We were raised with the belief that drinking milk builds strong bones. Milk is indeed loaded with calcium, an important component of bones. The belief made sense.

But, early in my medical training, I read several studies that shattered the certainty of the beliefs about milk and strong bones. At that time, in the early 1980s, the highest rates of osteoporosis were found in the US, Canada and northern Europe, countries that consumed large quantities of dairy products.

And, to my surprise, in the countries with the lowest rates of osteoporosis—like China and Japan—the traditional diet did not include dairy products.

Keep in mind that these studies reported on conditions a few decades ago, before the Americanization of traditional diets had spread worldwide.

Epidemiological studies from that same time period showed that when Asian people moved to western countries, over time, their osteoporosis rates resembled that of their host country.

What conclusions can one make from these studies? Is the consumption of dairy products in the host country responsible for the increase in the rate of osteoporosis among the Asian immigrants? Or is it related to eating more sugar and processed foods? Or a decrease in physical activity?

Another article I found in one of the medical journals reported that in countries such as Peru and India, consumption of calcium from food averaged around 300 mg a day. Yet, the rate of osteoporosis was very low. The small amount of calcium they consumed flies in the face of the recommendations drummed into us to take high doses of supplemental calcium, ranging from 1,000 to 1,500 mg a day.

So, how are we going to sort out the conflicting data and find meaning that translates into a healthy lifestyle?

The results of the studies clearly dispel the myth that you have to drink milk in order to have strong bones. And, we also learned that it is possible to have strong bones in the face of low calcium, as found in Peru and India. But how is that possible?

Did the countries with low rates of osteoporosis and low calcium consumption have strong bones because of their mostly plant-based diets? We know that animal foods—like dairy products—slightly acidify the pH of the blood. Minerals, such as the minerals in our bones, begin to dissolve in an acidic environment. Although dairy is high in calcium, it’s conceivable there can be a net loss of calcium from the bones due to heavy use of dairy products with their acidifying effects on the blood.

Leafy green vegetables, dried beans, broccoli, almonds and seaweed are just a few examples of non-dairy foods rich in not only calcium, but also in vitamins and minerals that are absolutely essential for the creation of strong bones. These include magnesium, potassium, vitamin K, and vitamin C, along with the trace minerals, like boron. Without these other essential elements, calcium alone does not make strong bones.

Are the low rates of osteoporosis in these countries related to spending more time outside in the sun, resulting in elevated vitamin D levels?

Did they have lower rates of osteoporosis because they were less likely to be taking medications that are known to seriously increase rates of osteoporosis and fractures? Some of these pharmaceutical drugs include the following:

1. Steroids used longer than six months, like for asthma
2. Long-term use of anti-seizure medications like valproic acid (Depakote) and phenytoin
3. Long-term use of a class of antidepressants called SSRIs (like Paxil and Prozac)
4. Some diabetic medications
5. Prolonged overdosing on thyroid medication
6. Hormone therapy to treat prostate cancer
7. Aromatase-inhibitors used to treat breast cancer
8. Hormone shots, like Depo-Provera
9. Overuse of anti-acids that contain aluminum which causes loss of calcium.

A major contributor to the low osteoporosis rates found in Asia, India and Peru is most likely the physical demands of their daily lives. Physical activity, like the hard labor found in less developed countries, keeps the calcium on the bones.

In fact, in medical school at the University of Colorado we used the Denver Broncos as our guinea pigs in some of our experiments. We asked the paid participants to stay in bed for several days. Each day their urine was measured for calcium loss. We were surprised at how quickly the body releases the calcium from the bones when there is no physical activity. Fortunately, as soon as their activity resumed, the loss of calcium stopped.

Three years ago I decided to get my first and only bone density scan to see how my bones were faring. For the past 30 years I have avoided dairy products and have taken no calcium supplements. My bone density results were consistent with the bones of a twenty year old. What could I attribute my favorable bone density to? The most obvious factor is the years of hauling heavy packs up and down tall mountains throughout the world for many years when I was younger, and then my continued daily physical activity at a more moderate level in the later years.

In regards to my diet, while I do eat small portions of grass-fed meat, I consistently eat a diet high in plant-based foods, rich in the vitamins and minerals needed to build strong bones. I get some sun exposure almost daily and take vitamin D with vitamin K.

Vitamin D helps absorption of calcium from our food. The vitamin D needs to be combined with Vitamin K. The vitamin K helps deliver the calcium to the bones. It also helps prevent the calcium from being deposited in the wrong places, like arteries and joints and other places in the body where there is chronic inflammation.

In fact, the latest recommendation is to NOT take calcium supplements because of the risk of calcium deposits in the coronary arteries. If you feel you need the extra calcium, look for calcium derived from algae. It is more easily absorbed and less likely to be deposited in the wrong places.

A diet high in sugar, simple carbs, alcohol, carbonated drinks and caffeine accelerates loss of calcium from the bones, thought to be related to the slight change in pH of the blood towards being more acidic. Again, minerals dissolve in an acidic environment. Vegetables are the best way to alkalinize the blood and bring it back to a more neutral pH.

So, what is the take-home message?

• Make weight-bearing exercises part of your daily routine, like hiking, dancing, and working out at the gym.
• Eat a mostly plant-based, whole foods diet with low sugar, alcohol, and simple carbohydrate consumption. If you are a carnivore, limit the red meat to grass-fed animals. If you eat dairy products, it’s best to limit the quantities you consume, with the emphasis on cultured products like yogurt, kefir and cheese.
• Take adequate doses of vitamin D (determined by test results) with vitamin K
• Get a few minutes of sunshine exposure whenever possible.
• Avoid long-term use of pharmaceutical medications known to cause bone loss.

Here’s to your good health!

Stay tuned for Part II—more Myths about Osteoporosis.