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Alisa Bowman
2013 May-June

Move Over, Milk

Want strong bones? You might not need dairy.

“So, are you going vegan?”

I’d already stopped eating meat and fish for ethical reasons, so why did my friend’s question send a chill down my spine? My eyes got wistful as visions of melty grilled cheese sandwiches, salads of sun-warm tomatoes and fresh, milky mozzarella, and the sharp, salty bite of Greek feta danced in my head.

“No way,” I sighed. “I could never give up cheese.”

For years, it seemed I had an itch that only cheese could scratch. More than a casual dalliance, cheese and I were carrying on a full-blown love affair. Not only did cheese bring me so much joy, it was rich in bone-building calcium. It was delicious—and good for me! How could I even think about giving it up?

But the more I learned about the dairy industry, the more I realized that cheese and I didn’t share the same values. For me, the hardship endured by dairy cows and their calves was just too much of a turnoff.

It was time for me to break up with the love of my culinary life.

The Bone of Contention

Still, I was worried. In my zeal to do no harm, would I end up harming my own health? For strong bones, the Institute of Medicine recommends adults consume between 1,000 and 1,200 milligrams of calcium daily, depending on age, and cheese and other dairy products are among the richest food sources of this mineral. As a result, many experts (including my own doctor) strongly recommend we consume three dairy servings daily. 

Was it even possible to give up dairy without weakening my bones?

For answers I scheduled an interview with Dr. Walter Willett, chairman of the Nutrition Department at Harvard’s School of Public Health. He’s also been co- and principal investigator of a landmark study that has tracked the lifestyle habits and health outcomes of 238,000 nurses since 1976, with results that have shaped current health recommendations on heart disease, diabetes, and many
other conditions.

I was floored when one of the first sentences out of Willett’s mouth was this: “Dairy is not the most important food for bone health.” 

He says, “The highest fracture rates in the world are in countries that drink the most milk and consume the most calcium.” In many African countries, women consume only 300 milligrams of calcium daily (the amount in roughly one serving of dairy), yet their hip fracture rates are low. The same is true for Japan and Peru. Compare that to the United States, where we consume three times more calcium and dairy, and our hip fracture rates are the highest in the world. 

The Nurses’ Health Study found that postmenopausal women who had been consuming 2.5 or more servings of dairy a day had the same risk of bone fractures as women who consumed fewer servings. And when Australian researchers compared the bone densities of 105 vegan Buddhist nuns to 105 nonvegetarians, they found no difference between the two groups. The nuns had bones that were just as strong as the milk drinkers.

If calcium is so important for our bones, and milk is one of the richest sources, how is it possible that three glasses of milk a day doesn’t reduce fracture risk? In part, calcium may not be as important as we’ve been led to believe (see “Do We Really Need So Much Calcium?”). But milk might also come packaged with other nutrients that undo calcium’s benefits.

Bones aside, dairy might reduce risk for both diabetes and colon cancer. But Harvard’s Willett says we can get those benefits with just one serving daily. Drinking any more, he says, could harm health more than it helps.

High dairy consumption—three or more servings daily—has been linked with prostate cancer and decreased semen quality in men, and breast cancer in women. 

Heart disease is also a concern. “Dairy might be the number one source of calcium in the diet,” says Dr. Michael Greger, the founder of NutritionFacts.org. “But it’s also the number one source of saturated fat, and saturated fat raises risk for heart disease, the number one killer of men and women.” 

The Power of Plants

What should we consume in place of dairy?

Fish is one possibility. The Nurses’ Health Study has found the consumption of dark, calcium-rich fish—swordfish, salmon, bluefish, sardines—one or more times a week dropped bone fracture risk by 33 percent. 

But if you’ve gone meatless, like me, then veggies are your answer.  Many are surprisingly rich sources of calcium. 

“You can get plenty of calcium from plant foods,” says dietitian Virginia Messina, author of Vegan for Life as well as the upcoming Vegan for Her. “You don’t have to drink milk.” 

One cup of most calcium-fortified nondairy beverages offers 300 milligrams of calcium—the same amount of calcium in a glass of cow’s milk. Other heavy hitters include navy beans (123 milligrams per cup) and kale (100 milligrams per cup). Plus, a wide array of fruits, vegetables, and legumes offer smaller amounts, including oranges (60 milligrams) and broccoli (43 milligrams).

A good rule of thumb, Messina says, is to consume three servings daily of any calcium-fortified plant foods (such as soy milk, almond milk, orange juice, or breakfast cereal) along with at least eight servings of fruits and vegetables.

Fruits and vegetables also house an array of other important bone builders, including magnesium, potassium, vitamin C, vitamin K, B vitamins, and carotenoids. In particular, vitamin K—found abundantly in green veggies like broccoli, brussels sprouts, collards, and kale—may be just as important as calcium for overall bone health. Women who consumed 110 micrograms of K daily dropped their fracture risk by 30 percent.

To keep bones strong, this is what Messina recommends daily:

    Two servings of dark leafy greens. Consume a variety. Collards and turnip greens are rich in calcium, but not as rich in the bone-building potassium. On the other hand, spinach and swiss chard contain a nutrient that prevents their calcium from being absorbed, but these greens are standout sources of potassium, she says. 

    Three servings of fruit, including one citrus. Fruit is loaded in antioxidants and potassium, and many fruits are rich sources of bone-building vitamin C, especially citrus fruit.

    Three servings of other vegetables. Nearly all types of produce help to keep the blood alkaline, which
prevents the body from robbing calcium from the bones, says Messina. 

You might also consider taking a few supplements, including vitamin D, which helps the body absorb calcium. It’s present in small amounts in fish, fortified foods, and certain types of mushrooms, and our skin also makes it when exposed to sunlight. Still, many people are deficient. Willett recommends people like me—who live in the dimly lit Northeast and who wear sunscreen religiously—take a supplement with 1,000 to 2,000 international units of D daily.

Another important supplement is B-12. Research has linked low levels of this vitamin with an increased prevalence of hip fractures. It’s mostly found in animal products, but is also present in various soy milks as well as some brands of nutritional yeast. For vegans, a 25 microgram supplement is the best insurance against low levels, says Messina.

And, of course, there’s exercise. “If you have ever had your arm in a cast, then you know that muscle wastes away when you don’t use it,” says Greger. “It’s the same with bone.” Regular exercise stimulates bone, causing it to retain more minerals. Greger recommends one hour of walking or another weight-bearing activity a day.

Since boning up on my knowledge, I’ve completely ditched cheese.  Surprisingly, the divorce was easier than expected. Nutritional yeast, it turns out, satisfies all my cheesy yearnings, and kale, collards, and other greens are now among my favorite dinner companions.

If only all other breakups could go so easily.  

Alisa Bowman wrote about the science and psychology of altruism in the Jan/Feb issue of Spirituality & Health.