Bone Health Study Edited - ResearchGate

Water IntakeWe hypothesized that low mineral drinking water might contribute to bone loss over a longperiod of time. In 2006, 22 of the 29 women with at least 3 measurements were using distilledor reverse osmosis water. Only 7 of the same women were doing so in 2007 and only 5 ineach of 2008 and 2009. No conclusion could be reached regarding this hypothesis in thisobservational study. It is one of several factors that play a role in bone health.Correlations between Bone Strength and Diet and LifestyleSince many factors determine bone strength, it was difficult to single out any one factor thatreally made a difference. It was clear that some women maintained or increased bone strengthwhile others lost bone strength. Eating habits were very similar and most of the women hadregular exercise programs. No single factor correlations were found between change in bonestrength and change in body mass index, in vitamin D level for 2008 or 2009, in bloodpressure, in pulse rate, in the product of frequency and duration of exercise, nor in a measureof how much vegetable juice, BarleyMax, salads, fruits, nuts, seeds, fiber, and flax oil thewomen consumed. The changes in bone strength were not correlated with any changes indietary patterns, either. Any reported changes in frequency of consuming vegetable juice,BarleyMax, salads, fruits, nuts, seeds, or legumes were not related to changes in bone strengthmeasures.Correlation between Resistance Exercise and Bone StrengthExercise type was the one factor that explained a significant portion of the variation betweenwhich women gained bone strength and which women lost bone strength. Women whoreported doing resistance training during any period of the 3-year study were separated in theanalysis from women who never reported doing resistance training (among the 29 womenwith at least 3 measurements). When these women were separated then into groups who eithergained or maintained bone strength and those who lost bone strength based on a 5% change inexpected value (similar to the Z-score, a relative bone strength measure compared to womenof the same age), it was clear that the women who practiced resistance training had anadvantage in keeping their bone strength. Five of 21 women who engaged in resistancetraining lost bone, while 6 of 8 women who reported only aerobic type exercise lost bonestrength (see Table 1). The difference between these two groups was significantly differentwhen tested with the appropriate statistical test, the two-tailed Fisher exact test (P 0.028). Therelative risk of bone loss was 0.32 for the resistance exercise group. The amount of risk ofbone loss attributable to lack of resistance exercise was estimated to be 68% for those who didnot do it.Because of the small number of women in the study, there is a wide range of possible error inthis number. The attributable risk possibly could be anywhere from 50 to 80%. Still, thisnumber illustrates that approximately half of the risk of bone loss could be mitigated just bydoing resistance exercises.When women who only reported once doing resistance training but not in other years weregrouped with the aerobic exercising women, the results were still in favor of resistancetraining as a powerful predictor of bone strength (P 0.052). Of the 13 women who reportedresistance training more than once, only 2 of them lost bone strength, while 9 of 16 women6

who did mostly aerobic exercise lost bone strength. The relative risk was 0.27 in this case,with an attributable risk of 73%.Table 1. Resistance or Aerobic Exercise for Bone Strength?All women who reported ever doing resistance training reported here.Lost boneMaintain / Gain BoneResistance 516Aerobic62RR 0.32P 0.028Table 2. Resistance or Aerobic Exercise for Bone Strength?Only women with more than one year of resistance exercise reported.Lost boneMaintain / Gain BoneResistance 211Aerobic97RR 0.27P 0.052DiscussionIn this observational study we found that, in this population of middle age to elderly women,the main factor determining whether an individual lost, maintained, or gained bone was thetype of exercise she engaged in. The differences between individual diets were not large, sothat even though dietary choices make a difference in bone health, the differences betweenindividuals’ diets in this study were not significant. Therefore, the impact of dietary choiceswas not detectable. However, the purpose of this study was to determine how a woman canimplement The Hallelujah Diet and maintain or even gain bone strength. The answer isresistance and vigorous weight-bearing exercise. It wasn’t the amount of protein, the amountof green leafy vegetables, the use of vitamin D or calcium supplements, or even the kind ofwater consumed that was the principal bone factor. From other studies we know that theseother factors are important, but this study indicates that resistance exercise, when added to TheHallelujah Diet, leads to strong bones.This study answers many questions that women have asked about The Hallelujah Diet.Women have wondered if this diet will cause them to lose both weight and bone strength. Doyou get enough protein for your bones on The Hallelujah Diet? Is there enough calcium forstrong bones on The Hallelujah Diet? It does help to have legumes to increase the proteinintake some, but legumes and extra protein by themselves will not make an individual’s bonesstronger.Yes, there can be enough calcium on The Hallelujah Diet. Yes, there is adequate protein. Asmall amount of nuts, seeds, and legumes will ensure that protein and minerals are sufficient.(Natural plant protein rich foods—not soy protein isolate—are also mineral rich.) A diet offruits, vegetable juice, and raw vegetables alone may not have enough protein, but that is notreally The Hallelujah Diet. Yes, you can build strong bones and follow The Hallelujah Diet.The answer is more about lifestyle, however.7

CalciumA recent population study from the United Kingdom found that vegans who had a dailydietary intake of less than 525 mg of calcium were at elevated risk of bone fractures (Applebyet al. 2007). Daily dietary intake of more than 525 mg of calcium was protective, and therewas no increased risk. Bhuddist nuns in Vietnam were compared with an omnivorous controlgroup in a recent study. Although the nuns had a much lower intake of calcium (330 205 vs.682 x 417 mg/day) there was no correlation between dietary calcium and bone mass density(Ho-Pham et al. 2009). Furthermore, there was no difference between these elderly nuns or thecontrol group for bone mass density at the femoral neck, lumbar spine, or the whole body.So, it is still debatable how important calcium is for bone health. It may depend more on otherfactors, as appears to be the case in the Hallelujah Bone Health Study. It is still wise toconsume sufficient calcium, which can be obtained from eating a sizable portion of leafygreens, other vegetables, nuts, seeds, and legumes. In our diet survey of Hallelujah AcresHealth Ministers the daily average calcium intake for women was 577 156 mg (Donaldson2001). Women with above average calcium intake wouldn’t have any problem, but anywoman with below average calcium intake may be at an increased fracture risk. A DEXAscan would really be necessary at the individual level to determine personal risk. If a womanhad already been diagnosed with osteoporosis or osteopenia, it would seem wise to use allavailable options to reduce the risk of fracturing a hip. Exercise, as vigorous as possible, is thefirst and most important recommendation. It is wise to optimize vitamin D levels and to followthe other recommendations of this study, especially increased intake of salad greens andlegumes. However, some women may want more calcium in the form of a supplement. Whatis the best form of supplemental calcium?In this study we recommended supplemental vitamin D and calcium citrate, along withmagnesium glycinate to women in the second year of the study that had low levels of vitaminD and osteoporotic bone strength scores. Since that recommendation further investigation hasled to the comparison of AdvaCal (calcium hydroxide and calcium oxide with heated algalingredient) and EZorb calcium (calcium aspartate anhydrous). AdvaCal is supported byseveral peer-reviewed studies for efficacy, including osteoporosis studies (Fujita et al. 1996;Fujita et al. 2000). EZorb calcium has been tested in an osteoporosis study and yieldedexcellent results (Tang et al. 2007). Increases in bone density were achieved with 520 mg ofcalcium as calcium aspartate anhydrous, compared to no increase with 1,500 mg of calcium ascalcium citrate.EZorb calcium is much more soluble than calcium citrate or AdvaCal, not only in an acidicpH, but all the way up to pH 11. This means that EZorb calcium can be assimilated in theacidic stomach environment, but it won’t form an unabsorbable precipitate in the smallintestine and it won’t interfere with the absorption of other minerals. Bioavailability ofcalcium citrate is around 40 to 45%, while the bioavailability of EZorb calcium was 92% inone lab study in rats (Tang 2000). For this reason Ezorb calcium is now the recommendedform of calcium for people who want a little more calcium. It is more expensive, but the bodyis able to utilize it all, it is effective at lower doses, it doesn’t interfere with absorption ofanything else, and it really works.8

Figure 3. A comparison of solubility of calcium as(left to right) calcium citrate, AdvaCal, and EZorb.200 mg of elemental calcium from each sourcewas mixed with 10 ml of distilled water and thenallowed to settle. The EZorb calcium instantlyformed a true solution, while calcium citrate andAdvaCal only formed a suspension.Vitamin DIn this study we also documented that manywomen have low vitamin D levels. Withoutsupplementation none of the women had optimallevels of vitamin D. Low levels of vitamin D willdecrease the uptake of calcium as much as 65%from the small intestines (Heaney et al. 2003).From the study just cited it appears that optimaluptake of calcium begins at a vitamin D levelaround 32 ng/ml. Clearly, the majority of womenin this study had suboptimal uptake of calciumbecause of low vitamin D levels. Even withsupplementation of 4,000 to 5,000 IU of vitaminD3 per day not all women achieved optimal levels. This indicates that supplementation ofvitamin D needs to be monitored on an individual basis to ensure optimal levels are obtained.Some people may absorb or be exposed to more sunshine to make more vitamin D throughsynthesis in the skin. As people age, their efficiency of vitamin D manufacture decreases. A70 year old only makes about 25% as much vitamin D from the same sun exposure as a 20year old (Holick 2004). This fact is not emphasized enough. Whereas 20 minutes of sunshinemay yield a significant dose of vitamin D for a youth, that same 20 minutes will not be enoughfor an elderly person’s vitamin D needs.Since vitamin D is required for many body systems beyond the bone structure, there are manybenefits to achieving and maintaining optimal vitamin D levels. We did not sample enoughwomen to conclude that all women in the USA need to use supplemental vitamin D. However,many other studies have also shown that very few women have optimal levels of vitamin D,even in southern Florida (Levis et al. 2005). For a nominal fee of 35, a blood test is availablethrough Hallelujah Acres to determine the blood level of vitamin D to ensure that thisimportant aspect of one’s health is optimized. Sunshine is free and supplemental vitamin D isvery cheap, so there is no reason to neglect one’s vitamin D status. It is perhaps the simplest,cheapest, and one of the most effective nutritional interventions a person can do (Faloon2009).Comparison with other studiesA recent study evaluated the bone density of raw vegans and compared with a control group.The raw vegans had lower bone density scores, but adequate vitamin D levels (Fontana et al.2005). That study left a question as to whether the raw vegan diet could support healthy bones.9

We found similar results in some women, but also found evidence that bone strength could bebuilt using The Hallelujah Diet. The answer is in the exercise more so than in the dietaryintakes, according to the results we found here.Many studies have shown that exercise (in particular weight bearing exercise or resistancetraining) builds bone structure. Intervention studies have shown exercise to improve bonemass density compared to just stretching or usual activity. Jogging, weight training, rowing,and aerobic exercises all were found to improve bone mass density (reviewed in Todd &Robinson 2003). Increased daily activity in older men and women has led to lower risk of hipfracture in Great Britain (Cooper et al. 1988). The same result was found among urbanChinese (Lau et al. 1988) who had a much lower intake of calcium. In a 21-year study of3,200 men aged 44 or older researchers found that those who engaged in vigorous physicalactivity were found to have a 62% reduced risk of hip fracture (Kujala et al. 2000).A meta-analysis of eight randomized clinical trials of post-menopausal women assigned towalking as exercise found evidence for benefit for the hip at the femoral neck, but no benefitfor the lumbar spine (Martyn-St James & Carroll 2008). They concluded, in agreement withthis report, that “other forms of exercise that provide greater targeted skeletal loading may berequired to preserve bone mineral density in this population.”Comparisons of resistance exercise and aerobic exercise have been mixed for effectiveness forbuilding bone density. Results depend on the intensity of the exercise because any exercisethat builds muscle will also build the associated skeletal structure. A review in 1999 concludedthat resistance exercise rather than aerobic exercise more consistently has been shown to helpbone density (Layne & Nelson 1999). Resistance and strength exercises are still therecommended type of exercise for maximizing bone strength (N. Schmitt et al. 2009).Drug TherapyBuilding bones through exercise has superior effects compared to using bisphosphonate drugsto stabilize existing bone structure. The bisphosphonate drugs prevent the breakdown of olderbone, but do not stimulate the osteoblasts to lay down new bone structure. Those who takethese drugs end up with high bone density but older, more brittle bone. Exercise improvesbone structure by encouraging the remodeling and strengthening of bone by the mechanismsdesigned for that purpose, rather than inhibiting natural processes. Side effects ofbisphosphonate drugs are a further complication. One serious complication is the high risk ofosteonecrosis of the jaw following any dental extractions or implantations while usingbisphosphonate drugs (AAOMS 2009). This infection of the jaw can lead to a partially healedfocal infection that harbors anaerobic bacteria that will continually poison the bloodstream.Individuals should not undergo tooth extractions while using any bisphosphonate drug. Recentstudies have also linked bisphosphonate drugs to increased risk of atrial fibrillation in women(Black et al. 2007; Heckbert et al. 2008).Limitations of this studyThis study was an observational study. There were some recommendations for dietarychanges, but the only significant dietary changes for most people were an increase in legumes10

and the use of re-mineralized water. Many of the women were already following the otherrecommendations. A few women also added resistance exercise over the course of the study.The strength of the study lies in its real world circumstances, following people as they usuallylive. Thus, the results can be directly applied to other women following The Hallelujah Diet inthe real world. This study shows that maintaining or even gaining bone strength is possiblewhile following The Hallelujah Diet.On the other hand, the study’s results are limited because we only know associations, ratherthan direct cause and effect. From this study alone, one cannot conclude with absolute proofthat resistance exercise causes greater bone mass and strength. The association is strong, butan observational study can never provide conclusive evidence. Another limitation is themethod of recording people’s usual dietary and lifestyle practices. We used a simple foodfrequency questionnaire querying only the most relevant foods. A dietary record would havebetter captured food intake, but would have increased the participants’ burden. Exercise couldhave been captured by a journal method as well, rather than by a simple questionnaire. Thismay have improved the precision of the study. This study was very limited in terms of findingresults of various dietary practices because participants’ diets were so similar. Suchinformation must be found in other studies.ConclusionThere were four major findings from the Hallelujah Bone Health Study:1. Strong healthy bones are not an automatic result for every woman following TheHallelujah Diet. While some of the women did have normal strength bones, and evenabove average for their age in some cases, many women had low bone strength. Someof this may be the result of previous diet and lifestyle choices before adopting theHallelujah Diet.2. Following the Hallelujah Diet won’t guarantee that you will continue to buildstrong healthy bones. It is possible, but here again, many women lost measurablebone strength over the course of the three years.3. Vitamin D levels for mostly older women, even in the southern USA, are not nearoptimal levels. Everyone living in the USA needs to use a vitamin D supplementbecause casual or even purposeful sunshine exposure is not sufficient for elderlypeople to optimize vitamin D levels.4. The most important factor in improving bone strength identified in this study isresistance training, or weight bearing exercise. Approximately half or even more ofthe risk of losing bone strength was due to lack of resistance training. In this study, thediets of t

diet (raw vegan, Hallelujah Diet, vegan, lacto-ovo-vegetarian) and length of time on current diet were recorded. In