building bone vitality A Revolutionary Diet Plan to Prevent Bone Loss and Reverse Osteoporosis Amy Joy Lanou, Ph.D Michael Castleman New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto Copyright © 2009 by The McGraw-Hill Companies, Inc All rights reserved Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher ISBN: 978-0-07-160020-0 MHID: 0-07-160020-5 The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-160019-4, MHID: 0-07-160019-1 All trademarks are trademarks of their respective owners Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark Where such designations appear in this book, they have been printed with initial caps McGraw-Hill eBooks are available at special quantity discounts to use as premiums and sales promotions, or for use in corporate training programs To contact a representative please visit the Contact Us page at www.mhprofessional.com TERMS OF USE This is a copyrighted work and The McGraw-Hill Companies, Inc (“McGraw-Hill”) and its licensors reserve all rights in and to the work Use of this work is subject to these terms Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile, disassemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate, sell, publish or sublicense the work or any part of it without McGraw-Hill’s prior consent You may use the work for your own noncommercial and personal use; any other use of the work is strictly prohibited Your right to use the work may be terminated if you fail to comply with these terms THE WORK IS PROVIDED “AS IS.” McGRAW-HILL AND ITS LICENSORS MAKE NO GUARANTEES OR WARRANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE McGraw-Hill and its licensors not warrant or guarantee that the functions contained in the work will meet your requirements or that its operation will be uninterrupted or error free Neither McGraw-Hill nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom McGraw-Hill has no responsibility for the content of any information accessed through the work Under no circumstances shall McGraw-Hill and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise Contents Foreword by Dean Ornish, M.D Acknowledgments Introduction: An Evidence-Based Approach to Bone Health and Osteoporosis Prevention PART v vii ix Why the Calcium Theory Is Wrong Countries That Consume the Most Milk, Dairy Foods, and Calcium Supplements Suffer the Most Fractures Why Some Osteoporosis Studies Should Be Taken More Seriously than Others 19 Milk, Dairy Foods, and Calcium Supplements by Themselves or in Any Combination Do Not Prevent Fractures 31 Calcium Intake During Childhood Does Not Prevent Fractures at Any Stage of Life 35 Vitamin D with or Without Calcium Prevents Few if Any Fractures 39 The Final Score: We Need a Theory That Works 45 PART The Bone Vitality Prescription: Low-Acid Eating and Daily Walking The Key to Strong Bones and Fracture Prevention: The Bloodstream’s Acid/Alkaline Balance 51 iii • • iv Contents Why a Forty-Year-Old Explanation Is “New” 85 Bricks and Mortar: For Strong Bones, the Body Needs More than Calcium 95 10 The Case Against Low-Acid Eating 111 11 Evolving Toward Low-Acid Eating—Painlessly 121 12 Recipes for Low-Acid Eating 137 13 As Important as Low-Acid Eating: Walk Your Way to Stronger Bones 151 PART Other Risk Factors for Osteoporosis and What You Can Do About Them 14 Diabetes, Frailty, and Fractures 171 15 Risk Factors for Fractures? Salt, Caffeine, Alcohol, Smoking, Depression, and Several Prescription Drugs 175 16 Should You Take Osteoporosis Drugs? 183 17 Save Your Bones and Save the Planet 199 18 Conclusion: We Need an Evidence-Based Approach to Bone Vitality 203 Appendix A Scorecard: Do Milk, Dairy Foods, and Calcium Supplements, by Themselves or Combined, Reduce the Risk of Fractures? 209 Appendix B Scorecard: Do Milk, Dairy, and Calcium Intake During Childhood Prevent Fractures? 223 Appendix C Scorecard: Does Vitamin D, with or Without Calcium, Reduce Fracture Risk? 227 References 235 Index 237 Foreword This book will change the way you think about bone density and osteoporosis The weakening of bones is often viewed as a calcium deficiency, when actually it’s an imbalance between calcium intake and excretion As nutrition professor Amy Joy Lanou, Ph.D., and noted medical journalist Michael Castleman eloquently reveal, diets rich in animal protein, including meat and dairy, add acid to the blood This acid accelerates osteoporosis by depleting bones of calcium, phosphorus, and sodium As the authors recommend, the most effective way to prevent bone loss is a combination of daily walking and what they call lowacid eating—that is, predominantly fruits, vegetables, legumes, and soy products—with little, if any, meat, dairy, and fish and a modest amount of breads, cereals, and pastas For more than thirty years I have directed a series of clinical studies in collaboration with my colleagues at the nonprofit Preventive Medicine Research Institute and the University of California, San Francisco, showing that a similar regimen (when combined with stress management techniques such as yoga and meditation and psychosocial support) can often stop or even reverse the progression of coronary heart disease, diabetes, high blood pressure (hyperten- v • • vi Foreword sion), high cholesterol (hypercholesterolemia), prostate cancer (and, by extension, breast cancer), and other chronic diseases Many people believe that advances in medicine have to be hightech and expensive In our studies, we have used the latest high-tech medical technology to prove how powerful a plant-based diet, moderate daily exercise, and other simple, low-tech, low-cost interventions can be It’s no coincidence that the program I recommend to prevent or even reverse coronary heart disease and other chronic diseases also helps prevent osteoporosis It’s the same program the National Cancer Institute recommends to prevent the most common types of cancer and that many other health authorities endorse for optimal health and well-being The body is an elegant biological system What’s good for one part of it—for example, the heart and blood vessels—is also good for other parts, such as strengthening bone and helping to protect against fractures Lanou and Castleman have analyzed more than twelve hundred studies showing that (1) the United States and other countries that consume the most milk, dairy, and calcium have the world’s highest fractures rates; (2) milk, dairy foods, and calcium supplements not reduce fracture risk and in some studies increase it; and (3) a diet high in fruits and vegetables consistently improves bone mineral density and reduces fractures If you follow their advice, you’re likely to reduce your risk of osteoporosis and fractures as well as enhancing your overall health and well-being I wholeheartedly recommend Building Bone Vitality —Dean Ornish, M.D Founder and President, Preventive Medicine Research Institute Clinical Professor of Medicine, University of California, San Francisco Author, Dr Dean Ornish’s Program for Reversing Heart Disease and The Spectrum Acknowledgments The authors gratefully acknowledge and thank: • Their agent, Amy Rennert, and everyone at the Amy Rennert Literary Agency, Tiburon, California • Their editors, Emily Carleton, Nancy Hall, Johanna Bowman, and Deborah Brody, and everyone at McGraw-Hill • Their families and friends, who graciously put up with their bone obsession during the writing of this book • And Neal Barnard, M.D.; T Colin Campbell, Ph.D.; Simon Chaitowitz; Sophie Mills, Ph.D.; Dean Ornish, M.D.; Barbara Ramsey, M.D.; Keith Ray, Ed.D.; Anne Simons, M.D.; Louanne Cole Weston, Ph.D.; and Tania Winzenberg, Ph.D vii • This page intentionally left blank Introduction An Evidence-Based Approach to Bone Health and Osteoporosis Prevention We’ve been told all our lives to drink milk for strong bones Many of us may even feel guilty when we don’t consume our recommended three servings of dairy each day In fact, we’ve been led to believe that we have a “calcium crisis” in the United States because many of us don’t drink the requisite three glasses The proposed solution? Drink more milk Eat more yogurt and cheese And to be sure we’re getting enough calcium to protect our bones, take a calcium supplement But why we think that milk, dairy foods, and calcium supplements prevent the broken bones (fractures) that osteoporosis causes? Because we’ve been told by our teachers, our doctors, and advertisers that we need lots of calcium to keep our bones strong as we age And because every major U.S health agency endorses daily consumption of milk and dairy: the surgeon general, the Centers for Disease Control and Prevention (CDC), the National Institutes of Health, and the Osteoporosis Foundation How they know that the conventional dietary wisdom prevents osteoporosis and fractures? Perhaps because research has shown that ix • • 230 Appendix C British Medical Journal] 326 (7387) (2003): 469 British researchers Prospective, 2,686 elderly followed years Fractures reduced 33 percent The three inconclusive trials: Avenell, A., et al “Vitamin D and Vitamin D Analogues for Preventing Fractures Associated with Involutional and Postmenopausal Osteoporosis.” Cochrane Database of Systematic Reviews CD000227 (2005) Scottish researchers Meta-analysis, 33 studies “Vitamin D showed no statistically significant effect on hip fracture (seven trials, 18,668 participants), vertebral fractures (four trials, 5,698 participants), or any new fracture (eight trials, 18,903 participants) Vitamin D with calcium marginally reduced hip fractures (seven trials, 10,376 participants), and nonvertebral fractures (seven trials, 10,376 participants), but there was no evidence of effect of vitamin D with calcium on vertebral fractures The effect appeared to be restricted to those living in institutional care [i.e., nursing homes].” Boonen, S., et al “Need for Additional Calcium to Reduce the Risk of Hip Fracture With Vitamin D Supplementation: Evidence from a Comparative Meta-Analysis of Randomized Controlled Trials.” Journal of Clinical Endocrinology and Metabolism 92 (2007): 1415 Belgian researchers Metaanalysis, four trials Vitamin D alone had no effect on hip fractures Vitamin D plus calcium reduced hip fracture risk marginally Shikari, M., et al “Effects of Years’ Treatment of Osteoporosis with Alpha-Hydroxyvitamin D3 on Bone Mineral Density and Incidence of Fracture: A Placebo-Controlled, Double-Blind Prospective Study.” Endocrinology Journal 43 (1996): 211 Japanese researchers Prospective, 113 elderly women with osteoporosis followed for years In the group receiving vitamin D, fractures were reduced 66 percent But because of the small number of participants, this result was not statistically significant The seventeen studies showing no benefit: Gallagher, J C., and D Goldgar “Treatment of Postmenopausal Osteoporosis with High Doses of Synthetic Calcitriol A Randomized Controlled Study.” Annals of Internal Medicine 113 (1990): 649 Creighton University researchers, Omaha, Nebraska Prospective, 50 elderly women followed for years “There were no differences between the two groups.” Grant, A M., et al “Oral Vitamin D3 and Calcium for Secondary Prevention of Low-Trauma Fractures in Elderly People (Randomized Evaluation Appendix C 231 • of Calcium or Vitamin D, the RECORD study): A Randomized, PlaceboControlled Trial.” Lancet 365 (9471) (2005): 1621 British researchers Prospective, 5,292 men and women, aged 70 or older, followed for up to years “Findings not support routine supplementation with calcium and vitamin D3, either alone or in combination, for the prevention of fractures in elderly people.” Jackson, R D., et al “Calcium Plus Vitamin D and the Risk of Fractures.” New England Journal of Medicine 354 (2006): 669 Ohio State University researchers Prospective, 36,282 women, ages 50 to 79 at the start, followed for years “Among healthy postmenopausal women, calcium with vitamin D did not significantly reduce hip fracture.” Jackson, C., et al “The Effect of Cholecalciferol (Vitamin D3) on the Risk of Fall and Fracture: A Meta-Analysis.” QJM [formerly Quarterly Journal of Medicine] 100 (2007): 185 British researchers Meta-analysis, trials Vitamin D had no significant effect on fracture risk Komulainen, M H., et al “HRT and Vitamin D in Prevention of NonVertebral Fractures in Postmenopausal Women: A Five-Year Randomized Trial.” Maturitas 31 (1998): 45 Finnish researchers Prospective, 464 postmenopausal women followed for years “In the vitamin D group, the fracture incidence was nonsignificantly decreased in comparison with the placebo group.” Law, M., et al “Vitamin D Supplementation and the Prevention of Fractures and Falls: Results of a Randomized Trial in Elderly People in Residential Accommodation.” Age and Ageing 35 (2006): 482 British researchers Prospective, 3,717 nursing home residents, average age 85, followed for up to 14 months Lips, P., et al “Vitamin D Supplementation and Fracture Incidence in Elderly People A Randomized, Placebo-Controlled Clinical Trial.” Annals of Internal Medicine 124 (1996): 400 Dutch researchers Prospective, 2,578 men and women over 70 followed for 3.5 years, taking either a placebo or vitamin D The vitamin D group suffered more fractures, but this fi nding was not statistically significant “Our results not show a decrease in the incidence of hip fractures and other peripheral fractures in Dutch elderly persons after vitamin D supplementation.” Loud, K J., et al “Correlates of Stress Fractures Among Preadolescent and Adolescent Girls.” Pediatrics 115 (2005): e399 Harvard researchers • 232 Appendix C Retrospective, 5,461 girls, ages 11 to 17 “Calcium intake, vitamin D intake, and daily dairy intake were all unrelated to stress fractures.” Lyons, R A., et al “Preventing Fractures Among Older People Living in Institutional Care: A Pragmatic Randomized Double-Blind PlaceboControlled Trial of Vitamin D Supplementation.” Osteoporosis International 18 (2007): 811 British researchers Prospective, 3,440 elderly men and women followed for years “Supplementation with oral vitamin D is not sufficient to affect fracture incidence among older people living in institutional care.” 10 Meyer, H E., et al “Can Vitamin D Supplementation Reduce the Risk of Fracture in the Elderly? A Randomized Controlled Trial.” Journal of Bone and Mineral Research 17 (2002): 709 Norwegian researchers Prospective, 1,144 nursing home residents followed for years “We found that 10 micrograms of vitamin D3 alone produced no fracture-preventive effect in a nursing home population.” 11 Michaelsson, K., et al “Dietary Calcium and Vitamin D Intake in Relation to Osteoporotic Fracture Risk.” Bone 32 (2003): 694 Swedish researchers Prospective, 60,689 women, ages 40 to 74 at the start, followed for 11 years “Dietary calcium or vitamin D intakes estimated at middle age and older age not seem to be of major importance for the primary prevention of osteoporotic fractures.” 12 Munger, R G., et al “Prospective Study of Dietary Protein Intake and Risk of Hip Fracture in Postmenopausal Women.” American Journal of Clinical Nutrition 69 (1999): 147 Utah State University researchers Prospective, 41,837 postmenopausal Iowa women followed for years “The risk of hip fracture was not related to intake of calcium or vitamin D.” 13 Ott, S M., and C H Chestnut “Calcitriol Treatment is Not Effective in Postmenopausal Osteoporosis.” Annals of Internal Medicine 110 (1989): 267 University of Washington, Seattle, researchers Prospective, 86 postmenopausal women followed for years “New fractures were seen in 16 percent of the placebo group and 26 percent of the calcitriol [i.e., vitamin D] group.” In other words, vitamin D increased fracture risk 14 Porthouse, J., et al “Randomized Controlled Trial of Calcium and Supplementation with Cholecalciferol (Vitamin D3) for Prevention of Fracture in Primary Care.” BMJ [formerly British Medical Journal] 330 (7498) Appendix C 233 • (2005): 1003 British researchers Prospective, 3,314 women, aged 70 or older, followed for up to 3.5 years “We found no evidence that calcium and vitamin D supplementation reduces the risk of clinical fractures in women with one or more risk factors for hip fracture.” 15 Richy, F., et al “Efficacy of Alphacalcidol and Calcitriol in Primary and Corticosteroid-Induced Osteoporosis: A Meta-Analysis of Their Effects on Bone Mineral Density and Fracture Rate.” Osteoporosis International 15 (2004): 301 Belgian researchers Meta-analysis, 17 studies “Only two studies specifically addressed the effects of calcitriol on spinal fracture rate Neither provided significant results.” 16 Smith, H., et al “Effect of Annual Intramuscular Vitamin D on Fracture Risk in Elderly Men and Women: A Population-based, Randomized, Double-Blind, Placebo-Controlled Trial.” Rheumatology 46 (2007): 1852 British researchers Prospective, 9,440 men and women over 75 followed for years “Annual injection of 300,000 IU of vitamin D2 is not effective in preventing non-vertebral fractures among elderly men and women in the general population.” 17 Wooton, R., et al “Fractured Neck of Femur in the Elderly: An Attempt to Identify Patients at Risk.” Clinical Sciences 57 (1979): 93 Retrospective, 110 cases, 72 controls “A striking fi nding was the marked similarity of all variables [blood levels of calcium and vitamin D] in the fracture and control groups.” This page intentionally left blank References References to the twelve hundred studies that form the basis of this book can be found at www.BuildingBoneVitality.com Abstracts of all the studies can be obtained for FREE from the National Library of Medicine’s PubMed service’s website (www.pubmed.gov): • On the home page left navigation bar, click Single Citation Matcher • Here is a sample citation: Lanou, A J., et al “Calcium, Dairy Products, and Bone Health in Children and Young Adults: A Re-Evaluation of the Evidence.” Pediatrics 115 (2005): 736 “Lanou AJ” is the author “Calcium Evidence” is the title “Pediatrics” is the journal “115” is the volume “2005” is the year of publication “736” is the first page of the article • On the Single Citation Matcher page, fi ll in the journal, year, volume, first page, author, and one or more key words from the article title Note: It’s rarely necessary to provide all this 235 • • 236 References information Quite often the journal, year, volume, and first page are enough Other partial combinations work too Or, if you prefer, we’re happy to send you copies of all twelvehundred-plus abstracts plus other documentation, 1,536 pages in all The documentation package weighs 20 pounds We ship via UPS to business or residential street addresses No PO boxes The cost for copying, shipping, and handling: $250 No credit cards Check or money order only Payable to: Self-Care Associates, PO Box 460066, San Francisco, CA 94146 Allow three weeks Index Page numbers followed by “f ” or “t” refer to figures or tables respectively Acidity, of foods, 121–22, 122–23t Action, mechanism of, for low-acid eating and walking, 203–4 Actonel (risedronate), 189, 190 Actos, 181 Aerobic conditioning, 157 Aerobics error, 157 Affluence, food consumption and, 88–89 Alcohol as risk factor for falling, 163 as risk factor for fractures, 178–79 Alendronate (Fosamax), 187–89, 190, 193, 197 Alkalinity of dried fruits, 123 of foods, 121–22, 122–23t guidelines for maintaining low, in diet, 124 maintaining, in diet, 123–24 American Dietetic Association, 72–73 American Heart Association, 72–73 Americans, reasons for sedentary lifestyle of, 155–57 Animal foods blood acidity and, 51 calcium excretion in urine and, 116–18 Animal protein intake, hip fractures and, 63, 64f, 66, 66f Anticonvulsant drugs, fracture risk and, 182 Anti-infl ammatory drugs, fracture risk and, 182 Anxiety, as risk factor for fractures, 181 Arby’s, 130 Aredia (pamidronate), 189, 190 Argentina, University of California, San Francisco, research study of age-adjusted hip fracture rates in, 6t Associations, between milk, diary, and calcium and, 13–14 Australia Tehran University Medical School research study of age-adjusted hip fracture rates in, 7t University of California, San Francisco, research study of age-adjusted hip fracture rates in, 6t Avandia, 181 Back deformities, 187 Baked Polenta, 150 Barnard, Neal, 72, 173 Barzel, Uriel S., 67 Bernstein, Daniel S., 46, 75 Berry Sauce, 143 Biological elegance, level of, as scientific theory for low-acid eating and walking, 205–6 Blair, Steven, 158 Blood composition of, 52 functions of, 51 pH of, 52 Blood acidity animal foods and, 61 fruits and, 61–62 vegetables and, 61–62 Blood pressure, testing for, 108 Body mass index, low, fractures and, 174 Bone calcium compounds in, 76–77 effect of soy foods on, 125–26 excess calcium excretion from, 118–19 Bone development, children’s, exercise and, 165–67 Bone mineral density (BMD), 17, 97 as second-rate test, 107–9 soy foods and, 106–7 Bone mineral density (BMD) studies, 24–25, 95–97 advantages of, 25 disadvantages of, 25 Bone strength nutrients required to build, 97–99 plant foods and, 68–71 Bone vitality, vegan eating and, 71–72 Boniva (ibandronate), 189 Boron, 97 fruit-and-vegetable sources of, 100 Brazil, Tehran University Medical School research study of age-adjusted hip fracture rates in, 8t Breakfast recipes See also Dessert recipes; Dinner recipes; Lunch recipes; Salad recipes Berry Sauce, 143 fruits and vegetables for, 128 low-acid menu planning for one week of, 131–32 Scrambled Tofu with Vegetables, 139 Updated Southern: Yellow Corn Grits, Sautéed Greens, and Fresh Tomato, 138–39 Burger King, 130 Cabbage and Fruit Salad, 144 Caffeine, as risk factor for fractures, 176–78 Calcitonin (Miacalcin or Fortical), 191–92 Calcium association between fractures and, 14 inability to prevent fractures and, 95–96 from plant foods, 68–71 plant sources of, 69–71t in urine, 53–54 vegans and consumption of, 71 Calcium balance, 67–68 Calcium compounds, in bone, 76–77 237 • • 238 Calcium excretion source of excess, 118–19 in urine, animal foods and, 116–18 Calcium intake, during childhood, studies of fracture prevention and, 35–37 Calcium paradox, 10, 62–67 Calcium theory, 68, 74 hip fractures and, 9–10 support for, in Croatia, 34 Calcium triumvirate, Campbell, T Colin, 80, 89 Canada, University of California, San Francisco, research study of age-adjusted hip fracture rates in, 6t Carbohydrates, discovery of, 87 Carotenemia, 106 Case-control studies, 22–24 advantages of, 24 disadvantages of, 24 major fl aw of, 23 “matched” controls in, 23–24 memory and, 23 Cattle grazing, 199–202 Centers for Disease Control and Prevention (CDC), 72–73 Cheese, acidity of, 123 See also Dairy products Cheung, A M Children’s bone development, exercise and, 165–67 Children’s diets, low-acid eating and, 134–36 Chile, University of California, San Francisco, research study of age-adjusted hip fracture rates in, 7t China Tehran University Medical School research study of age-adjusted hip fracture rates in, 8t University of California, San Francisco, research study of age-adjusted hip fracture rates in, 7t Chinese diets, 80–81 Clinical trials, 19 gold standard of, 21–22 level of, for low-acid eating and walking, 204–5 Cobalamin See Vitamin B12 Coconut Dahl, 146–47 Cohort studies, 21 Controlled trials, 21 Cooper, Kenneth, 157 Copper, 97 fruit-and-vegetable sources of, 100 Cordain, Loren, 82, 83 Cretan Salad, 146 Crete, University of California, San Francisco, research study of age-adjusted hip fracture rates in, 6t Croatia calcium theory and fracture rates in, 10 Mayo Clinic research study of age-adjusted hip fracture rates in, 4t support for calcium theory in, 34 Cross-sectional trials, 24 Curried Potatoes and Peas, 145–46 Dairy industries, influence of, on eating habits, 92 Dairy products association between fractures and, 14 consumption of, 89 studies of fracture prevention and, 31–34 DASH See Dietary Approaches to Stop Hypertension) diet Denmark, Yale research study of age-adjusted hip fracture rates in, 5t Index Depression, as risk factor for fractures, 180–81 Dessert recipes See also Breakfast recipes; Dinner recipes: Lunch recipes; Salad recipes Fruit Smoothies, 137–38 fruits and vegetables for, 129 Strawberry-Rhubarb Crumble, 145 Diabetes as risk factor for fractures, 171–73 type 1, 172 type 2, 172–73 Didronel (etidronate), 189, 190 Dietary Approaches to Stop Hypertension (DASH) diet, 74 Dietary protein, in urine, 53–54 See also Protein Diets high-salt, fractures and, 175–76 kids’, low-acid eating and, 134–36 Dinner recipes See also Breakfast recipes; Dessert recipes; Lunch recipes; Salad recipes; Vegetables Baked Polenta, 150 Coconut Dahl, 146–47 Cretan Salad, 146 Curried Potatoes and Peas, 145–46 fruits and vegetables for, 128–29 low-acid menu planning for one week of, 133–34 MC’s Soup, 139–40 Mediterranean Potato Salad, 140–41 Summer Ratatouille with Polenta, 148–49 Thai Curry with Vegetables, 147–48 Triple-Vegetable Pasta Primavera, 142–43 Vegetable Fajita Burrito, 143–44 Dowager’s hump, 187 Dried fruits, alkalinity of, 123 Drinking See Alcohol Drowsiness, as risk factor for falling, 163 Drug compliance, 187–88 Eating out, low-acid eating and, 129–31 Eggless salad sandwich, 141 England See United Kingdom Epidemiology, 13–14 level of, for low-acid eating and walking, 203–4 Esselstyn, Caldwell, 72 Essential fatty acids, 99 fruit-and-vegetable sources of, 101 Estrogen, 184 Etidronate (Didronel), 189, 190 Evista (raloxifene), 191 Evolution, level of, as scientific theory for low-acid eating and walking, 205–6 Exercise See also Walking best, for fracture prevention, 153–55 children’s bone development and, 165–67 fracture risk and, 151–53 as mood elevator, 181 nonaerobic, 157–58 osteoporosis and, 17 for reducing falls, 161 weight-bearing, fracture prevention and, 153–55 Experimental studies, 21 Eyesight, as risk factor for falling, 163 Fall-proofi ng homes, for fracture prevention, 161–64 Falls exercise for reducing, 161 as predictor of bone mineral density (BMD), 107 preventing, to reduce fractures, 160–64 risk factors for, 163 Fast food, low-acid eating and, 130–31 Index Fats, discovery of, 87 Finland University of California, San Francisco, research study of age-adjusted hip fracture rates in, 6t Yale research study of age-adjusted hip fracture rates in, 5t Fluoride, 98 fruit-and-vegetable sources of, 100 Folic acid, 98 fruit-and-vegetable sources of, 101 Food groups, USDA, 90–91 Former Yugoslavia University of California, San Francisco, research study of age-adjusted hip fracture rates in, 7t Yale research study of age-adjusted hip fracture rates in, 5t, 6t Forteo (teripararide), 190–91, 193 Fortical (calcitonin), 191–92 Fosamax (alendronate), 187–89, 190, 193 raisins vs., 197 Fracture prevention best exercise for, 153–55 fall-proofi ng one’s home for, 161–64 falls and, 160–64 recap of studies of, 47 studies of calcium intake during childhood, 35–37 studies of dairy products and, 31–34 vitamin D and, 39–43 Fracture prevention weight-bearing exercise, 153–55 Fracture risk caffeine consumption and, 176–78 depression and, 180–81 diabetes and, 171–73 exercise and, 151–53 frailty and, 163 high-salt diets and, 175–76 low body mass index and, 174 obesity and, 165 osteoporosis and, prescription drugs for increasing, 181–82 preventing falls to reduce, 160–64 smoking and, 179–80 Fracture Risk Assessment (FRAX), 108 Fractures See also Hip fractures alcohol consumption and, 178–79 association between milk, dairy, and calcium and, 14 vertebral, 187 Frailty, as risk factor for falling, 163 Framingham Heat Study, 20–22 France, University of California, San Francisco, research study of age-adjusted hip fracture rates in, 6t FRAX See Fracture Risk Assessment Fruit Smoothies, 137–38 Fruits best sources for essential bone-building nutrients, 99–100 blood acidity and, 61–62 for breakfasts, 128 counting daily consumption of, 126–28 as cure for osteoporosis, 103–4 for dessert, 129 for dinners, 128–29 dried, alkalinity of, 123 for lunches, 128–29 “one serving” of, 127 for snacks, 129 239 • Genetics hip fractures and, 12–13 osteoporosis and, 17 Germany hip fracture rates in, 11 Tehran University Medical School research study of age-adjusted hip fracture rates in, 8t University of California, San Francisco, research study of age-adjusted hip fracture rates in, 6t Greece, Tehran University Medical School research study of age-adjusted hip fracture rates in, 8t Hegsted, D Mark, 75 High heels, as risk factor for falling, 163 High-salt diets, fractures and, 175–76 Hip fractures See also Fractures age-adjusted variation in rates of Mayo Clinic research study, 4t Tehran University Medical School research study of, 7–8t University of California, San Francisco, research study of, 6–7t Yale research study of, 5–6t animal protein intake and, 63, 64f, 66 calcium consumption and, 9–10 calcium theory and, 9–10 exercise and, 11–12 malnutrition and, 115–16 racial genetic differences and, 12–13 risk of, dietary animal consumption and, 65–66, 66f vegetable protein intake and, 63, 64f vegetable-to-animal intake ratio and, 63, 65f, 66 vitamin D deficiency and, 10–11 Hong Kong hip fracture rate in, 12–13 Mayo Clinic research study of age-adjusted hip fracture rates in, 4t Tehran University Medical School research study of age-adjusted hip fracture rates in, 8t University of California, San Francisco, research study of age-adjusted hip fracture rates in, 7t Yale research study of age-adjusted hip fracture rates in, 5t Hormone replacement therapy (HRT), 184–86 Hormones, osteoporosis and, 17 HRT See Hormone replacement therapy Hummus, Red Pepper, 142 Ibandronate (Boniva), 189 Intervential trials, 21 Iran, Tehran University Medical School research study of age-adjusted hip fracture rates in, 8t Ireland, University of California, San Francisco, research study of age-adjusted hip fracture rates in, 6t Ireland, Yale research study of age-adjusted hip fracture rates in, 5t Israel hip fracture rates in, 11 Mayo Clinic research study of age-adjusted hip fracture rates in, 4t University of California, San Francisco, research study of age-adjusted hip fracture rates in, 6t Yale research study of age-adjusted hip fracture rates in, 5t Italy, University of California, San Francisco, research study of age-adjusted hip fracture rates in, 7t • 240 Japan Tehran University Medical School research study of age-adjusted hip fracture rates in, 8t University of California, San Francisco, research study of age-adjusted hip fracture rates in, 7t Keys, Ancel, 77–79 KFC, 130 Kids’ diets, low-acid eating and, 134–36 Knee pain, as risk factor for falling, 163 Kuwait, Tehran University Medical School research study of age-adjusted hip fracture rates in, 8t “Latest Study,” tyranny of, 29–30 Liebig, Justus von, 87 Longevity, osteoporosis and, 16–17 Low-acid eating, 46–47, 73–74 case against, 111–19 cattle-grazing and, 199–202 eating out and, 129–31 fast foods and, 130–31 guidelines for, 124 kids’ diets and, 134–36 menu planning for one week of breakfasts, 131–32 dinners, 133–34 lunches, 132–33 paradigm shifts in, 86–87 recipes for, 137–50 as scientific theory, levels of biological elegance, 206–7 cellular level, 205 clinical trials, 204–5 epidemiology, 203–4 evolution, 205–6 mechanism of action, 204 Low-acid theory, 62–67 as osteoporosis cure, 74–75 publication and publicity bias and, 92–94 Lunch recipes See also Breakfast recipes; Dessert recipes; Dinner recipes; Salad recipes; Vegetables Baked Polenta, 150 Cabbage and Fruit Salad, 144 Coconut Dahl, 146–47 Cretan Salad, 146 Curried Potatoes and Peas, 145–46 Eggless Salad Sandwich, 141 fruits and vegetables for, 128–29 low-acid menu planning for one week of, 132–33 MC’s Soup, 139–40 Mediterranean Potato Salad, 140–41 Summer Ratatouille with Polenta, 148–49 Thai Curry with Vegetables, 147–48 Triple-Vegetable Pasta Primavera, 142–43 Vegetable Fajita Burrito, 143–44 Magnesium, 98 fruit-and-vegetable sources of, 100 Malaysia Tehran University Medical School research study of age-adjusted hip fracture rates in, 8t University of California, San Francisco, research study of age-adjusted hip fracture rates in, 7t Malnutrition, hip fractures and, 115–16 Manganese, 98 fruit-and-vegetable sources of, 100 Massey, Linda K., 67 McDonald’s, 89, 130 MC’s Soup, 139–40 Meat industries, influence of, on eating habits, 91–92 Medical news reporting, 29–30 Mediterranean eating, 73, 77–81 Index Mediterranean Potato Salad, 140–41 Menu planning, for low-acid eating breakfasts, 131–32 dinners, 133–34 lunches, 132–33 Meta-analyses, 26 advantages of, 27 disadvantages of, 27 Miacalcin (calcitonin), 191–92 Milk See Dairy products Morocco, Tehran University Medical School research study of age-adjusted hip fracture rates in, 8t Narcotics, as risk factor for falling, 163 National Cancer Institute, 72–73, 92 Nestle, Marion, 89, 91 Netherlands, the hip fracture rates in, 11 Mayo Clinic research study of age-adjusted hip fracture rates in, 4t University of California, San Francisco, research study of age-adjusted hip fracture rates in, 7t Yale research study of age-adjusted hip fracture rates in, 5t New Guinea University of California, San Francisco, research study of age-adjusted hip fracture rates in, 7t Yale research study of age-adjusted hip fracture rates in, 6t New, Susan A., 103–4 New Zealand Mayo Clinic research study of age-adjusted hip fracture rates in, 4t University of California, San Francisco, research study of age-adjusted hip fracture rates in, 6t Nexium, fracture risk and, 182 Nigeria hip fracture rate in, 13 University of California, San Francisco, research study of age-adjusted hip fracture rates in, 7t Nonaerobic exercise, 157–58 Norway Mayo Clinic research study of age-adjusted hip fracture rates in, 4t Tehran University Medical School research study of age-adjusted hip fracture rates in, 7t University of California, San Francisco, research study of age-adjusted hip fracture rates in, 6t Yale research study of age-adjusted hip fracture rates in, 5t Nurses’ Health Study, 20–22 Nutrients See also specific nutrient best fruit, vegetable, nut, and legume sources of, 100–102 best sources of, 102–3 Nutrition science, 87 Obesity, 156 fractures and, 165 Observational studies, 21 Ornish, Dean, 72 Osteoporosis best possible study for, 19–20 bottom line on, 195–97 as cause of fractures, fruits and vegetables as cure for, 103–4 low-acid eating as cure for, 74–76 reasons women suffer more, 16–17 research spending on, 19 toll of, in United States, 15–16 241 • Index Osteoporosis drugs, 183–97 compliance and, 192–93 effectiveness of, 186–89 hormone replacement therapy as predecessor, 184–86 most cost-effective, 193 thiazide diuretics and, 194–95 Ovo-lacto-vegetarians, vitamin B12 and, 101 Pamidronate (Aredia), 189, 190 Paradigm shifts, 86–87 Pasta Primavera, Triple-Vegetable, 142–43 Pedometers, 159–60 pH, of blood, 52 below normal, 52–53 Phosphorus, 98 fruit-and-vegetable sources of, 100 Physical activity See Exercise; Walking Plant foods bone strength and, 68–71 as calcium source, 69–71t Polenta, Baked, 150 Pollan, Michael, 87–88 Portugal, University of California, San Francisco, research study of age-adjusted hip fracture rates in, 6t PPIs (proton pump inhibitors) fracture risk and, 182 Premarin, 185 Prescription drugs, as risk factor for fractures, 181–82 Prevacid, fracture risk and, 182 Prilosec, fracture risk and, 182 Prospective trials, 21 advantages of, 22 of dairy products, 32–33 disadvantages of, 22 organizational methods for, 21 types of, 21 for vitamin D, 40–41 Protein, 99, 115 calculating required consumption for, 89 dietary in urine, 53–54 discovery of, 87 effect of, on acidity of urine, 55–60t fruit-and-vegetable sources of, 101 Protohumans, 81–82 Proton pump inhibitors (PPIs), fracture risk and, 182 Prout, William, 87 Race, hip fractures and, 12–13 Raisins, Fosamax vs., 197 Raloxifene (Evista), 191 Randomized, double-blind, controlled trial (RDBCT), 21 RDBCT See Randomized, double-blind, controlled trial Recipes See Breakfast recipes; Dinner recipes; Lunch recipes; Salad recipes; Vegetables Reclast (zoledronic acid), 189–90, 190, 193 Red Pepper Hummus, 142 Retrospective trials, 22–24 advantages of, 24 disadvantages of, 24 major fl aw of, 23 “matched” controls in, 23–24 memory and, 23 Risedronate (Actonel), 189, 190 Risk factors, for fractures alcohol consumption, 178–79 anxiety, 181 caffeine consumption, 176–78 depression, 180–81 diabetes, 171–73 frailty, 174 high-salt diets, 175–76 prescription drugs, 181–82 smoking, 179–80 stress, 181 Salad recipes See also Dessert recipes; Dinner recipes; Lunch recipes Cabbage and Fruit, 144 Cretan, 146 Eggless, sandwich, 141 Mediterranean Potato, 140–41 Salt, effect of, on bones, 175–76 Saudi Arabia hip fracture rates in, 12 University of California, San Francisco, research study of age-adjusted hip fracture rates in, 7t Scrambled Tofu with Vegetables, 139 Sebastian, Anthony, 63–67 Sedatives fracture risk and, 181 as risk factor for falling, 163 Seizure medications, fracture risk and, 182 Significance, 27–29 statistical, 28–29 Silica (silicon), 98 fruit-and-vegetable sources of, 100 Singapore hip fracture rates in, 12 Mayo Clinic research study of age-adjusted hip fracture rates in, 4t Tehran University Medical School research study of age-adjusted hip fracture rates in, 8t University of California, San Francisco, research study of age-adjusted hip fracture rates in, 7t Yale research study of age-adjusted hip fracture rates in, 6t Smoking, as risk factor for fractures, 179–80, 197 Snacks, fruits and vegetables for, 129 South Africa Mayo Clinic research study of age-adjusted hip fracture rates in, 4t University of California, San Francisco, research study of age-adjusted hip fracture rates in, 7t Yale research study of age-adjusted hip fracture rates in, 6t South Korea, University of California, San Francisco, research study of age-adjusted hip fracture rates in, 7t Soy foods, 106–7, 114 effect of, on bone, 125–26 Spain University of California, San Francisco, research study of age-adjusted hip fracture rates in, 7t Yale research study of age-adjusted hip fracture rates in, 5t Stamford, Bryant, 158 Statistical significance, 28–29 Steroids, fracture risk and, 182 Strawberry-Rhubarb Crumble, 145 Stress, as risk factor for fractures, 181 Summer Ratatouille with Polenta, 148–49 Sunscreens, 104 Suppers See Dinner recipes Supplements, as sources for nutrients, 102–3 • 242 Sweden Tehran University Medical School research study of age-adjusted hip fracture rates in, 7t University of California, San Francisco, research study of age-adjusted hip fracture rates in, Yale research study of age-adjusted hip fracture rates in, 5t Switzerland Tehran University Medical School research study of age-adjusted hip fracture rates in, 8t University of California, San Francisco, research study of age-adjusted hip fracture rates in, 6t Taiwan, Tehran University Medical School research study of age-adjusted hip fracture rates in, 7t Teripararide (Forteo), 190–91, 193 Thai Curry with Vegetables, 147–48 Thailand Tehran University Medical School research study of age-adjusted hip fracture rates in, 8t University of California, San Francisco, research study of age-adjusted hip fracture rates in, 7t Thiazide diuretics, osteoporosis drugs and, 194–95 Tofu, 126 Scrambled, with Vegetables, 139 Tranquilizers fracture risk and, 181 as risk factor for falling, 163 Triple-Vegetable Pasta Primavera, 142–43 Type diabetes, 172 Type diabetes, 172–73 Ultraviolet light, 104 United Kingdom Mayo Clinic research study of age-adjusted hip fracture rates in, 4t Tehran University Medical School research study of age-adjusted hip fracture rates in, 8t University of California, San Francisco, research study of age-adjusted hip fracture rates in, 6t Yale research study of age-adjusted hip fracture rates in, 5t United States hip fracture rates in, 11 Mayo Clinic research study of age-adjusted hip fracture rates in, 4t osteoporotic fractures in, reasons for sedentary lifestyle of Americans in, 155–57 Tehran University Medical School research study of age-adjusted hip fracture rates in, 7t toll of osteoporosis in, 15–16 Yale research study of age-adjusted hip fracture rates in, 5t United States Department of Agriculture (USDA) dietary recommendations of, 90–91 influence of meat and dairy industries on, 91–92 missions of, 90 Updated Southern Breakfast: Yellow Corn Grits, Sautéed Greens, and Fresh Tomato, 138–39 Urine calcium in, 53–54 dietary protein in, 53–54 effect of common foods on acidity of, 55–60t, 55–62 Index Valium, 181 Vegans calcium consumption of, 71 vitamin B12 and, 101 Vegetable Fajita Burrito, 143–44 Vegetable protein intake, hip fractures and, 63, 64f Vegetables best sources for essential bone-building nutrients, 99–100 blood acidity and, 61–62 for breakfasts, 128 counting daily consumption of, 126–28 as cure for osteoporosis, 103–4 for desserts, 129 for dinners, 128–29 Fajita Burrito, 143–44 for lunches, 128–29 “one serving” of, 127 Scrambled Tofu with, 139 for snacks, 129 Summer Ratatouille with Polenta, 148–49 Thai Curry with, 147–48 Triple, Pasta Primavera, 142–43 Vegetable-to-animal intake ratios, hip fractures and, 63, 65f, 66 Vertebral fractures, 187 Vitamin A, 98 excessive intake of, 106 fruit-and-vegetable sources of, 101 Vitamin B6, 98 fruit-and-vegetable sources of, 101 Vitamin B12, 99, 101–2 Vitamin C, 98, 113, 180 fruit-and-vegetable sources of, 101 Vitamin D, 10–11, 98, 104–5, 167 deficiency, hip fractures and, 10–11 fracture prevention and, 39–43 fruit-and-vegetable sources of, 101 prospective trials of, 40–41 Vitamin E, 113, 180 Vitamin K, 98, 105, 114 fruit-and-vegetable sources of, 101 Wachman, Amnon, 46, 75 Walking, 158–60 See also Exercise pedometers for, 159–60 regularity and, 159–60 as scientific theory, levels of biological elegance, 206–7 cellular level, 205 clinical trials, 204–5 epidemiology, 203–4 evolution, 205–6 mechanism of action, 204 Weight See Obesity Weight-bearing exercise, fracture prevention and, 153–55 Wendy’s, 130 Wilson, Robert, 184–85 Wyeth-Ayerst, 185 Yogurt See Dairy products Zinc, 98 fruit-and-vegetable sources of, 101 Zoledronic acid (Zometa or Reclast), 189–90, 190, 193 Zometa (zoledronic acid), 189–90, 190, 193 About the Authors Amy Joy Lanou, Ph.D., is an assistant professor of health and wellness at the University of North Carolina, Asheville She has taught nutrition at Cornell University and Ithaca College She is the author of Healthy Eating for Life for Children (Wiley, 2002) She has written or delivered more than fifty scientific articles, reports, and presentations, with an emphasis on bone health and the benefits of low-acid eating In 2005, she testified before the committee that revised the USDA Food Pyramid and urged the members to embrace the lowacid approach They didn’t She is also a senior nutrition scientist for the Physicians Committee for Responsible Medicine, a Washington, D.C.–based nonprofit organization dedicated to promoting preventive medicine through nutrition Dr Lanou received her B.S in Nutrition Science from the University of California at Davis (1985) and her Ph.D in Human Nutrition from Cornell University (1994) Michael Castleman, M.A., has been called “one of the nation’s top health writers” (Library Journal) Over the past thirty-five years, he has written more than fifteen hundred health articles for national magazines, plus twelve consumer health books, including An Aspirin a Day, Nature’s Cures, Before You Call the Doctor, and The Healing Herbs, which has sold more than a million copies He has been nominated for National Magazine Awards twice, for articles on advances in breast cancer prevention, detection, and treatment and how smoking destroys the body He is a Phi Beta Kappa graduate of the University of Michigan (1972) He earned a master’s degree in journalism at UC Berkeley (1979) and has taught medical writing at the Graduate School of Journalism there He lives in San Francisco Visit mcastleman.com ... you—greens and beans Low-acid eating paired with daily walking keep calcium in bones That’s the key: choose a dietary pattern and lifestyle that allows bone to absorb? ?and retain—dietary calcium You’ll.. .building bone vitality A Revolutionary Diet Plan to Prevent Bone Loss and Reverse Osteoporosis Amy Joy Lanou, Ph.D Michael Castleman New York Chicago San Francisco Lisbon London Madrid... Low-Acid Eating 137 13 As Important as Low-Acid Eating: Walk Your Way to Stronger Bones 151 PART Other Risk Factors for Osteoporosis and What You Can Do About Them 14 Diabetes, Frailty, and Fractures