New studies confirm that Mediterranean-style diets help bone health
More than 50 million Americans suffer from osteoporosis and resulting brittle bones.
Osteoporosis leads one in two women and one in four men aged 50 or older to suffer a bone fracture, which can lead to a downward spiral of health problems.
Osteoporosis simply means “porous bone disease”, and it’s composed of three archaic Greek terms: “osteo” (bone), “por” (porous), and “osis” (disease).
It’s fitting that the term is of Greek origin because that region’s traditional diet — and the traditional diets of other Mediterranean nations — may help prevent osteoporosis.
Traditional diets remain most common in Greek islands of the Aegean Sea, such as Crete — which explains why our title recommends that you “Eat like a Cretan”.
Let’s examine the results of three recent studies, which suggest that traditional-style Mediterranean diets can go a long way toward helping preserve bone health.
First, let’s remind ourselves of what researchers mean by “Mediterranean diet”.
What is the Mediterranean diet?
The “Mediterranean diet” that so many studies find healthful resembles the way people ate — and sometimes still do — in the more rural regions of Spain, Southern Italy, and Greece.
These are its key elements, listed in descending order of importance in the eating plan:
- Fruits and vegetables (foundation of the diet)
- Beans, nuts, seeds, and whole grains
- Fish (wild) and shellfish (wild or cultured) 2-4 times per week
- Poultry (pasture-fed) and natural cheese
- Extra virgin olive oil (and small amounts of craft butter)
- Herbs and spices (minimal added salt)
- Red meat (grass-fed) 2-3 times a month
- Red wine once per day or less
Note: There’s good evidence that seafood-source omega-3s — which abound in salmon and fatty Mediterranean fish like anchovies and sardines — support optimal bone health. For more on that, see Fishy Diets May Bolster Hip Bones and other articles in the Omega-3s/Bone Health section of our newsletter archive.
Conversely, excessive intakes of omega-6 fatty acids — such as in the standard American diet — appear to weaken bones: see Omega-3s Seen as Stellar Bone-Builders and Omega-3 Fats Built Rats' Bones; Omega-6s Weakened Them.
Mediterranean diet + vitamin D3 cut leg-bone loss in osteoporosis patients
The femur is the large leg bone that connects to the hip, and its “neck” region is especially vulnerable to fracture.
For all practical purposes, the femur neck is part of the hip structure, and hip fractures account for almost one-third (30%) of all hospitalized patients in the United States.
Someone who suffers a hip fracture is up to 37% more likely to die in the following year, and of those who survive, nearly one-half never regain their former level of independence.
The results of a large European clinical trial showed that — among people who've already lost bone mass in their femoral neck region — following the Mediterranean diet for just one year can reduce bone loss in that critical region.
Surprisingly, this was the first long-term clinical trial to examine the impact of the Mediterranean diet on bone health in older adults (Jennings A et al. 2018).
The trial, led by scientists from the University of Bologna, involved 1,142 adults aged 65-79, recruited in five countries: Italy, the UK, the Netherlands, Poland and France.
The participants were divided into two groups for this one-year trial:
- Mediterranean diet
- Control group, who ate their regular diet
The adults in the Mediterranean diet group ate more fruits, vegetables, nuts, unrefined grains, olive oil, and fish than usual. They also limited dairy products and meat and consumed only moderate amounts of alcohol.
Bone density was measured in all the participants at the beginning of the trial and after 12 months.
After one year, volunteers assigned to the control group displayed the normal loss of bone density expected with the aging that took place over a year.
However, adults with osteoporosis of the femoral neck who followed the Mediterranean diet enjoyed increased bone density in that critical region.
While adults without osteoporosis saw no change in bone density, the researchers suspect that a longer trial might have shown positive impacts in those people as well.
As the study’s lead author — Prof Susan Fairweather-Tait, from Norwich Medical School — said, “Bone takes a long time to form, so the 12-month trial, although one of the longest to date, was still a relatively short time frame to show an impact. So, the fact we were able to see a marked difference ... is significant.”
And she offered a wise observation: “A Mediterranean diet is already proven to have other health benefits, reducing the risk of cardiovascular disease, Parkinson’s, Alzheimer’s and cancer. So, there’s no downside to adopting such a diet, whether you have osteoporosis or not.”
Brazilian study shows post-menopause bone benefits of Mediterranean diet
As mentioned above, women are at higher risk for osteoporosis as they age, particularly after menopause.
And a recent Brazilian study found that the heart-healthy Mediterranean diet boosts the strength of older women’s bones (Silva TR et al. 2018).
The study involved 103 healthy women from southern Brazil (average age 55) who’d experienced menopause around age 50.
As lead investigator Thais Silva, Ph.D., noted, the estrogen decline that accompanies menopause speeds bone loss and shrinks lean muscle mass.
Before the study began, all the participants underwent scans to measure their bone density, body fat, and muscle mass.
In addition, the subjects answered survey questions about their diets over the previous month, to determine its “Mediterranean diet score”, or how closely it resembled the ideal Mediterranean diet.
Encouragingly, this study’s results linked a higher Mediterranean diet score (MDS) with higher bone mineral density — as well as greater muscle mass, which is another key factor in protecting bone strength.
Mediterranean diet — and extra-virgin olive oil — linked to better bone health
Animal studies have linked higher intakes of olives and extra virgin olive oil to reduced risk for osteoporosis.
Likewise, several epidemiological studies have found lower rates of osteoporosis among people living in Mediterranean regions, where extra virgin olive oil is the predominant cooking fat.
(The proven cardiovascular and brain benefits of olive oil are clearly tied to the uncommon and particularly potent antioxidants in unrefined, extra virgin grade, which are either absent from or scarce in lesser grades.)
Two studies published since 2012 reinforce the link between Mediterranean diets — and extra-virgin olive oil — and better bone health.
The findings from an epidemiological study indicated that men who ate a Mediterranean diet rich in extra virgin olive oil enjoyed better bone health (Fernández-Real JM et al. 2012).
The data came from 127 men aged 55-80 who’d participated in a larger heart-health study called Prevencion con Dieta Mediterranea (prevention with the Mediterranean diet) or PREDIMED, which followed the participants for two years.
All the participants in the original clinical trial were assigned to one of three groups:
- Low-fat diet
- Mediterranean diet with added mixed nuts
- Mediterranean diet with added extra-virgin olive oil
Before the study and after two years, the researchers measured the participants’ blood levels of osteocalcin — a protein produced when new bone tissue is created — as well as other biomarkers of bone health.
The results linked the Mediterranean diet plus olive oil with a significant boost in bone formation — a finding not seen in the other two groups. Interestingly, calcium levels stayed the same in the olive oil group, but fell over the course of two years in the other two groups.
The study’s lead author — José Manuel Fernández-Real, MD, PhD, of Spain’s Hospital Dr. Josep Trueta — highlighted the novel nature of their finding: “This is the first randomized study which demonstrates that olive oil preserves bone, at least as inferred by circulating bone markers, in humans.”
Last year, Italian researchers published the results of an epidemiological study in 418 healthy people — 105 men and 313 women — whose ages ranged from 36 to 64 years (Savanelli MC et al. 2017).
All the participants underwent bone scans and completed a diet questionnaire originally developed for the PREDIMED study.
These were the results:
- Lower bone density was linked to consuming more red meat.
- Higher bone density was linked with closer adherence to the Mediterranean diet, and specifically to consuming more extra-virgin olive oil, vegetables, fruits, legumes, and fish.
As the researchers concluded, “The results demonstrate a positive correlation between bone health status and adherence to MD [Mediterranean diet], suggesting that high adherence promotes bone health.”
Eat like a Cretan, not a cretin
The standard American diet is associated with weaker bone — and brain — health.
That's probably attributable to its nutritionally empty calories and extreme "omega imbalance" between intakes of omega-6 and omega-3 fatty acids.
As prominent brain researcher Michael Crawford, Ph.D., wrote in his prophetic 1973 book, "What We Eat Today", the standard American diet is virtually designed to produce dull brains and promote dementia.
Instead, for a strong brain and durable bones, it makes sense to avoid the cretinous Western diet and eat more like a Cretan!
- Fernández-Real JM, Bulló M, Moreno-Navarrete JM, et al. A Mediterranean Diet Enriched with Olive Oil Is Associated with Higher Serum Total Osteocalcin Levels in Elderly Men at High Cardiovascular Risk. The Journal of Clinical Endocrinology and Metabolism. 2012;97(10):3792-3798. doi:10.1210/jc.2012-2221.
- Jennings A et al. A Mediterranean-like dietary pattern with vitamin D3 (10 µg/d) supplements reduced the rate of bone loss in older Europeans with osteoporosis at baseline: results of a 1-y randomized controlled trial. Am J Clin Nutr. 2018 Jul 11. doi: 10.1093/ajcn/nqy122. [Epub ahead of print] PubMed PMID: 30007343.
- Savanelli MC et al. Preliminary results demonstrating the impact of Mediterranean diet on bone health. J Transl Med. 2017 Apr 24;15(1):81. doi: 10.1186/s12967-017-1184-x.
- Silva TR, Carolina CM, Mara Spritzer PM. Mediterranean Dietary Pattern is Positively Associated with Bone Mineral Density and Lean Mass in Postmenopausal Women: a Cross-Sectional Study. Presented at ENDO 2018 Annual Meeting of the Encorine Society. March 19, 2018.