Even just a single extra serving of fruits and vegetables per day is associated with lower bone fracture risk.
Three Reasons Fruits and Vegetables May Reduce Osteoporosis Risk
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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
Even just a single extra serving of fruits and vegetables per day is associated with lower bone fracture risk. Why? Well, osteoporotic fracture risk is associated with higher levels of inflammation in your blood––for example, C-reactive protein and specifically, a more pro-inflammatory diet. Those eating higher on the dietary inflammatory index have about a 30 percent greater associated risk of osteoporosis and fracture than those eating more anti-inflammatory diets, and a higher intake of fruit and vegetables decreases inflammation. So, that’s one possible reason.
Free radicals may also play a role in eating away at your bone, suggesting that pro-oxidant stress may contribute to osteoporosis. Both the total antioxidant power and capacity of people’s bloodstreams and diets are significantly lower in those with osteoporosis, And, how do we squash free radicals and improve antioxidant status? With fruits and vegetables. For example, consumption of vitamin C-rich foods is associated with lower risk of hip fracture, osteoporosis, and bone loss. Every additional increase of 50mg of dietary vitamin C a day, which is about the equivalent of one orange, may lower the risk of hip fracture by five percent.
The third way fruits and vegetables may help our bones is through acid-base balance. As we grow older, there’s a slight drop in the pH of our blood, as our blood becomes more acidic with age. This is thought to be due to the waning ability of our kidneys to excrete excess acid. In vitro studies suggest a drop in pH may lead to activation of the cells that break down bone, and an inhibition of cells that build bone back up. So, how about eating alkaline-forming foods?
The most acid-forming foods are meat and cheese––especially fish, and the most alkaline, or base-forming, foods are fruits and vegetables. This may help explain why if you experimentally remove fruits and vegetables from people’s diets, a marker of bone formation significantly drops, and a marker of bone loss shoots up. And, vice-versa when you add fruits and vegetables back into their daily diets.
The greater the estimated ratio between acid-forming foods and alkaline-forming foods, the greater the risk of hip fracture, supporting the rationale to eat less acidic diets. But this was based on observational data. To prove cause-and-effect, two-year double-blind, randomized controlled trials were performed in which the three added servings of fruits and vegetables, or the equivalent of six extra servings, failed to have an effect. But randomize people to the equivalent of nine daily servings of fruits and vegetables worth of an alkaline-forming compound, and you do see a significant increase in bone volume and density in the spine, hip, and throughout the whole body.
Are there any fruits and vegetables that are particularly good? That’s the question I’ll address, next.
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- Mun H, Liu B, Pham THA, Wu Q. C-reactive protein and fracture risk: an updated systematic review and meta-analysis of cohort studies through the use of both frequentist and Bayesian approaches. Osteoporos Int. 2021;32(3):425-435.
- Brondani JE, Comim FV, Flores LM, Martini LA, Premaor MO. Fruit and vegetable intake and bones: A systematic review and meta-analysis. PLoS One. 2019;14(5):e0217223.
- Fang Y, Zhu J, Fan J, et al. Dietary Inflammatory Index in relation to bone mineral density, osteoporosis risk and fracture risk: a systematic review and meta-analysis. Osteoporos Int. 2021;32(4):633-643.
- Hosseini B, Berthon BS, Saedisomeolia A, et al. Effects of fruit and vegetable consumption on inflammatory biomarkers and immune cell populations: a systematic literature review and meta-analysis. Am J Clin Nutr. 2018;108(1):136-155.
- Zhao F, Guo L, Wang X, Zhang Y. Correlation of oxidative stress-related biomarkers with postmenopausal osteoporosis: a systematic review and meta-analysis. Arch Osteoporos. 2021;16(1):4.
- Ávila-Escalante ML, Coop-Gamas F, Cervantes-Rodríguez M, Méndez-Iturbide D, Aranda-González II. The effect of diet on oxidative stress and metabolic diseases-Clinically controlled trials. J Food Biochem. 2020;44(5):e13191.
- Zeng LF, Luo MH, Liang GH, et al. Can Dietary Intake of Vitamin C-Oriented Foods Reduce the Risk of Osteoporosis, Fracture, and BMD Loss? Systematic Review With Meta-Analyses of Recent Studies. Front Endocrinol (Lausanne). 2020;10:844.
- Sun Y, Liu C, Bo Y, et al. Dietary vitamin C intake and the risk of hip fracture: a dose-response meta-analysis. Osteoporos Int. 2018;29(1):79-87.
- Cao JJ, Whigham LD, Jahns L. Depletion and repletion of fruit and vegetable intake alters serum bone turnover markers: a 28-week single-arm experimental feeding intervention. Br J Nutr. 2018;120(5):500-507.
- Frassetto L, Sebastian A. Age and systemic acid-base equilibrium: analysis of published data. J Gerontol A Biol Sci Med Sci. 1996;51(1):B91-B99.
- Frassetto L, Banerjee T, Powe N, Sebastian A. Acid Balance, Dietary Acid Load, and Bone Effects-A Controversial Subject. Nutrients. 2018;10(4):517.
- Hayhoe RPG, Abdelhamid A, Luben RN, Khaw KT, Welch AA. Dietary acid-base load and its association with risk of osteoporotic fractures and low estimated skeletal muscle mass. Eur J Clin Nutr. 2020;74(Suppl 1):33-42.
- Macdonald RM, et al. Two year double blind randomized controlled trial in postmenopausal women shows no gain in BMD with potassium citrate treatment. J Bone Miner Res. 2006;21:S15.
- Dawson-Hughes B. Acid-base balance of the diet-implications for bone and muscle. Eur J Clin Nutr. 2020;74(Suppl 1):7-13.
- Jehle S, Hulter HN, Krapf R. Effect of potassium citrate on bone density, microarchitecture, and fracture risk in healthy older adults without osteoporosis: a randomized controlled trial. J Clin Endocrinol Metab. 2013;98(1):207-217.
Motion graphics by Avo Media
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
Even just a single extra serving of fruits and vegetables per day is associated with lower bone fracture risk. Why? Well, osteoporotic fracture risk is associated with higher levels of inflammation in your blood––for example, C-reactive protein and specifically, a more pro-inflammatory diet. Those eating higher on the dietary inflammatory index have about a 30 percent greater associated risk of osteoporosis and fracture than those eating more anti-inflammatory diets, and a higher intake of fruit and vegetables decreases inflammation. So, that’s one possible reason.
Free radicals may also play a role in eating away at your bone, suggesting that pro-oxidant stress may contribute to osteoporosis. Both the total antioxidant power and capacity of people’s bloodstreams and diets are significantly lower in those with osteoporosis, And, how do we squash free radicals and improve antioxidant status? With fruits and vegetables. For example, consumption of vitamin C-rich foods is associated with lower risk of hip fracture, osteoporosis, and bone loss. Every additional increase of 50mg of dietary vitamin C a day, which is about the equivalent of one orange, may lower the risk of hip fracture by five percent.
The third way fruits and vegetables may help our bones is through acid-base balance. As we grow older, there’s a slight drop in the pH of our blood, as our blood becomes more acidic with age. This is thought to be due to the waning ability of our kidneys to excrete excess acid. In vitro studies suggest a drop in pH may lead to activation of the cells that break down bone, and an inhibition of cells that build bone back up. So, how about eating alkaline-forming foods?
The most acid-forming foods are meat and cheese––especially fish, and the most alkaline, or base-forming, foods are fruits and vegetables. This may help explain why if you experimentally remove fruits and vegetables from people’s diets, a marker of bone formation significantly drops, and a marker of bone loss shoots up. And, vice-versa when you add fruits and vegetables back into their daily diets.
The greater the estimated ratio between acid-forming foods and alkaline-forming foods, the greater the risk of hip fracture, supporting the rationale to eat less acidic diets. But this was based on observational data. To prove cause-and-effect, two-year double-blind, randomized controlled trials were performed in which the three added servings of fruits and vegetables, or the equivalent of six extra servings, failed to have an effect. But randomize people to the equivalent of nine daily servings of fruits and vegetables worth of an alkaline-forming compound, and you do see a significant increase in bone volume and density in the spine, hip, and throughout the whole body.
Are there any fruits and vegetables that are particularly good? That’s the question I’ll address, next.
Please consider volunteering to help out on the site.
- Mun H, Liu B, Pham THA, Wu Q. C-reactive protein and fracture risk: an updated systematic review and meta-analysis of cohort studies through the use of both frequentist and Bayesian approaches. Osteoporos Int. 2021;32(3):425-435.
- Brondani JE, Comim FV, Flores LM, Martini LA, Premaor MO. Fruit and vegetable intake and bones: A systematic review and meta-analysis. PLoS One. 2019;14(5):e0217223.
- Fang Y, Zhu J, Fan J, et al. Dietary Inflammatory Index in relation to bone mineral density, osteoporosis risk and fracture risk: a systematic review and meta-analysis. Osteoporos Int. 2021;32(4):633-643.
- Hosseini B, Berthon BS, Saedisomeolia A, et al. Effects of fruit and vegetable consumption on inflammatory biomarkers and immune cell populations: a systematic literature review and meta-analysis. Am J Clin Nutr. 2018;108(1):136-155.
- Zhao F, Guo L, Wang X, Zhang Y. Correlation of oxidative stress-related biomarkers with postmenopausal osteoporosis: a systematic review and meta-analysis. Arch Osteoporos. 2021;16(1):4.
- Ávila-Escalante ML, Coop-Gamas F, Cervantes-Rodríguez M, Méndez-Iturbide D, Aranda-González II. The effect of diet on oxidative stress and metabolic diseases-Clinically controlled trials. J Food Biochem. 2020;44(5):e13191.
- Zeng LF, Luo MH, Liang GH, et al. Can Dietary Intake of Vitamin C-Oriented Foods Reduce the Risk of Osteoporosis, Fracture, and BMD Loss? Systematic Review With Meta-Analyses of Recent Studies. Front Endocrinol (Lausanne). 2020;10:844.
- Sun Y, Liu C, Bo Y, et al. Dietary vitamin C intake and the risk of hip fracture: a dose-response meta-analysis. Osteoporos Int. 2018;29(1):79-87.
- Cao JJ, Whigham LD, Jahns L. Depletion and repletion of fruit and vegetable intake alters serum bone turnover markers: a 28-week single-arm experimental feeding intervention. Br J Nutr. 2018;120(5):500-507.
- Frassetto L, Sebastian A. Age and systemic acid-base equilibrium: analysis of published data. J Gerontol A Biol Sci Med Sci. 1996;51(1):B91-B99.
- Frassetto L, Banerjee T, Powe N, Sebastian A. Acid Balance, Dietary Acid Load, and Bone Effects-A Controversial Subject. Nutrients. 2018;10(4):517.
- Hayhoe RPG, Abdelhamid A, Luben RN, Khaw KT, Welch AA. Dietary acid-base load and its association with risk of osteoporotic fractures and low estimated skeletal muscle mass. Eur J Clin Nutr. 2020;74(Suppl 1):33-42.
- Macdonald RM, et al. Two year double blind randomized controlled trial in postmenopausal women shows no gain in BMD with potassium citrate treatment. J Bone Miner Res. 2006;21:S15.
- Dawson-Hughes B. Acid-base balance of the diet-implications for bone and muscle. Eur J Clin Nutr. 2020;74(Suppl 1):7-13.
- Jehle S, Hulter HN, Krapf R. Effect of potassium citrate on bone density, microarchitecture, and fracture risk in healthy older adults without osteoporosis: a randomized controlled trial. J Clin Endocrinol Metab. 2013;98(1):207-217.
Motion graphics by Avo Media
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Three Reasons Fruits and Vegetables May Reduce Osteoporosis Risk
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Content URLDoctor's Note
Next, I look specifically at onions and tomatoes for osteoporosis.
This video was originally part of my webinar all about osteoporosis. You can watch that full recording, including a great Q&A.
When it comes to fractures, Fall Prevention Is the Most Important Thing for Preventing Osteoporosis Bone Fractures.
What about medications that treat osteoporosis? See How Well Do Medicines Like Fosamax Work to Treat Osteoporosis? and Side Effects of Osteoporosis Medications Like Fosamax, Boniva, and Reclast.
Should we be concerned about a common class of medications causing osteoporosis? Check out Acid Reflux Medicine May Cause Osteoporosis for more.
What is The Best Exercise Type and Frequency for Bone Density? Check out the video.
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