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2009-05-18 Amy Joy Lanou PhD Bone Health

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Welcome to Staying Healthy Today, a health-oriented radio show committed to bringing you key experts in the fields of nutrition, prevention and integrated medicine.

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Today's show topic is "Why Calcium, Estrogen and Drugs Aren't the Answer to Bone Health." Our guest today is Dr. Amy Joy Lanou, PhD, Assistant Professor of Health and Wellness at the University of North Carolina in Asheville. She has taught Nutrition at Cornell University and Ithaca College. She is the author of "Healthy Eating for Children." She has written or delivered more than 50 scientific articles, reports and presentations with an emphasis on bone health and the benefits of low acid eating. In 2005, she testified before a committee that revised the USDA food pyramid and urged them to embrace the low acid approach to bone health and diet. She is also senior nutrition scientist for the Physicians' Committee for Responsible Medicine, a Washington DC based nonprofit organization dedicated to promoting preventive medicine through good nutrition. Dr. Lanou received her B.S. in Nutrition Science from the University of California at Davis in 1985 and her PhD in Human Nutrition from Cornell University in 1994. Recently, she has co-authored a book with Michael Castleman entitled "Building Bone Vitality: A Revolutionary Diet Plan to Prevent Bone Loss and Reverse Osteoporosis - Without Dairy Foods, Calcium, Estrogen and Drugs." She also recently authored a paper entitled "Should Dairy Be Recommended as Part of a Healthy Vegetarian Diet? Counterpoint" in the American Journal of Clinic Nutrition, 2009, supplement 89, page 1638.

KIRK HAMILTON: I want to welcome Dr. Amy Joy Lanou for coming on the show today, and thank you for coming, Dr. Lanou.

DR. AMY JOY LANOU: It's my pleasure.

KIRK HAMILTON: Can you take a few moments and share with us your educational background and what you're doing right now and your current interests?

DR. AMY JOY LANOU: Sure. I did my undergraduate work and my graduate work in nutrition. My undergraduate degree is from U.C. Davis, and my Ph.D. is from Cornell. I was looking at human nutrition and predominantly looking at the relationship between diet and disease risk. I am currently working at University of North Carolina, Asheville, as an Assistant Professor in the Department of Health and Wellness.

KIRK HAMILTON: What does the Health and Wellness group teach? Is that to undergraduates or is that to a medical school?
DR. AMY JOY LANOU: We are almost exclusively an undergraduate institution. It's a small to medium-sized public liberal arts college. So it's an interesting place to be a nutrition and health teacher because I get to work with students with interests across all sorts of fields.

KIRK HAMILTON: Well, I must say, you caught my attention when I was going through the American Journal of Clinical Nutrition and the article there, "Should Dairy Be Recommended As Part Of A Healthy Vegetarian Diet? Counterpoint." Then as I got to know a little bit about your background you've written a book called "Building Bone Vitality: A Revolutionary Diet Plan to Prevent Bone Loss and Reverse Osteoporosis - Without Dairy Foods, Calcium, Estrogen and Drugs." That almost seems heretical, that last part, to what we've been hearing and from my own perspective. I'll just get my bias out front. Just from a clinical point of view, there are few foods that I've found wreak more havoc in patient's lives symptom-wise than dairy foods. I've been giving people therapeutic trials off dairy products for more than 25 years. And there's not a symptom that I haven't seen improve in one shape or form with elimination of dairy products, which isn't the only reason to do that. So, with that in mind, when did you begin to question that a lot of calcium is needed for bone, and cow's milk products as the source of calcium that is necessary to prevent bone loss and fractures?

DR. AMY JOY LANOU: I had the great fortune to work with T. Colin Campbell shortly after I finished my Ph.D., and as part of the work that I was doing with him, he was teaching a course on vegetarian nutrition. I was working with him and I was also teaching at Essex College at the time, and he invited me to sit in on his vegetarian nutrition course and the day he did his lecture on milk I was flabbergasted. I had gone through, by that time, something like 12 years of post-high school education and teaching about nutrition and I had never seen the data that he showed, which was study after study showing all of these concerns about the impact of cow's milk or specific components of cow's milk on health and chronic disease. It was then that I was first alerted to the fact that the data is really poor connecting dairy or calcium, specifically to bone health, and that sort of started me down this path, and that's some probably 15 years ago now. I felt like maybe kids do when they learn that there isn't a Santa Claus. It's like you figure out that your parents don't know everything, but I was already teaching and I was like - oh my gosh! What if I've been wrong? What if I have been recommending a food to people that is really doing them more harm than good.

KIRK HAMILTON: Can you name some of the key points that Dr. Campbell mentioned about the harmful effects? I know, I've read the China Study, but a little bit about, for example, that milk protein has a higher risk to causing hepatic cancer if you're exposed to a toxin. Can you mention a couple of those pearls that he stated?

DR. AMY JOY LANOU: You know, he did a lot of work with casein, the proteins in milk and cancer risk. And that data I think is particularly interesting and scary, and now we're learning more and more at the population level about these relationships. The relationship between prostate cancer and dairy consumption and the relationship between breast cancer and dairy consumption and ovarian cancer. So there's a whole number of these. But I think the data that impressed me the most at that time was the relationship between dairy ingredients and heart disease, and I hadn't seen that at all, and myself was very concerned about getting heart disease because I learned when I was in college that I had high cholesterol. And so it was very striking for me to see this - it wasn't all his own data, it was just data that he had gathered about these health concerns associated with milk consumption. And, of course, the type I diabetes and, I mean, he just went through this whole laundry list of studies showing that there were some reasons why we should be thinking about whether or not this is a food we want to be putting in our bodies, and certainly whether or not as a teacher you want to be recommending dairy products as part of a healthy diet.

KIRK HAMILTON: Let's talk about the data regarding calcium and milk product intake in countries that have the highest amounts of intake, and does that correlate with improved bone health and reduced fracture risk?

DR. AMY JOY LANOU: Well, no. That's what I think is really amazing. I think it was the World Health Organization looking at the data worldwide that kind of brought what they called a calcium paradox to our attention. And that is exactly what you're talking about, is the countries where dairy consumption is lowest or where calcium consumption is lowest, are the places where hip fracture rates are lowest or sort of the downstream effects of osteoporosis are at the lowest levels, and it's exactly opposite of what you think. In the countries where we consume a lot of dairy, drink a lot of milk, have dairy in our national dietary guidelines, these are the places where osteoporosis risk is high and hip fracture rates are the highest.

KIRK HAMILTON: Is that due to the unhealthy American diet which just happens to be full of dairy products? Or is there something innately in consuming dairy products that counter-intuitively or factually causes adverse effects on bone?

DR. AMY JOY LANOU: That's actually a very good question. It's my understanding from looking at the literature is it's really our dietary pattern. It's really our dietary pattern overall. It's the fact that we're consuming so much food from animal sources, so little food from plant sources as a nation or as a culture, and that puts our bodies out of balance in such a way that it actually pulls calcium out of the bones and into the blood and then on out in the urine. So we have a problem of we're pouring a lot of calcium into our food supply, but we're pouring it right on through because of our overall dietary pattern that's high in protein, that's high in particular animal protein, that's high in salt and low in vegetable foods, those foods that actually help us keep calcium in our body and in bones.

KIRK HAMILTON: What is the biochemistry of a higher animal protein diet that causes calcium spill?

DR. AMY JOY LANOU: Basically, what happens when we use, particularly use protein for energy, not so much when we're using protein to make body proteins, but when we use protein for energy, we increase the breakdown of protein. When we're using it for energy, we increase the acidity of the blood and our body likes to have blood that's very close to neutral. So what happens is that we have to pull calcium compounds out of blood or out of bone to neutralize that acidity and then the calcium compound plus the acids get sent out through the kidney and into the urine. So it's the actual metabolism of those foods. People often ask me about this acid based thing, and they say, well, oranges taste acidy, tomatoes taste acidy, but they actually don't create an acid ash in the blood because it's not the acidity of the food that's the problem, it's the breakdown products. Not even the digestive product, but the breakdown product of those amino acids when they're used for energy that creates that out of balance, or lack of balance, or increased acidity in the blood.

KIRK HAMILTON: Then, when you look at foods (animal protein) they have an acid ash effect to them. Is it vegetables and fruits that make an alkaline ash? And then animal protein is an acid ash? But aren't whole grains neutral or sometimes they can be acid ash, too? Or am I wrong on this?

DR. AMY JOY LANOU: They can, yes. I mean, one of the interesting things is just how may different acid producing foods are, or base producing or alkaline producing. So, yes, the fruits and the vegetables are the most alkaline. And some of your dried fruits per serving have the highest alkalinity to them relative to the acid based balance in the blood. And interestingly, among the animal foods, cheese has the highest acid load or creates the highest potential renal acid load, whereas milk is not as high, meat is sort of in between those two, eggs in between those two, and actually a lot of the proteins and vegetable foods are closer to neutral, like beans, are closer to neutral. You're right, some of the grains as well. Particularly wheat, interestingly, is a little bit to the acid, but if you think of - I don't have the numbers in front of me, but if 0 is neutral, grains might be about 4. Most acid grains might be about 4 on the scale. Cheese is 20 or 25, meat around 10. So, you can see that in the scales - it's the animal based foods, even though there are some plant-based foods that are acid producing, are much lower. So it takes a lot less fruits or vegetables to counteract the acidity of a grain than it does to counteract the acidity of a slice of cheese.

KIRK HAMILTON: You know, it's interesting you brought up the cheese because I am working on a book project, and one of the things I did was I looked at food intake patterns over the last century. The government actually has those intakes from 1909. Food availability patterns. And if you look at milk products, beverage milk has actually gone down over the last century. But cheese has skyrocketed in the last 50 years in particular. I mean, the graph is mind boggling. So, when you said that, I take a lot of people off dairy products, cheese is the number one thing. I don't see as many people drinking whole milk as much as I see people just consuming cheese massively and it's on every kind of food when you go out, and it's very, very addictive. And when you said that, that really rings true to me because cheese is such a popular food. When I ask people to stay off dairy products and especially cheese, they look at me like, honestly, I've said the world is flat or I'm a communist or something like that. I mean, it's -

DR. AMY JOY LANOU: I do absolutely understand. It's like people say, "Well I don't drink any milk at all, but I could never give up my cheese." I'm like, you need to reset your priorities if you want to take care of your bones.

KIRK HAMILTON: The whole casomorphin thing, whether that's true or not, you know, I like to throw that at the patients. But I do know one thing that I can say with almost 100% certainty, is if someone will stay off cheese for three weeks, the cravings goes away. It's not a week, it's for whatever reason it's about two or three weeks and then the cravings tend to go.

When you say in your article, and you probably say this in your book as well, that number one, you don't have to take a calcium supplement, and two the level of intake is 500 mg of calcium per day, that again is almost heretical, but you read, see, hear - I have the figures in front of me. The DRI for children between 4 and 8 years of age is 800 mg a day, and then for teens is 1300 mg a day, and for adults between 19 and 50 it's a 1000 mg per day. That's a pretty bold statement to say, "Consume 500 mg of calcium in your diet and your bone density will be okay." Comment?

DR. AMY JOY LANOU: I got that figure from the World Health Organization and what they've done is they used to use numbers similar to ours. But if you look at the report that is about how to reduce chronic disease, the only recommendation they make for calcium is 300 to 500 mg a day for adults in those places in the world where hip fracture rates are particularly problematic. So they don't even make any recommendation for calcium for adults for osteoporosis prevention in places where it's not a major concern. And what they're doing is they're looking at the data from a different perspective. The U.S.'s and I think this would be fair to say, for the European Union, for the most part, as well. We've based our calcium recommendations on short-term balance studies. How much calcium do you have to pour in to make sure that the amount you are pouring in is equal to or greater than the amount that's coming out when you're pouring that in, by drinking it or eating it. And that depends to a large degree on what the overall diet is. So, if the overall diet is the kind of diet where calcium is going to be dumped back out, or the absorption fraction from the calcium rich foods is low, then those numbers are going to get pushed higher and higher in order to achieve balance. And so our numbers are set artificially high based on a dietary pattern that is not health promoting.

KIRK HAMILTON: You compare the absorption of elemental calcium from dairy foods versus from vegetable foods. Can you comment on the difference between the two? The bioavailability?

DR. AMY JOY LANOU: Yes. Milk typically, fluid milk, the absorption fraction is around 30 to 32%. Actually, roughly the absorption fraction from some of the better supplements, as well, is around 30 to 32%. The absorption fraction from beans and dark leafy greens with the exception of spinach, but all of the cabbage family vegetables, all the other dark leafy greens, is up in the 55 to 60%. So it's nearly double. The amount of calcium that's absorbed from the food or percentage is doubled from those beans and greens - from those plant-based calcium rich food sources.

KIRK HAMILTON: I had no idea that beans were that rich of a source of calcium. How about my favorite? Is spinach? You just shot me in the heart!

DR. AMY JOY LANOU: Well spinach, unfortunately, has another substance in it that gives it part of it's characteristic flavor and mouth feel that reduces the absorption fraction, so the absorption fraction from spinach is closer to 10%. So, if you eat a whole lot if it, you'll still get a reasonable amount and certainly there's a lot of other wonderful reasons to eat spinach, but I wouldn't rely on spinach as your one calcium food source.

KIRK HAMILTON: So, in your book "Building Bone Vitality," you're not recommending dairy foods or calcium, estrogen or drugs. So, can you go down your list from diet to exercise, whatever else you would recommend? Can you do that?

DR. AMY JOY LANOU: I certainly can. So the main thing would be to increase the fruits and vegetables in your diet. Especially, if you're eating anywhere near the standard American diet levels of less than five servings a day. I think most of us are, on average, in the two to three servings a day. Two serving at every meal, a fruit or vegetable at every meal. Have your snacks be fruits and vegetables. Overall, limit or completely avoid foods from animal sources, and those are kind of the big diet dietary recommendations. The other thing is move. Particularly get outside in the sunshine and move if you happen to live someplace where the sun does shine, and hopefully all of your listeners do. But I think that's another really important piece of the puzzle - is giving your bones a reason to live. When you use your bone, just like when you use your muscle, it stimulates the growth of new bone. It stimulates rebuilding bone cells. So, not only do we have to the right nutrients in the body for bone, we need to be able to get those nutrients from the body into the bone, and we can do that in part - one of the helpers for that is vitamin D, and we make vitamin D by exposure to the sun. So getting some sun exposure is another really important piece. So gardening is a fantastic activity. Grow some fruits and vegetables, get outside in the sun, use your back, use your shoulders, use your wrists, use your hips, and together that combination will help to improve your bone vitality throughout your life.

KIRK HAMILTON: How about if someone is eating the typical American diet? They're not on this other one yet. Can you pick out certain things that might be highlighted to change if you're already doing the bad habits?

DR. AMY JOY LANOU: Well, I think the focus would be on really trying to rebalance away from animal foods towards plant foods and in particular - one good place to start would be to look at how many servings of fruits and vegetables you're consuming. If you aren't getting any, or just one or two a day, figure out a way to shift your diet so that you're consuming more fruits and vegetables. I'd say that's kind of the highest priority, because that will help with acid based balance even if you're consuming a lot of these high acid foods. And then walk your dog or get outside and move.

KIRK HAMILTON: Got it, more fruits and vegetables and exercise for the average American, a place to start. Can too much plant protein cause hypercalcuria, like animal protein?

DR. AMY JOY LANOU: Well, that's actually a really good question. There's a few studies that have looked at that and found that a plant protein diet doesn't have anywhere near the calcium excreting effect. Plant proteins or diets that are rich in plant protein tend not to dump as much calcium in the urine as one rich in animal protein. The theory behind that is has to do particularly with some of the types of amino acids that are more prevalent in meat. But I would definitely recommend moderating protein intake. One of the things that I've seen happen in the years that I've been on earth is our, at least in the U.S., is there's kind of a love affair with protein and I think that we should really be thinking about meeting our protein needs, but not meeting them at twice the level of what we are expected to need. We need about 10 to 15% of the calories as protein. And that's actually set high to make sure it's enough for everybody, or about 0.8 gm/kg up to maybe twice that much if you're an athlete, particularly an endurance athlete or a strength athlete. But, it turns out that that's not a very large proportion of the diet. Even if you need 1.6 gm/kg body weight. It still might be - it's still usually around 10 to 15% of calories because if you're exercising at that level you need higher calorie intake as well.

KIRK HAMILTON: You've made it pretty clear that the more alkaline ash diet, rich in fruits and vegetables, more plant protein, less sugar, less salt, more exercise, more sunshine, is the way to go. How did this occur, this such strong belief, that 1) we needed so much calcium and 2) we needed it from dairy products? Maybe certain power structures support research in that area because it economically helps different industries? Is that the reason?

DR. AMY JOY LANOU: Well, I think that's the reason our cheese intake has - I know in the last 30 years our cheese intake has tripled, and that has been by design. The National Dairy Council and the USDA and fast food companies have partnered together to increase our cravings for cheese and increase our interest in cheese and increase our consumption of cheese. The kind of bigger question, or maybe the bigger answer is there's kind of a logic to it. If you start to understand osteoporosis, that osteoporosis is loss of calcium from bone, and we started to understand where you could get calcium in the diet, there was kind of this logical leap that went from, okay, if osteoporotic bone is bone that has lost mineral and we know that food has lots of mineral in it, then if we just add this food to the system then with any kind of luck that would mean that we will have stronger bones. Well, it turns out that that logic just hasn't made sense. But, my sense is that we've wanted to believe it, as a nation anyways, we've wanted to believe. And you're right, there are certainly some economic pressures that have kept that in place because it is one of the strongest, most lucrative industries in the U.S.. So, there's reason for government to want to support that industry. But I don't think it started from a place of-- I think it started from a place of logic and we've just had a hard time believing that our logic about that is wrong. But, the way I think about it is, it's like if you wanted to build a house and you have a building site and you bring a whole lot of bricks to the building site, they will just sit there in a pile unless you have somebody or someone to stack them together, put mortar between them, make sure the neighbors don't run off with wheelbarrows full of your bricks. So all we have been paying attention to is putting those bricks on the building site and what we need to pay attention to is how do we move them into the structural component of our bodies, the bones, and how do we get to keep them there, and that's a lot more than just adding more calcium to the system.

KIRK HAMILTON: We're talking to Dr. Amy Joy Lanou, and her book is "Building Bone Vitality: A Revolutionary Diet Plan to Prevent Bone Loss and Reverse Osteoporosis." And the key words here, the subtitle is " Without Dairy Foods, Calcium, Estrogen and Drugs." Do you have any final comments you would like to make? It's been very informative.

DR. AMY JOY LANOU: I'd like to thank you for your interest in this topic. I think it's such an important message and it's something that we can all, you know, we all have the ability to take better care of our bones simply by taking the attention off milk as the way to take care of our bones and moving it to eating more fruits and vegetables, getting some sun exposure and moving our bodies.

KIRK HAMILTON: Well, thank you, Dr. Lanou, for spending the time with me today. I really enjoyed it and I'm glad you're from my alma mater, as well. It's a small world, and we'll talk to you soon.

DR. AMY JOY LANOU: Great. Thank you.

KIRK HAMILTON: In closing, I would like to thank Dr. Amy Joy Lanou for her excellent work and her new book called "Building Bone Vitality: A Revolutionary Diet Plan to Prevent Bone Loss and Reverse Osteoporosis - Without Dairy Foods, Calcium, Estrogen and Drugs." And then also her excellent article in the American Journal of Clinical Nutrition regarding the role of dairy products in bone health. If I could summarize what she's encouraging is we need to create a more alkaline ash diet, and that is the way we burn certain macronutrients or foods. And to do that, the most alkaline foods are vegetables and fruit, and the higher animal protein diets that you have, the more likelihood there is a more acid ash burn in the body and the body takes calcium from bone to neutralize the blood. A total intake of 500 mg of calcium per day in the diet may be enough to achieve calcium balance if you have a diet that is more alkaline ash than the high animal protein diet, which is more acid ash like the typical American diet. Other things that you can do are to reduce salt intake and to reduce sugar intake. These can cause excess calcium spill. So get sunshine, get aerobic weight-bearing exercise, and again, eat more fruits and vegetables.

In closing, I want to thank you, the audience, for listening today on this edition of Staying Healthy Today Radio. And remember, until next time, Stay and Be Well.

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