Bone Health and Ayurveda
by Robert Keith Wallace, PhD
How much calcium should you take? Do acidic foods affect your bone health? How can you avoid osteoporosis? Our bones represent an amazing dynamic system. They are constantly being created and destroyed. The cells that help create bones are osteoblasts, while osteoclasts break down the bones and make calcium available for various biological functions.
When we are young, the balance favors increasing bone mass, and as we get older, the balance shifts towards losing bone mass. This is an enormous problem for the elderly, who often have thinner bones and are prone to falls. Osteoporosis is characterized by a weakening of the bone structure, resulting in a greater risk of hip and other bone fractures. This health problem affects millions and is extremely costly. After one or more hip breaks or fractures, patients lose stamina and have a difficult time recovering.
Calcium and Bone Health
The usual recommendation you hear when a person has a fall and breaks a bone is, “Are you getting enough calcium?” Systematic reviews of research show that consuming the usual recommended dose of 1000 to 1200 mg of calcium has only a minor effect on bone density and doesn’t seem to reduce fractures in people over 50. Bone mineral density (BMD) is a frequently used measure to assess bone health (1,2). A low BMD suggests osteoporosis and an increased risk of a fracture, but a higher BMD does not always mean better bone health, as it has been associated with an increased risk of breast cancer and other conditions (3). So, you or your doctor can no longer say, “Take the recommended amount of calcium, and you will be healthy.” We know the importance of calcium for children, and more recent studies suggest calcium supplementation may be beneficial in young people under the age of 35. Calcium and Vitamin D are essential for healthy bones. To absorb calcium, your body also needs vitamin D. What is being questioned is the effect of extra calcium supplementation at an older age.
Calcium and Diet
There are several sources of calcium in food, such as dairy products, dark green leafy vegetables, and calcium-fortified foods and beverages. You can also get vitamin D from egg yolks, fortified foods, and sun exposure. If you are a vegan or lactose intolerant, then you may need to take a calcium supplement to get your recommended daily dose. However, if you are older, it is unclear how this might help your bone health, and since there are some questions about the side-effects of high-dose calcium supplements and their relation to heart disease and cancer, this makes the situation even more complicated. Calcium supplements can also cause side effects such as gas, constipation, and bloating, as well as interact with prescription medications. You may need to try a few different types of calcium supplements to identify the one that you tolerate the best. To make matters even more complex, there is a question of how well different doses and types are absorbed into the body. The simplest solution is to rely on dietary calcium, recognizing that excessive calcium doesn’t give you extra bone protection.
Diet and Bone Health
Protein consumption has been shown to be beneficial for bone density by providing amino acid substrates necessary for bone matrix formation. Still, there is no significant association between protein intake and fracture incidence (4). As we explained, bone is undergoing constant repair and renewal with no real addition and subtraction of bone. The whole process can, however, be significantly affected by pH (5). A more acidic state shows a lower pH, usually below 7, while a more alkaline condition shows a pH above 7. At a pH of 7.4, the osteoblasts that build bone are active, and at pH 6.9, which is more acidic, the osteoclasts that break down bones to free calcium are active (6). When bones are broken down, this can help neutralize a more acidic condition in the body tissue. The pH is normally very stable at 7.35 due to several systems that include the bicarbonate buffering system of blood plasma, gas exchange in the lungs, and excretion of excess acid by the kidneys. Food intake affects the pH of the blood and, therefore, bone activity. Drinking cans of cola, which are generally acidic, must use both the kidneys and the blood buffering system. Some foods like cheese and egg yolks are acidic, while other foods like vegetables and fruits are usually more basic. There is no one diet that seems to be best for bone health. The most obvious recommendation is to have a balanced diet with sufficient fruits and vegetables and enough protein to supply the needed amino acids.
In addition to diet, there are other factors such as exercise, diabetes, and hormones that can also affect the acidity of the blood. Estrogen, for example, increases osteoblast regulation, building up more bone. When estrogen levels fall in postmenopausal women, this has a negative effect on bone formation. As we get older, there is an increased chance for metabolic acidosis as kidney function weakens, and the body will depend more heavily on bone and blood to maintain acid-base homeostasis (7).
Ayurveda and Bone Health
Ayurveda is one of the most ancient systems of medicine that originated in India. Ayurveda emphasizes living in balance through a holistic approach that includes dietary and lifestyle practices personalized for each individual according to the state of fundamental elemental forces in the physiology known as doshas (8).
Thinning of bones and a decrease in bone mass can occur with an imbalance in the Vata dosha, which is the elemental force associated with air and ether. The qualities of Vata dosha are cold, dry, and irregular in nature. If Vata is out of balance, it can lead to more brittle bones. For bone health, it is important to keep Vata dosha in balance. Foods that are warm, unctuous, and grounding help balance Vata dosha. This includes healthy fats, ghee, olive oil, as well as cooked leafy green veggies, rice, soups, and warm Vata-pacifying tea. Foods that tend to aggravate Vata are cold and dry foods, as well as raw or overly processed foods. One common recommendation is warm milk boiled with the addition of certain herbs such as cardamom, cinnamon, ginger, and cloves. Of course, if you are lactose intolerant, then this is not an option. Additionally, herbs like shatavari and ashwagandha may be used to support bone health.
Ayurveda also recommends lifestyle changes such as yoga and regular exercise, improved sleep habits, meditation (we suggest Transcendental Meditation), and maintaining a good daily routine. The insights of Ayurveda, of course, should be integrated with conventional medical advice as part of an integrative prevention and treatment program.
- Bristow SM, Bolland MJ, Gamble GD, Leung W, Reid IR. Dietary calcium intake and change in bone mineral density in older adults: a systematic review of longitudinal cohort studies. Eur J Clin Nutr. 2022 Feb;76(2):196-205. doi: 10.1038/s41430-021-00957-8. Epub 2021 Jun 15. PMID: 34131304.
- Tai V, Leung W, Grey A, Reid IR, Bolland MJ. Calcium intake and bone mineral density: systematic review and meta-analysis. BMJ. 2015 Sep 29;351:h4183. doi: 10.1136/bmj.h4183. PMID: 26420598; PMCID: PMC4784773.
- Lucas, FL; Cauley, JA; Stone, RA; Cummings, SR; Vogt, MT; Weissfeld, JL; Kuller, LH (Jul 1, 1998). Bone mineral density and risk of breast cancer: differences by family history of breast cancer. Study of Osteoporotic Fractures Research Group. American Journal of Epidemiology. 148 (1): 22–29. doi:10.1093/oxfordjournals.aje.a009554. PMID 9663400.
- Kerstetter, JE (December 2009). Dietary protein and bone: a new approach to an old question. The American Journal of Clinical Nutrition. 90 (6): 1451–52. doi:10.3945/ajcn.2009.28812. PMID 19864406.
- Barzel, US; Massey, LK (June 1998). Excess dietary protein can adversely affect bone. The Journal of Nutrition. 128 (6): 1051–53. doi:10.1093/jn/128.6.1051. PMID 9614169.
- Arnett, TR (February 2008). Extracellular pH regulates bone cell function. The Journal of Nutrition. 138 (2): 415S–18S. doi:10.1093/jn/138.2.415S. PMID 18203913.
- Cao, JJ; Nielsen, FH (November 2010). Acid diet (high-meat protein) effects on calcium metabolism and bone health. Current Opinion in Clinical Nutrition and Metabolic Care. 13 (6): 698–702. doi:10.1097/MCO.0b013e32833df691. PMID 20717017. S2CID 1332501.
- Living in Balance with Maharishi Ayurveda by Robert Keith Wallace, PhD, Karin Pirc, MD, Julia Clark, MS, Maharishi University Press, 2023