his studies by heart…. !! I began with his first DVD and he was my inspiration for the major change in my life. This osteoporosis is a little bump, but I like what you said about needing to do what you think is right…
    Thank you for your comments and help.

    • JJ

      eileenmcv: I’m later to this scene (healthy whole, plant food eating) than you, but I’ve become an ardent fan. I’m making new recipes every weekend. I am also enjoying the research and knowing that while there are no guarantees in life, I am doing everything I can to stay healthy. Pretty cool.

      Good luck with your bones. I get the sense that you will do very well in the future.

  • http://nutritionfacts.org/members/eileenmcv/ eileenmcv

    ThoraM60
    Interesting that you have similar issues….. I received the test results over the phone, so I had ample time to research before met with my Dr.
    My research told me that I did not want to do the drug (fosamax, Boniva etc.) There was too much information relating to the negative effects of these drugs) and I told the Dr. that I was sure that I could stop the progress if I was more diligent with the Kale, beans etc. base of plant choices. She supports my vegetarian/almost vegan lifestyle and I highly respect her. Well, she chose to educate me about all of the drugs ( even the IVdrip one… YIKES!!!) from her clinical knowledge and experience. This was her recommendation: Do what you’re doing…. continue to take the New Chapter Bone Strength “take care” formula two per day… Continue the B12, and DHA. Do weight bearing exercise. Add Boniva once per month for one year and then retest. If the test result in one year shows no further bone loss/ or improvement, discontinue the Boniva if I choose. I thought long and hard and she told me that she has had many patients that have done this successfully.
    so… I agreed… Boniva is the supplement. I will do it for one year.
    I would love to know your approach this issue.

    • beccadoggie10

      How are you doing with Boniva? My arthritis physician prescribed this for me since I keep fracturing bones. My latest are two spinal injuries. And, the last spinal injury is incredibly painful without a brace, such as getting up in the middle of the night, or walking even in a rollator.

      I know I need to do something and am eating healthy vegan to fight pain and inflammation (Dr. Neal Barnard recommended this in his book, Foods That Fight Pain.), but the pain is severe. Plus, everything I’ve read on Boniva includes more pain while the medication is in effect, and the mediation is effective for 3-5 years after it has been stopped.

      Other patients who have pain from the drug tell me that bone pain all over the body is not the only side effect they have, there is also fractured femurs, (something I have yet to fracture), esophageal reflux disease if one lies down within an hour after taking the drug, kidney damage; calcium loss in bones; and more.

      I’ve been afraid of taking anything with recombinant DNA, but now with my second bone fracture of the spine within 11 months, I’m interested in learning more from those on the drug. Have you experiences recent bone fractures of the hip, wrist, knee, or spine, since 2006?

      For the record, I am 71 and have been diagnosed with osteoporosis.

      .

  • http://nutritionfacts.org/members/thoram60/ ThoraM60

    eileenmcv ….I would like to share some more thoughts…I’m not so comfortable on a public site…send me your email
    and I’ll reply….would like to know more about your experience with vegan
    ThoraM60@aol.com

  • http://nutritionfacts.org/members/eileenmcv/ eileenmcv

    JJ…
    Just received the
    “Building Bone Vitality” book you recommended. It has a powerful beginning and I thank you for mentioning it…

  • http://nutritionfacts.org/members/dsikes/ DSikes

    Wait a minute. Pages 204-210 in the Campbell & Campbell’s “The China Study” (paperback) summarize the results of numerous studies that themselves were meta-analyses of in some cases over 1,000 different studies, all of which apparently support a negative relationship between animal protein consumption and bone health. Charts that show a striking relationship between average calcium consumption and hip fracture rates must be due to something other than coincidence. I’m confused…

    • http://nutritionfacts.org/members/toxins/ Toxins

      I also recall Dr. Greger mentioning calcium being peed down the toilet in his book, Atkins Exposed, so I too am somewhat confused.

      • http://nutritionfacts.org/members/carlyerin14/ carlyerin14

        In Documentary, Forks over Knives, I also heard this message about calcium intake and hip fractures. Dairy protein causing metabolic acidosis – calcium leaching out of bones, causing weak bones.. I am also confused

        • http://nutritionfacts.org/members/drdons/ DrDons

          I view the study that Dr. Greger cites as one piece of information to be weighed against others as we develop our beliefs about what to eat. It is a metaanalysis of several pooled studies. This is increasingly popular type of study… it is cheap and fast. However pooling studies together introduces many problems since you are often comparing apples to oranges. You need to have a fair amount of statistical savy and access to the data of the pooled studies to fairly interpret the results. They may have excluded studies that would have led to a different conclusion. Given the weight of all studies I still advise patients to avoid dairy for bone health. Of course there are alot of other reasons not to consume dairy. You can look at any of the 45 videos that Dr. Greger has posted which outline the problems with dairy. Problems range from hormones and relation to acne & chronic disease( http://nutritionfacts.org/videos/hormones-in-skim-vs-whole-milk/, heart disease, cancer and Parkinson’s (http://nutritionfacts.org/videos/industrial-carcinogens-in-animal-fat-2/) and more pertinent to the bone question is the vegan vs omnivore study looking at bone density see http://nutritionfacts.org/videos/long-term-vegan-bone-health/. I plan on getting used to being confused but by keeping up on the latest science at NutritionFacts.org you will be making the best decisions… current take home message is dairy is out… unless you are a newborn calf. The best and most thorough resource I have found has been mentioned by others… Building Bone Vitality by Amy Lanou.

          • Eileen

            I agree totally and plan to stay on the above course. Making that decision in light of all the information that is available is  clearing the confusion for me!!

  • http://nutritionfacts.org/members/carlyerin14/ carlyerin14

    I have been given mixed messages on dairy. In Documentary, “Forks over Knives”, the message was given that dairy results in metabolic acidosis, causing calcium to leach out of the bones to neutralize the acidic environment.. is this fiction?

  • http://nutritionfacts.org/members/dsikes/ DSikes

    I’ve seen studies that show virtually no relationship between calcium intake in a population and their hip fractures rate (more calcium does not equal fewer, or more, hip fractures). If you want to predict which populations have the worst hip fractures the best correlate is animal protein intake. So, if these new studies show that animal protein is not the cause, there must still be something, probably in animal foods, that is the cause of this well documented pattern. I’m really looking forward to hearing Dr. Greger’s thoughts on this.

  • http://nutritionfacts.org/members/doctordave/ DoctorDave

    Yesterday I pulled this paper and read it carefully. After doing so, I found it amazing that Dr Greger and Mr Norris supported it at all. Why pick this one paper from all the other possibilities, Dr Greger? This paper seems to say it’s okay to eat hamburgers (in any amount) if you have osteoporosis since this will actually strengthen your bones a little. This is hardly supportive of HSUS. I admit my confidence is deeply shaken. Here is what I found:

    1. This study explicitly excluded studies of calcium excretion and calcium balance data (see the section “Design” in the Abstract). So there is no way that these results apply to situations of “peeing bones” anywhere. Thank heavens, all those prior studies on Atkins dupes or desperate meat-eating subjects peeing their bones down the drain through measured calcium excretion are still valid.

    2. This was a review and summary of former studies, so no new clinical data were generated. In fact, neither were any new conclusions generated. We have known for a long time that BMD and BMC are unreliable measures of bone status. And this study found only 1-2% increase of BMD for an increase of dietary protein from all sources, which was reported despite the authors acknowledgment of confounding problems among the regressions used. However, this 1-2% sensitivity is certainly within the measurement uncertainty of BMD, which also was not discussed, so this is not a useful conclusion or analysis. Further, no relationship of protein to bone fracture was found. This is not surprising since bone fractures introduce a whole new array of their own metrics to confound the results (what did they fall on, from how high, how did they twist, etc, etc, etc).

    3. I deeply question the range of the protein measured in the source studies used. Dr Campbell was thorough and eloquent in his analysis of such flawed studies in his book The China Study (please read his chapter 14, then read it again). Furthermore, he specifically addresses BMD and osteoporosis on pages 203-211. Anyone with osteoporosis should be required to read this book once at least, the whole thing, then talk to a plant-strong informed MD, such as doctor John McDougall in Santa Rosa, CA, before doing anything else. The one thing Dr Campbell doesn’t talk about is the importance of weight bearing exercise in the bone context, which NASA uses to help the astronauts when their bones become depleted from low gravity space missions.

    My sincerest best wishes to anyone with bone problems. Seek the truth, there is a lot of misinformation in this particular area. Dr Campbell’s work has been thoroughly reviewed multiple times by the finest scientific authorities and Dr McDougall has been practicing science-based, diet-based medicine for over 30 years. These people are the best there is with respect to diet and health.

  • http://nutritionfacts.org/members/RainVainik/ Rain Vainik

    Dear dr Greger, would you please try to sort out all (or at least some) of the confusion these comments here create in addition to your video; which (the video) already creates some in me as I have been quite strong supporter of dr. Campbell and dr. McDougall myself + fan of “Forks Over Knives” where the same issue is presented somewhat differently…

  • guest

    I looked at the summary and conclusions of the cited study and it said nothing about protein, metabolic acidosis or protein causing bone loss at all. The study talks about protein improving bone density and that the analysis of the studies did not show any statistical significance in protein improving bone density.  I’m confused as to how this meta-analysis proves that protein doesn’t cause metabolic acidosis and subsequent bone loss.

  • guest

    This meta-analysis excluded studies of calcium excretion and calcium balance, those studies may have led to completely different conclusions about proteins effect on bone loss and calcium excretion.  

  • mikey

    Not enough evidence here to dismiss ingestion of large amounts of animal protein causing osteoprosis. It is well known in countries that have high consumption of dairy products also have a high incidence of osteoprosis. We also know that highly acidic foods such as sugars meat white flour produce an acidic enviroment and this overly acidic enviroment is corrected by the body producing buffers..re the pancreas to neutralize this condition.Furthermore, high protein consumption of either plant or animal causes many pathological conditions such as gout, various arthritis, etc It is also known that a high percentage of kidney stones are made of calcium. Ones body always tries to return itself to homeostasis and the proper ph is necessary to maintain this homeostasis. Thus the body will do what it requires to either neutralize an acidic condition or increase acidity to correct for an alkaline condition.

    • beccadoggie10

      Animal protein, I have found, increases pain and inflammation in my body. Whether or not it was the cause of my osteoporosis, I know not. The cause may have been too much sitting, not enough exercising outside in the sunshine (since 2005) and little weight bearing exercise. From what I’ve read or heard from body builders, such as Red LeReille who has a health club near me, is that weight lifting builds or amasses bone.

      But my spine has been twice fractured now in the last month, and is too painful for me to lift any weights. The pain is reduced by wearing a brace during the day, but I need to lie flat at night without a brace. And rising is extremely painful.

  • SB

    Dr. Greger,
    Why haven’t you at least attempted to clear the confusion on this topic? Seems a little questionable to me.
    I would love to see you explain in further detail why you have supported this study and reply to the past posts that question it’s details.

  • Massimo

    We all know that animal proteins are bad to bone, while vegetable proteins are not. The rationale between this seems to be the stronger acidifying effect of the former. I am trying to put some numbers on this but I am having troubles.
    One way of estimating – roughly, OK – the acidifying effects of proteins is to look at their content of sulphur-containing amino acids, namely methionine and cyst(e)ine. Now, when expressed in mg of these amino acids per gram of protein, the difference between meat/fish/dairies and grains is not so macroscopic (beans is different; indeed, the limiting amino acid in beans is often methionine).
    Another way of quantifying the acidifying effect is by using the PRAL index. But then, again, the difference between the index of grains and that of animal proteins is not so big.
    What other indices one should look at to get an approximate measure of the observed effects, then?

  • UrbanFarmer

    I recently read that bones regrow themselves over a period of time – smaller bones “turn over” every two to three years, large bones every ten to twelve years. That means, with a good diet and an adequate amount of load-bearing exercise, one should be able to reverse some of the effects of osteoporosis, given enough time.

  • rick

    We have significant evidence that higher animal consumption equals higher osteoporosis, Given the above video, do we know the cause of this weakening of bone?

    • Toxins

      Actually, what we thought to be the case is false. Dr. Greger is getting to this in the current Volume 15 so keep your eyes open for it. Just to briefly summarize, when we consume animal protein, we actually absorb more calcium which then ends up appearing in the urine, we do not actually buffer the acidity with our bones. There are other significant issues though from consuming foods that have an acidic renal acid load as Dr. Greger will discuss, but bone loss is not one of them.

  • Ed Sanville

    I don’t understand why the nutrition research community is so sloppy. Why did they come to that false conclusion in the first place? Shouldn’t this be fairly easy to test thoroughly? Did they just not feel like designing the necessary controlled experiments? These “mistakes” often seem like these clowns are just making up hypotheses on the fly without adequate testing. It’s very frustrating to deal with.

    • Toxins

      Most studies testing biological processes use resulting biomarkers, such as MMA production for b12 status. The same idea was applied. In theory it makes sense, but I agree more thorough research should have been conducted before the community came to a firm conclusion as the newly discovered myth will continue to perpetuate for years.

  • Red Sonja
  • William Dwyer

    True, protein per se is not necessarily deleterious to bone mineral density. In fact, a certain amount of protein is necessary to build and repair bone. What is “bad to the bone” is a lot of protein along with an insufficiently alkaline diet — a diet heavy in acid-forming foods like meat, legumes and grains, and light on alkaline forming ones like fruits and vegetables.

    See the following studies showing that the alkaline mineral potassium
    bicarbonate (KHCO3) attenuates bone loss. Potassium citrate, found in
    abundance in fruits and vegetables, converts to potassium bicarbonate in
    the body; therefore fruits and vegetables should have the same effect
    as KHCO3 if they’re consumed in sufficient quantities vis-a-vis
    acid-forming foods, such as meat, legumes and grains.

    IMPROVED MINERAL BALANCE AND SKELETAL METABOLISM IN POSTMENOPAUSAL WOMEN TREATED WITH POTASSIUM BICARBONATE

    http://www.ncbi.nlm.nih.gov/pu

    TREATMENT WITH POTASSIUM BICARBONATE LOWERS CALCIUM EXCRETION AND BONE RESORPTION IN OLDER MEN AND WOMEN

    http://press.endocrine.org/doi

    LONG-TERM PERSISTENCE OF THE URINE CALCIUM-LOWERING EFFECT OF POTASSIUM BICARBONATE IN POSTMENOPAUSAL WOMEN

    http://press.endocrine.org/doi

    I’ve improved my own bone mineral density over a two-year period as
    demonstrated via dexascan by supplementing my diet with KHCO3 along with ensuring that my urinary pH is kept sufficiently alkaline.