If I were to try and condense what I regard as good nutritional advice into a soundbite, I’d say ‘Eat like a caveman (or cavewoman)’. The idea here being to emulate the diet we as a species evolved on, and are best adapted to. There is, I think, abundant research that strongly supports this as being, in the main, the way to go. Though I appreciate there will be some who reject the notion of primal eating based on (I think) faulty paradigms such as saturated fat is bad and grains are good.
Another supposed anomaly here is dairy products. They do seem to be quite a recent addition to the diet (5000 years or so), so in theory not so important for health. Many nutritional commentators tell us, though, they are almost essential for our bones. Yet, the bony record from before about 10,000 years ago shows good bone health. How did we manage for more than 2 millions years without cow’s milk and now suddenly need it? Maybe, just maybe, we don’t need it at all.
I decided to revisit some of the science in this area recently. I found a quite-recent meta-analysis (amassing of similar studies) which looked at the relationship between milk consumption and risk of hip fracture [1]. I think fracture risk, by the way, is a much better judge of the value of dairy products than bone density. The whole point, supposedly, of having dense bones is to prevent fracture, so it makes sense to look at this (not density).
Neither in women nor men was there any relationship between milk drinking and risk of fracture (higher milk consumption was not associated with reduced risk of hip fracture).
In another meta-analysis, this same group of researchers looked at the relationship between calcium intake and hip fracture [2]. The results were the same – no reduced risk of fracture associated with higher calcium intakes.
This second meta-analysis also looked at intervention studies, in which individuals were treated with calcium. These sorts of study trump the epidemiological studies discussed so far, in that they can actually prove ‘causality’ i.e. that, say, calcium causes few fractures.
Looking at four trials in which risk of hip fracture specifically was assessed, those taking calcium (compared to placebo) turned out to be at 64 per cent increased risk of fracture. Oh. Maybe all this milk and calcium is not such a good idea after all.
References:
1. Bischoff-Ferrari HA, et al. Milk intake and risk of hip fracture in men and women: A meta-analysis of prospective cohort studies. J Bone Miner Res. 2010 Oct 14. [Epub ahead of print]
2. Bischoff-Ferrari HA, et al. Calcium intake and hip fracture risk in men and women: a meta-analysis of prospective cohort studies and randomized controlled trials. Am J Clin Nutr. 2007;86(6):1780-90.
I’m pretty certain that calcium is almost completely useless at best.
I think high-fat dairy doesn’t need to be banished though, it is our best source of Vit K2 and contains almost no lactose.
Research does show that high-fat dairy consumption has a massive effect on cardiovascular health, probably due to K2 content.
This research appears to omit an initial test of whether the subjects were actually deficient in calcium, which I understand to be a very common problem. – On http://www.vitamins-nutrition.org/vitamins/calcium.html – from the BBC The Truth About Food site, it says: “Calcium is the mineral most likely to be deficient in the average diet,” and further advice on that website is to eat extra dairy calcium (they suggest dairy yoghurt) as a means of losing excess weight. The researchers were interventionist and the advice was based on the positive results that were obtained by giving dairy yoghurt daily to overweight subjects taking part in the programme. I realise the dairy yoghurt would also have contained vitamin D, though I don’t remember vitamin D being mentioned in the programme. My personal belief is that the weight loss achieved was certainly in part due to reduction in fluid retention caused by salt sensitivity, one of the causes of obesity, osteoporosis and higher risk of fractures.
My particular interest in calcium ties in with my own extreme salt sensitivity and consequent serious calcium depletion, caused by having taken HRT for years, very literally ill-advisedly. This led to a complicated fracture of the right (dominant) humerus, which in turn led to other serious and lasting problems in my life. I drink about half a pint of milk a day and I eat unsweetened full-fat probiotic organic yoghurt every day and I take calcium and magnesium caplets every day, as well, of course, as the vitamin D3 recommended on your blog pages, and I would not willingly give up any of these because I am convinced that they ALL do me good.
Dr. Jaminet said that people with gut problems should do well to avoid dairy, but people with a healthy gut should be able to tolerate some dairy. From the Perfect Health Diet blog: http://perfecthealthdiet.com/?p=262
Interesting. I can recall reading articles years ago, when i worked in the health food industry, about milk drinking and dairy eating being possibly behind the wests high rates of osteoporosis. The anti-milk crowd will often point that bit of information out. I wondered if it was true. Sounds like it might be.
What the “drink plenty of milk!” crowd doesn’t point out is that milk is full of sugar. If you’re knocking back the USDA-recommended three cups per day of non-fat milk, that’s 39 grams of liquid sugar. A 12-ounce Coke doesn’t have that much sugar. Better to eat a can of sardines–they’re full of calcium, vitamin D, and phosphorus, and only one gram of carb.
Another thing…vitamin D, which one of the studies cited here mentioned as being necessary for calcium absorption, is fat soluble. In other words, that fat-free milk the govt. recommends won’t, on its own, give you any vitamin D you can absorb, even if the milk is fortified with it.
I read this post with interest, as I have osteoporosis. The dairy/no dairy argument seems to swing back and forth like a pendulum. One thing I notice here is that everyone’s seems to be restricting their comments to cow’s milk. I certainly find cow’s milk indigestible, but enjoy goat’s and sheep’s yoghurts instead. Is there any difference in the effect on bone density between these three different types of dairy, I wonder? There is also the whole other topic of whether we should regard low bone density as a ‘disease’ anyway. It’s on my mind particularly at the moment, as I’m about to have my bi-annual DEXA scan, followed, I’ve no doubt, by yet another exhortation to take bisphosphonates – which I shall once again refuse.
Whether or not you believe calcium is good for you (for bones or otherwise), should be it’s own discussion. Lumping milk in there just because it contains calcium is sloppy. The title of this article could be changed by replacing milk with broccoli since, that too contains calcium.
So aside from the calcium, good or bad debate, drinking milk should be a separate discussion.
For example people say to avoid milk, not because it contains calcium, but because it causes your blood to be more acidic. Another reason people cite is that milk sugar, lactose. is not digested properly by some. There might be other reasons, but these 2 seems to come up the most.
On the other hand, milk contains several nutrients (other than the calcium question), that are KNOWN to be good for you, and hard to find otherwise.. trans-palmitoleic acid (TPA), conjugated linoleic acid (CLA), etc.
So in the end, it’s important to do some critical thinking, and not be misled by sensational headlines.
anonymoose
The post was specifically about the common perception that milk (and calcium) is essential for healthy bone health (and the lack of evidence for this). The title of the post actually reflects what the blog post is about and doesn’t seem ‘sensational’ to me. But thank you for your comments.
I have a particular interest in this. Diagnosed with breast cancer in 2006, following chemo and radiotherapy I was prescribed Femara (letrazole). This is known to thin the bones so I had a benchmark dexa test – although there is a fair bit of evidence that chemotherapy itself can cause bone loss, so this should ideally have been done earlier.
Two years on – and after 2 years’ worth of calcium + viatamin D supplements – the test showed bone loss in both hips of around 4%, less in the spine. This was classed as osteopenia and my GP prescribed biphosphonates to prevent further damage.
I didn’t take them, waiting for my annual oncology check-up. The oncologist thought I could wait to see what the next test showed. In the meantime I also stopped taking the calcium. I wasn’t remembering every day and worked out that I eat at least the dosage of the supplement each day. I drink barely any milk, do eat cheese, but mainly my intake is from vegetables and fish. I did start taking vitamin D though.
Last week I saw my gp and she had the results – no measurable deterioration. She was quite surprised, but impressed. I do walk a lot, and was extremely active/sporty when younger, which I’d have thought would help build strong bones.
It’s very difficult to try and decide for yourself the best thing to do, but happily in this instance I seem to have got it right.
Good stuff – but you don’t mention Jane Plant’s work on growth factor in dairy and breast cancer. For myself i believe that was a life saver – as it was for her obviously: (Profesor)Jane Plant: ‘Your Life in Your Hands’ Virgin Books
Moira Phillips
Very interesting stuff. I am pleased to see John focusing on the risk of fracture rather than bone density. As an engineer, there is a clear distinction between “strength” and “density”. Strong bones = great. Flexible bones = great. Dense bones = almost irrelevant factor. The ability to withstand impact forces is not determined by density. I’d far rather my bones to be made from bamboo than slate! I wonder what level of research has been conducted into this side of things….
I can’t comment on the nutrient side of the debate, but I do know that Prof Jane Plant talks an awful lot of sense in her books, so I’ve reduced my dairy (apart from yogurt) and now get my calcium from fish and leafy veg – which ties in with John’s comment on following a “caveman” diet.
I wonder whether any of this research looked at how the milk was treated before it was consumed. The kind of milk found in the supermarket has nothing much to do with what comes out of the cow. I’m lucky enough to get raw organic milk direct from the farm and it tastes so much better than the homogenised muck that is available in the shops. It also has a higher, and variable, fat content with the cream floating to the top. That’s what milk was like when I was a child and there were many fewer people with milk allergies then.
I’m surprised that neither the article nor the comments mention magnesium at all! Calcium intake must be balanced by magnesium intake (ratio 3:2 or 2:1), for it seems that the one depletes the other if the balance is not right!
It is also said that the chemical form of the calcium is important – apparently calcium citrate is the one best absorbed.
I have also just read an interesting article on salt: The ‘baddie’ is table salt (sodium chloride), whereas other forms of salt, such as Nat.Mur for instance, are beneficial and necessary. It would thus be wise to substitute the regular table salt with other, better forms of salt.
On the other hand, pure, untreated sea salt aparently does not have the harmful effects that refined table salt (which contains chemical additives) has.
I’ve seen too many older women who are late to the game of building protection for their bones – and in and out of the hospital because they simply fell.
I’ll take my calcium in the form of yogurt or low-fat kefir. In addition, a supplemental pill at bedtime along with some supplemental vitamin D.
‘The Truth About Food’ (TTAF) was a factual BBC TV series dating to 2007 for which an accompanying book was also published. It was fairly ground-breaking at the time; not so much for being especially well informed upon matters food and health, perhaps, but for being able to take the ‘reasonably well informed’ and attractively deliver that content to a lay audience. I expect people amongst its audience who had not previously given ‘food’ much thought began to think more carefully about diet and health.
Those behind TTAF recreated an experiment where volunteers, camping in an enclosure at Paignton Zoo, lived on an ‘ape diet’, predominantly raw veg and fruit, for two weeks and saw marked alterations ‘for the better’ in metrics commonly considered markers for health. No other content of which I am aware has shown such a demonstrably clear association between the content of our diet and the workings of our body for popular appeal.
Footage of the experiment fell on the cutting room floor, though. The ‘chapter’ did not reveal that the initial diet-plan was not entirely tenable. Volunteers found there weren’t enough hours in the day to munch there way through the 5kg of veggies needed to make up 2300 calories per day. As I recall cooked mackerel was introduced as an additional feature of the diet plan. Previously unbroadcast footage of the experiment turned up in a BBC Horizon program, ‘Did Cooking Make Us Human’, broadcast spring 2010 and revealed this.
TTAF certainly catalysed my own interest but having taken that interest further and reviewed TTAF content I have come to feel the program richly deserved a follow-up series. Such a series, I think, deserves the title, ‘The Real Truth About Food’ and it would have to include content on nutrition and economics to get across how and why so many myths have been propagated in the name of ‘nutritional science.’
To the best of my recollections neither cereals nor dairy were included in the TTAF ‘ape diet’.
The peoples of the steppes of Eurasia invented an amazing variety of products from the animals they herded including butter, cheese, yoghurt, kefir – to make milk more digestible. Their survival depended on it and it would appear they were healthy. I am no milk lover (being lactose intolerant) however, I do eat small amounts of sheep and goats yoghurt, kefir and cheese from animals, that have ‘led a good life’ i.e. by husbandry techniques that respect their needs and does not treat them as machines. I think understanding how cultures used and made a food digestible should not be thrown aside for maybe, bad science and profitability by food manufacturers. Low fat, pasteurized, homogenized milk from cows fed high protein, unnatural diets is just part of the industrialized ‘Western diet’
What concerns me as I walk through supermarkets is the row upon row of drinks aimed at children: brightly colored, sugary and carbonated – does not this stuff ‘rob’ the calcium from childrens’ bones? Another product of the highly profitable ‘Western diet’.
Perhaps a more holistic approach to dairy would be small amounts of good quality, organic, full fat (for Vit D absorption) cultured dairy products along with lots of green vegetables for an ample supply of magnesium and fun exercise for kids outside to hopefully soak up some of the precious sun’s rays to lay down good skeletal health.
Bone health is essentially hormonal. There is a list of nutrients as long as your arm involved in bone building and the process of bringing them all together in a way which clears old bone and continuously builds new bone is entirely dependent on the direction of hormones. If researchers just look at dietary milk/calcium and don’t take this into consideration it is quite likely that they will see no definite relationship. I don’t know whether any of the studies you mentioned took this into account or not. For example any diet which creates insulin resistance will be detrimental to bone health because this in itself causes a hormonal imbalance. Once again carbs are suspect.
If we needed dairy we would be the only mammal created by nature depending on milk – and that of another species at that – as adults. Doesn’t make sense …
Re Kevin eakins’s comments above.
That would make sense. I’m not extreme or fanatical, but do believe my diet in general must be responsible for the apparent health of my bones despite having to take the letrazole.
I’m not a veggie but eat a lot of vegetables and several veggie meals a week.
No fizzy or other sugary drinks.
Absolutely no ‘diet’ or low-fat products.
Bread is all homemade, wholemeal & spelt.
Occasional cakes & biscuits almost always homemade.
Virtually no pre-prepared foods.
Relatively low carb.
What I cook/we eat is by means odd or cranky, no-one would say ‘oh yes, the house with the weird food’. It’s just real food.
I feel no guilt at all eating the odd bar of chocolate or bag of crisps (I drink wine too).
I may have had cancer but I honestly can’t remember when I last had a cold or the ‘flu.
I am wading my way through a book entitled “The Body Electric” by Robert O. Becker M.D. Story of one doctors journey from trying to establish why salamanders could regenerate limbs to all he discovered about bodies. A book well worth reading but has a lot of technical information for casual reading. Dr. Briffa, this one is for you if you haven’t already read it! Anyway he brings up the discovery of how copper acts as a peg holding the apatite crystals onto collagen. Page 133 of the book. The point is that there are many metabolic processes that go into our having healthy bones. I know a diet and supplements to give us a complete array of what a body requires and then the exercise to distribute those nutrients throughout the body are essential. It is known that obese individuals usually do not have osteoporosis and it is known that bones do not uptake nutrients unless there is resistance exerted on them. Woman, we can’t sit back after the little ones no longer need packing around. We must be exerting weight on our bones. Heavy housework, gardening, and I do moderate weight training.
Thanks Dr. Briffa for stepping out of the box and helping all of us to a healthier life. I love being healthy!!!!