Are Vegan Diets Bad For Your Bones?

The Secrets To A Healthy Vegan Diet

Author: Dr. Stephen Chaney

Frail ElderlyOsteoporosis is a debilitating and potentially deadly disease associated with aging. It affects 54 million Americans. It can cause debilitating back pain and bone fractures. 50% of women and 25% of men over 50 will break a bone due to osteoporosis. Hip fractures in the elderly due to osteoporosis are often a death sentence.

As I discussed in a previous issue of “Health Tips From The Professor”, a “bone-healthy lifestyle requires 3 essentials – calcium, vitamin D, and weight bearing exercise. If any of these three essentials is presence in inadequate amounts, you can’t build healthy bones. In addition, other nutrients such as protein, magnesium, zinc, vitamin B12, and omega-3 fatty acids may play supporting roles.

Vegan and other plant-based diets are thought to be very healthy. They decrease the risk of heart disease, diabetes, and some cancers. However, vegan diets tend to be low in calcium, vitamin D, zinc, vitamin B12, protein, and omega-3 fatty acids. Could vegan diets be bad for your bones?

A meta-analysis of 9 studies published in 2009 (LT Ho-Pham et al, American Journal of Clinical Nutrition 90: 943-950, 2009) reported that vegans had 4% lower bone density than omnivores, but concluded this difference was “not likely to be clinically relevant”.

However, that study did not actually compare bone fracture rates in vegans and omnivores. So, investigators have followed up with a much larger meta-analysis (I Iguacel et al, Nutrition Reviews 77, 1-18, 2019) comparing both bone density and bone fracture rates in vegans and omnivores.

How Was This Study Done?

Clinical StudyThe investigators searched the literature for all human clinical studies through November 2017 that compared bone densities and frequency of bone fractures of people consuming vegan and/or vegetarian diets with people consuming an omnivore diet.

  • Vegan diets were defined as excluding all animal foods.
  • Vegetarian diets were defined as excluding meat, poultry, fish, seafood, and flesh from any animal but including dairy foods and/or eggs. [Note: The more common name for this kind of diet is lacto-ovo vegetarian, but I will use the author’s nomenclature in this review.]
  • Omnivore diets were defined as including both plant and animal foods from every food group.

The investigators ended up with 20 studies that had a total of 37,134 participants. Of the 20 studies, 9 were conducted in Asia (Taiwan, Vietnam, India, Korea, and Hong-Kong), 6 in North America (the United States and Canada), and 4 were conducted in Europe (Italy, Finland, Slovakia, and the United Kingdom).

Are Vegan Diets Bad For Your Bones?

Here is what the investigators found:

Unhealthy BoneBone density: The clinical studies included 3 different sites for bone density measurements – the lumbar spine, the femoral neck, and the total body. When they compared bone density of vegans and vegetarians with the bone density of omnivores, here is what they found:

Lumbar spine:

    • Vegans and vegetarians combined had a 3.2% lower bone density than omnivores.
    • The effect of diet was stronger for vegans (7% decrease in bone density) than it was for vegetarians (2.3% decrease in bone density).

Femoral neck:

    • Vegans and vegetarians combined had a 3.7% lower bone density than omnivores.
    • The effect of diet was stronger for vegans (5.5% decrease in bone density) than it was for vegetarians (2.5% decrease in bone density).

Whole body:

    • Vegans and vegetarians combined had a 3.2% lower bone density than omnivores.
    • The effect of diet was statistically significant for vegans (5.9% decrease in bone density) but not for vegetarians (3.5% decrease in bone density). [Note: Statistical significance is not determined by how much bone density is decreased. It is determined by the size of the sample and the variations in bone density among individuals in the sample.]

Bone FractureBone Fractures: The decrease in bone density of vegans in this study was similar to that reported in the 2009 study I discussed above. However, rather than simply speculating about the clinical significance of this decrease in bone density, the authors of this study also measured the frequency of fractures in vegans, vegetarians, and omnivores. Here is what they found.

  • Vegans and vegetarians combined had a 32% higher risk of bone fractures than omnivores.
  • The effect of diet on risk of bone fractures was statistically significant for vegans (44% higher risk of bone fracture) but not for vegetarians (25% higher risk of bone fractures).
  • These data suggest the decreased bone density in vegans is clinically significant.

The authors concluded, “The findings of this study suggest that both vegetarian and vegan diets are associated with lower bone density compared with omnivorous diets. The effect of vegan diets on bone density is more pronounced than the effect of vegetarian diets, and vegans have a higher fracture risk than omnivores. Both vegetarian and vegan diets should be appropriate planned to avoid dietary deficiencies associated with bone health.”

The Secrets To A Healthy Vegan Diet

Emoticon-BadThe answer to this question lies in the last statement in the author’s conclusion, “Both vegetarian and vegan diets should be appropriate planned to avoid dietary deficiencies associated with bone health.” 

The problem also lies in the difference between what a nutrition expert considers a vegan diet and what the average consumer considers a vegan diet. To the average consumer a vegan diet is simply a diet without any animal foods. What could go wrong with that definition? Let me count the ways.

  1. Sugar and white flour are vegan. A vegan expert thinks of a vegan diet as a whole food diet – primarily fruits, vegetables, whole grains, beans, nuts, and seeds. A vegan novice includes all their favorites – sodas, sweets, and highly processed foods. And that may not leave much room for healthier vegan foods.

2) Big Food, Inc is not your friend. Big Food tells you that you don’t need to give up the taste of animal foods just because you are going vegan. They will just combine sugar, white flour, and a witch’s brew of chemicals to give you foods that taste just like your favorite meats and dairy foods. The problem is these are all highly processed foods. They are not healthy. Some people call them “fake meats” or “fake cheeses”. I call them “fake vegan”.

If you are going vegan, embrace your new diet. Bean burgers may not taste like Big Macs, but they are delicious. If need other delicious vegan recipe ideas, I recommend the website https://forksoverknives.com.

3) A bone healthy vegan diet is possible, but it’s not easy. Let’s go back to the author’s phrase “…vegan diets should be appropriate planned to avoid dietary deficiencies associated with bone health.” A vegan expert will do the necessary planning. A vegan novice will assume all they need to do is give up animal foods. 

As I said earlier, vegan diets tend to be low in calcium, vitamin D, zinc, vitamin B12, protein, and omega-3 fatty acids. Let’s look at how a vegan expert might plan their diet to get enough of those bone-healthy nutrients.

    • Calcium. The top plant sources of calcium are leafy greens and soy foods at about 100-250 mg (10-25% of the DV) of calcium per serving. Some beans and seeds are moderately good sources of calcium. Soy foods are a particularly good choice because they are a good source of calcium and contain phytoestrogens that stimulate bone formation.

A vegan expert makes sure they get these foods every day and often adds a calcium supplement.

    • Protein. Soy foods, beans, and some whole grains are the best plant sources of protein.soy

It drives me crazy when a vegan novice tells me they were told they can get all the protein they need from broccoli and leafy greens. That is incredibly bad advice.

A vegan expert makes sure they get soy foods, beans, and protein-rich grains every day and often adds a protein supplement.

    • Zinc. There are several plant foods that supply around 20% the DV for zinc including lentils, oatmeal, wild rice, squash and pumpkin seeds, quinoa, and black beans.

A vegan expert makes sure they get these foods every day and often adds a multivitamin supplement containing zinc.

    • Vitamin D and vitamin B12. These are very difficult to get from a vegan diet. Even vegan experts usually rely on supplements to get enough of these important nutrients.

4) Certain vegan foods can even be bad for your bones. I divide these into healthy vegan foods and unhealthy “vegan” foods. 

    • Healthy vegan foods that can be bad for your bones include.
      • Pinto beans, navy beans, and peas because they contain phytates.
      • Raw spinach & swiss chard because they contain oxalates.
      • Both phytates and oxalates bind calcium and interfere with its absorption.
      • These foods can be part of a healthy vegan diet, but a vegan expert consumes them in moderation.
    • Unhealthy “vegan” foods that are bad for your bones include sodas, salt, sugar, and alcohol.
      • The mechanisms are complex, but these foods all tend to dissolve bone.
      • A vegan expert minimizes them in their diet.

5) You need more than diet for healthy bones. At the beginning of this article, I talked about the 3 Weight Trainingessentials for bone formation – calcium, vitamin D, and exercise. You can have the healthiest vegan diet in the world, but if you aren’t getting enough weight bearing exercise, you will have low bone density. Let me close with 3 quick thoughts:

    • None of the studies included in this meta-analysis measured how much exercise the study participants were getting.
    • The individual studies were generally carried out in industrialized countries where many people get insufficient exercise.
    • The DV for calcium in the United States is 1,000-1,200 mg/day for adults. In more agrarian societies dietary calcium intake is around 500 mg/day, and osteoporosis is almost nonexistent. What is the difference? These are people who are outside (vitamin D) doing heavy manual labor (exercise) in their farms and pastures every day.

In summary, a bone healthy vegan lifestyle isn’t easy, but it is possible if you work at it.

The Bottom Line 

A recent meta-analysis asked two important questions about vegan diets.

  1.     Do vegans have lower bone density than omnivores?

2) Is the difference in bone density clinically significant? Are vegans more likely to suffer from bone fractures?

The study found that:

  • Vegans had 5.5%–7% lower bone density than omnivores depending on where the bone density was measured.
  • Vegans were 44% more likely to suffer from bone fractures than omnivores.

The authors of the study concluded, ““The findings of this study suggest that…vegan diets are associated with lower bone density compared with omnivorous diets, and vegans have a higher fracture risk than omnivores…Vegan diets should be appropriate planned to avoid dietary deficiencies associated with bone health.”

In evaluating the results of this study, I took a detailed look at the pros and cons of vegan diets and concluded, “A bone healthy vegan lifestyle isn’t easy, but it is possible if you work at it.”

For more details about study and my recommendations for a bone healthy vegan lifestyle read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Do Calcium And Magnesium Reduce Migraines?

Avoiding Migraines

Author: Dr. Stephen Chaney

headacheMigraines can be agonizing. They can upend your life. Drugs provide some relief, but they have side effects. I am often asked about natural approaches for preventing migraines.

My simple answer is that there is no single thing that can eliminate migraines. As the saying goes, “It takes a village”. There is no “magic” supplement or herb you can take. It requires a holistic approach to defeat migraines.

I will discuss the holistic approach for migraines in more detail below. But first I would like to describe a recent study (SH Meng et al, Frontiers in Nutrition, doi.org/10.3389/fnut.2021.653765) that suggests calcium and magnesium should be part of that holistic approach.

How Was This Study Done?

Clinical StudyThis study used data from the CDC’s most recent National Health and Nutrition Examination Survey (NHANES). The CDC has been doing these surveys since 1960, but the most recent NHANES study began in 1999.

Briefly, data collection for the current NHANES began in early 1999 and remains a continuous annual survey. Each year approximately 7,000 randomly selected residents across the United States are given the opportunity to participate in the NHANES survey.

The NHANES survey provides information on demographics, physical examinations, laboratory tests, diet surveys, and other health-related questions.

This study used data from 10,798 NHANES participants between 1999 and 2004 who completed a questionnaire asking if they suffered from severe headaches or migraines.

[Based on previous studies they considered self-reported severe headaches as likely migraines and grouped the two together. Accordingly, I will simply refer to them as migraines in this review.]

Here are a few important characteristics of the participants:

  • Gender was 51% male and 49% female.
  • Average age was 51.
  • Average intake was low for both calcium (70% of the RDA) and magnesium (62% of the RDA).
  • Only 20% suffered from migraines. However, the gender discrepancy was significant.
    • Women (64%) were much more likely to suffer from migraines than men (36%). This is consistent with previous studies.

Do Calcium And Magnesium Reduce Migraines?

dairy foodsThe investigators divided intake of both calcium and magnesium into quintiles and compared the frequency of migraines of those in the highest quintile with those in the lowest quintile.

  • For calcium, the highest quintile was ≥1,149 mg/day, and the lowest quintile was ≤378 mg/day.
    • For comparison, the RDA for calcium is 1,200 mg/day for women between 50 and 70 and 1,000 mg/day for men between 50 and 70.
  • For magnesium, the highest quintile was ≥371 mg/day, and the lowest quintile was ≤161 mg/day.
    • For comparison, the RDA for magnesium is 320 mg/day for women over 30 and 420 mg/day for men over 30.

For women:

  • Those with the highest intake of calcium were 28% less likely to suffer from migraines than those with the lowest intake of calcium.
  • Those with the highest intake of magnesium were 38% less likely to suffer from migraines than those with the lowest intake of magnesium.

For men:

  • Those with the highest intake of calcium were 29% less likely to suffer from migraines than those with the lowest intake of calcium.
  • Those with the highest intake of magnesium were 20% less likely to suffer from migraines than those with the lowest intake of magnesium, but this result was not statistically significant.

The authors concluded, “Our study found that high dietary intake of calcium and magnesium…were inversely associated with migraines in women. For men, high dietary calcium intake was inversely associated with migraines. People should pay more attention to dietary calcium and magnesium, which may be an effective way to prevent migraines.”

Avoiding Migraines

headacheThis study showed that RDA levels of both calcium and magnesium are effective at reducing the risk of developing migraines. However, if you suffer from migraines, you are probably looking for more than a 28-38% reduction in migraines. You want them to be gone. That is why a holistic approach is best.

What does a holistic approach for migraines look like? In fact, it is very individualistic. Different things work for different people. Here are a few suggestions.

  • In addition to calcium and magnesium, make sure you are getting enough omega-3 fatty acids, vitamin D, coenzyme Q10, riboflavin, and vitamin B12 in your diet.
  • Avoid “trigger foods”. Different foods trigger migraines in different people, but here are a few of the most common.
    • Nitrate-containing processed meats.
    • Cheeses containing tyramine such as blue, feta, cheddar, Parmesan, and Swiss.
    • Alcohol, especially red wine.
    • Chocolate and foods containing caffeine.
    • Processed foods.
  • Some evidence suggests that a plant-based diet may reduce migraines, but only if it includes adequate amounts of the nutrients listed above.
  • Stay hydrated. Drink pure water rather than other beverages.
  • If overweight, shed some pounds. Obesity is linked to migraines.
  • Get adequate rest.
  • Try stress reduction techniques like yoga or meditation.

This is not a comprehensive list. If you have migraines, I probably left some of your favorite approaches off my list. The bottom line is that there are many natural approaches for reducing migraines. None is a “magic bullet” by itself but keep searching for the ones that help you the most.

What Does This Study Mean For You?

calcium supplementsGetting back to magnesium and calcium, this study shows that RDA levels of both calcium and magnesium are sufficient to significantly reduce your risk of migraines. The problem is that many Americans are not getting RDA levels of calcium and magnesium from their diets. Why is that?

  • Dairy foods are the biggest source of calcium in the American diet. However, many Americans don’t get enough dairy foods in their diet because:
    • Restrictive diets like Vegan and Paleo exclude dairy foods.
    • They are trying to avoid saturated fats.
    • They are lactose intolerant or have milk allergies.
    • They have a malabsorption disease or have undergone gastric bypass surgery.
  • Magnesium is found in lots of whole foods. The problem is that most Americans are eating highly processed foods instead of whole foods.

If you are not getting enough calcium and magnesium in your diet, supplementation is a viable option. However, you don’t want megadoses of either one. You just want to reach RDA levels. Here are some tips:

Calcium:

  • Start by estimating how much calcium you are getting from your diet. My rule of thumb is to estimate 250 mg of calcium from each serving of dairy and an additional 200 mg of calcium from a typical diet. Subtract that from 1,200 mg, and you have the amount of supplemental calcium you need to match the highest quintile of calcium intake in this study.
  • The calcium supplement should also contain vitamin D because vitamin D is needed for calcium absorption.
  • Take no more than 500 mg of supplemental calcium at a time. Higher amounts are absorbed less efficiently.
  • It is generally better to take calcium supplements between meals than with meals. That is because many components of the typical diet interfere with calcium absorption. For example,
    • Phytates in some high fiber foods.
    • Oxalic acid in spinach and some other leafy greens.
    • Saturated fats.

Magnesium:

  • The amount of magnesium in your diet is more difficult to calculate. However, 200 mg of magnesium will take you from the lowest quintile to the highest quintile in this study. And if you are already at the highest quintile, an extra 200 mg will not be excessive.
  • Magnesium can cause diarrhea, so I suggest a slow-release magnesium supplement.

The Bottom Line 

Migraines can be agonizing. They can upend your life. Drugs provide some relief, but they have side effects. I am often asked about natural approaches for preventing migraines.

My simple answer is that there is no single thing that can eliminate migraines. As the saying goes, “It takes a village”. There is no “magic” supplement or herb you can take. It requires a holistic approach to defeat migraines.

A recent study reported that calcium and magnesium should be part of a holistic approach to reduce migraines.

The study found that:

For women:

  • Those with the highest intake of calcium were 28% less likely to suffer from migraines than those with the lowest intake of calcium.
  • Those with the highest intake of magnesium were 38% less likely to suffer from migraines than those with the lowest intake of magnesium.

For men:

  • Those with the highest intake of calcium were 29% less likely to suffer from migraines than those with the lowest intake of calcium.
  • Those with the highest intake of magnesium were 20% less likely to suffer from migraines than those with the lowest intake of magnesium, but this result was not statistically significant.

The authors concluded, “Our study found that high dietary intake of calcium and magnesium…were inversely associated with migraines in women. For men, high dietary calcium intake was inversely associated with migraines. People should pay more attention to dietary calcium and magnesium, which may be an effective way to prevent migraines.”

For more details about other components of a holistic approach and my recommendations for calcium and magnesium supplementation read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Does Poverty Affect Nutritional Status?

How Can We Improve Nutrition In Disadvantaged Communities?

Calcium FoodsRecently there has been increased focus on health disparities in disadvantaged communities. In our discussions of the cause of these health disparities, two questions seem to be ignored.

1. Does poverty play a role in poor nutrition?

2. Does poor nutrition play a role in the health disparities we see in disadvantaged communities?

The study (K Marshall et al, PLoS One 15(7):e0235042) I discuss in this week’s “Health Tips From The Professor” attempts to address both of these questions.

Before, I start, let me put this study into context.

  • Osteoporosis is a major health problem in this country. Over 2 million osteoporosis-related fractures occur each year, and they cost our health care system over 19 billion dollars a year. Even worse, for many Americans these osteoporosis-related fractures often cause:
    • A permanent reduction in quality of life.
    • Immobility, which can lead to premature death.
  • Inadequate calcium and vitamin D intakes increase the risk of osteoporosis.

While most studies simply report calcium and vitamin D intakes for the general population, this study breaks them down according to ethnicity and income levels. The results were revealing.

How Was The Study Done?

Clinical StudyThis study drew on data from the 2007-2010 and 2013-2014 National Health and Nutrition Examination Surveys (NHANES). These surveys are conducted by the National Center for Health Statistics, which is part of the CDC. They are designed to assess the health and nutritional status of adults and children in the United States and are used to produce health statistics for the nation.

The NHANES interview includes demographic, socioeconomic, dietary, and health-related questions. The examination component consists of medical, dental, and physiological measurements, as well as laboratory tests administered by highly trained medical personnel. All participants visit a physician. Dietary interviews and body measurements are included for everyone.

This study measured calcium intake, vitamin D intake, and osteoporosis for adults 50 and older. The data were separated by gender, ethnic group and income level. Four different measures of poverty were used. For purposes of simplicity, I will only use one of them, income beneath $20,000, for this article.

Does Poverty Affect Nutritional Status?

The Effect of Ethnicity And Gender On Calcium And Vitamin D Intake: 

FriendsWhen the authors looked at the effect of ethnicity and gender on calcium and vitamin D intake, in people aged 50 and older the results were (Note: I am using the same ethnic nomenclature used in the article):

Hispanics:

    • 66% (75% for women and 56% for men) were getting inadequate calcium intake.
    • 47% (47% for women and 47% for men) were getting inadequate vitamin D intake.

Non-Hispanic Blacks:

    • 75% (83% for women and 64% for men) were getting inadequate calcium intake.
    • 53% (51% for women and 54% for men) were getting inadequate vitamin D intake.

Non-Hispanic Whites:

    • 60% (64% for women and 49% for men) were getting inadequate calcium intake.
    • 33% (30% for women and 37% for men) were getting inadequate vitamin D intake.

For simplicity, we can generalize these data by saying:

Gender:

    • Women are more likely to be calcium-deficient than men.
    • Men are more likely to be vitamin D-deficient than women.

Ethnicity: For both genders and for both calcium and vitamin D:

    • The rank order for deficiency is Non-Hispanic Blacks > Hispanics > Non-Hispanic Whites.

The Effect Of Poverty On Calcium Intake, Vitamin D Intake, And Osteoporosis:

PovertyWhen looking at the effect of poverty, the authors asked to what extent poverty (defined as income below $20,000/year) increased the risk of calcium and vitamin D deficiency in adults over 50. Here is a summary of the data

Hispanics:

    • For both Hispanic women and Hispanic men, poverty had little effect on the risk of calcium and vitamin D deficiency.

Non-Hispanic Blacks:

    • For Non-Hispanic Black women, poverty had little effect on the risk of calcium deficiency, and vitamin D deficiency.
    • For Non-Hispanic Black men, poverty increased the risk of both calcium and vitamin D deficiency by 32%.

Non-Hispanic Whites:

    • For Non-Hispanic White women, poverty had little effect on the risk of calcium deficiency but increased the risk of vitamin D deficiency by 30%.
    • For Non-Hispanic White men, poverty increased the risk of both calcium deficiency and vitamin D deficiency by 18%.

For simplicity, we can generalize these data by saying:

    • Poverty increased the risk of both calcium and vitamin D deficiency for Non-Hispanic Black men, Non-Hispanic White women, and Non-Hispanic White men.

Other statistics of interest:

  • The SNAP program (formerly known as Food Stamps) had little effect on calcium and vitamin D intake. There are probably two reasons for this:
    • In the words of the authors, “While the SNAP program has been shown to decrease levels of food insecurity, the quality of the food consumed by SNAP participants does not meet the standards for a healthy diet.” In other words, the SNAP program ensures that participants have enough to eat, but SNAP participants are just as likely to prefer junk and convenience foods as the rest of the American population. The SNAP program provides no incentive to eat healthy foods.
    • We also need to remember that dairy foods are a major source of calcium and vitamin D in the American diet and that Hispanics and Non-Hispanic Blacks are more likely to be lactose-intolerant than the rest of the American population. There are other sources of calcium and vitamin D in the American diet. But without some nutrition education, most Americans are unaware of what they are.
  • An increased risk of osteoporosis was found in Non-Hispanic Black men, and Non-Hispanic Whites with incomes below $20,000/year.
    • This increased risk of osteoporosis was seen primarily for the individuals in each group who were deficient in calcium and vitamin D. There were other factors involved, but I will focus primarily on the effect of poverty on calcium and vitamin D intake in the discussion below.

How Can We Improve Nutrition In Disadvantaged Communities?

Questioning WomanLet’s start with the two questions I posed at the beginning of this article:

1. Does poverty play a role in poor nutrition?

2. Does poor nutrition play a role in the health disparities we see in disadvantaged communities?

In terms of calcium intake, vitamin D intake, and the risk of osteoporosis, the answer to both questions appears to be, “Yes”. So, the question becomes, “What can we do?”

It is when we start to ask what we can do to increase calcium and vitamin D intake and decreased the risk of osteoporosis in disadvantaged communities that we realize the complexity of the problem. There are no easy answers. Let’s look at some of the possibilities.

[Note: I am focusing on what we can do to prevent osteoporosis, not to detect or treat osteoporosis. The solutions for those issues would be slightly different.]

1. We could increase funding for SNAP. That would increase the quantity of food available for low income families, but, as noted above, would do little to improve the quality of the food eaten.

2. We could improve access to health care in disadvantaged communities. But unless physicians started asking their patients what they eat and start recommending a calcium and vitamin D supplement when appropriate, this would also have little impact on diet quality.

3. We could improve nutrition education. A colleague of mine in the UNC School of Public Health ran a successful program of nutrition education through churches and community centers in disadvantaged communities for many years. The program taught people how to eat healthy on a limited budget. Her program improved the health of many people in disadvantaged communities.

However, the program was funded through grants. When she retired, federal and state money to support the program eventually dried up. The program she started is a model for what we should be doing.

4. The authors suggested food fortification as a solution. In essence, they were suggesting that junk and convenience foods be fortified with calcium and vitamin D. That might help, but I don’t think it is a good idea.

If we want to improve the overall health of disadvantaged communities, we need to find ways to replace junk and convenience foods with healthier foods. Adding a few extra nutrients to unhealthy foods does not make them healthy.

5. The authors also said that a calcium and vitamin D supplement would be a cheap and convenient way to eliminate calcium and vitamin D deficiencies. Unfortunately, supplements are currently not included in the SNAP program. Unless that is changed, even inexpensive supplements are a difficult choice for families below the poverty line.

As I said at the beginning of this section, there are no easy answers. It is easy to identify the problem. It would be easy to throw money at the problem. But finding workable solutions that could make a real difference are hard to identify.

Yes, we should make sure every American has enough to eat. Yes, we should make sure every American has access to health care. But, if we really want to improve the health of our disadvantaged communities, we also need to:

  • Change the focus of our health care system from treatment of disease to prevention of disease.
  • Train doctors to ask their patients what they eat and to instruct their patients how simple changes in diet could dramatically improve their health.
  • Provide basic nutrition education to disadvantaged communities at places where they gather, like churches and community centers. This would cover topics like eating healthy, shopping healthy on a limited budget, and cooking healthy.

We don’t necessarily need another massive federal program. But those of us with the knowledge could each volunteer to share that knowledge in disadvantaged communities.

  • Cover basic supplements, like multivitamins, calcium and vitamin D supplements, and omega-3 supplements in food assistance programs like SNAP.

The Bottom Line

Osteoporosis is a major health problem in this country. Over 2 million osteoporosis-related fractures occur each year, and they cost our health care system over 19 billion dollars a year. Even worse, for many Americans these osteoporosis-related fractures often cause:

  • A permanent reduction in quality of life.
  • Immobility, which can lead to premature death.

We know that inadequate calcium and vitamin D intakes increase the risk of osteoporosis. But most studies simply report calcium and vitamin D intakes for the general population. At the beginning of this article, I posed two questions.

  1.  Does poverty play a role in poor nutrition?

2. Does poor nutrition play a role in the health disparities we see in disadvantaged communities?

A recent study looked at the effect of gender, ethnicity and income levels on calcium intake, vitamin D intake, and the risk of developing osteoporosis. The results of this study shed some light on those two questions.

When looking at the effect of gender and ethnicity on the risk of inadequate calcium and vitamin D intake, the study found:

  • Women are more likely to be calcium-deficient than men.
  • Men are more likely to be vitamin D-deficient than women.
  • For both genders and for both calcium and vitamin D, the rank order for deficiency is Non-Hispanic Blacks > Hispanics > Non-Hispanic Whites. [Note: Note: I am using the same ethnic nomenclature used in the study.]
  • Poverty (defined as incomes below $25,000/year) significantly increased the risk of both calcium and vitamin D deficiency for Non-Hispanic Black men, Non-Hispanic White women, and Non-Hispanic White men.
  • An increased risk of osteoporosis was also found in Non-Hispanic Black men, and Non-Hispanic White men and women with incomes below $20,000/year.
  • This increased risk of osteoporosis was seen primarily for the individuals in each group who were deficient in calcium and vitamin D.

In short, this study suggests that the answer to both questions I posed at the beginning of the article is, “Yes”.

For more information and a discussion of what we could do to correct this health disparity in disadvantaged communities, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Health Tips From The Professor