The Better Bones Blog

by Dr. Susan Brown, PhD.

A bowl of lentils

5 diet changes that add years to your life

Improving your diet quality by 20% can lead to a longer life — and it’s surprising how small the changes are to get you there.

A recent study in the New England Journal of Medicine shared how making a few minor tweaks to your eating habits can produce a noticeable increase in your lifespan. I find it fascinating that this was the first time researchers actually looked at whether changing your eating habits for the better would have any effect on how long you live. It seems so obvious that the answer would be yes — but no one had ever actually done research to see if it’s really true.

And boy, is it true.

What the study looked at

Researchers analyzed data from almost 48,000 women who participated over a total of 16 years in the Nurses Health Study and 26,000 men who took part in the Healthy Professionals Follow-Up Study. What they found is that those whose diets scored consistently high on three separate measures of diet quality had between 11 and 14% lower risk of death from any cause than those whose diet quality scored consistently low.

That’s pretty impressive by itself, but the part that really caught my attention was what the study found when people made the commitment to healthier eating. Those participants whose diet quality scores improved by 20% over time had a reduction of between 8 to 17% in their risk of death by any cause—regardless of whether those improvements took 8, 12, or 16 years to accomplish. The association was stronger when cardiovascular causes of death were considered in isolation. And the reverse was also true: If the participants’ diet quality got worse over time, their risk of dying during the study period grew by 6–12%.

5 diet changes that may just save your life

Something else that I noticed about this study — so many of the diet changes researchers note can lengthen your lifespan are the same eating habits that do so much to protect your bones!

1. Less meat, more lentils. The authors noted that “…increase in consumption of nuts and legumes from no servings to 1 serving per day and a reduction in consumption of red and processed meats from 1.5 servings per day to little consumption will result in an improvement of 20 points in the score.” So if you are thinking of beef stew for dinner, you might want to skip the red meat and eat a bean-based chili instead — with plenty of veggies!

2. Use high-fiber whole grains instead of their processed counterparts. In place of pasta or white rice, why not try wild rice instead? It’s higher in fiber and lower in carbohydrate — and less acidifying. (Throw in a handful of chopped walnuts or cashews for additional anti-inflammatory benefits.)

3. Skip the soda and drink water with a splash of lemon or lime juice instead. Citrus fruits are especially alkalizing additions — and it’s almost universally true that most of us aren’t well hydrated so drink up!

4. Eat more leafy greens. Commit to adding at least one leafy green vegetable — even just one! — to your plate at one meal each day. You’d be amazed at how easy it is — and you’ll get more out of it if you substitute it for something less beneficial, like pasta or potatoes. Whether cooked or in a fresh salad, the benefits of leafy greens are unmistakable.

5. Experiment with spices. There are a number of spices with bone-supporting properties, and it’s a simple matter to include them to your recipes. I’ve offered some suggestions for using one of them, turmeric, in an earlier post.

I know many people think that making changes to improve health is an arduous uphill climb. It isn’t! If there’s one thing I hope all my readers will share with their family and friends, it’s this: You can make a big difference by making a few small changes.

Have a friend who could use this information? Please share this blog — and save a life!

Reference:
Sotos-Prieto M., Bhupathiraju S.N., Mattei J., et al. Association of changes in diet quality with total and cause-specific mortality. N Engl J Med 2017;377(2):143–153.

How much magnesium do you need to prevent fracture?

Is magnesium the missing ingredient for preventing bone fracture?

Are you getting enough magnesium? The mineral may not immediately spring to mind when you think about important nutrients for your bones — but two new studies that found a strong relationship between insufficient magnesium and fracture risk could change this.

Low magnesium and hip fracture are connected

The first study (Kunutsor et al, 2017) found that having low magnesium levels in the blood correlated to a 44% higher risk of bone fractures, particularly hip fractures. This was done by looking at serum magnesium levels of 2,245 middle-aged men (age 43-61 years old).

The study noted that none of the men with what they regarded as “high” magnesium levels (more than 2.3 mg/dL) fractured at all. I should mention that the FDA sets the serum magnesium reference range at 1.8-3.6 mg/dL, so 2.3 mg/dL hardly qualifies as a “high” level of magnesium. It’s not even in the middle of the range! And that raises the possibility that chronic, latent magnesium deficiency may have been depleting the study participants’ bones of this needed mineral (Elin, 2011).

How much magnesium do you need to lower fracture risk?

Researchers also continue to reveal the importance of dietary intake of magnesium — especially for women. The second study (Veronese et al, 2017) included 1,577 and 2,071 women with an average age of 60 years. During the 8 year study, 560 participants — almost 15% — had a fracture. The risk of fracture also decreased significantly in the people who had the highest magnesium intake — 53% in the men, and 62% in the women.

One of the important findings was that in women, the effects were only seen to a significant degree in the ones who achieved the recommended daily allowance (RDA) of dietary magnesium, which was 320 mg/day (for men, it was 420 mg/day).

I generally recommend a daily magnesium intake of: 400-800 mg/day (which is somewhat higher than the RDA).

Here’s how to get the magnesium you need

I get two messages from these studies. One is obvious: We need to pay more attention to magnesium for healthy bones! Both studies show that people who lacked adequate magnesium would have benefited from having more, either through changes to their diet or by taking a magnesium supplement. They also show that even a small increase in daily magnesium intake can produce a significant effect. Ideally, though, we want to get enough to keep our bones healthy — and current ideas of what constitutes “enough” are probably too low.

The other message is perhaps less obvious, but no less important: chronic, latent magnesium deficiency is something you can probably fix pretty easily, assuming there’s no hidden disease process that prevents absorption. A good way to start is to try adding more magnesium-rich foods to your diet, like this easy salad recipe that gives you 350 mg of magnesium. You can also learn more about supplementing for magnesium with my Better Bones Basics.

Magnesium rich salad recipe

Try this magnesium-rich warm salad

In a bowl, toss:
1 cup steamed or sautéed spinach (157 mg of magnesium)
1 avocado, sliced (58 mg of magnesium)
1/4 cup almonds (105 mg of magnesium)
3.5 ounces of sautéed tofu (30 of magnesium)
Sea salt and pepper to taste (optional)

Hear Dr. Susan Brown talk about the importance of magnesium for bone health

References:

Elin RJ. Re-evaluation of the concept of chronic, latent, magnesium deficiency. Magnes Res 2011;24(4):225-227.

Food and Drug Administration. Investigations Operations Manual 2017: Appendix C. Silver Spring, MD: US FDA. Available at https://www.fda.gov/ICECI/inspections/IOM/ (accessed August 7, 2017).

Kunutsor SK, Whitehouse MR, Blom AW, et al. Low serum magnesium levels are associated with increased risk of fractures: a long-term prospective cohort. Eur J Epidemiol 2017; doi: 10.1007/S10654-017-0242-2.

Veronese N, Stubbs B, Solmi M, et al. Dietary magnesium intake and fracture risk: data from a large prospective study. Br J Nutr 2017; doi: 10.1017/S0007114517001350.

Bone Drugs: Are they worthwhile?

Conflicting advice on bone drugs — what does the evidence say?

It’s no secret that I’m no fan of bone drugs in general. I’ve found the arguments for their use deeply unconvincing for decades. And now, European researchers looking at the accumulated evidence about the various drugs’ long-term effects are starting to come to the same conclusion:

Except in extreme cases, bone drugs don’t offer enough benefit in reducing the risk of fractures to be worth the price paid in terms of both short- and long-term side effects.

A European/Canadian research group reviewed the evidence on bisphosphonates like:

  • alendronate (Fosamax),
  • ibandronate (Boniva) and zoledronic acid (Zometa or Reclast)
  • teriparatide (Forteo)
  • denosumab (Prolia)
  • two treatments not used in the U.S.: calcitonins and strontium ranelate

Their findings struck me as good general “lessons” for all of us to learn.

‘Denser’ bones are not always stronger bones

The review found that the majority of osteoporotic fractures happened in those who did not have “osteoporotic bone density.” This helps confirm: Bone density alone cannot predict fracture risk.

Other recent studies show a large percentage of people who fracture have only osteopenia or even normal bone density. Many people with an osteoporotic bone density never fracture.

Not all fractures are created equal

When it comes to assessing bone drugs’ effects, a painless vertebral fracture or a toe fracture (painful, but not life-altering) shouldn’t be considered as clinically important as a hip fracture, which is life-changing.

Yet many drug trials either focus on vertebral fractures or on “non-vertebral” fractures as an endpoint. The stubbed toe becomes equivalent to a hip fracture in determining how effective the drugs are in fracture prevention.

Not surprisingly, when hip fractures are looked at specifically as the endpoint of choice, the researchers discover something different. They found that the data on less serious fractures of toes, wrists and so forth obscure the fact that the drugs don’t do much to prevent the most serious and dangerous osteoporotic fractures.

Bone drugs’ benefits remain inconclusive

The benefits of taking a bone drug must outweigh the costs for it to be worth recommending. And even in high-risk older adults, such benefits have not been shown conclusively.

In weighing the risk-benefits of bone drugs, researchers took a hard line on the importance of evaluating all costs. “Clinical trials evaluating harm-benefit balance in osteoporosis or fracture prevention should be well-powered long-term studies that include hard endpoints,” they note. “Total mortality, total serious adverse events, hip fractures, and functional status are essential outcomes.”

New U.S. osteoporosis guidelines miss the mark

What’s frustrating to me is that experts in the U.S. still focus uncritically on the flawed studies that the review critiques. They glibly parrot the ideas that bone density is the same thing as fracture risk and that drugs offer protection from fractures.

Case in point: The American College of Physicians’ latest osteoporosis guidelines, which were published virtually simultaneously with the European review. They make a “strong recommendation” for the use of bisphosphonate drugs “to reduce the risk of hip and vertebral fractures.” Most galling to me, they openly equate bone mineral density with fracture risk: “most women with normal DXA scores” it notes, “do not progress to osteoporosis within 15 years.”

To which I respond with the European review’s first lesson: Denser bones ≠ stronger bones.

References:
Erviti J, Gorricho J, Saiz LC, Perry T, Wright JA. Rethinking the Appraisal and Approval of Drugs for Fracture Prevention. Front Pharmacol. 15 May 2017 | https://doi.org/10.3389/fphar.2017.00265

Qaseem A, Forciea MA, McLean RM, Denberg TD, for the Clinical Guidelines Committee of the American College of Physicians. Treatment of Low Bone Density or Osteoporosis to Prevent Fractures in Men and Women: A Clinical Practice Guideline Update From the American College of Physicians. Ann Intern Med. 2017;166:818–839.


Consultation Newsletter Quiz Shop