Category Archives: Diet

Fermented Milk Reduces Bone Resorption

Abstract

Short-term effect of bedtime consumption of fermented milk supplemented with calcium, inulin-type fructans and caseinphosphopeptides on bone metabolism in healthy, postmenopausal women.

Milk products are good sources of calcium and their consumption may reduce bone resorption and thus contribute to prevent bone loss.
We tested the hypothesis that bedtime consumption of fermented milk supplemented with calcium inhibits the nocturnally enhanced bone resorption more markedly than fermented milk alone, and postulated that this effect was most pronounced when calcium absorption enhancers were added.
In a controlled, parallel, double-blind intervention study over 2 weeks we investigated the short-term effects of two fermented milks supplemented with calcium from milk minerals (f-milk + Ca, n = 28) or calcium from milk minerals, inulin-type fructans and caseinphosphopeptides (f-milk + Ca + ITF + CPP; n = 29) on calcium and bone metabolism in healthy, postmenopausal women, and compared them with the effect of a fermented control milk without supplements (f-milk, n = 28). At bedtime 175 ml/d of either test milk was consumed. Fasting blood samples and 48 h-urine were collected at baseline and at the end of the intervention. Urine was divided into a pooled daytime and nighttime fraction. Multifactorial ANOVA was performed.
Fermented milk independent of a supplement (n = 85) reduced the nocturnal excretion of deoxypyridinoline, a marker of bone resorption, from 11.73 +/- 0.54 before to 9.57 +/- 0.54 micromol/mol creatinine at the end of the intervention (P = 0.005). No effect was seen in the daytime fraction. Differences between the three milks (n = 28 resp. 29) were not significant. Fermented milk reduced bone alkaline phosphatase, a marker of bone formation, from 25.03 +/- 2.08 to 18.96 +/- 2.08 U/l, with no difference between these groups either. Fermented milk increased the nocturnal but not daytime urinary excretion of calcium and phosphorus. The effects on calcium and phosphorus excretion were mainly due to the group supplemented with Ca + ITF + CPP.
Bedtime consumption of fermented milk reduced the nocturnal bone resorption by decelerating its turnover. Supplemented calcium from milk mineral had no additional effect unless the absorption enhancers ITF + CPP were added. A stimulated intestinal calcium absorption may be assumed, since urinary calcium excretion increased at a constant bone resorption.

Adolphi B, Scholz-Ahrens KE, de Vrese M, Açil Y…
Eur J Nutr Feb 2009
PMID: 19030908

Equol is Bone Sparing, Like Isoflavones in Rats

Abstract

Modulation of soy isoflavones bioavailability and subsequent effects on bone health in ovariectomized rats: the case for equol.

Soy products are of particular interest because of their potential health benefits in a range of hormonal conditions, such as osteoporosis, due to their high content in phytoestrogens. Because equol, the main metabolite from soy isoflavones, is thought to be powerful, the present study was designated to evaluate the bone-sparing effects of equol by either providing the molecule through the diet or by eliciting its endogenous production by modulating intestinal microflora by short-chain fructooligosaccharides (sc-FOS) or live microbial (Lactobacillus casei) together with daidzein, its precursor.
A comparison with daidzein and genistein was also performed. Rats (3 months old) were ovariectomised (OVX) or sham-operated (SH). Ovariectomised rats were randomly assigned to six experimental diets for 3 months: a control diet (OVX), the control diet supplemented with either genistein (G), or daidzein (D), or equol (E) at the level of 10 microg/g body weight/d. The remaining OVX rats were given daidzein at the dose of 10 mug/g body weight/d, simultaneously with short-chain FOS (Actilight, Beghin-Meiji) (D+FOS) or Lactobacillus casei (Actimel, Danone) (D+L). The SH rats were given the same control diet as OVX.
Genistein, daidzein or equol exhibited a bone sparing effect. Indeed, total femoral bone mineral density (BMD) was significantly enhanced (compared to that of OVX rats), as was the metaphyseal compartment. Bone strength was improved by E consumption, but not by genistein or daidzein given alone. As far as the FOS diet is concerned, the addition of prebiotics significantly raised efficiency of the daidzein protective effect on both femoral BMD and mechanical properties. The effects of lactobacillus were similar, except that the increase in metaphyseal-BMD was not significant.
In conclusion, long-term equol consumption, like genistein and daidzein, in the ovariectomized rat, provides bone sparing effects. Adding indigestible sugars, such as FOS or live microbial as L. casei, in the diet significantly improves daidzein protective effects on the skeleton.

Mathey J, Mardon J, Fokialakis N, Puel C…
Osteoporos Int May 2007
PMID: 17333448

FOS + Soy Effects Additive For Some Parameters in Rats

Abstract

The effects of fructo-oligosaccharides in combination with soy protein on bone in osteopenic ovariectomized rats.

The intestinal microflora is important in rendering soy isoflavones bioavailable by facilitating their conversion to equol. Hence, substances that can modulate the intestinal microflora could affect the bioavailability of isoflavones. In this study, we examined the effects of fructo-oligosaccharides (FOS), a prebiotic, on enhancing the effects of soy isoflavones on bone in ovariectomized osteopenic female rats.
Sixty-three 9-month-old female Sprague-Dawley rats were either sham-operated (Sham; one group) or ovariectomized (Ovx; four groups) and were fed a control diet for 3 months to induce bone loss. After bone loss was confirmed via dual-energy x-ray absorptiometry, rats were placed on dietary treatment for 4 months. The Sham and one Ovx group received a control diet, and the remaining Ovx groups received either a soy protein-based diet (Soy), a FOS-supplemented diet (FOS), or a soy protein-based and FOS-supplemented diet (Soy+FOS). Before the termination of the study, whole-body bone mineral density (BMD) and bone mineral content (BMC) were assessed under anesthesia. Immediately after euthanasia, bone specimens were collected for the assessments of BMD, BMC, and biomechanical and microarchitectural properties.
Whole-body BMD values were significantly higher in FOS and Soy+FOS groups compared with Ovx controls. The tibial BMC increased by 10%, 6%, and 4% in Soy, FOS, and Soy+FOS groups, respectively, compared to the Ovx control group. FOS and FOS+Soy treatments had the most pronounced effects in enhancing lumbar BMC and BMD. The FOS+Soy combination effectively improved tibial microarchitectural properties by enhancing trabecular number and lowering trabecular separation compared with Ovx controls. The effects of dietary treatments on lumbar microarchitectural properties were minimal and biomechanical properties of the femur were not affected by any of the dietary treatments.
Our findings suggest that, although incorporation of either soy or FOS in the diet of Ovx rats can improve BMD of the whole body, tibiae, and lumbar vertebrae, their combination had no any additive effects. However, in terms of microarchitecture, the combination of soy and FOS had a greater effect in reversing the loss of certain microarchitectural parameters such as tibial trabecular number, separation, and thickness.

Devareddy L, Khalil DA, Korlagunta K, Hooshmand S…
Menopause
PMID: 16837891

Review: Carbs, FOS and Inulin Beneficial for Bones

Abstract

Osteoporosis and intake of carbohydrates.

Adequate energy intake including carbohydrates is essential to maintain bone mass. Emaciation along with deficiency in nutrients, such as calcium, vitamin D, and protein is a significant risk factor for bone loss, and should be avoided.
However, there is no clinical evidence that shows the direct effects of carbohydrate on bone mass. On the other hand, excessive intake of carbohydrates results in obesity, which causes other metabolic diseases such as diabetes mellitus (DM). Therefore, dietary regimen must be balanced in general, and complications and conditions of individual patients should be taken well into account. In addition, energy intake is a basis for adequate exercise in order to maintain physical activity and ideal body weight, which will further decrease the risk of bone fracture. Some indigestible carbohydrates, such as inulin and oligofructose, are shown to increase the availability of minerals from foods, and thus can be beneficial to bone mass.

Nakayama K, Katayama S
Clin Calcium Apr 2005
PMID: 15802784

Review: Adding Calcium, Magnesium, Vitamin D, Vitamin K, Inulin, Protein, and Phytoestrogens to Foods

Abstract

Biomarkers of bone health appropriate for evaluating functional foods designed to reduce risk of osteoporosis.

Osteoporosis is a growing global problem. The health care costs and decreased productivity and quality of life are staggering. Much research is invested in life-style approaches to build peak bone mass during growth to prevent osteoporosis as well as to treat the disease in later life. Functional foods have enjoyed a niche in bone health. Foods fortified with Ca are most popular. Other bone nutrients such as vitamin D, Mg and vitamin K are sometimes added. Future products are likely to include enhancers of Ca absorption such as inulin or whey proteins. Dietary factors that reduce urinary Ca loss (plant proteins) or suppress bone resorption (possibly phyto-oestrogens) are also gaining attention. Methodologies for evaluating the effectiveness of functional foods on bone health include measures of bone quality such as bone densitometry or measures of Ca metabolism, particularly absorption. Biochemical markers for bone turnover are less satisfactory for diet-related effects. Use of a rare isotope, 41Ca, and accelerator mass spectrometry offers a new approach for assessing the ability of functional foods to suppress bone resorption.

Weaver CM, Liebman M
Br. J. Nutr. Nov 2002
PMID: 12495464

Review: Milk + Resistance Training

Abstract

Impact of milk consumption and resistance training on body composition of female athletes.

Resistance exercise (RE) preceding the provision of high-quality dairy protein supports muscle anabolism. Milk contains bioactive components, including two high-quality protein fractions, calcium and vitamin D, each of which has been shown modulate body composition (increasing lean mass and decreasing fat mass) under energy balance and hypoenergetic conditions. These dairy nutrients are also essential for skeletal health. Acutely, no study of RE and milk/whey consumption has been undertaken exclusively in female athletes, let alone women, nevertheless, studies with both men and women show increased lean mass accretion following milk/whey compared to soy/placebo. Currently, no longer-term RE studies with milk supplementation have been done in female athletes. However, trials in young recreationally active women demonstrated augmented increases in lean mass and decreases in fat mass with RE and milk or whey protein consumption. The amount of protein consumed post-exercise is also important; two trials using yogurt (5 g protein/6 oz) failed to demonstrate a positive change in body composition compared to placebo. For bone health, RE plus dairy improved bone mineral density at clinically important sites and reduced bone resorption. With energy restriction, in one study, higher dairy plus higher protein resulted in greater fat loss, lean mass gain and improved bone health in overweight women. In another study, milk and calcium supplementation showed no greater benefit. Neither trial exclusively utilized RE. Overall, RE and milk/dairy consumption positively impact body composition in women by promoting losses in fat, gains or maintenance of lean mass and preservation of bone. Future studies in female athletes and under energy restriction with RE alone are warranted.

Josse AR, Phillips SM
Med Sport Sci 2012
PMID: 23075559

Alendronate + Exercise Prevents All Bone Loss During Spaceflight

Abstract

Bisphosphonates as a supplement to exercise to protect bone during long-duration spaceflight.

We report the results of alendronate ingestion plus exercise in preventing the declines in bone mass and strength and elevated levels of urinary calcium and bone resorption in astronauts during 5.5 months of spaceflight.
This investigation was an international collaboration between NASA and the JAXA space agencies to investigate the potential value of antiresorptive agents to mitigate the well-established bone changes associated with long-duration spaceflight.
We report the results from seven International Space Station (ISS) astronauts who spent a mean of 5.5 months on the ISS and who took an oral dose of 70 mg of alendronate weekly starting 3 weeks before flight and continuing throughout the mission. All crewmembers had available for exercise a treadmill, cycle ergometer, and a resistance exercise device. Our assessment included densitometry of multiple bone regions using X-ray absorptiometry (DXA) and quantitative computed tomography (QCT) and assays of biomarkers of bone metabolism.
In addition to pre- and post-flight measurements, we compared our results to 18 astronauts who flew ISS missions and who exercised using an early model resistance exercise device, called the interim resistance exercise device, and to 11 ISS astronauts who exercised using the newer advanced resistance exercise device (ARED). Our findings indicate that the ARED provided significant attenuation of bone loss compared with the older device although post-flight decreases in the femur neck and hip remained. The combination of the ARED and bisphosphonate attenuated the expected decline in essentially all indices of altered bone physiology during spaceflight including: DXA-determined losses in bone mineral density of the spine, hip, and pelvis, QCT-determined compartmental losses in trabecular and cortical bone mass in the hip, calculated measures of fall and stance computed bone strength of the hip, elevated levels of bone resorption markers, and urinary excretion of calcium.
The combination of exercise plus an antiresoptive drug may be useful for protecting bone health during long-duration spaceflight.

Leblanc A, Matsumoto T, Jones J, Shapiro J…
Osteoporos Int Jul 2013
PMID: 23334732

No Bone Benefit in Young Healthy Women from 3 Months Resistance Training or Protein

Abstract

Effects of resistance training and protein supplementation on bone turnover in young adult women.

The strength of aging bone depends on the balance between the resorption and formation phases of the remodeling process. The purpose of this study was to examine the interaction of two factors with the potential to exert opposing influences on bone turnover, resistance exercise training and high dietary protein intake. It was hypothesized that resistance training by young, healthy, untrained women with protein intakes near recommended levels (0.8 g.kg(-1).d(-1)) would promote bone formation and/or inhibit bone resorption, and that subsequent supplementation to provide 2.4 g protein.kg(-1).d(-1) would reverse these effects.
Bone formation was assessed with serum bone-specific alkaline phosphatase (BAP) and osteocalcin (OC), and bone resorption with urinary calcium and deoxypyridinoline (DPD). Biochemical, strength, anthropometric, dietary, and physical activity data were obtained from 24 healthy, untrained, eumenorrheic women (18-29 y) at baseline, after eight weeks of resistance training (3 d.wk(-1), approximately 1 hr.d(-1); 3 sets, 6-10 repetitions, 13 exercises, 75-85% maximum voluntary contraction), and after 12 weeks of resistance training and 10 days of protein/placebo supplementation. Subjects were randomized (double-blind) to either a high protein (HP) or training control (TC) group and, during the final 10 days, consumed either enough purified whey protein to bring daily protein intake to 2.4 g.kg(-1).d(-1), or an equivalent dose of isoenergetic, carbohydrate placebo.
Strength, lean tissue mass, and DPD increased significantly in both groups over time, while percent body fat and BAP decreased (repeated measures ANOVA, p < or = 0.05, Bonferroni correction). No significant changes were observed for serum OC or urinary calcium, and no significant group (TC, HP) x time (baseline, week 8, week 12) interactions emerged for any of the biochemical measures.
(1) Twelve weeks of high-intensity resistance training did not appear to enhance bone formation or inhibit bone resorption in young adult women, as assessed by biochemical markers of bone metabolism. (2) Subsequent maintenance of a high protein intake for 10 days in these regularly-training, calcium-replete women also showed no effects on bone metabolism.

Mullins NM, Sinning WE
Nutr Metab (Lond) Aug 2005
PMID: 16098231 | Free Full Text

The results are surprising. The full study is available using the link above. The authors note that these women were taking calcium supplements.

…to exclude the potential effects of calcium deficiency, each subject was given a supply of calcium supplements … to begin consuming for the duration of the study. Each was instructed to carry the calcium tablets in her purse or backpack, and was regularly reminded to consume one 500-mg tablet, twice per day.

There may not have been much more bone enhancement to gain.

…the subjects were healthy, eumenorrheic, calcium-replete women, regularly participating in high-intensity exercise.

They measured alkaline phosphatase, serum osteocalcin, urinary calcium. and urinary deoxypyridinoline.

It is possible that other biomarkers may have produced different results, and that, given a longer time frame, bone densitometry could detect osteogenic effects.

 

Chocolate Bad for Bones

Abstract

Chocolate consumption and bone density in older women.

Nutrition is important for the development and maintenance of bone structure and for the prevention of osteoporosis and fracture. The relation of chocolate intake with bone has yet to be investigated.
We investigated the relation of chocolate consumption with measurements of whole-body and regional bone density and strength.
Randomly selected women aged 70-85 y (n=1460) were recruited from the general population to a randomized controlled trial of calcium supplementation and fracture risk. We present here a cross-sectional analysis of 1001 of these women. Bone density and strength were measured with the use of dual-energy X-ray absorptiometry, peripheral quantitative computed tomography, and quantitative ultrasonography. Frequency of chocolate intake was assessed with the use of a questionnaire and condensed into 3 categories: or=1 time/d.
Higher frequency of chocolate consumption was linearly related to lower bone density and strength (P<0.05). Daily (>or=1 times/d) consumption of chocolate, in comparison to Older women who consume chocolate daily had lower bone density and strength. Additional cross-sectional and longitudinal studies are needed to confirm these observations. Confirmation of these findings could have important implications for prevention of osteoporotic fracture.

Hodgson JM, Devine A, Burke V, Dick IM…
Am. J. Clin. Nutr. Jan 2008
PMID: 18175753 | Free Full Text

This is disappointing. Cocoa is normally so healthy. My first thought was that they may be seeing the effects of sugar. Reading the full study, which is available for free using the link above, the authors made these comments:

Chocolate is usually also rich in sugar and contains the methylxanthines, theobromine and caffeine (27), and oxalate (11, 12)….

Oxalate is a potent inhibitor of calcium absorption (13). Furthermore, a single 100-g dose of dark chocolate was found to increase calcium excretion by 147% (14). The basis for this is not clear, but it is likely to include an effect of sugar to increase urinary calcium excretion (14, 15), dependent in part on an increase in plasma insulin that itself stimulates calciuria (29).

I wonder what would happen if you consumed a very dark chocolate (so very low in sugar) and supplemented calcium and vitamin D? The idea being that the very dark chocolate would avoid most of the sugar, and the calcium and vitamin D would hopefully overcome the reduced calcium absorption.

Olive Oil, but Not Nuts, May Protect Bones

Abstract

A Mediterranean diet enriched with olive oil is associated with higher serum total osteocalcin levels in elderly men at high cardiovascular risk.

The intake of olive oil has been related to the prevention of osteoporosis in experimental and in in vitro models. Very few prospective studies have evaluated the effects of olive oil intake on circulating osteocalcin (OC) in humans.
The objective of the study was to examine the longitudinal effects of a low-fat control diet (n=34), a Mediterranean diet enriched with nuts (MedDiet+nuts, n=51), or a Mediterranean diet enriched with virgin olive oil (MedDiet+VOO, n=42) on circulating forms of OC and bone formation markers in elderly men at high cardiovascular risk.
Longitudinal associations between baseline and follow-up (2 yr) measurements of total OC, undercarboxylated osteocalcin, C-telopeptide of type I collagen, and procollagen I N-terminal propeptide (P1NP) concentrations were examined in 127 elderly men randomized to three healthy dietary interventions.
Baseline characteristics (age, body mass index, waist circumference, lipid profile, fasting insulin levels, and bone formation and resorption markers) were similar in all intervention groups. The total osteocalcin concentration increased robustly in the MedDiet+VOO group (P=0.007) in parallel to increased P1NP levels (P=0.01) and homeostasis model assessment-β-cell function (P=0.01) but not in subjects on the MedDiet+nuts (P=0.32) or after the control diet (P=0.74). Interestingly, the consumption of olives was associated positively with both baseline total osteocalcin (r=0.23, P=0.02) and the 2-yr osteocalcin concentrations (r=0.21, P=0.04) in the total cohort.
Consumption of a Mediterranean diet enriched with virgin olive oil for 2 years is associated with increased serum osteocalcin and P1NP concentrations, suggesting protective effects on bone.

Fernández-Real JM, Bulló M, Moreno-Navarrete JM, Ricart W…
J. Clin. Endocrinol. Metab. Oct 2012
PMID: 22855341

Interestingly, nuts did not show a benefit.