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The Osteoporosis Diet

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Your daily choices matter. No single food you eat will sabotage your health. But your overall eating pattern is prescient—it determines what your future health will likely be. 

You can’t exercise away a bad diet and you can’t wish away the reality that your choices matter. What you eat day after day, month after month is the single biggest determinant of how much pain and disability you’ll have as you age, and how long you’ll live. 

When it comes to bones, if you’re eating like most Americans, you’re destroying your bones. A review of 49 studies from more than 20 countries showed that the Western dietary pattern is associated with lower bone mineral density and increased osteoporosis and fracture risk.1 This diet is a high acid diet packed with soft drinks, fried foods, meat, processed foods, sweets, desserts, and refined grains. Unfortunately, it’s how most Americans eat, which could explain why there’s an epidemic of osteoporosis, heart disease, diabetes, obesity, and other diseases that can largely be prevented or controlled with diet. 

In contrast, the healthy dietary pattern, which is a high alkaline diet rich in fruit, vegetables, whole grains, nuts, and legumes and lean proteins like poultry and fish is associated with increased bone mineral density and lower fracture risk.2,3,4

The healthy dietary pattern is how many traditional cultures eat in the Mediterranean region, including countries like southwestern France, Spain, and Italy. In these countries, people following the healthy dietary pattern eat far more whole foods than Americans do. These include foods like fish and other seafood, olive oil, legumes, seeds and nuts, whole grain rice and root vegetables. 

There’s also a difference in the kinds of fats consumed. Approximately 40% of the energy consumed in the Mediterranean diet comes from fat, which is relatively high and goes against the “low-fat diet” craze popular in the US for years. But your body needs fat. Your brain is 60% fat, and fat is needed for mood, a healthy nervous system, hormone production, and the immune system. Unlike the standard American diet, the Mediterranean dietary pattern emphasizes monounsaturated fatty acids, which is a healthy type of fat found in olive oil, nuts, and seeds.5 

Essentially, following this whole foods, alkaline diet provides a long list of both macro- and micronutrients the body uses for bone health. Consuming foods rich in healthy fats and lean proteins, as well as manganese, potassium, phosphorous, calcium, iron, vitamin K, vitamin B12, folate, and vitamins C, D, and E is associated with a lower risk of bone fractures.6 

The more someone sticks to eating this way the better. One study that evaluated the dietary patterns of more than 70,000 women and men concluded that the more someone adhered to a Mediterranean dietary pattern the greater the health benefits.7 Compared to those who only loosely followed this way of eating, people who most strictly ate that way had an incredible 22% decrease in total fracture risk from diet alone. 

Supporting these findings, researchers looked at dietary patterns of postmenopausal women. They found that people who more closely followed a Mediterranean diet had an incredible 20% decreased risk of hip fractures.8 Hip fractures are the most dangerous type of osteoporosis fracture. If you have osteoporosis and break a hip, your risk for dying is increased for up to 10 years after, so reducing hip fracture risk by 20% simply by changing how you eat is incredible.9 

We all have to eat, so you might as well be doing something good for yourself instead of increasing your risk for a future of increased pain and disability and an early death. The science is clear. It’s in your best interest to eat whole foods, Mediterranean diet.  

Foods to Eat and Avoid

To help you understand which foods you should emphasize and which ones you should reduce or avoid altogether, I’ve created a chart. As a rule of thumb, fill your plate full of vegetables, fruit, and whole grains. Get protein from seafood or poultry and consume extra virgin olive oil instead of canola, corn oil, or other oils.

A quick note about olive oil. It’s not a high heat oil. When oils get too hot, they become rancid, which destroys their health benefits. Olive oil is best used raw, drizzled over vegetables, salads, or proteins. If you cook with it, cooking on low heat, such as sautéing vegetables is a good way to go. 

If you see it start to smoke, you’ve heated it too high and are creating destructive trans fatty acids and free radicals. Extra virgin olive oil (EVOO) has a smoke point of 350 to 420 degrees Fahrenheit while avocado oil has a smoke point of 520 degrees Fahrenheit. That’s why you want to reserve EVOO for use at room temperature or low-heat cooking. Avocado oil is an excellent choice for cooking at higher temperatures.

Foods to Eat

Fruit

Apples
Avocado
Banana (high glycemic)
Berries
Blackberries
Cantaloupe
Cherries, sour
Coconut, fresh
Currants
Dates
Figs
Grapes
Grapefruit
Honeydew Melon
Kiwi
Lemon
Lime
Nectarine
Orange
Peach
Pear
Pineapple
Raisins
Raspberries
Rhubarb
Strawberries
Tangerine
Tomato
Tropical Fruits
Plums
Watermelon

Vegetables

Beets
Broccoli
Cabbage
Carrot
Cauliflower
Celery
Chard
Cucumber
Eggplant
Garlic
Green Beans
Peas
Kale
Leafy Green Vegetables
Lettuce
Mushrooms
Olives
Onions
Peppers
Pumpkin
Radishes
Spinach
Sprouts
Sweet Potatoes
Tomatoes
Watercress
Wild Greens

Grains

Barley
Brown Rice
Bulgur
Faro
Quinoa

Oils
Avocado Oil (for cooking at higher temperatures)
Extra Virgin Olive Oil (room temperature or low heat)
Proteins

Chicken
Eggs (chicken, duck, quail)
Fish (anchovies, halibut, sardines, salmon, tuna)
Red Meat (OK if eaten rarely), best if grass fed and grass finished
Seafood (clams, oysters, shrimp)
Tempeh
Tofu
Turkey

Legumes
Black Beans
Cannellini Beans
Garbanzo Beans
Lentils
Navy Beans
Pinto Beans
Nuts and Seeds

Almonds
Cashews
Chestnuts
Hazelnuts
Macadamia Nuts
Peanuts
Pecans
Pistachios
Pumpkin Seeds
Walnuts

Foods to Minimize or Avoid

Refined Grains
White bread
White pasta
White rice
Processed Foods
Cereals
Cookies
Corn Chips
Crackers
Potato chips
Refined Sugars
Artificial sweeteners
Candy
Desserts
High fructose corn syrup
Ice Cream
Pastries
Oils
Canola Oil
Corn Oil
Margarine
Soybean Oil
Vegetable Oil
References

1Movassagh, EZ, Vatanparast, H. Current Evidence on the Association of Dietary Patterns and Bone Health: A Scoping Review. Adv Nutr. 2017; 8:1–16. [Article]

2Langsetmo L, Poliquin S, Hanley DA, et al. Dietary patterns in Canadian men and women ages 25 and older: relationship to demographics, body mass index, and bone mineral density. BMC Musculoskelet Disord. 2010; (11)20. [Article]

3Okubo H, Sasaki S, Horiguchi H, et al. Dietary patterns associated with bone mineral density in premenopausal Japanese farm women. Am J Clin Nutr. 2006; 83(11):85–92. [Article]

4Zeng FF, Wu BH, Fan F, et al. Dietary patterns and the risk of hip fractures in elderly Chinese: a matched case-control study. J Clin Endocrinol Metab. June 2013; 98:2347–55. [Article]

5Palomeras-Vilches, Anna, Viñals-Mayolas, Eva, Bou-Mias, Concepcio, et al. Nutrients. Oct. 2019; 11(10): 2508. [Article]

6Samieri C, Ginder Coupez V, Lorrain S, Letenneur L, Allès B, Féart C, Paineau D, Barberger-Gateau P. Nutrient patterns and risk of fracture in older subjects: results from the Three-City Study. Osteoporos Int. Apr 2013; 24:1295–305. [Article]

7Byberg L, Bellavia A, Larsson SC, Orsini N, Wolk A, Michaelsson K. Mediterranean Diet and Hip Fracture in Swedish Men and Women. J Bone Miner Res. 2016;31(12):2098-2105. [Article]

8Haring B, Crandall CJ, Wu C, et al. Dietary Patterns and Fractures in Postmenopausal Women: Results From the Women’s Health Initiative. JAMA Intern Med. 2016;176(5):645-652. [Article]

9Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR. Mortality Risk Associated With Low-Trauma Osteoporotic Fracture and Subsequent Fracture in Men and Women. JAMA. 2009;301(5):513-521. [Article]

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