Tag Archives: osteoporosis

Are Calcium Supplements Safe?

 

Death in a bottle?

Death in a bottle?

Monica is a smart and media-savvy nutritionist who brought me on board as a blogger at NutritionData many years ago. Click the link below for her surprising conclusion on calcium supplementation.

Monica writes:

“The National Osteoporosis Foundation published a new report this week, insisting that calcium supplements are safe for your heart. Two weeks ago, Johns Hopkins cardiologist Erin Michos published a paper saying the opposite.

She claims that the NOF review (which was funded by a pharmaceutical company that makes calcium supplements) omitted certain studies (such as the ones she included in her own review) that might have changed the conclusion.

These are just the latest two volleys in a five-year-long tennis match between experts on whether you should or shouldn’t take calcium supplements.  And you thought politics was divisive.”

Source: Calcium Supplements: Safe or Not?

For Seniors On Weight-Loss Diet, Strength Training Beats Aerobics For Preserving Bone Mineral Density

according to an article at MedPageToday.

"One more rep then I'm outa here!"

“One more rep then I’m outa here!”

The two experimental groups had about 60 participants each, so it was a relatively small study. (In general, the larger the study, the more reliable the findings.) Most participants were white women; mean age was 69. The experimental intervention ran for five months. An excerpt:

In one trial, the participants were randomized to a structured resistance training program in which three sets of 10 repetitions of eight upper and lower body exercises were done 3 days each week at 70% of one repetition maximum for 5 weeks, with or without calorie restriction of 600 calories per day.
In the second study, participants were randomized to an aerobic program which was conducted for 30 minutes at 65% to 70% heart rate reserve 4 days per week, with or without calorie restriction of 600 calories per day.

The beneficial bone effect was seen at the hip but not the lumbar spine.

Thin old bones—i.e., osteoporotic ones—are prone to fractures. Maintaining or improving bone mineral density probably prevents age-related fractures. In a five-month small study like this, I wouldn’t expect the researchers to find any fracture rate reduction; that would take years. 

Most elders starting a weight-training program should work with a personal trainer. I don’t quite qualify as elderly, but click if interested in my personal fitness program.

Steve Parker, M.D.

PS: Strength training is also known as weight training and resistance exercise.

Theoretical Support for the Healthfulness of the Paleo Diet

See modern man walking off that cliff?

See modern man walking off that cliff?

Aren’t people healthier now, thanks to the Agricultural and Industrial Revolutions?

As a marker for health, we can look at life span and longevity. Humans started to see dramatic increases in longevity probably around 30,000 years ago, before the revolutions. Nevertheless, Kuipers, Joordens, and Muskiet note that average life expectancy after the start of the Agricultural Revolution 10,000 years ago fell from about 40 to around 20 years.

Other researchers report that average height in the Nile River Valley at the time of the transition fell by 4 inches (10 cm). The Agricultural Revolution allowed for rapid expansion of human populations through more births, but those folks still didn’t live very long. As before the revolution, infections and high infant/child mortality rates were devastating killers, dragging down average life spans. If you survived childhood, you had a shot at hitting 50 or 60.

At the dawn of the Industrial Revolution, life expectancy at birth was only 35–40 years, even in then-sophisticated cultures like Switzerland. Consider Thomas Jefferson, the principal author of the U.S. Declaration of Independence and the third U.S. president, who lived between 1743 and 1826 (he died on July 4, Independence Day). He and his wife Martha had six children; only two survived to adulthood, and only one past the age of 25. Martha died at age 33. This mortality picture was typical for the times.

Since 1800, life expectancy has doubled in industrialized countries, but it’s mostly due to public health measures and economic prosperity. Other than smallpox vaccination, it wasn’t until the mid-20th century that medical care advances contributed in a major way to longevity.

Overview: Conflict Between Our Paleolithic Genes and Modern Life

A number of diseases or conditions may result from the mismatch of our Paleolithic genes and modern lifestyle. If not caused by the mismatch, they’re aggravated by it. These are the so-called “diseases of civilization”:

  • type 2 diabetes
  • high blood pressure
  • overweigh and obesity
  • dental caries (tooth decay or cavities)
  • osteoporosis
  • fertility problems (polycystic ovary syndrome)
  • pregnancy complications (pre-eclampsia, gestational diabetes)
  • some cancers (colon, breast, prostate)
  • heart disease (such as coronary artery disease)
  • major and postpartum depression
  • autism
  • schizophrenia
  • some neurodegenerative diseases (Parkinsons disease, Alzheimer’s disease)
  • constipation
  • hemorrhoids
  • diverticulosis
"I ate well over 70 grams of fiber daily!"

“I ate well over 70 grams of fiber daily!”

Overweight and Obesity

The Paleolithic diet is lower in total carbohydrate calories compared to the standard American diet: 30-35% versus 50-55% of calories. The higher consumption today, especially of highly processed refined carbohydrates, contributes to overweight and obesity, diabetes, gallbladder disease, heart disease, and possibly dementia. Ian Spreadbury hypothesizes that carbohydrate density of modern foods may be the cause of obesity. Refined sugars and grains—types of acellular carbohydrates—are particularly bad offenders. These acellular carbs may alter our gut microorganisms, leading to systemic inflammation and leptin resistance, etc. Our Paleolithic ancestors had little access to acellular carbohydrates. Here’s how Spreadbury explains acellular: “Tubers, fruits, or functional plant parts such as leaves and stems store their carbohydrates in organelles as part of fiber-walled living cells. These are thought to remain largely intact during cooking, which instead mostly breaks cell-to-cell adhesion. This cellular storage appears to mandate a maximum density of around 23% non-fibrous carbohydrate by mass, the bulk of the cellular weight being made up of water. The acellular carbohydrates of flour, sugar, and processed plant-starch products are considerably more dense. Grains themselves are also highly dense, dry stores of starch designed for rapid macroscopic enzymic mobilization during germination. Whereas foods with living cells will have their low carbohydrate density “locked in” until their cell walls are breached by digestive processes, the chyme produced after consumption of acellular flour and sugar-based foods is thus suggested to have a higher carbohydrate concentration than almost anything the microbiota of the upper GI tract from mouth to small bowel would have encountered during our coevolution.” (Reference: “Comparison with ancestral diets suggests dense acellular carbohydrates promote an inflammatory microbiota, and may be the primary dietary cause of leptin resistance and obesity,” in Diabetes, Metabolic Syndrome, and Obesity: Targets and Therapy. 2012; vol 5: 175–189. doi: 10.2147/DMSO.S33473 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3402009/)

Added sugar provides 17 % of total energy in modern societies, contributing to overweight, obesity, tooth decay, and diabetes. Modern diets provide 15–20% of calories from protein, compared to 25–30% in the Paleolithic diet. To the extent that high protein consumption is satiating, lower consumption may cause over-eating of carbohydrates and fats, then overweight and obesity and all their associated medical conditions.

Heart Disease

I written elsewhere on the blog that the much lower omega-6 to omega-3 fatty acid ratio in the Paleolithic diet. There’s some evidence that today’s high ratio may contribute to systemic inflammation and chronic disease, heart disease in particular. Today’s ratio is quite high due to our consumption of industrial seed oils, such as those derived from soybeans, peanuts, corn, and safflower. And we don’t eat enough cold-water fatty fish, which are major sources of omega-3 fatty acids. Two long-chain polyunsaturated fatty acids, EPA and DHA, are essential fatty acids. That means our bodies cannot make them. We have to get them from diet. DHA and EPA are also cardioprotective omega-3 fatty acids.

High Blood Pressure

Most modern diets have much more sodium and much less potassium than the Paleolithic diet, perhaps contributing to high blood pressure, which in turn contributes to heart attacks, strokes, and possibly premature death. The higher magnesium content of the paleo diet may also help prevent high blood pressure.

Gastrointestinal Problems

We eat much less fiber these days, contributing to constipation, hemorrhoids, and diverticulosis. Some experts believe low fiber consumption adversely effects development of palate bones, jaws, and tooth placement.

Osteoporosis

Our lower vitamin D levels these days may cause osteoporosis (thin fragile bones) and raise the risk of diabetes and cancer. Our prehistoric ancestors spent more time in the sun, allowing their bodies to make vitamin D.

Type 2 Diabetes

Robert Lustig and associates looked at sugar consumption and diabetes rates in 175 countries and found a strong link between sugar and type 2 diabetes. It’s not proof of causation, just suggestive. From the scientific article abstract: “Duration and degree of sugar exposure correlated significantly with diabetes prevalence in a dose-dependent manner, while declines in sugar exposure correlated with significant subsequent declines in diabetes rates independently of other socioeconomic, dietary and obesity prevalence changes. Differences in sugar availability statistically explain variations in diabetes prevalence rates at a population level that are not explained by physical activity, overweight or obesity.” (Reference: Basu S, Yoffe P, Hills N, Lustig RH (2013) The Relationship of Sugar to Population-Level Diabetes Prevalence: An Econometric Analysis of Repeated Cross-Sectional Data. PLoS ONE 8(2): e57873. doi:10.1371/journal.pone.0057873)

A major diet change from Stone Age to modern diets is a reduction in magnesium consumption. This could be one reason type 2 diabetes is a problem today. A 2013 article at Diabetes Care suggests that higher magnesium consumption in modern populations may protect against type 2 diabetes (Reference: http://care.diabetesjournals.org/content/early/2013/09/23/dc13-1397.abstract.html?papetoc).

Dental Problems

Dentist John Sorrentino wrote at his blog in 2012: “The truth is that tooth decay is a relatively new phenomenon. Until the rise of agriculture roughly 10,000 years ago, THERE WAS NO TOOTH DECAY IN HUMANS. Let that sink in for a moment. Humanity is 2,500,000 years old. For the first 2,490,000 years no one ever had a cavity. If we understand that tooth decay started when people started farming instead of hunting and gathering for a living clearly you realize that tooth decay is a disease or mismatch between what you are eating and what your body expects you to eat. If we examine the past as prologue it becomes clear that the path to proper health starts in the mouth and the answers are so simple that not only did a Cave Man do it. They perfected it.” (Reference: http://www.sorrentinodental.com/blog.html?entry=why-teeth-decay-i)

To be fair and balanced, a research report from 2014 found a very high incidence of caries (cavities) in a Stone Age population living in what is now Morocco. The authors attributed the cavities to heavy consumption of acorns, which are rich in carbohydrates and sticky, to boot.

Orthodontist Mike Mew, BDS, MSc, made a presentation at the 2012 Ancestral Health Symposium titled “Craniofacial Dystrophy—Modern Melting Faces.” Dr. Mew says 30% of folks in Western populations have crooked teeth and/or malocclusion, and the mainstream orthodontic community doesn’t know why. But they’ve got expensive treatment for it! Dr. Mew thinks he knows the cause and he shared it at the symposium. The simple cure is “Teeth together. Lips together. Tongue on the roof of your mouth.” And eat hard food that requires lots of chewing, like our ancestors did, ideally in childhood before age 9. Older people also benefit, he says.

NPR (National Public Radio) in February, 2013, ran an article called “Ancient Choppers Were Healthier Than Ours,” by Audrey Carlsen. An excerpt: “Hunter-gatherers had really good teeth,” says Alan Cooper, director of the Australian Centre for Ancient DNA. “[But] as soon as you get to farming populations, you see this massive change. Huge amounts of gum disease. And cavities start cropping up.” And thousands of years later, we’re still waging, and often losing, our war against oral disease. Our changing diets are largely to blame. In a study published in the Nature Genetics, Cooper and his research team looked at calcified plaque on ancient teeth from 34 prehistoric human skeletons. What they found was that as our diets changed over time — shifting from meat, vegetables and nuts to carbohydrates and sugar — so too did the composition of bacteria in our mouths. Not all oral bacteria are bad. In fact, many of these microbes help us by protecting against more dangerous pathogens. (Reference: http://www.npr.org/blogs/health/2013/02/24/172688806/ancient-chompers-were-healthier-than-ours)

Dentist Mark Burhenne wrote the following at Huffington Post – Canada: “It is generally well accepted that tooth decay, in the modern sense, is a relatively new phenomena. Until the rise of agriculture roughly 10,000 years ago, there was nearly no tooth decay in the human race. Cavities became endemic in the 17th century but became an epidemic in the middle of the 20th century (1950). If we understand that tooth decay started when people started farming, rather than hunting and gathering, it’s clear that tooth decay is the result of a mismatch between what we’re eating and what our bodies are expecting us to eat based on how they evolved….The recent changes in our lifestyle create a “mismatch” for the mouth, which evolved under vastly different environments than what our mouths are exposed to these days. Our mouths evolved to be chewing tough meats and fibrous vegetables. Sugar laden fruit was a rare and special treat for our paleolithic ancestors. Now, our diets are filled with heavily processed foods that take hardly any energy to chew — smoothies, coffees, and sodas high in sugar, white bread, and crackers to name just a few.” (Reference: http://www.huffingtonpost.ca/mark-burhenne/paleo-diet-oral-health_b_4041350.html)

Shrinking Brains

Since the end of the Stone Age, human brain size has been shrinking. That’s not good, is it? Anthropologist John Hawks has noted that over the past 20,000 years, the average volume of the human male brain has decreased from 1,500 cubic centimeters to 1,350 cc, losing a chunk the size of a lemon. The female brain has shrunk proportionately. Anthropologists don’t know why. Is it modern nutrition? The experts aren’t sure what it means for our future. As for me, I think the answer is in Mike Judge’s movie, “Idiocracy.”

His brain was bigger than yours

His brain was bigger than yours

Death By Sugar

Sugar-sweetened beverages kill almost 200,000 worldwide annually, according to a Gitanjali Singh, Ph.D., a postdoctoral research fellow at the Harvard School of Public Health. How could that be? Sugar-sweetened beverages contribute to obesity, which in turn leads to diabetes, cardiovascular disease, and some cancers. (Reference: Singh, GM, et al “Mortality due to sugar-sweetened beverage consumption: A global, regional, and national comparative risk assessment,” American Heart Association Epidemiology and Prevention/Nutrition, Physical Activity and Metabolism 2013 Scientific Sessions, Abstract EPI-13-A-879-AHA.) Reducing consumption of sugar-sweetened beverages was one of the major points in the American Heart Association’s 2010 guidelines for reducing heart disease.

Elderly Cognitive Impairment

Diets high in sugar and other carbohydrates raise the risk of elderly cognitive impairment, according to recent research by the Mayo Clinic. Mild cognitive impairment is often a precursor to incurable dementia. (Most authorities think dementia develops more often in people with diabetes, although some studies refute the linkage.) Researchers followed 940 patients with normal baseline cognitive functioning over the course of four years. Diet was assessed via questionnaire. Study participants were ages 70 to 89. As the years passed, 200 of them developed mild cognitive impairment. Compared with those eating the lowest amount of sugar, those eating the most sugar were 1.5 times more likely to develop cognitive impairment. Looking at total carbohydrate consumption, those eating at the highest levels of carbohydrate consumption were almost twice as likely to develop mild cognitive impairment. The scientists note that those eating lower on the carbohydrate continuum were eating more fats and proteins. (Reference: Mayo Clinic website, published October 16, 2012 http://www.mayoclinic.org/news2012-rst/7128.html)

Is a Paleolithic-Style Diet the Healthiest Way to Eat?

Certified paleo-compliant, plus high omega-3 fatty acids

Certified paleo-compliant, plus high omega-3 fatty acids

The jury’s still out on that one! My strong sense is that it’s definitely more healthful than the Standard American Diet. Maybe the traditional Mediterranean diet or DASH diet is even healthier. Don’t hold your breath waiting for the randomized controlled trials that would answer the question definitively.

If the paleo diet is the healthiest, which version is best? That’s a question for another day (or year).

The most healthful diet for you depends on your genetic make-up and any medical conditions you have.

Steve Parker, M.D.

Worried About Inadequate Calcium on Your Paleo Diet?

Bix at Fanatic Cook has a post on calcium and dairy consumption as regards to protection against broken hips from thin bones (osteoporosis). Or rather the lack of protection!

I’ve worried before that most paleo diets could be deficient in calcium because they don’t include milk products. Osteoporosis in adults or inadequate bone growth in kids are about the only significant problems you might see if that’s the case.

Bix quotes Harvard professor and pediatrician Dr. David Ludwig:

“Humans have no nutritional requirement for animal milk, an evolutionary recent addition to diet. Anatomically modern humans presumably achieved adequate nutrition for millennia before domestication of dairy animals, and many populations throughout the world today consume little or no milk for biological reasons (lactase deficiency), lack of availability, or cultural preferences.

Adequate dietary calcium for bone health, often cited as the primary rationale for high intake of milk, can be obtained from many other sources. Indeed, the recommended levels of calcium intake in the United States, based predominately on balance studies of 3 weeks or less, likely overestimate actual requirements and greatly exceed recommended intakes in the United Kingdom.

Throughout the world, bone fracture rates tend to be lower in countries that do not consume milk compared with those that do. Moreover, milk consumption does not protect against fracture in adults, according to a recent meta-analysis.”

Read the whole enchilada.

Another article mentions Dr. Ludwig:

People with a high-quality diet — those who get adequate protein, vitamin D and calcium from things like leafy greens, legumes, nuts and seeds — may get little or no added nutritional benefit from consuming three servings of dairy a day, Ludwig argues.

Hmmm. Wonder how he feels about grains. Sounds paleoish so far.

I’m just about ready to stop worrying about calcium.

Steve Parker, M.D.

Low Calcium Intake May Not Matter for Bone Health

paleobetic diet, diabetic diet, calcium

Modern “films” are digital

I’ve worried about the relatively low calcium content of most paleo diets. I see lots of little old ladies eating non-paleo with hip, spine, and wrist fractures related to the bone-thinning disease called osteoporosis. The bones break because they’re not adequately dense. Some experts think low calcium intake causes osteoporosis.

A Vietnamese study published in 2009 compared bone density of Buddhist nuns, who are vegans, with omnivorous controls. Dietary calcium content was 330 mg/day in the vegans, 682 mg/day in the omnivores. Nevertheless, bone density and osteoporosis prevalence were not significantly different between the groups. (Unfortunately, fracture rates were not reported.)

So perhaps the relatively low calcium content of paleo diets isn’t anything to worry about.

Steve Parker, M.D.

h/t Jamie Scott

CavemanDoctor On Calcium Consumption and Osteoporosis

paleo diet, Steve Parker MD,calcium, osteoporosis

I worry about her bones 50 years hence

I’ve fretted here before about possible inadequate calcium intake on typical paleo diets. Colin Champ, M.D., otherwise known as CavemanDoctor, has a way around it. A quote summarizes his ideas:

“In Review:

  1. Calcium levels and bone health are multifactorial and calcium intake is just the tip of the iceberg.
  2. Don’t count on dairy for calcium and instead get it naturally in highly absorbable forms in the foods nature laid out for you.
  3. Instead, avoid foods that result in decreased absorption and increased excretion of calcium like milk.
  4. Get some sun (not sun burns) or if that is not possible, take some vitamin D3.
  5. Lift heavy weights and sprint as the heavy loads stimulates bone mineralization and decrease bone breakdown.
  6. Avoid chronic stress and the increase in glucocorticoids that results.
  7. Increase your highly absorbable sources like green leafy vegetables, and decrease poorly absorbable sources like milk, and avoid its downside with its large amounts of lactose (sugar).
  8. Avoid large amounts of carbohydrates that cause significant insulin release and calcium loss in the urine.”

Read the rest.

Do Vegetables and Fruits Prevent Disease?

Switching to the paleo diet often leads to increased vegetable and fruit consumption

Switching to the paleo diet often leads to increased vegetable and fruit consumption

Potential answers are in the American Journal of Clinical Nutrition (2012).  I quote:

For hypertension, coronary heart disease, and stroke, there is convincing evidence that increasing the consumption of vegetables and fruit reduces the risk of disease. There is probable evidence that the risk of cancer in general is inversely associated with the consumption of vegetables and fruit. In addition, there is possible evidence that an increased consumption of vegetables and fruit may prevent body weight gain. As overweight is the most important risk factor for type 2 diabetes mellitus, an increased consumption of vegetables and fruit therefore might indirectly reduces the incidence of type 2 diabetes mellitus. Independent of overweight, there is probable evidence that there is no influence of increased consumption on the risk of type 2 diabetes mellitus. There is possible evidence that increasing the consumption of vegetables and fruit lowers the risk of certain eye diseases, dementia and the risk of osteoporosis. Likewise, current data on asthma, chronic obstructive pulmonary disease, and rheumatoid arthritis indicate that an increase in vegetable and fruit consumption may contribute to the prevention of these diseases. For inflammatory bowel disease, glaucoma, and diabetic retinopathy, there was insufficient evidence regarding an association with the consumption of vegetables and fruit.

It bothers me that vegetables and fruits are lumped together: they’re not the same.

The paleo diet is unfairly characterized as meat-centric. It can certainly provide beaucoup vegetables and fruits. Diabetics should be careful which ones they choose, to avoid spikes in blood sugar.

Steve Parker, M.D.

Maybe We Don’t Need as Much Calcium As We Think

I’ve worried about the relatively low calcium amounts provided by most paleo diets.  Maybe I shouldn’t. Fanatic Cook Bix has a new post about various calcium absorption mechanisms in our bodies. If intake is low, certain mechanisms kick in, allowing us to absorb more than is usual. I quote:

So, someone who is eating less than 400 mg – which is half the recommended amount (the DRIs are 800-1000 mg/day, some groups recommend up to 1300 mg) – may, all else being equal, end up with a similar calcium status as someone eating 1000 mg or more because an active transport mechanism kicks in at lower intakes. As well, more calcium may be absorbed from the colon.

Calcium is not unusual in this regard. Absorption of nutrients is often higher when intake is low, and vice versa. Zooming in on one nutrient, in this case calcium, and fretting over whether we’re “getting enough” has a downside if it leads to taking supplements. Many nutrients compete for intestinal absorption, e.g. zinc supplements have been shown to substantially reduce calcium absorption. And, it should be said, what the body doesn’t absorb goes out with the feces.

It may be better to focus on eating a variety of minimally processed foods than to focus on discrete nutrients, and let the body take care of itself.

Read the rest.

At any given time, I usually have at least one little old lady on my hospital service who has fallen and fractured her hip, wrist, pelvis, or humerus (arm bone that’s part of the shoulder). Nearly always she has the bone-thinning disease called osteoporosis, which may be related to calcium consumption. If we can prevent osteoporosis with diet and exercise, that’s much preferable to dealing with the fractures.

Too Much Calcium May Be Worse Than Too Little

I’ve been fretting that the paleo diet may not provide enough calcium to keep aging bones strong. On the other hand, the writer(s) at the Joslin Diabetes Blog point out that too much calcium may promote cardiovascular disease.

The February, 2013, issue of British Medical Journal has a pertinent research report. The Joslin blogger writes:

Participants were women from a mammography cohort who were asked about their calcium consumption, using a food frequency questionnaire, at baseline and seven-to-ten years later. The 61, 433 women were followed for a period of 19 years. During that time, 6894 participants died of cardiovascular disease or stroke. The researchers found that the women taking over 1400mg of calcium per day had a higher incidence of cardiovascular disease. Participants whose calcium consumption remained within suggested bounds, between 600mg and 1000mg per day, did not appear to have a greater vulnerability to cardiac disease.

Read the rest.

I confess I haven’t read the BMJ article.

I always wonder about overall death rates when I see results like this. A group may have higher or lower rates of cardiovascular disease, and yet live longer than the comparison group. An intervention could prevent cardiovascular disease and cardiovascular death, yet increase the incidence of death from infection, cancer, accidents, or suicide, etc.

I bet a lot of adults eating a paleo-style diet approach or exceed 600 mg a day of calcium. I’m feeling better about the calcium in paleo diets. But I don’t want to have to depend on feelings.

The Joslin blogger notes that, “Perhaps it is time to have a conversation with your health care provider to determine what the best dose of calcium is for you.” Problem is, I’m not sure any healthcare provider really knows the best “dose” of calcium for the average person, whether supplemental or dietary calcium.

Sorry, men. These findings may or may not apply to you. At least you don’t have to worry about osteoporosis nearly as much as women.

Steve Parker, M.D.

PS: In case you hadn’t run across it elsewhere, note that taking a calcium supplement without a concomitant vitamin D supplement may be more harmful than taking calcium with vitamin D.

 

A Paleo Problem: Calcium

paleo diet, Steve Parker MD,calcium, osteoporosis

I worry about her bones 50 years hence

It appears difficult to meet the Recommended Dietary Allowance (RDA) for calcium while eating most versions of the paleo diet.  That’s because they don’t include milk products.  The Linus Pauling Institute at Oregon State University has a review of calcium as related to nutrition and health, last updated in late  2010. They say that few Americans hit their recommended daily calcium goal.

I see lots of little old ladies with hip and other fractures related to osteoporosis. Trust me, you don’t want to go there. It’s difficult to reverse osteoporosis, an insidious process that’s been going on for decades before the fracture.

Osteoporosis may be related to years of inadequate calcium consumption. Adequate vitamin D is  an important part of the equation, too. Blood calcium levels are strictly regulated, and if they’re too low, calcium is pulled from the bones to fill the blood’s tank.

Broccoli and bok choy are fair sources of calcium, but pale in comparison to milk. Bok choy isn’t a part of my diet; I’m not even sure I’ve ever had it. Below is a video on bok choy cooking. Looks simple enough.  I need to look into kale, too.

Many paleophiles promote bone broth, but I haven’t figured out why yet. Is it high in calcium? (Hat tip to Wendy Schwartz for the word “paleophile”.)

A can of sardines looks like a good source of calcium: 350 mg or 35% Daily Value.

Can you help me worry less about calcium deficiency?