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2011-04-27 Amy Joy Lanou PhD Bone Health: Why Calcium, Estrogen and Drugs Aren't The Answer

April 27, 2011, By Kirkham R. Hamilton, PA-C
8 copyright 2011, Prescription 2000, Inc.
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KIRK HAMILTON: Hi, my name is Kirk Hamilton your host of Staying Healthy Today. And our mission is simple: To provide you credible usable health information from interviews and our educational resources to help you Stay and Be Well in the busy modern world. Please take a few moments before or after listening to this interview to browse through the Prescription2000.com website, the home of Staying Healthy Today Radio, for our free educational services.

Today's show topic is "Bone Health: Why Calcium, Estrogen and Drugs Aren't The Answer." Our guest today is Dr. Amy Joy Lanou, an Associate Professor of Health and Wellness at the University of North Carolina, Asheville. She is also co-author of the book entitled, "Building Bone Vitality. A Revolutionary Diet Plan to Prevent Bone Loss and Reverse Osteoporosis; Without Dairy Foods, Calcium, Estrogen or Drugs."

So welcome, Dr. Lanou. Thanks so much for coming back to the show today. Last time you were here was, oh gosh, in 2009, and you had just released your book. So again thank you for being on the show today.

DR. AMY JOY LANOU: It's my pleasure to be here.

KIRK HAMILTON: So tell me. What's happened with this wonderful book of yours, "Building Bone Vitality. A Revolutionary Diet Plan to Prevent Bone Loss and Reverse Osteoporosis." What's the kind of feedback?

DR. AMY JOY LANOU: Well I feel like we've gotten a really good response from the general public, from individuals who are interested in learning more about how to take good care of their bones. And I think I've felt great about the response at that level.

KIRK HAMILTON: The public level. How about your peers?

DR. AMY JOY LANOU: Well it's pretty interesting. Among my nutrition peers there's you know, people are like, "Wow I think you are really onto something!" I have a colleague, for example, up in at Penn State who has been saying for a long time we are going to be B the whole nutrition community is gonna be embarrassed when this information, when the information gets clearer that calcium or adding calcium to the diet isn't doing what we think it's been doing. And we're gonna be embarrassed. So there's been, I think there's some general agreement, although not complete agreement at all that we're onto something here. That there's, that the literature is pretty clear and we're gonna need to do some back-stepping and figuring out what we can do to improve opportunities for taking good care of bone.

KIRK HAMILTON: Well you know I was at a conference at UCSF and the endocrinologist gets up to talk about bisphosphonates and bone. And I swear I think he, your book must have been crossing his path and he was somewhat frustrated with it. He didn't say the name, but what he said was, "Yeah and those alkaline diets." And he made this comment, and I just flashed to your book because, I don't know if he was referring to it all, but he said patients come in and talk to him about alkaline diets and bone loss and blah blah blah. So maybe you're walking down that path and you shook a little roots here. But I want to start off, basically the premise to back up for some people. You know, what is the basic premise of "Building Bone Vitality" if it's not calcium?

DR. AMY JOY LANOU: Well, I think there's kind of two main messages in the book. One of them is that we've really, we as a nutrition and medical community, but nutrition community in particular, have sort of over focused on the importance of a single nutrient for bone health. And really we've put way too much emphasis on the single nutrient calcium. And the research now is showing particularly if you look at the end point of fracture rate that adding more calcium to the diet beyond the sort of 500, 600 mg that might, we thought would be necessary for a long time, isn't helping us reduce fracture rates. So that's sort of one, one piece of it. And the other piece of it then is well what can we do. What kinds of things are important from a nutrition and lifestyle perspective relative to bone health. And I think that's the other main focus of the book is that it's dietary patterns that really matter. And it's the balance of, nutrients that are alkaline forming as compared to nutrients that are acid forming that ends up mattering.

KIRK HAMILTON: So let's talk about how does, I mean your body buffers itself very well, the blood does. So when you say acidifying, why would acidifying cause bone loss, number one, and why would it not be buffered in some shape or form by the body?

DR. AMY JOY LANOU: Well the problem is, is that it is buffered by the body. And what we used, one of the things that we use to buffer acidity in the blood stream is calcium compounds in bone. And so it is the body's ability to do a good job of combating dietary acidity with its own components right with it's building blocks as it were from a nutritionist's perspective that is what's getting us into trouble. So it's not that we, our bodies aren't good at buffering acidity, they are. But it's that action, that buffering action, that is actually causing an increased loss of calcium from the bone at least in people who have highly acid diets.

KIRK HAMILTON: So what are the factors in the Western diet? I mean I think we are talking about that, that increased acidity and cause bone loss.

DR. AMY JOY LANOU: Well the sort of original research that sent us down this path is this, the finding that there's a strong relationship between hip fracture rate in, or a risk of hip fracture or hip fracture rates in countries that consume diets that are high in animal protein. So one of the factors that increases this, that looks like anyways related to this increased risk of hip fracture is animal protein in the diet. We also have a nice body of literature that shows that fruit and vegetable consumption in particular, and plant-based diets more generally have a, seem to have a bone sparing effect, or the hip fracture rates are lower in diets that are richer in plant foods and particularly richer in fruits and vegetables. And so that is sort of what kind of led us to the path of looking at what is it about those, those dietary patterns that might be causing this difference in hip fracture rate.

KIRK HAMILTON: Well let me be the devil's advocate because I interviewed Loren Cordain, who's the author of the "Paleo Diet," and his dietary approach would be, you know, 50 to 60% of the calories come from wild animal food so to speak, free range animal food, and then the rest is fruits, vegetables, nuts and seeds. And while he acknowledged that there was some spilling of calcium in the urine, he said the net effect was because IGF1 was increased with animal food consumption, that there was a net calcium absorption. And so he felt very strongly about that, you have to look at it like a piggy bank, you just can't look at it as you know what causes loss. You have to add up what causes enhanced absorption. So that was one thing. And then he would bring in hunter/gatherer populations and why don't they have rampant bone loss. So that was number one. Number two, he brought out a point that grains, because I know you're a vegetarian and I'm a vegetarian and you know I support that lifestyle, but grains are an acidic food, correct?

DR. AMY JOY LANOU: Yes, yes.

KIRK HAMILTON: So his big things was you know refined grains and grains in general because we consume so much would be more of a problem than the animal food because number one they are acidic. I don't know if they're quite as acidic as animal food, animal protein, but they're acidic. And two is that they have a lot of anti-nutrients in them from his perspective. So you know I wonder how you would answer that.

DR. AMY JOY LANOU: Yeah, and I think those are good points. And I would agree that what matters is the overall lifestyle and dietary package, on bone health. Right. Hunter/gatherers if they are truly are hunter/gatherers, have a lot of physical activity to hunt and gather. So that's another really important piece. If you are a sedentary person consuming a diet that is 50 to 60% animal foods and otherwise fruits and vegetables and very little grains you may not see that same kind of benefit on bone that he's citing in the hunter/gatherer population. So it's not diet only that matters but I think the overall dietary pattern or lifestyle. So that's I think to the first point. And now I've forgotten the second point.

KIRK HAMILTON: Oh, it was the grains.

DR. AMY JOY LANOU: Oh, the anti-nutrients and the IGF1. Well it's interesting. I mean, it's interesting to me. IGF1, it is true that higher levels of IGF1 are bone promoting, bone growth promoting. And that's one of the reasons bone growth, people, humans have higher IGF1 levels when they're young because they're growing and they're growing new bone so that is, that connection is correct. In adults having higher levels of IgF1 isn't always a good thing. If you're no longer growing and you have higher levels of IGF1 you may, we see a connection in the literature between higher levels of IGF1 and increased risk of breast cancer, increased risk of prostate cancer. And so there's some, you know I would almost, if I had the opportunity to speak with Dr. Cordain, I would put it back to him and say but hey what about this overall, what about this piece of the overall picture.

KIRK HAMILTON: Well I'll answer it for you because I got into a round robin with him a little bit and I read his papers and basically he would say that IGF binding protein goes up and so therefore in animal food versus a dairy product, dairy products he's very much against because the IGF binding protein doesn't go up and insulin goes up. But in meat protein he said that the IGF binding protein does go up so that helps reduce the cancerogenic effect of the meat.

DR. AMY JOY LANOU: That's interesting.

KIRK HAMILTON: So that's that argument. I mean, because it made me think. But his biggest thing, because he's an anti-grain kind of guy, because it's (grains) something that we didn't evolve with. He believes that they're somewhat acidic and also that the fact that they have a lot of anti-nutrients and so that was his big thing. He says that's more of a concern to him, so.

DR. AMY JOY LANOU: Yeah, and that's really interesting. I mean there's a fair amount of research that's been done looking at the calcium absorption fractions from vegetables but not as much, from the impact of grains on calcium absorption. So I think there, there may be something to be said for that. I would argue that our overall dietary patterns in the U.S. and in a lot of the Western Europe is so high in both dairy and meat that we've gotten ourselves into, and really not that high in grains. High in sugar but not that high in actual whole grains. In fact, most of us in eating Western diets are consuming what I would suggest is far too little complex carbohydrate from fruits, vegetables, grains or legumes. Now, I'm not particularly a grain promoter. I'm happy to see people get it from any of those plant-based sources provided they're whole foods, but I think the one place that Paleo diet, and those of us
promoting and interested in the health benefits of entirely plant-based diets, is that we're all talking about whole foods. And I think that's a place where there's some really strong cross-over.

KIRK HAMILTON: Well I, there is common ground. He wouldn't, I mean I don't want to get into a Paleo discussion here with you. But I mean it comes from that, because basically you know his diet is a low glycemic diet, it's like an unrefined plant-based diet, you know it's rich in fruits and vegetables. He's not a dairy guy at all. I mean, very anti-dairy. But that brings up a point that I want you to comment on. There's a quote, the chapter in your book entitled "Countries That Consume The Most Milk, Dairy Products and Calcium Supplements Suffer The Most Fractures." Now I say that to patients you know and they kind of look at me like I'm an idiot. And I try and dig it out of your book. But can you go over that a little bit because that is a huge statement. You can't deny it if the facts are there.

DR. AMY JOY LANOU: Yeah. Thank you, yes. Um, there have been a series of studies, most of them done in the 80s and early 90s looking at the fracture rates in different countries and trying to correlate that with dietary patterns in different countries. And the consistency of the series of studies helps us to feel comfortable in saying that so strongly. Meaning if there was only one correlation study suggesting that Norway, Sweden, Denmark, the U.S. and the United Kingdom had higher hip fracture rates than places in the world where dairy and meat intake are much lower, we wouldn't have, we wouldn't have the same sort of oomph behind that statement. But because it's been repeated in so many studies at this point it seems pretty, like quite strong evidence.

KIRK HAMILTON: Has anybody done a study, taking you know your plant-based diet approach, a whole food plant-based diet approach, and taking some people who have bone loss, and see if it improves or slows it, or negates it or improves bone density?

DR. AMY JOY LANOU: We need that study.

KIRK HAMILTON: Yeah.

DR. AMY JOY LANOU: Absolutely we need it on a large scale over a long term. One of the problems is with dietary pattern research in general, and that's across all different types of dietary patterns, and particularly in bone health research is that it takes such a long time to see a, it takes such a long time to see an effect that it's hard to get those studies funded. And when it's a dietary pattern approach to improving long term health or reducing chronic disease risk, there's very little,it's very difficult I should say to get the big dollars to do those long term studies.

KIRK HAMILTON: Now in your...

DR. AMY JOY LANOU: That's not to say it shouldn't be done, we need it, and you're right. It doesn't exist in that particularly in a randomized control trial form.

KIRK HAMILTON: So your theory then is taking fractions of research and putting together to build a model? I mean if that's, if it hasn't been shown in sense of putting it all collectively together, that's what you're doing, correct?

DR. AMY JOY LANOU: Exactly.

KIRK HAMILTON: Okay.

DR. AMY JOY LANOU: Yes. There are cohort studies. There's lots of epidemiologic research. There's studies that show that the mechanism is correct. But there is no random, that I'm aware of, there's been no randomized control trial of an entirely plant-based diet with 60 minutes of exercise most days of the week to show that with people with chronic bone loss, to show that that has improved it.

KIRK HAMILTON: So let's talk about sex hormones for a minute because you say you know in part of the cover of your book, the subtitle, "Why Calcium, Estrogen and Drugs Aren't The Answer." I'm a big fan of studying healthy aging populations and one of my favorite books is "The Okinawa Program " because they actually did a 25-year study on the centenarians and they actually took blood levels of certain things. And when you look at their centenarians, their estrogen levels are higher, well age matched they're higher. So are the DHEA levels and a few other things. Now that can mean you're healthier just in general and you maintain your sex hormones longer. They're not taking it (hormones). But you say estrogen isn't the answer but are you saying that why?

DR. AMY JOY LANOU: That's a good question. Thank you. It's, the reason we took that approach is because of the concerns with long term use of estrogen replacement therapy. And similarly we're recommending against, or I should say we're recommending for using a dietary approach, a dietary and lifestyle approach to taking good care of our bodies and reducing risk of chronic disease including bone loss rather than let's take some external hormones, let's take a drug, let's take some nutrient supplements and see if we can possibly reduce those risks. So the overall, so the overall answer to your question has to do with the combination of the safety of taking a lifestyle and dietary approach compared to the safety of taking a pharmacologic approach.

KIRK HAMILTON: Okay. The 500 milligrams a day that you come up to recommend, does that come from the World Health Organization? Didn't you say somewhere, I don't want to misquote you, that the World Health Organization recommends 500 mg of calcium a day and is that from their research. That they feel that, plus a more whole food type of diet, will prevent bone loss?

DR. AMY JOY LANOU: Yeah. I try to be careful about making a specific milligrams of calcium recommendation a day, but in the World Health Organization does in one of their documents where they're talking about the calcium paradox, does say that they recommend in countries where fracture rates are high that adults should consume between 400 and 600 mg of calcium a day. The World Health Organization also has a table of calcium, recommended calcium levels that is, looks a little bit more like an average of all of the different countries ideas about the amounts of calcium that we should be consuming. What I'm sure of is that 1200, 1400, 2000 mg a day is not better than 600, 700 and 800. But what I can't tell you is, and I don't think the research is there. What I can't tell you is here's the right amount for you. It's somewhere under 1000 and it's somewhere over 500, but I don't know what the exact number is, 500 or over.

KIRK HAMILTON: We are talking to Dr. Amy Joy Lanou, co-author of the book "Building Bone Vitality. A Revolutionary Diet Plan to Prevent Bone Loss and Reverse Osteoporosis Without Dairy Foods, Calcium, Estrogen or Drugs." Can you in brief, go from the alkaline foods through the most acidic foods, just so people get a picture of what more foods they should eat to create a more alkaline diet?

DR. AMY JOY LANOU: Sure. The foods that are the most alkaline forming would be dried fruits, are the highest in general. And then all of the vegetables. So fruits, dried fruit, fruit, dried vegetables if you consume dried vegetables. Not a lot of people do, vegetables. And then sort of in the middle, more central, sort of closer to neutral, would be things like beans, some types of grains, even fluid milk. Those are kind of near neutral. And then the things that are more acidic or acid forming are eggs, yogurt, fish, meats, the more processed, a lot of the more processed grains, processed grains sort of in the oh 3-4 range. Most meats in the 8-9 range. And I think our biggest acid former are the cheeses. And they tend, the hard cheeses are up around 15 to 20, whereas the softer cheeses are sort of more similar to the meats and the sort of 10 to 12 to 15 range. So that's kind of a quick view. Beans, I think I might have said that, are somewhere more neutral.

KIRK HAMILTON: So the goal then is if you eat, let's say you ate an acid-forming food that you want to balance it with more fruits and vegetables generally, correct?

DR. AMY JOY LANOU: Exactly.

KIRK HAMILTON: And you have charts in your book that I've seen that you know kind of give you a ballpark equation of how to create 0, so to speak, or...

DR. AMY JOY LANOU: Yes.

KIRK HAMILTON: Ok.

DR. AMY JOY LANOU: Yes.

KIRK HAMILTON: Tell me about plant protein versus animal protein. You've talked about animal protein and your belief that it causes you to spill more calcium to buffer the blood. How about vegetable protein? A soybean, nut or seed? What does that do? Is it the same or different?

DR. AMY JOY LANOU: Well, there's kind of, there's two things going on here. The way that the acid or alkalinity of a food is calculated is based on its potential renal acid load and using that calculation you wouldn't actually see a difference between plant proteins and animal proteins. But because what's calculated in there is amount of total protein, amount of total phosphorous, those are sort of, make it more acid and then the amount of calcium, magnesium and potassium which would make the food more alkaline forming. So using the calculation you wouldn't see a difference between them, based on the protein itself. You wouldn't see a difference. There is some interesting work though, that shows ecologically, from an ecologic perspective, that diets richer in proteins from plant foods don't have the same negative impact on bone that diets rich in animal proteins do. So there's like, maybe there's something else going on here. And one of the theories behind it is that there's an effect of the sulfur-containing amino acids, which are an acid-forming effect of the sulfur-containing amino acids, which are more prevalent in animal based foods than they are in plant-based foods.

KIRK HAMILTON: So would you say that in review of your approach it's the lifestyle, the diet, that creates the alkaline diet and more plant-based obviously, sunlight and exercise? Is that kind of your triad?

DR. AMY JOY LANOU: Yes. I would say focusing your diet around whole plant-based foods, moving very regularly, doesn't have to be a lot and it doesn't have to be high intensity. And yeah, get outside and play.

KIRK HAMILTON: So is there sunlight in Asheville right now?

DR. AMY JOY LANOU: You know, when I started the call it was pouring and now the sun is peaking through.

KIRK HAMILTON: See, that's cuz you're doing my show! That's why!

DR. AMY JOY LANOU: That must be it.

KIRK HAMILTON: Bringing light to the world!

DR. AMY JOY LANOU: Yay!

KIRK HAMILTON: Mark in the next window is dying. Well, is there any last parting comments you'd like to make on diet and bone loss?

DR. AMY JOY LANOU: I think you've asked some great questions. Just, I guess that people might want to know that they have a lot of control over their own quality of life as they age. And we can, no matter what, where we're starting with, we can make a lot of progress simply by making some pretty straightforward easy to manage changes in our lifestyle in the ones that we just mentioned.

KIRK HAMILTON: Alright, and your book is available at Amazon, of course, and other...

DR. AMY JOY LANOU: Yes.

KIRK HAMILTON: ...areas?

DR. AMY JOY LANOU: Yes.

KIRK HAMILTON: Okay Dr. Lanou. Thank you so much for coming on the show today. I really appreciate it. It's nice catching up after a year and-a-half or so. It's a fast year.

DR. AMY JOY LANOU: Yeah, my pleasure.

KIRK HAMILTON: And I wish you just great success with your book. And anytime you get a new one, let me know.

DR. AMY JOY LANOU: Will do. Thank you, Kirk, it's good to talk to you.

KIRK HAMILTON: Good to talk to you. And I want to thank you, the audience, for listening to this edition of Staying Healthy Today Radio. And until next time, Stay and Be Well.

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