Charla posted the following question:

Robb,

Another question if you don’t mind. My mom was also told she has pre-Osteoporoses she was tested and put in the chart right on the edge of yellow and red. Later, she went gluten free. She went back to the DR.’s he said he had never seen some one get stronger. She is now in the yellow close to the green being good. The Dr. says he didn’t know how she was doing it neither did my mom. I was talking to her last night and said mom what if it is that you are gluten free … everything started to click for her. I know you mentioned this in the lecture but…what is the relationship between Osteoporosis and gluten?

Fantastic question and and interesting answer. When we are thinking about osteoporosis there are two things to consider: How much bone matrix are we taking in, how much bone matrix are we excreting. To some degree Dr.’s and dietitians get this (kinda) and this is why they recommend calcium supplements (increase the amount of building blocks) or drugs like Fosamax (improve mineral retention). The ONLY problem with this scenario is calcium supps do not work and although Fosamax improves bone density it does little to nothing for bone strength!! Bones are a pretty amazing engineering project with a calcium based crystal lattice that is reinforced with protein. Think re-bar+ concrete. The complex is amazingly strong, flexible and resilient. Fosamax simply stuffs calcium in the bones in an amorphous manner that does nothing to improve bone strength or prevent fractures. Bummer. What about the calcium supplements? Well, if we can not absorb it OR if we exrete more than we take in, it does not matter how much calcium we take in…other than high dose calcium can precipitate a heart attack or stroke!

Well Frack-my-fanny!! What the hell should we do with grandma!? Fosamax does not work and has crappy side-effects, calcium supplements don’t work and increase heart attack/stroke risk!!! Where should we look for an ANSWER!!?!?

In the immortal words of my grandfather from Arkansas: “Well, shit son, let’s start at the beginning.” I know some folks out there “just don’t buy into” the notion of evolutionary biology…but when it keeps delivering the goods…, aw shucks, who wants to really UNDERSTAND what’s at play here! If we just deal with outcomes it can be like magic! This way we never need to understand anything! We can just navigate the world via trial and error! We can live via superstition instead of a system of understanding! It’ll be as much fun as the dark ages! Ok…I’ve been drinking a lot of coffee today, but I think y’all get my point. Let’s use a little Evolutionary Medicine to figure out what’s happening here. When we are thinking about bone health, we need to consider absorption and retention/excretion. Let’s look at each of those.

You Will be Assimilated!

Believe it or not, the intestines are a rip-roaring place of excrement and adventure! It is the interface between “us” and the outside world…it’s where you absorb all the raw materials to make YOU. Mineral absorption happens in the small intestine and it is dependant upon an intact gut lining, vit d status and a few other factors. If our gut lining is irritated…from pesky neolithic foods for instance…you can not absorb minerals efficiently. Calcium, magnesium, zinc, copper, iron…they all just schwoosh right out your pooper and you never get to turn them into bone, hemoglobin, or super-oxide dismutase! Osteoporosis is sky-high among celiacs…oh, and among folks with autoimmune diseases. All those folks have irritated gut lining. Hmmm. When people adopt a paleo diet the gut heals and minerals get absorbed. We also tend to eat more protein on a paleo diet and although the vegetardians like Mcdougal think the acid load at the kidneys removes calcium from the bones, it turns out we actually absorb and retain MORE calcium due to hormonal shifts from a high protein diet. From the Protein Debate:

A similar experiment confirmed that elevated dietary protein enhances calcium absorption and thereby counters the increased urinary excretion of calcium (110). Furthermore, a series of recent dietary interventions in humans has shown that high protein, meat based diets do not cause loss of calcium from the skeleton, but actually have a favorable effect upon it by lowering bone resorption (105, 107, 111, 112) and may actually increase bone formation by dietary protein induced increases in IGF-1 (105).

Interesting, no? a compensatory mechanism of increased calcium absorption that supercedes excretions…oh, and the increase of anabolic hormones that improve bone health like Igf-1!

Retentive Much?

Retention and excretion are largely acid base issues and Prof. Cordain (again) has the goods on this.

I don’t want to re-invent the wheel on that, so I’ll just say that a paleo diet is a net alkalanizing diet. You only need ~20% of your cals to come from fruit and veggies to accomplish this.

So, the short-hand reasons why a paleo diet is beneficial for osteoporosis is that absorption is improved by healing the gut lining + improved hormonal state from increased protein intake. Retention is improved by a net-alkaline diet. Perhaps most importantly, it works.