The Primacy of the Low Carbohydrate Diet - part 2 of 2

chalem_laurence_134_01By Laurence D. Chalem

The (6b) Skeletal (bone) system, beyond studies about the correlation between osteoporosis and calcium, is supported by a low-carbohydrate diet in "The Effect of a Low-Carbohydrate Diet on Bone Turnover," by J. D. Carter, F. B. Vasey, and J. Valeriano.

Here, the authors set out to determine whether or not a low-carbohydrate diet would lead to increased bone turnover. Thirty patients (15 study subjects and 15 controls) were recruited for this 3-month study.

The 15 patients on the diet were instructed to consume less than 20 g of carbohydrates per day for the 1st month and then less than 40 g per day for months 2 and 3. Control subjects had no restrictions on their diet. And the conclusion? "Although the patients on the low-carbohydrate diet did lose significantly more weight than the controls did, the diet did not increase bone turnover markers compared with controls at any time point. Further, there was no significant change in the bone turnover ratio compared with controls."

In what could be classified as the only compendium devoted to the relationship between the skeletal system and diet, Nutrition and Bone Health (2004) doesn't advocate any particular diet, although it does include an article (the book is a collection of independently written articles) describing both the plate model of the UK and the former pyramid model of the US.

The authors used these models as an assumption of diet; that, and a reference to fat leading to heart disease, without quoting any specific, credible evidence in defense of either. As you read more and more health, diet, medical, reference books and articles, you'll find support of those two concepts without evidence common faults. Mark Twain understated it best when he said "Be careful about reading health books. You could die of a misprint."

However, if I could choose one quote from the book to best embody its entirety, it is that "bone health is not a mononutrient issue." Some specific examples include:

"An inadequate intake of calcium and an inadequate level of vitamin D, alone and in combination, influence calcium-regulating hormone levels. Deficiency of either nutrient results in reduced calcium absorption and a lower circulating ionized concentration. The latter stimulates the secretion of parathyroid hormone (PTH), a potent bone-resorbing agent. Over time, a small increase in the circulating level of PTH leads to measurable and significant bone loss and increased risk of fracture."

"Vitamin A deficiency is characterized by xerophthalmia, night blindness, cessation of growth, and increased susceptibility to infections. On the other side, very vitamin A intake might affect, among others, bone and bone metabolism, as it has long been known. High vitamin A intake seems to accelerate bone loss."

• "Fluorine is an indispensable trace element and plays a role in normal development and maintenance of the skeleton and teeth. As is true for other essential trace elements, deficiency or excess has clinical consequences: intakes below the recommended daily dose result in growth and development retardation, whereas long-term high intake leads to hyperostosis or even severe skeletal sclerosis."

Low-fat endorsing as it may be perceived, one article clearly supports the use of fat in promoting bone health: "Dairy products are complex, containing many essential nutrients, and thus their effects on bone health are likely more that can be accounted for by any single constituent and the totality of their effects may be more than the sum of parts."

But more interesting is the book's discussion on fruits and vegetables:

• "The approach of using food groups to examine the relationship between diet and disease is an appropriate and logical approach to examining the relationship between diet and osteoporosis. There is somewhat remarkable agreement among countries as to the proportions with which we should be eating food groups. The data suggest that milk and milk products (as providers of more than 50% of total dietary calcium) and fruit and vegetables are beneficial to bone health across the age ranges, although clearly more work on fracture reduction is required."

• "Only two large population-based studies have examined the specific impact of dietary "quality"/food groups directly on indices of bone health, namely, the Aberdeen Prospective Osteoporosis Screening Study (APOSS) and the Framingham Offspring Study. Cluster analysis on 904 women (mean age 54 yr.), pre-, peri-, and postmenopausal, showed that a number of food groups, including fried foods, cakes, processed meats, and puddings, were associated with worsening hip bone loss..."

• "These data support the findings of both the original APOSS baseline study and the older Framingham cohort and indicate that a high fruit and vegetable intake is protective to the skeleton, whereas high candy consumption is associated with lower bone mass, regardless of gender. These data also suggest that a high intake of fatty, sugary foods is detrimental to bone health around the time of menopause."

This last quote conflicts with one of the most interesting cohort studies I've seen on the subject. In "Food Choices and Coronary Heart Disease: A Population Based Cohort Study of Rural Swedish Men with 12 Years of Follow-up," by Sara Holmberg, Anders Thelin, and Eva-Lena, the authors concluded: "Daily intake of fruit and vegetables was associated with a lower risk of coronary heart disease when combined with a high dairy fat consumption, but not when combined with a low dairy fat consumption. Choosing wholemeal bread or eating fish at least twice a week showed no association with the outcome."

As with other nutritional controversies, we find the unifying answer to whether or not it's fruits and vegetables per se or in combination with other foods that reduces heart or bone disease risk in Good Calories, Bad Calories, by Gary Taubes, and here he delivers the last words: "As a matter of logic, though, it doesn't necessarily imply that the lack of vitamins are caused by the lack of fresh fruits and vegetables...It's possible that eating easily digestible carbohydrates and sugars increases our need for vitamins that we would otherwise derive from animal products in sufficient quantities...There is an increased need for these vitamins when more carbohydrate in the diet is consumed."

The Primacy of the Low Carbohydrate Diet part 1

Laurence D. Chalem (b. 1963), a type 1 diabetic, has been passionately researching diabetes for the last decade. In his most recent book, Essential Diabetes Leadership, Laurence investigates the literature of the last three centuries in search of an optimal treatment of diabetes.

August 2011

13. Ibid, p. 245.

14. Ibid, pages 236-237.

15. Ibid, p. 237. See also the following: Macdonald HM, New SA, Grubb DA, Goloden MHN, Reid DM. "Impact of Food Groups on Perimenopausal Bone Loss." In: Burckhardt P, Dawson-Hughes B, Heaney RP, eds. Nutritional Aspects of Osteoporosis 2000 (4th International Symposium on Nutritional Aspects of Osteoporosis, Switzerland, 1997). Challenges of Modern Medicine. Ares-Serono, Academic, New York, 2001, pp. 399-408; Tucker KL, Chen H, Hannan MT, et al. "Bone Mineral Density and Dietary Patterns in Older Adults: the Framingham Osteoporosis Study." Am J Clin Nutr 2002; 76:245-252; New SA, Bolton-Smith C, Grubb DA, Reid DM. "Nutritional Influences on Bone Mineral Density: a Cross-Sectional Study in Premenopausal Women." Am J Clin Nutr 1997; 65:1831-1839; New SA, Robins Sp, Campbell MK, et al. "Dietary Influence on Bone Mass and Bone Metabolism: Further Evidence of a Positive Link Between Fruit and Vegetable Consumption and Bone Health?" Am J Clin Nutr 2000; 71:142-151; & Tucker KL, Hannan MT, Chen H, Cupples A, Wilson PWF, Kiel DP. "Potassium and Fruit & Vegetables are Associated with Greater Bone Mineral Density in Elderly Men and Women." Am J Clin Nutr 1999; 69:727-736. Op cit. "Food Groups and Bone Health," by Susan A. New. In: Nutrition and Bone Health. Edited by M.F. Holick and B. Dawson-Hughes. New Jersey: Humana Press Inc., 2004, p. 237.

16. The authors followed coronary heart disease morbidity and mortality in a cohort of rural men (N = 1,752) participating in a prospective observational study. Dietary choices were assessed at baseline with a 15-item food questionnaire. 138 men were hospitalized or deceased owing to coronary heart disease during the 12 year follow-up. See "Food Choices and Coronary Heart Disease: A Population Based Cohort Study of Rural Swedish Men with 12 Years of Follow-up," by Sara Holmberg, Anders Thelin, and Eva-Lena Stiernström. Int. J. Environ. Res. Public Health 2009, 6, 2626-2638; doi: 10.3390/ijerph6102626. Available online at Retrieved on 12/13/09.

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