Will a Few Yogurts a Day Keep the Falls and Fractures Away?
Only about 12% of the U.S. population consumes an adequate number of servings of dairy foods each day.
Diminished bone strength has been linked to an increased risk of falls, incomplete physical recovery, and other negative outcomes.
Increasing calcium and protein consumption daily should be considered "preventive maintenance."
My friend Mary handed me a cup of coffee and asked what I wanted in it. "Just some milk," I replied. Her face fell. "I don’t think we have any milk, but let me look." After rummaging through a stuffed refrigerator, she held out a pint of milk, sniffed it, and told me to do the same. "It seems fresh," I said optimistically, and poured some into my coffee.
"Don’t you drink milk?" I asked. "Never," was the reply. "We don’t eat any dairy except for some cheese occasionally. I think I bought that milk when my sister came over for brunch."
"But you have had several falls and fractures over the past five years," I reminded her, "and both you and Bob (her husband) have osteoporosis. How do you get enough calcium?"
The answer was calcium supplements, but she admitted that they upset her stomach, and so she tended to avoid taking them. Her husband, who was taking several pills daily for other ailments, hated adding more, and he also tended to skip his daily dose of calcium.
Mary and Bob are not unique in their avoidance of calcium-rich foods such as milk, soft cheeses like ricotta and cottage cheese, and yogurt.
Data from the National Health and Nutrition Examination Survey ("NHANES 2015–2016") found that only about 12% of the U.S. population consumes an adequate number of servings of dairy foods. Indeed, the only age group that met their daily dairy consumption was 2- to 3-year-old children.
Adults are supposed to consume three servings of dairy products daily: one serving equals 1 cup milk, yogurt, or ricotta, ½ cup cottage cheese, or 1 ounce of a hard cheese. Ice cream doesn’t count. Many may be turning to plant-based 'milk’ especially if they have lactose intolerance (there are lactose-free milk-based products), experience allergic reactions to milk protein, follow a vegan diet, or want something creamy to put in their coffee without the calories contained in whole milk.
Plant-based milks and some yogurts and cheeses contain similar nutrients to cow-derived dairy primarily by the addition of synthetic supplements. And, in some cases, fortification of these 'artificial milks' may not result in a product resembling natural milk; there may be less calcium, less vitamin D, and considerably less protein. And this is potentially a problem for those experiencing a decrease in bone density.
Bone strength may diminish naturally with aging, and also as a result of disorders in bone metabolism such as osteopenia and osteoporosis. The consequence is increased risk of falls, incomplete physical recovery, possible brain trauma, and even death. However, a recently published study suggested that it might be possible to diminish falls (and their costs) in an older population by increasing the amount of calcium and protein in the diet.
Evidence for this comes from a recently published study carried out in several Australian residential facilities for the elderly. Almost 7,300 residents in 27 facilities in Australia were given a diet supplemented with additional dairy products and protein, or kept on a conventional diet. The experimental diet supplied 1,142 mg a day of calcium and 69 grams of protein. The control diet contained 700 mg a day of calcium and 58 grams of protein (0.9g/kg of body weight). The additional calcium and protein were supplied by increasing the amount of milk, yogurt and cheese products in the daily menu.
The results were compelling. The number of falls and fractures was high, but there was a significant difference in these incidents between the two groups. After only three months, the group eating the additional dairy products had a 11% decrease in falls, a 46% reduction in hip fractures, and a 33% reduction for all breaks, compared to those eating moderate amounts of calcium and protein.
Falling is a major problem, and one need not be elderly to be vulnerable. A large puppy, an icy sidewalk, and a squirrel in an adjacent tree is a perfect set-up for a fall by the person at the other end of the leash. The daughter of a friend fell under similar conditions, fractured her hip, and was found to have osteoporosis. She was in her 50s, considerably younger than the residents in the study.
Increasing calcium consumption and making sure that enough protein is consumed daily should be considered 'preventive maintenance.' We practice preventive maintenance for our cars by not waiting until our car needs oil or its tire pressure checked. So too, we shouldn’t wait until we stumble over a curb and break an ankle or find ourselves with a stress fracture after a long run to worry about making sure our bones receive the nutrients they need to maintain bone density. And we certainly should not wait until we are in our nineties and in a residential facility.
If plant-based dairy products are substituted for those coming from a cow, it is important to consume those whose protein and calcium contents resemble those found in the cow-sourced products. We should be eating about 1000 mg of calcium a day, although some authorities would like to see this increased by 100 or 200 milligrams per day. Thus it is important that at least a third of our calcium requirements be supplied by one serving of a cow or plant-based dairy food. Only cow? What about sheep and goat milk, which are present in many kinds of cheese? And goat milk is readily available.
Protein requirements are based on body weight, but may vary based on activity, age, and whether one is pregnant, recovering from a serious illness, bulking up muscle, or preventing bone loss. The International Osteoporosis Foundation recommends consuming at least 0.8grams of protein per kg body weight to prevent this bone disorder (convert pounds to kg by dividing by 2.2.) Interestingly, the control group in the Australian study were eating slightly more protein, about 0.9 grams per kg body weight, and yet experienced significant falls and fractures.
Decreases in bone density can occur for decades, and unless tests to measure this are ordered, it is a silent symptom-free process. That is, until the fall, the jarring of hip against a chair, or bumping an arm against a door, and the discovery that not only is the bone fractured, but all the bones have lost some density.
Prevention may be as close as the yogurt in your refrigerator.