Doctor's Note

Here are a few other videos on bone health:
Phytates for the Prevention of Osteoporosis
Alkaline Diets, Animal Protein, & Calcium Loss
Vitamin D Recommendations Changed
How the Institute of Medicine Arrived at Their Vitamin D Recommendation

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. And check out the other videos on dairyomnivores, and vegans. Also, there are 1,449 other subjects covered in the rest of my videos--please feel free to explore them as well!

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  • Michael Greger M.D.

    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. And check out the other videos on dairy, omnivores, and vegans. Also, there are 1,449 other subjects covered in the rest of my videos–please feel free to explore them as well!

    • Corina

      Can you tell me why – in general – poppy seeds are not mentioned as a good source of nutrients (especially minerals)? I use to put them in my morning green smoothies. Is it ok?

  • Toxins

    I thought dairy leaches calcium from the bones from its acidity?

    • Michael Greger M.D.

      The scientific nutrition community used to believe that the abundance of sulfur-containing amino acids in animal proteins would lead to a negative calcium balance, but that is outdated thinking. See for one of the later reviews. And on a personal note, Toxins, thank you for your prolific commenting–I love it!

      • Toxins

        Haha, I have watched literally all your videos and I want to have as close to a full understanding of nutrition as I can. I saw your video link but now my question is, what is the cause of osteoporosis? Does nutrition play a role?

        • Tan Truong

          Yes, thanks Toxins for all your replies here. It’s good to see people always willing to help, yet always looking for nutritional facts as old truths stand and fall.

      • Jinda

        Dr. Greger,

        I have been doing my reading and many online sources still mention acidity of meat causing release of calcium in bones into our urine. If this is not true, then what is the linkage between consuming too much protein/dairy with increase in osteoporosis if any at all?


  • Tan Truong

    Interesting. I assumed the vegans would have the stronger bones. Well maybe the nuns didn’t consume enough calcium-rich plants. I know lately, the Buddhists, at least where I live, have developed and/or use a lot of processed food, but I don’t know if this is a regional thing as I live in Toronto.

  • Plant Based since 2011

    I was diagnosed with osteopenia before I became a whole foods vegan in 2011. I know to get sunshine and exercise, but is there specific diet suggestions to strengthen my bones?

    • Don Forrester MD

      The best reference I have seen concerning osteoporosis and osteopenia is Amy Lanou’s book, Building Bone Vitality. It appears that the acid/base issue is critical. There are some plant foods that have less effect than others. I know that Dr. Greger reported on a meta analysis study that didn’t support the acid base issue but there are issues with meta analytic studies that are difficult to sort out. Congrats on improving your diet in 2011.

  • alexandra g

    I am 62 years old and have been a vegetarian/vegan since I was 19. I was just diagnosed with osteoporosis and I am shocked. I work out every single day…I do weight bearing exercises and forms of aerobics. My diet is great. My D3 levels are high. Everything checks out well and yet I have osteoporosis. I am baffled and very concerned.

    • Don Forrester MD

      Even if you do everything correct there is no guarantee that you won’t get a specific chronic condition. Of course I was vegetarian for 15 years before going plant based 7 years ago. During that time I consumed dairy which is probably the worse thing you can do for bone health. As I mentioned in my previous post the best reference I have seen concerning osteoporosis is Amy Lanou’s book, Building Bone Vitality. It should not only give you suggestions to adjust your diet but has a chapter on drug therapy. It appears that thiazide diuretics are as effective as Fosamax type drugs. In my experience they are better tolerated and have fewer side effects. Of course the decision to take drugs and which drugs should be worked out between you and your physicians.

    • Arjan den Hollander.

      Natto can help repair the damage, studies showed thickening of the femur neck.

      Calcium is part of a group of substances that work on bone.
      D3, calcium , K1 , K2, magnesium.
      Low magnesium intake might have caused erosion of bone calcium.

  • Florin

    Hi, Doctor Greger,
    How about the health of tendons and ligaments? I couldn’t find any references on your site, and I’m wondering what’s best for the vegan runners like myself to keep them in good shape and avoid diet related injuries.
    Thank you.

    • Don Forrester MD

      I haven’t seen any articles that specifically relate to your question. There is alot of published advice in this area some evidence based and some not. You might enjoy reading Scott Jurek’s book, Eat Run, or the book he coauthored, Born to Run, for some advice. Scott is a vegan. Beyond diet as you know there are other factors. One study showed that running every day yielded a high rate of injuries after 9 months where as exercising every other day had a very small injury rate. Another program which has been successful for some of my patients is the Jeff Galloway program on Running Injury Free. I think the best diet would be the one we are designed for… whole food plant based diet… I would avoid GMO’s… good luck on finding enjoyment and avoiding injury.

      • Florin

        Thank you very much Doctor Forrester for your answer. I’ve read (almost) all about it, from Scott Jurek to Rich Roll and Brendan Brazier, but I still don’t know how to address a ligament/tendon injury. Is it similar to a bone or closer to a muscle? Maybe I can adjust my diet to speed up the recovery?

        • Don Forrester MD

          I would say tendons and ligaments are more similar to muscles than bone. I’m sure the diet does influence the rate of healing but rest and time are also needed… always difficult for those of us who like to exercise.

          • Florin

            Thank you very much Doctor Forrester for your answer. I followed your advice&tips and found a lot of new (to me) and interesting stuff in the Jeff Galloway’s programs. Keep up the good work!

  • Maddie

    Can a woman who is diagnosed with osteoporosis, reverse her condition with a plant based diet? Or is the best protocol an integrative approach of medication and a plant based diet?

    • JoAnn Ivey

      10 years I was diagnosed with osteoporosis at age 57. My doc told me to read The China Study, get off meat and dairy, and go to the gym and lift heavy weights. My diet automatically became way less acidic, but a crucial factor is the weight bearing/resistance exercises. I’ve had 2 DEXA’s since then and each one was showing osteopenia, the last one even better than the first. As a side effect, I lost the gastric reflux I had been plagued with, plaque on my aorta, and arthritis in hand and shoulder. BTW whole food plant-based is not potato chips, fries and Coke. I eat hardly any processed foods and add no oil, sugar or salt. That’s the kind of protocol that was shown to actually reverse heart disease (Ornish and Esselstyn studies)

      • amy rosen

        JoAnn – I was diagnosed recetnly with osteoperosis but feel since I eat I aslready eat a healthy diet of plants (almost no oil and no salt ) what more can I do? will investigate the vitamins and supplements before medication

        • Thea

          amy rosen: I’m sorry to hear you were diagnosed with osteoporosis. That’s a very hard diagnosis to get.

          I know you were writing to JoAnn, and I hope you get your reply. I just thought I might be able to provide some assistance as well.

          I highly recommend reading the book, “Building Bone Vitality – A Revolutionary Diet Plan to Prevent Bone Loss and Reverse Osteoporosis”. It sounds like your diet is already extremely healthy. But maybe this book will help you tweak your diet further specifically for bone health.

          I’ll also point out that JoAnn mentioned weight lifting/exercise. The proper type of exercise seems to be at least as important as a good diet. If you read the book I listed above, it has a whole chapter on exercise – making some fascinating distinctions between those exercises which help bones and those which (while healthy in a general sense) do not actively create strong bones. If it turns out that you are really doing all you can on the diet front, you may want to look into certain types of exercise — and it doesn’t have to be weight lifting.

          Hope that helps.

          • Thea

            I should also mention that the book has a chapter on the pros and cons of various drugs for osteoporosis that you may find helpful.

          • amy rosen

            Hi Thea – I plan to order the book you recommended shortly. Thank you….however at the end of the day I need to get calcium from the food I eat. I eat an extremely healthful diet “ala” Dr Fuhrman style. I eat zero artificial sugar, the only oil outside my home and a minimal amount of salt outside my home…,.I limit these quit a bit. My dinners consist of extremely huge chopped salads with 1-2 cups of chickpeas and a variety of nuts, raisons and vegetables. When I look at my calcium intake, I do not get enough on this diet. I now added drinking 8 oz of OJ with calcium added to help, but will need help to get a minimum of 1,000 or 1,200 needed mg just to maintain bone health —-I NEED TO REVERSE IT – I am scared because my doctor said I must eat dairy – and that’s it. I also added a vitamin of 1,000mg of calcium that I never took before. Still I struggle with all the kale, chickpeas and broccolli in my salads to get to the much needed 1,000mg. The almond milk I use on my oat based cereal in the morning only has 10% of daily calcium. I will read the book for ideas. I am only 56 years old and way too young for this diagnosis. Also, I have excersised all my life with weights and cardio. I recently broke my wrist very badly and wonder if it would have been so bad if my bones were more dense. what is scary is…… I am probably already eating and doing most of what the book you recommended will be recommending leaving what for me to change….?

          • Thea

            amy rosen: Again, I’m so sorry you are going through all that. And indeed, based on your description, you are eating a fantastically healthy diet. There may indeed be nothing you can change. I’m not an expert and can’t say.

            Having said that, let me offer you some “food for thought”. Here are some key factors I learned in Building Bone Vitality: It takes 17 other nutrients besides calcium to build strong bones. “If bones were just sticks of calcium, they would be chalk. [Chalk snaps very easily.] Bones are living cells (mature osteoblasts) held immobile in a lattice of protein-rich collagen whose spongelike spaces are filled by crystals of hardened calcium compounds and other minerals.”

            The Building Bone Vitality book explains what those 17 other nutrients are and which foods have a of them. The book also has a few recipes and general guiding principles to follow to maximize overall bone health, not just focus on calcium.
            Maybe those ideas will help you?

            I learned that people in some countries with daily calcium intakes in the 500 range (if I remember correctly) have much lower fracture rates compared to America. Your doctor’s focus on calcium deficiency as the reason America has an osteoporosis problem goes against the evidence.

            All this information makes me think that your focus on calcium is misplaced. Yes, having too little calcium in the diet is a problem, but having too much also appears (to me) to be a problem. And we have some evidence that taking calcium supplements may be detrimental to your overall health in other areas besides bones (heart risk and something else). I’m concerned about your addition of a calcium supplement. The Building Bone Vitality book may give you ideas on how to balance your overall nutrient intake (not just a focus on calcium) to maximize your bone health.

            Dr. Greger will be addressing calcium in videos that are coming up soon. I recommend taking a look at this page for an intro:

            Of course, there is no guarantees. It is harder to reverse a problem than to prevent it in the first place. Now that you have this problem, you will have a struggle ahead. However, with the determination and discipline you are displaying in your posts, I’m very hopeful for you. I feel in my bones that you will succeed. (pun intended, sentiment sincere)

          • Thea

            amy: Part 2: My post was getting too long. So, I decided to break it into two posts. Here is some info about some studies that may also interest you:

            Here is a recent mini-article from Meetout Mondays:

            “No Link Between Milk & Calcium Intake

            Researchers at the University of Auckland recently shared the results of an aggregate study wherein there is zero correlation between bone strength and milk intake. In fact, there are actually links to bone fragility and milk intake.

            “…researchers found that an excessive amount of calcium can lead to heart disease and kidney stones…Dr. Karl Michaelsson, a professor who studies osteoporosis at Sweden’s Uppsala University,…found that individuals who drank the most milk had the highest risk of bone fractures and early death,” notes’s coverage of the findings. That’s pretty heavy stuff considering the history of the milk industry and what they’ve been claiming, for so many years.

            Here is a quote from an article from an article from the BBC from October 2014. If you can find the article, there is a whole lot of good info. Note how this study contradicts your doctor’s insistence on drinking milk. (Insisting you drink milk doesn’t make sense from a whole lot of angles. Is it time to find a new doctor???? Of course, a lot of factors go into choosing a doctor. I’m just suggesting that this ignorance on your doctor’s part of how to fix your serious condition is a serious factor.)

            “High milk diet ‘may not cut risk of bone fractures’
            Milk is rich in calcium, a key component of bones

            The research, conducted in Sweden, showed women who drank more than three glasses a day were actually more likely to break bones than those who had less. Drinking lots of milk may not lower the risk of fracturing bones, a study in the British Medical Journal suggests.

            The researchers cautioned that their work only suggested a trend and should not be interpreted as proof that high milk consumption caused fractures.


            Consider the following quote that I got from Rami. If milk is not good for kids’s bone health, why would it be good for an adult woman?

            A review published in the Journal of Pediatrics focused on the benefits of dairy “the findings of epidemiologic and prospective studies have raised questions about the efficacy of the use of dairy products for the promotion of bone health.” after a review of the existing literature and finding “A positive relationship between dairy product consumption and measures of bone health in children or young adults was reported in 1 of 4 cross-sectional studies; in 0 of 3 retrospective studies; in 0 of 1 prospective study; and in 2 of 3 randomized, controlled trials. Only 1 of these randomized clinical trials adequately controlled for vitamin D intake, and it showed no significant effect of dairy products on BMD [bone mineral density]” , they concluded, “Scant evidence supports nutrition guidelines focused specifically on increasing milk or other dairy product intake for promoting child and adolescent bone mineralization.”


            A meta-analysis published in the British Medical Journal found, “The small effect of calcium supplementation on bone mineral density in the upper limb is unlikely to reduce the risk of fracture, either in childhood or later life, to a degree of major public health importance.”and “The authors concluded that the literature did not support recommendations for consumption of dairy products for bone health end points in children and young adults…Our quantitative systematic review confirms this conclusion” The authors also state, “Our results also do not support the premise that any type of calcium supplementation is more effective than another.” Even studies that used intakes of 1400 mg per day of calcium showed no benefit.



            This is just a sampling. The authors of the book Building Bone Vitality cite more than 1,200 studies and claim that the calcium theory of healthy bones just does not stand up to the actual evidence to date and given the volume of evidence available, this conclusion is not likely to change.

            Hope this helps!

  • Saddha

    This is a ridiculous study. Nuns are isolated, the average person has to face stress and other daily hassles. to try to use such a study is irresponsible since other studies show vegans to have weaker bones than omnivores by as much as 5 %, not to mention lesser storage iron, deficiencies in iodine as well as testosterone. Mental illness is also high in vegans.

    • JacquieRN

      Hi Saddha, I would point you to a few other research reviews to get you started to address your concerns about weaker bones, iron, iodine and testosterone. I am not sure what “mental illness” you are referring to but here are some for depression (check out the search function or alphabetically on left navigation bar)

      Have fun exploring.

      • Saddha

        I think I know you guys are a cult which is why you are citing only cults studies –… #!po=32.5758
        The growth of a child is a sensitive indicator of the potential negative effects of vegetarian, vegan and macrobiotic diets. Children younger than two years of age who were fed vegetarian or vegan diets exhibited significant lower mean weight and length velocities (12) and were overall lighter in weight and smaller in stature than reference populations (13).
        Vegetarian Mom Charged With Manslaughter After Baby Dies of Malnutrition
        Vegetarianism produces subclinical malnutrition, hyperhomocysteinemia and atherogenesis.
        Do you know?
        Vitamin B12 is found primarily in meat. According to several studies, 92% of strict vegetarians experience vitamin B12 deficiencies, resulting in anemia, exhaustion, and a greater likelihood of coronary artery disease.
        The Survey reveals that the four southern states of Andhra Pradesh (32.5%), Karnataka (37.6%), Kerala (22.9%) and Tamil Nadu (29.8%), have lower malnutrition rates than Haryana (39.6%), Rajasthan (39.9%) and Uttar Pradesh (42.4%). The data also reveals that consumption of fish, chicken or meat at least once a week by women in Andhra Pradesh (69.5%), Karnataka (45.9%), Kerala (89.6%) and Tamil Nadu (66.1%) is much higher than in Haryana (5.5%), Rajasthan (11%), and Uttar Pradesh (14.7%). Karnataka fares worse of all the southern states in terms of malnourishment and intake of fish/ chicken/meat.
        Gujarat and Punjab don’t present a rosy picture either. In cash-surplus Gujarat, 44.6% children are malnourished, and in food-surplus Punjab, the rate is 24.9%. Is it mere coincidence that women in Gujarat (12.4%) and Punjab (20.1%) have a lower intake rate of fish/chicken/meat than the national average of 40.9%?
        Vegetarianism and veganism lead to brain atrophy!!! It literally shrinks the brain!

        Research shows the more mental disorders people have, the more likely they choose to become vegetarians:

        Rather, our results are more consistent with the view that the experience of a mental disorder increases the probability of choosing a vegetarian diet, or that psychological factors influence both the probability of choosing a vegetarian diet and the probability of developing a mental disorder.

        Vegans and vegetarians also are more likely to suffer from iodine deficiencies resulting in lower vital thyroid functionality:

        The average 24-hour urinary iodine concentration in omnivores, lacto-ovovegetarians, and vegans was 216 mcg per liter, 172 mcg per liter, and 78 mcg per liter, respectively. More than 25% of the lacto-ovovegetarians and 80% of the vegans were iodine deficient compared with only 9% of omnivores. Severe iodine deficiency was found in 27% of the vegans, 10% of the lacto-ovovegetarians, and none of the omnivores. Evaluation of the lacto-ovovegetarian and vegan diets showed that they both were lacking in iodine-rich foods, but lacto-ovovegetarians had a higher intake of iodine due to intake of dairy products and eggs.

        • JacquieRN

          Hi Saddha, thank you for citing studies you feel are important for others to investigate since we welcome vigorous debate of the science. However, we aim to make a place where people feel comfortable posting without feeling attacked by comments that are inappropriate, like calling this a cult. Dr. Greger has gotten more sensitive to this after a physician who graciously donated his time to answer people’s questions stopped contributing because of the acrid atmosphere. So please, for everyone’s benefit, help us foster a community of mutual respect or your future comments will be deleted. Thank you in advance.

          • Youcef

            I agree about attitude. That put aside, I think it’s very healthy for this group to have people with different views, particularly views that challenge the very essence of this group veganism and health, and that challenge the studies.

  • Ellen Kowallis

    My daughter, after eating vegan and following Dr Esselstyn’s plan for about a year now, had her bone density checked this week. Where she should be about a10 she scored 2. Can you give her any advice?

  • Bill

    I’m a 54 year old male and been following a whole food plant based diet for over 3 years. Generally, I feel great and have gotten off my statins, lost 30 pounds and get plenty of exercise through road cycling. I slipped on some ice a couple of months ago and thought I sprained my ankle, but it still didn’t quite feel right so I saw an Orthopedic specialist and was found to have an oblique nondisplaced fracture at the base of the medial malleolus, along with a split tear of the inframalleolar peroneal longus tendon. I have taken Nexium daily for 15 years and am scheduled for a bone density scan next week. My doctor is concerned that my diet may be adversely affecting my bone health and I’m looking for some specific resources I can share with him that may allay his concerns.

    • Thea

      Bill: Sounds like you are doing so well! Except for that terrible fall anyway. I highly recommend the following book:
      “Building Bone Vitality” by Amy Lanou and Michael Castleman

      Also, you might check out Brenda Davis’ book Becoming Vegan.

      Both are great sources of information about eating plant based and bone health. These sources might prompt you to tweak your diet, but over all should support what you are doing and provide assurance for your doctor.

      You might also check out some of the other videos on this site showing how diet affects bone health.

      Hope that helps.

  • Mary Dax

    is heart attack a potential risk from calcium supplementation? Is there a safe amount of calcium to take, and what form is best – lactate, carbonate, citrate, chelated?

  • waejae

    Can you consume too much calcium from supplements? I don’t have a calcium deficiency, but being vegan everyone is telling me to supplement my calcium. I thought that an excess of calcium can land in the heart or in bones joints (like sandpaper). Any thoughts?

    • Toxins

      There is no need to supplement calcium. Calcium needs are lower if you are not consuming animal products and if sodium is low.

      “Reducing animal protein intakes by 40 g reduces the intercept [calcium balance] value and requirement to 600 mg. Reducing both sodium and protein reduces the intercept value to 450 mg.”

      Eat plenty of dark leafy greens, such as kale and collarsd, as well as beans. You can track your nutrient intake with

  • Farnaz

    Hello Doctor Greger,
    Thank you for all your research and helpful information.
    My mom is 70 years old and she has been a vegan for one year. her doctor recommended injection of Prolia twice a year for her osteoprosis.
    I want to know your opinion on Prolia.
    Please advise whether it is a safe and useful drug for Osteoprosis and if there are other ways to treat osteoprosis.
    Thank you for your help.

    • MsGregor

      Did you get any information on this? same case with my mother! I’d really appreciate some advice!