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What is the relationship between protein and bone health? Calcium and vitamin D are important for bone health, but the role of protein has been controversial. Nancy Robinson, RD, recommends that a bone-healthy diet include 25 to 30 grams of protein at three meals per day. Pharmacist Kent MacLeod states that there is a positive relationship between protein and bone health. This article will explore whether protein is necessary for bone health for people with osteoporosis.

Protein and Bone Health

The concern some people have with protein and bone health is the effect protein has on acid production in the body. When protein is metabolized in the body, acid is generated.  This acid has to be neutralized and calcium is a natural ‘buffer’. Since an increase in dietary protein results in greater calcium loss in the urine, it was thought that excess dietary protein was pulling calcium out of the bones, and subsequently weakening them.

A recent meta-analysis (where researchers do an exhaustive search of the medical and scientific literature and base conclusions on what the highest quality studies collectively demonstrate) found that protein did not have a negative effect on bone health, specifically bone mineral density (BMD).

In fact, the research shows that the positive relationship between protein and bone health and that there was a slight incremental effect of dietary protein on BMD.  There was no effect, either positive or negative, on fracture incidence (1) such as a compression fracture.

Based on this extensive review, and commentary from other researchers (2-3), it can be concluded that there is a positive relationship between protein and bone health. So will eating more protein increase your bone strength?

Maybe.

 

protein and osteoporosis

Protein and Ageing

Research is pointing more and more toward protein needs increasing as people age. Ageing appears to be associated with a reduced ability to stimulate skeletal muscle protein synthesis.

To maximize muscle protein synthesis, recent research proposes the diet include 25 to 30 grams of high quality protein at 3 meals per day. One 2013 study found that elderly women with a daily protein intake greater than 70 grams had a significantly decreased risk of frailty. The women with the highest plant protein intake had a 34 percent decreased risk of frailty. The women with the highest animal protein intake had 27 percent decreased risk of frailty. These findings seem to indicate a positive relationship between protein and bone health.

Protein Sources

All of your protein does not have to come from meat, fish, cheese and eggs. When you eat lots of vegetables the amount of protein in the vegetables can contribute significantly to your total protein intake. When you eat meat, you only need 3 ounces to get approximately 21 grams of protein. So if you combine 3 ounces meat with 2 cups of vegetables for a meal, you will generally get at least 25 grams of protein.

Many people eat much more protein than this and not enough vegetables. While others, especially at breakfast, don’t get enough protein. Muscles need a steady supply of protein all day and in general most people can’t absorb more than 25 to 30 grams of protein at one time.

You also need to consume adequate calories from carbohydrates and healthy fats so that protein is available for optimal utilization by the body.

Protein and Osteoporosis: Why Protein is Important

Protein is an excellent source of energy and has multiple roles in the body:  muscles, hair, skin, enzymes, antibodies, hormones, neurotransmitters and for storage and transport of other molecules. Unfortunately, many seniors, especially if they are living on their own, and subsiding on ‘tea and toast’, do not get enough protein in their diet.

A poor quality diet quality can lead to weakness, fatigue, sleeping problems, nutritional deficiencies, and a host of other problems. This is problematic for the well-being of seniors, those most susceptible to osteoporosis, and may worsen the chances of a fall.

Finding the Right Balance

The goal is to eat enough protein to maximize muscle synthesis while still keeping a good acid alkaline balance in the diet. The role of an alkaline focused diet in the treatment of osteoporosis is controversial and not all researchers believe acid foods contribute to osteoporosis. Other experts believe high acid eating is one of the reasons osteoporosis is so widespread in western countries.

Nancy Robinson’s opinion is that the evidence is compelling enough to warrant balancing high acid foods with alkaline foods. Eating lots of fruits and vegetables is the main way to achieve a healthy acid alkaline balance and is also believed to reduce the risk of some cancers, diabetes and Alzheimer’s.

Regardless of what current ongoing and future studies find regarding the role of acid and alkaline foods in osteoporosis we already know eating lots of fruits and vegetables is good for us.   Visit Nancy’s website for more information on the acid alkaline theory of eating and its possible role in osteoporosis.

How to Improve Intake of Protein

In our low-fat world, many foods are being shunned because of their fat content. Eggs, nuts, cheese, milk and other dairy products are easy sources of protein for older adults and seniors.  Additional dietary sources of protein include meat and legumes (but these often take more preparation and/or cooking time).

One of the easiest ways to add more protein to our diet is to have it at breakfast.  It has been shown that having a caffeinated coffee and either a muffin, bagel, or donut at breakfast dramatically increases insulin levels in the body (4).  Having this type of breakfast repeatedly over time, may increase your chance of developing diabetes.

All of us, no matter what our age, can benefit from having some protein in the morning.  Pharmacist Kent MacLeod starts his day with a protein shake, made from high quality whey protein. Kent has provided two recipes for protein shakes below. The first is particularly interesting because it includes fish oil with protein shake.

Recommendations

Nancy Robinson recommends the following general guidelines for keeping high acid foods balanced with alkaline foods and have designed my Eating Plan to meet these criteria:

Have 1 serving of fruit or vegetable:

  • For every ounce of meat or egg eaten.
  • For every cup of milk, yogurt or beans eaten.
  • For every slice of bread or cup of pasta, grain or rice eaten.

Have 2 servings of fruit or vegetables:

  • For each ounce of cheese eaten.

Check out the free demo of one-weeks worth of my menus on Nancy’s website to see how these recommendations are incorporated into actual meal plans—including the use of meat, fish and vegetarian entrees.

Protein and Strength Training

If you participate in a strength-training program to gain bone strength and improve balance then it is important to eat enough protein to maximize muscle synthesis while still keeping a good acid alkaline balance in the diet.

Consult a Health Professional

These protein recommendations may not apply to individuals who have diseases or conditions affecting protein metabolism as they should work with health care providers that specialize in their condition and can customize their protein intake and diet to their individual needs.

Conclusions

  • Protein has a slight positive effect on bone mineral density, not a negative effect as previously thought.
  • Protein is an important component of everyone’s diet, and should NOT be avoided by those with osteoporosis.
  • Incorporating modest amounts of protein in the diet of older adults and seniors will enhance overall health.
  • Having a protein shake or a protein-rich food in the morning is a healthier choice than a coffee-and-a-carbohydrate breakfast.

Two Recipes for Protein and Bone Health

NutriChem Pharmaceutical has spent quite a bit of time sourcing a supplier for our own NutriChem Logical Choice Whey. The whey they have has a particularly good dispersibility and a mild flavour.

Here are two recipes that are quite popular. Enjoy!

Fish Oil with Protein Shake Smoothie

Ingredients:

  • 1 scoop of Logical Whey Protein (83.1 calories)
  • 250 ml (large cup) of unsweetened almond milk  (40 calories for 1 cup)
  • 1 tsp of Fiberrific fiber powder (4.5 grams of fiber per teaspoon)
  • 1 tsp of Cyto-Matrix Fish Oil (approx 45 calories)
  • 1 tbsp of whole flaxseed freshly grounded (approx 45 calories)
  • Pinch of cinnamon
  • Optional: add NutriChem Nutridophilus Powder

Directions:

  • Blend all ingredients in a blender with a few ice cubes. If smoothie is too thick, add a little water or some more ice.

Notes:

  • Approx: 213 total calories
  • 168 calories without the fish oil
  • Flax, Fish and Antioxidant oils require refrigeration after opening.
  • When using fiber supplements it is necessary to ensure that you are properly hydrated so please drink plenty of water.

Logical Whey Low Calorie Orange Banana Creamsicle Protein Shake Smoothie

Ingredients:

  • 1 scoop of Logical Whey Protein Vanilla (83.1 calories)
  • ½ cup orange juice (approx 60 calories)
  • ½ cup water
  • ½ banana (frozen is best) (approx 50 calories)
  • 1 tsp of Fiberrific fiber powder (4.5 grams of fiber per tsp)
  • 1 tsp of Flora flax or Cyto-Matrix Fish Oil.  (approx 45 calories)
  • Optional: Add NutriChem Nutridophilus Powder

Directions:

  • Blend all ingredients in a blender with a few ice cubes. If smoothie is too thick, add a little water or some more ice.

Notes:

  • Approx:  238 total calories
  • 193 calories without the flax or fish oil
  • Flax, Fish and Antioxidant oils require refrigeration after opening.
  • When using fiber supplements it is necessary to ensure that you are properly hydrated so please drink plenty of water.
protein and bone health

Osteoporosis Guidelines

For more information, check out my Osteoporosis Guidelines.

 

References

  1. Darling, AL et al.  (2009)  Dietary protein and bone health:  a systematic review and meta-analysis.  Am J Clin Nutr  90:  1674-92.
  2. Kerstetter, JE  (2009)  Dietary protein and bone:  a new approach to an old question.  Am J Clin Nutr  90:  1451-2.
  3. Bonjour, JP  (2005)  Dietary protein:  an essential nutrient for bone health.  J Am Coll Nutr  24:  526S-36S.
  4. Moisey, LL et al.  (2008)  Caffeinated coffee consumption impairs blood glucose homeostasis in response to high and low glycemic index meals in healthy men.  Am J Clin Nutr  87:  1254-61.

Comments

October 30, 2010 at 1:24pm

Farida Tavares

Very informative and much needed information for older people in our society. I have been training with Margaret for over four years now and can attest to the positive effects of the correct exercises in weight control and maintainance of bone density

November 4, 2010 at 1:43pm

Janis Leiterman

Hi Margaret, I greatly value your evidence-based approach in guiding me on my journey toward wellness. I particularly appreciate your taking the time to summarize, in plain language, what would amount to extensive reading. When I can stick to your guidelines for my protein intake, it has a significant impact on my carbohydrate cravings; I skip my cookies & coffee breaks, don't get the (likely insulin-induced) shakes and best of all.....LOSE WEIGHT. It's such a win-win formula. This evidence helps me to re-commit in my constant challenge to change my behaviour. Do you mind sharing your morning shake recipe? Or is it on the site already. Thanks for all of the ways you help me,
Jan

November 5, 2010 at 6:33pm

Richard Martin

Hi Janis: I have asked Kent MacLeod for some protein shake recipes. He has given me two and I have provided them in a separate post. Enjoy!
- Margaret