Noe Valley Voice May 2009

Bone Book Authors: Calcium Not All It's Cracked Up to Be

By Olivia Boler

If you want strong bones, you should drink lots of milk and take calcium supplements, right? Not if you ask nutrition scientist Amy Lanou and health writer Michael Castleman, co-authors of a new book titled Building Bone Vitality: A Revolutionary Diet Plan to Prevent Bone Loss and Reverse Osteoporosis.

In the guide, due out in June from McGraw-Hill publishers, Lanou and Castleman make the case for a "low-acid diet" based on fruits and vegetables as the best way to keep bones strong and healthy. They also explain why they think the traditional "calcium theory of osteoporosis" is wrongheaded.

With a foreword by health guru Dean Ornish, the book offers a wealth of research, plus some bone-friendly recipes. The Noe Valley Voice recently chatted with Castleman--who is also a novelist and a 28-year neighborhood resident--about calcium, diet, and why Noe Valley is a great place for maintaining healthy bones.

Noe Valley Voice: Talk a bit about the calcium theory and why you think it's wrong.

Michael Castleman: The calcium theory is kind of like a secular religion and everyone believes in it. Our U.S. health agencies--the Surgeon General, the Centers for Disease Control and Prevention, the National Institutes of Health--everyone says to women, "Get more calcium." And over the last 30 years, women keep bumping up the calcium because they're told they need to be getting 1,000 mg a day and they need to get it from supplements.

Why do these organizations think it's so important? Well, it's a straight line. Bones have a lot of calcium. But they also are made up of 16 other nutrients. The thinking is, however, if people have osteoporosis and don't have strong bones, they must not have a lot of calcium.

But if you take a look at the worldwide epidemiology, as Amy and I did, you'll see this view is totally myopic. Those countries with the highest calcium consumption--the U.S., Western Europe, Australia, and New Zealand--their bone health is doing terribly. At the same time, our rates of osteoporosis are rising, and women are taking more calcium. We looked at four research surveys on four different continents over 20 years, all doing different counting techniques. They show that countries that have little calcium consumption, and a lot of these are Asian--China, Thailand, Japan--they consume less than 500 mg of calcium a day, yet their rate of hip fracture is 70 percent lower than ours! Either all these surveys are lying or calcium isn't the key.

Now, epidemiology points in certain directions but never really proves anything. You need experimental research for proof. No one else has done what Amy and I did: We fished out every bone fracture study conducted since 1975. Of 140 studies of dietary risk factors for osteopathic fracture, one-third--about 40 studies--show that if you bump up calcium with milk, dairy, cheese, yogurt, and pills, you get some decrease in fractures. The other two-thirds show little or no difference [caused by] the intake of calcium. That's two-to-one against the calcium theory. Those studies that show no benefit to calcium are gold-plated studies. Harvard followed 80,000 middle-aged nurses for 12 years and tracked what they were eating. You know what they found? Calcium had no effect on preventing bone fractures.

NVV: In your book, you write about the news media supporting the calcium theory. Why do you think that is?

MC: There are a number of reasons, and a whole chapter in the book addresses this. One is the 40 studies that show a benefit from calcium have taken place over 30 years, and that's one a year. That's enough to keep in the headlines the idea that milk helps bones. Another reason is a publication bias in science: If your study shows that something doesn't happen rather than something did happen, it's harder to get published. We had a hell of a time searching out the studies that show calcium does not prevent fractures.

Also, the dairy industry is hugely, politically powerful in the United States, and the USDA [U.S. Department of Agriculture] has been telling people since World War II, "Drink milk for strong bones." It seems innocuous and makes sense. The job of the USDA is to promote agriculture in the U.S., and its subsidiary mission is to tell Americans to get good nutrition by eating the things grown here. When these beliefs get established, it is difficult to break them. Think about all the times you've seen the "Got milk?" ads. Vegetable growers, for reasons that escape me, haven't done something like that, and I think it's stupid, but that's the way it is.

There's also a feeling of entitlement in this country. When people become affluent, they eat more meat and dairy and fewer plants, and they feel it's their God-given right. Traditional diets--plant-based diets--in developing countries are getting left behind as their affluence increases.

NVV: Talk about the diet you advocate, a low-acid diet. It sounds vegan.

MC: What we recommend in the book is low-acid eating, which is a plant-based diet much lower in protein than what most Americans eat. Protein is made of amino acids, and the gut breaks protein down into 20 amino acids. The human body has to maintain a certain pH [a measure of acidity or alkalinity], so when the blood becomes slightly more acidic, alarms go off to flood the blood with an alkaline material to neutralize the acid, and the main alkaline material in the body is calcium carbonate. This gets pulled out from our bones, and that is the fundamental explanation of osteoporosis--you get weak bones and fractures.

People believe you drink milk and it goes into bone, but that is not how it works. There are two groups of cells, the osteoblasts that build bone matter and osteoclasts which clear out old bone. When the blood is slightly acidic, the bone builders go to sleep and the clasts have to destroy bone to neutralize the acid and calcium in the blood. With a plant diet, the clasts go to sleep and the blasts wake up and build bone.

The last chapter in our book presents a good scientific theory advocating a plant-based diet. Plants contain protein, but they are also mostly alkaline. So when we eat a salad, we get some protein and it gets broken down into those amino acids, but they are introduced into the blood with alkaline material, and the body doesn't have to dip into bone matter.

Those who say if you become a vegetarian, you don't have enough protein are in error. Americans get twice as much protein as they need for good health. You can be a vegan and get enough protein. But you don't have to be a vegetarian to save your bones. The healthiest way to eat is a near vegetarian diet, which is mostly plant foods with occasionally a little bit of protein. I am a near vegetarian. I eat chicken and seafood about twice a week, and I rarely eat red meat. Amy, my co-author, is a vegan.

NVV: Some people really like their cheese, and frozen yogurt is popular again. Are there any benefits to dairy and protein-rich foods at all?

MC: Yes, there are benefits, and they do provide some nutrients. Americans eat a tremendous amount of meat and dairy, which is high in saturated fat, and those are linked to things like stroke, cancer, diabetes, Alzheimer's, and osteoporosis. When you eat a high fat/protein diet, you're at risk for all the things Americans are suffering from. When you look at the research, vegetarians are healthier. I occasionally have ice cream, but I get six to eight servings of fruits and vegetables every day. People need to make informed choices.

NVV: What about grains?

MC: Grains are slightly acid-forming, but nowhere near as acid-forming as meat, poultry, and dairy. It takes three servings of alkaline, plant-based foods to neutralize one serving of a high-acid food. It takes about one and a half to two servings to neutralize the acid in grains. So if you eat something like pasta primavera, you're fine.

NVV: Hip fractures can mean death to an elderly person, although people are living longer. Does this low-acid diet extend not only life but also quality of life in later years?

MC: Hip fracture is the major public health hazard of osteoporosis. All bones break with osteoporosis, but only one type has public health consequences. Within a year, 25 percent of those people who suffer a hip fracture die. Those who don't have to go into nursing homes, which is very expensive. A broken ankle in an 85-year-old woman will cause her pain, but you don't put her in a nursing home and raise taxes to pay for it. Medicaid and Medi-Cal are paying for the hip fractures. It's a lot cheaper if people die without going into a nursing home, plus those are not happy places. If you follow a low-acid diet, you have less chance of getting cancer and heart disease and going into a nursing home. People will still die, but they'll also live longer. The worldwide epidemiology is clear.

NVV: What about vitamin supplements? Some people just don't like to eat fruits and veggies.

MC: Food is better than vitamins. They are called supplements for a reason. I have nothing against vitamins. I take a multi-vitamin. A lot of Americans think they can substitute or erase a bad diet with supplements. No, you eat food. Food first.

NVV: What can Noe Valleyans in particular do to follow the book's guidance?

MC: No matter what your take on diet, daily exercise is critical to bone health. Walking is the best exercise, and 30 to 60 minutes a day is critical. Noe Valley is a very walkable neighborhood with hills, so it's a good neighborhood for bone health. Beyond that, Noe Valley has got the farmer's market and will have Whole Foods at some point, so it's easy to get a wide range of fruits and vegetables in Noe Valley.

Here's a recipe from Building Bone Vitality, a health guide by Michael Castleman and Amy Lanou to be published next month. The soup is easy to make, and according to my kitchen testers, quite tasty. --Olivia Boler

MC's Soup

Serves 2 to 4

This recipe was developed from ingredients found at Trader Joe's. The ingredients require no preparation at all. Just throw everything into a soup pot and heat.

1 32-ounce container of any type of vegetable soup: broccoli, tomato, carrot, mushroom, sweet corn, butternut squash, black bean, French onion, carrot/ginger, red pepper/tomato, or curried red lentil, available at health food stores and many supermarkets (visit or

1 10-ounce package of frozen vegetables or, if you have time, 3 to 4 cups peeled (if necessary) and chopped fresh vegetables (such as zucchini, carrots, mushrooms, spinach, or green beans)

1 cup mild, medium, or spicy tomato salsa

1 cup chopped tofu or soy ground beef substitute (optional)

1 15-ounce can kidney, garbanzo, pinto, or other beans (optional)

Mix everything in a soup pot. Heat and eat. This soup is hearty enough for a meal. Refrigerated, it keeps for several days. If you have access to a microwave, it's great for lunch at work.

--Published with permission from Building Bone Vitality: A Revolutionary Diet Plan to Prevent Bone Loss and Reverse Osteoporosis, by Amy Lanou and Michael Castleman (McGraw-Hill, June 2009)