DAIRY PRODUCTS, like milk, cheese, and yogurt, are high in calcium, and are commonly promoted as foods that build strong bones. Yet, osteoporosis, which is a chronic loss of bone mass, occurs most often in nations with the highest intake of dairy products (Lanou, 2006). Women in the U.S. typically lose about half of their bone mass in a lifetime (Brown & Jaffe, 2000), with average losses of 1% for each adult-year. Older women have a higher risk for bone fracture than for breast cancer (Cauley et al., 2008). What is the cause of this association between a high intake of dairy products and the prevalence of osteoporosis?

Sulfur Amino Acids

For a young calf, cow milk, consumed straight from the producer, is nature’s perfect food, providing nutrients for rapid growth of bone and muscle. But humans do not grow at the rate of young calves, and so dairy products are not properly matched to the nutrient needs of humans. For example, humans do not require the large amount of sulfur amino acids in protein supplied by a high intake of dairy foods. For the majority of the population, the requirement for protein is actually 30% lower than the Recommended Daily Allowance (RDA), or only about 5–6% of calories needed to maintain bodyweight (Campbell & Campbell, II, 2006), or approximately 0.6 grams per kilogram of bodyweight. A 175-lb. male who burns 2700 calories needs only about 35-43 grams of protein, or approximately one gram for each four-five pounds of bodyweight. Nevertheless, the average intake of protein in the Western diet is three times higher at 15%–16% of calories. Researchers have long known that excess amounts of protein increase calcium excretion from the body (Margen et al., 1974). Doubling protein intake from 35 grams to 78 grams increases the body's calcium loss by 50% (Hegsted et al., 1981). Due to the high sulfur amino acid content of dairy protein, consumed in combination with sulfur amino acids in protein from animal flesh, eggs, grains, and legumes, dairy products not only fail to prevent osteoporosis, they may contribute significantly to the cause of bone loss by increasing the acid load within the body.

Normally, biocarbonates in fruits and vegetables buffer acids as they are produced in the human body during metabolism (Lanham-New, 2008). Nevertheless, according to Arnett (2008), as excessive amounts of protein are metabolized, extracellular fluid around bone begins to become more acidic, and the concentration of positive hydrogen ions builds up in the fluid. To defend against this harmful buildup of acid, bone begins to release negative hydroxyl ions to neutralize the hydrogen ions and form water. However, in the process of releasing these buffering hydroxyl ions, bone is also forced to release calcium and phosphate, which are eliminated in the urine. It is important to note that the calcium released from bone does not directly buffer and neutralize the acid. Calcium ions have positive charges, which repel positive hydrogen ions rather than attract and buffer them. This helps explain why ingesting large amounts of calcium doesn't protect against the adverse effects of excessive protein intake. 

Bone “casts” out calcium and other substances due to the action of bone cells called osteoclasts, with a “c.” Bone “brings” in calcium and other nutrients due to the action of bone cells called osteoblasts, with a “b.” Arnett described how osteoblasts are deactivated when extracellular fluid becomes more acidic, or when the fluid’s pH drops. In other words, even though dairy products like milk supply calcium, the acidic effect of an excessively high protein intake within the human body from consuming large quantities of milk intended to meet the needs of rapidly growing calves causes a drop in fluid pH, which turns off the action of osteoblasts to absorb the milk's calcium. At the same time, the lowered pH increases the action of osteoclasts to release calcium, phosphate, and hydroxyl ions from bone. The end result is that there is a net loss of calcium and other matter from bone. The more dairy products consumed, the higher the net loss! A National Dairy Council study confirmed this. Researchers supplemented a test group with three 8–ounce glasses of milk a day, which significantly increased bone fracture rates compared to a control group that didn't receive the supplementation. The researchers concluded the rise in fractures was most likely due to a 30% increase in protein intake from cow milk (Recker & Heaney, 1985). Human milk, by comparison, is much lower in protein and sulfur amino acids, and does not cause this problem. No fracture-risk protection from cow milk consumption was found in prospective studies in Sweden in 2003 that followed 60,689 women over 11 years and in the Harvard Nurses’ Health Study in 1997 that followed more than 75,000 women over 12 years, or in meta-analysis studies in 2007 and 2005 that compared dairy consumption and fracture risk (Lanou, 2009).

Incidentally, osteoporosis drugs work by killing osteoclasts. You might think this is an effective way to avoid bone loss, and these drugs have been shown to increase bone mineral density (BMD). However, according to Small (2005), "...there is no precise and consistent relationship between a given increase in BMD and a specific decrease in fracture risk with osteoporosis therapy." Osteoclasts are necessary for normal, healthy bone turnover. Worn out bones in an adult human are normally cast out and gradually replaced with fresh, new, stronger bone every ten years, thanks to the balanced action of osteoclasts and osteoblasts. Upsetting this continuous bone turnover, by killing osteoclasts, interferes with the renewal of bone strength, which can lead to disastrous long-term adverse effects such as spontaneous fractures of the femur (Visekruna, Wilson, & McKiernan, 2008). Small concluded that, "Fracture risk depends on a number of variables that contribute to bone strength in addition to BMD, such as bone size, shape, architecture, and turnover." While Sally Field cheerfully promotes the osteoporosis drug Boniva, she may not be so cheerful ten years from now if her bone strength and bone turnover have been severely compromised.

The healthiest and easiest solution to prevent osteoporosis is to lower your overall intake of protein by consuming fewer high-protein foods, like dairy products. Ironically, at lower intake levels, dairy products no longer provide any advantages over other natural foods, such as fruit, nuts, and vegetables, in supplying calcium to the diet. Oranges, dried figs, dates, collards, kale, broccoli, romaine, almonds, and other natural foods all contain ample supplies of calcium. One soon discovers that one can be just as adequately nourished, and maintain healthy bones, on a properly balanced diet of all plant foods, without dairy products whatsoever. Measured by calorie, many plant foods are higher in calcium than dairy! And there is no risk of consuming excessive amounts of sulfur-rich protein from fruits and vegetables as a source of calcium. 

Campbell (2008) estimated the daily need for calcium on a low-protein, plant-based diet at about 400–600 mg, which is significantly less than the 1,200 mg currently recommended for adults over 50 years eating a high-protein, Western diet—a recommendation that continues to rise in a futile attempt to prevent osteoporosis by supplying more calcium through dairy products. Vegans who consume at least 525 mg of calcium a day do not have higher fracture rates than the rest of the population (Appleby et al.). Even at ultra-low dietary calcium intake levels of 150–200 mg a day, researchers have never seen calcium deficiency diseases in normal people who eat a natural-food diet (Paterson, 1978). Osteoporosis in otherwise normal people is never caused by low calcium intake. Osteoporosis is caused by factors that remove calcium from bone. Consuming as much as 1,400 mg of calcium a day did not prevent a net loss of calcium in subjects on a high-protein diet (Allen et al., 1979). 

To summarize:
1. Calcium deficiency diseases are not caused by a low intake level of calcium in the Western diet.
2. Ingesting more calcium does not prevent the loss of bone calcium due to excess protein intake.
3. Dairy products contain excessive sulfur-rich protein that exceeds human biological needs and contributes to calcium loss from bone.

To prevent osteoporosis, even vegetarians and vegans who avoid dairy products must take care to include a proper balance of fresh raw fruit and green leafy vegetables in their diets, and they must avoid excessive protein intake from eating large amounts of grains, legumes, tofu, soymilk, hummus, and high-protein nuts and seeds. For example, cashews, almonds, pistachios, and sunflower seeds have 13%–14% calories from protein, while there are only 4–5% calories from protein in low-protein nuts, like pecans, coconuts, and macadamia nuts. A veggie burger has over 35% calories from protein!

Dr. Campbell observed that adverse health effects begin to appear in people consuming a diet that totals over 10% calories from protein, yet, he noted that a typical vegan diet, which includes grains and legumes, has 13% total calories from protein! Not surprisingly, a recent study found no significant difference in the prevalence of osteoporosis between groups of vegans and omnivores, and that the disease progressed with age equally in both groups (Ho-Pham et al., 2009).

Thus, even with abundant amounts of fruit and vegetables, and use of other so-called alkalinizing supplements, no one should ingest excessive amounts of calories from protein, whether from plant or animal sources, and expect to avoid the acidifying effects that negatively impact health. Referring to an acid condition in the human body, Dr. George W. Crile, the father of physiologic surgery, wrote in Man—An Adaptive Mechanism, "...acidosis is a factor in many diseases—acute and chronic." 

During World War I, Mikkel Hindhede (1920) placed the people of Denmark on a low-protein plant-based diet with less alcohol, and reduced the national death rate in one year by an astounding 34%! In the global flu pandemic of 1918, Denmark had the world's lowest mortality (Murray et al., 2006). Similar reductions in mortality have been replicated in  laboratory animals fed a modified-protein diet with restricted amounts of the sulfur amino acid methionine (McCarty et al., 2009), which is most commonly found in meat and other high-protein foods. Elevated blood serum levels of homocysteine, which is derived from methionine, is a biomarker for cardiovascular disease (Ruijter et al., 2009). On the other hand, people with the highest serum concentrations of α-carotene, found in greens and other fruits and vegetables, had a 39% reduced risk of death (Li et al., 2010).

As in Denmark during WWI, the potential exists today for reductions in mortality and healthcare costs from a plant-based 5–6% protein diet. Unfortunately, the Danes had an unappealing bland diet imposed on them, and they quickly reverted to a high-protein diet after the war. They now have the highest per capita rate of osteoporosis in the world (Nationmaster.com, 2009). Fortunately, we have much more appealing foods we can use on a low-protein diet.

Sweet fruits, avocados, and raw, unsalted, low-protein nuts, such as pecans, macadamia nuts, and coconuts (which are also low in methionine), are some examples of the best foods that provide the necessary concentrated sources of energy from unrefined fat and carbohydrates in a plant-based diet to maintain bodyweight, while keeping overall protein intake at 5–6% of calories. See Sample Menus below.

Is the fear of dietary saturated fat causing you to eat an unhealthy, unbalanced diet? See: Is the Lipid Theory Dead? Also see: 
The Optimal Diet for Humans and Bananas, Coconuts, and Green Smoothies: Nature's Perfect Foods. For a comparison of calories from protein in nuts, grains, legumes, fruit, and vegetables, see Maintaining Healthy Bodyweight on a Raw Food Diet. Calculate your maintenance calorie allowance with The Body Fat Guide. 

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Because teeth are bones, a low-protein, plant-based diet applies equally as well in preventing diseases of the teeth, gums, and jaw. The World Health Organization (2003) reported that when the pH of saliva rises to an alkaline value of 7, it becomes super-saturated with calcium and phosphate, and remineralizes worn tooth enamel. Victoria Boutenko (2005) described how she raised her salvia pH by consuming large quantities of dark leafy green vegetables in green smoothies made with fruit. She recommended consuming 1–2 pounds of leafy greens a day. Hafer (2001) reported that giving caries-resistant rats ammonia, which is naturally produced in high levels when excessive protein is metabolized, made the rats susceptible to dental caries. 

Phosphorus

In addition to excess sulfur from protein, bone loss occurs when dietary phosphorus intake exceeds calcium intake, which occurs independently of the absolute phosphorus intake level (Sax, 2001). Calcium binds with phosphorus in the blood to form calcium-phosphate. Excess phosphorus consumption lowers intestinal calcium absorption in animals (Koshihara et al., 2005). As phosphorus levels increase and calcium levels decrease in the blood, parathyroid hormone is released to restore calcium balance by increasing calcium absorption, releasing calcium from bone and causing the kidneys to excrete phosphorus. To avoid excessive phosphorus intake, nutrition authorities often recommend consuming at least a 1:1 molar ratio of dietary calcium to phosphorus to prevent bone loss (Kemi, 2010), which converts into a weight ratio of 1.3:1 (One mole of calcium, 40.08 grams, divided by one mole of phosphorus, 30.97 grams, equals 1.3. In other words, because calcium molecules weigh 30% more than phosphorus molecules, trying to combine equal weights of phosphorus and calcium molecules would leave you short calcium molecules unless you increase the calcium amount 30% by weight.) 

The calcium-phosphorus weight ratio in human bone and human milk averages about 1.5:1 (Huttunen et al, 2007), with a ratio of 1.7:1 providing optimal retention for both phosphorus and calcium in the human fetus and in premature infants (Pelegano et al., 1991). The USDA and other sources have found over 2:1 ratios in human breast milk. This implies that similar ratios are required in the diets of pregnant and nursing mothers to avoid maternal bone loss. The average ratio of calcium to phosphorus in the Western diet is only 0.25:1 (Lamberg-Allardt, Karp, & Kemi, 2010). Phosphorus is most often found in high-protein foods like dairy products, meat, grains, legumes, and high-protein nuts. Phosphorus levels are low in low-protein coconuts and macadamia nuts, especially measured by calorie. Macadamia nuts and dates have about half the amount of phosphorus per calorie (0.22 mg) as oranges (0.42 mg). Potatoes (0.83 mg) and whole wheat bread (0.82 mg) have almost 3 times more phosphorus per calorie than bananas (0.29 mg). One baked potato or two cups of white rice has as much phosphorus as five large bananas. Lean beef (0.95 mg) is higher in phosphorus per calorie than almonds (0.87 mg). Two-percent cow milk is about twice as high in phosphorus per calorie (1.84 mg) as lean beef, and phosphorus in no-fat milk (2.9 mg) is over 10 times higher per calorie than in macadamia nuts! Many sweet fruits, with the exception of citrus, figs, and papayas also have higher phosphorus levels than calcium, although the absolute amount of phosphorus in fruit is low compared to dairy, grains, meat, nuts, and legumes. Nevertheless, all these foods need to be balanced with calcium supplied from dark leafy green vegetables.

Dairy products have only a 1.3:1 calcium to phosphorus ratio, which appears insufficient to meet average human bone ratios of 1.5:1 and breast milk ratios of 2:1 mentioned above. Additionally, only 32% of calcium is absorbed from milk and cheese (Lanou, 2009). Calcium and phosphorus are not as available for human nutrition in pasteurized milk compared to raw milk (Kramer, Latzke, & Shaw, 1928). Phosphatase, an enzyme in raw milk that is responsible for calcium utilization in forming bone, is completed destroyed when milk is pasteurized. Cow's milk contains over 6.5 times more phosphorus than human milk (Lenstrup, 1926), and has been linked to tetany (muscle cramping from decreased extracellular calcium levels) when fed to newborn human infants (Gardner, MacLachlan, Pick, Terry, & Butler, 1950). Campbell (2008) found that a diet with 20% calories from casein, a phospho-protein in cow milk, was carcinogenic when fed to rats. Ohnishi and Razzaque (2010) demonstrated that phosphorus toxicity causes bone deformities and premature aging in laboratory animals. Compared to a healthy group fed a 2:1 calcium to phosphorus ratio, lab animals fed the same amount of calcium but with increased phosphorus (0.9:1 weight ratio) had abnormal tooth development and enamel formation (Jekla, Krejcirovab, Buchtovac, & Knoteka, 2011).

In her book on using a low-phosphorus diet to correct behavioral problems in children, Hafer (2001) asserted that successfully treating calcium metabolic disorders, including bone disorders like osteoporosis, is only possible with low-phosphate food. Hafer pointed out that cow milk contains excessive phosphorus for humans, and, because calcium metabolism is controlled solely by the blood phosphate level, Hafer asserted that high blood-phosphate levels which occur from excessive milk intake produce bone disorders independently of calcium intake levels, high or low. When blood serum levels of phosphorus rise above normal (hyperphosphatemia), serum calcium levels respond by rising as calcium is removed from bone, and this excess serum calcium and phosphate product may be deposited in soft tissue (Block et al., 1998) causing vascular calcification and kidney stones. A type of arthritis may also occur as calcium phosphate crystals are deposited in joints. 

Hafer (2001) criticized the concept of a Ca:P intake ratio for overlooking the independent calcium and phosphorus regulatory mechanisms in the body (e. g., intestinal absorption and kidney filtration), and she suggested it is more important to keep phosphorus intake levels low. Although Sax (2001) noted that bone loss (resorption) is lower when calcium intake is increased, studies in humans have shown that high calcium intake does not completely counteract the effect of excess phosphorus (Lamberg-Allardt et al., 2010). Intestinal phosphorus absorption is more than twice as efficient as calcium absorption (Razzaque, 2011). Therefore, if equal molar amounts of calcium and phosphorus are required for bone formation, humans likely developed on a diet that is more than twice as rich in dietary calcium than phosphorus—which is reversed in the Western diet.

To summarize: calcium intake is effective in protecting against bone loss when the Ca:P ratio is high. However, when phosphorus rises to a critical level, bone loss occurs regardless of the Ca:P ratio. Thus, dairy products' high phosphorus content can lead to critically high blood-phosphate levels that disturb calcium metabolism and cause bone loss. Similar to excess sulfur in protein, the harmful effects of excess phosphorus are not prevented by extra calcium. Toxic sulfur and phosphorus levels along with poor calcium bioavailability explains why consuming excessive dairy products from cows causes osteoporosis. In contrast to dairy products, kale has a calcium to phosphorus weight ratio that is almost twice as high (over 2.5:1), has twice the absorption rate of calcium as pasteurized dairy, is lower in sulfur amino acids, and is a much better food to build human bone, especially consumed raw in a green smoothie with fruit. If you consume dairy you need to keep the intake low and balance it with healthier food—the opposite of what the dairy industry promotes.

The Food and Nutrition Board of the Institute of Medicine lists the Dietary Reference Intake (DRI) for phosphorus for adults under 50 years as 700 mg and for calcium as 1,000 mg. This is roughly equivalent to 10 mg of phosphorus per kilogram of bodyweight. Some researchers have suggested a 12.6 mg phosphorus intake per kilogram of bodyweight, and the Merck Manual stated that daily dietary phosphorus  intake levels under 1,000 mg are sufficient to treat early stages of kidney disease. Other researchers have treated kidney patients with low-phosphate diets at ~ 8 mg phosphorus per kilo of bodyweight. Three 8-ounce servings of 2% cow milk, as recommended by USDA Dietary Guidelines for Americans and Canada's Food Guide, contains 673 mg of phosphorus, which is 96% of the DRI for phosphorus, and 30% above the recommended amount of sulfur amino acids. In combination with phosphorus and sulfur amino acids from other foods like meat, eggs, potatoes, legumes, and grains, recommended milk consumption causes calcium imbalances from toxic phosphorus and sulfur levels. 

"Milk times three is good for me? Milk times three...toxicity!"

The typical vegan diet previously mentioned with 13% of calories from protein has 1764 mg of phosphorus, which is sufficient to cause hyperphosphatemia and soft tissue calcification.

Take this Bone Loss Quiz.

The adult skeleton normally loses 400 mg. of calcium a day (Williams et al, 1997). Whether bone suffers a net loss of calcium depends on factors that cause the body to either retain or remove additional amounts of calcium from bone. In addition to excess phosphorus and protein, salt, caffeine, alcohol, refined carbohydrates, lack of sunshine, and lack of weight-bearing exercise are some other factors that contribute to bone loss (Vegetarians in Paradise, 2009). Even an excess of natural, unrefined carbohydrates can cause bone loss (See How Much Fruit Is Too Much?).

If possible, use a nutrient counter to analyze your diet every now and then to make sure you are keeping your protein intake at approximately 5–6% of the calories needed to maintain a healthy bodyweight. This is the best way to ensure the maintenance of healthy, strong bones. Here is a Diet Analyzer Excel spreadsheet I created to analyze the protein, fat, carbohydrate, calories, calcium, and phosphorus content in grams of fruit, nuts, and vegetables. The analyzer totals the percentages of calories from macronutrients as well as the calcium-phosphorus ratio. 

If you are not a vegan, you can add other foods to the Diet Analyzer by copying information from the link to the USDA at the bottom of the spreadsheet. However, don't be surprised to see your protein intake immediately skyrocket to 10%, 15%, or more if you add grains, legumes, and animal foods to your diet. See the bottom table.

A sample raw vegan Bone-Builder Diet includes blended soups, salads, and smoothies made with:
500 grams pineapple, 450 grams apple, 500 grams papaya, 500 grams orange, 100 grams dried figs, 180 grams collards, 180 grams kale, 250 grams coconut milk, 100 grams avocado, and 60 grams macadamia nuts. According to the USDA nutrient database, this diet supplies 2,178 calories, 6% protein, 35% fat, 59% carbs, 1277 mg calcium, and 638 mg phosphorus with a calcium-phosphorus weight ratio of 2:1. 

5–6% Protein, Raw, Vegan Sample Menus:

Calories from Protein in Grain, Legume, and Animal Foods:

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