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Osteoporosis: Building Better Bones

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Objectives: This study sought to reveal the methods by which women could maintain or improve bone structure within the context of following The Hallelujah Diet. Study Design: Women were recruited for a 3-year observational study. Measures of bone strength (quantitative ultrasound of heel), and a diet and lifestyle questionnaire were completed yearly. Women with low bone density were encouraged to consume B-Flax-D daily (a supplement containing vitamins B12, B6, K2 and D3 in a flax seed base), spend more time in sunshine in the summer (for higher levels of vitamin D), eat at least one more serving of dark leafy vegetables per day than previously eaten, get weight bearing exercise daily, eat legumes at least three times a week, and drink re-mineralized water rather than distilled water. Results: Fifty-seven women began the study. Initially there were 11 women with normal T-scores, 26 women with osteopenic T-scores, and 20 women with osteoporotic T-scores. All women who were not taking vitamin D supplements had lower-than-optimal vitamin D levels. Twenty-nine women had at least three measurements for temporal trend analysis. Among these women the biggest dietary changes were an increase in legumes and a move towards using re-mineralized water rather than distilled water. Compared to an absolute standard of the BUA (Bone ultrasonic attenuation), 14 women decreased in bone strength, 7 remained the same, and 8 increased in bone strength. Fewer women who were classified in the osteoporotic range got worse during the study (3/10) compared to women in the osteopenic range (6/11) or women in the normal range (5/8). There were no correlations between dietary factors or vitamin D status and gain or loss of bone strength. The only positive correlation, which explained more than half of the variation, was between bone strength and resistance training. Only 5 of 21 women who reported engaging in resistance training at any time during the study lost bone, while 6 of 8 women who reported only aerobic type exercise lost bone strength. The relative risk of bone loss (RR = 0.32, P=0.028, two-tailed Fisher exact test) for the resistance exercise group was statistically different from the aerobic group. Conclusions: Women following The Hallelujah Diet can best improve their bone strength by engaging in resistance training and vigorous weight-bearing exercise. All post-menopausal women need to use about 5,000 IU of vitamin D daily to help optimize their health. More may be needed. If supplemental calcium is recommended by a health care practitioner, the most soluble, highly assimilated calcium is calcium aspartate anhydrous, sold as EZorb calcium (Elixir Industries).
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The Hallelujah Bone Health Study
Michael Donaldson, PhD, Hallelujah Acres Foundation
Abstract
Objectives: This study sought to reveal the methods by which women could maintain or
improve bone structure within the context of following The Hallelujah Diet.
Study Design: Women were recruited for a 3-year observational study. Measures of bone
strength (quantitative ultrasound of heel), and a diet and lifestyle questionnaire were
completed yearly. Women with low bone density were encouraged to consume B-Flax-D
daily (a supplement containing vitamins B12, B6, K2 and D3 in a flax seed base), spend more
time in sunshine in the summer (for higher levels of vitamin D), eat at least one more serving
of dark leafy vegetables per day than previously eaten, get weight bearing exercise daily, eat
legumes at least three times a week, and drink re-mineralized water rather than distilled water.
Results: Fifty-seven women began the study. Initially there were 11 women with normal T-
scores, 26 women with osteopenic T-scores, and 20 women with osteoporotic T-scores. All
women who were not taking vitamin D supplements had lower-than-optimal vitamin D levels.
Twenty-nine women had at least three measurements for temporal trend analysis. Among
these women the biggest dietary changes were an increase in legumes and a move towards
using re-mineralized water rather than distilled water. Compared to an absolute standard of the
BUA (Bone ultrasonic attenuation), 14 women decreased in bone strength, 7 remained the
same, and 8 increased in bone strength. Fewer women who were classified in the osteoporotic
range got worse during the study (3/10) compared to women in the osteopenic range (6/11) or
women in the normal range (5/8).
There were no correlations between dietary factors or vitamin D status and gain or loss of
bone strength. The only positive correlation, which explained more than half of the variation,
was between bone strength and resistance training. Only 5 of 21 women who reported
engaging in resistance training at any time during the study lost bone, while 6 of 8 women
who reported only aerobic type exercise lost bone strength. The relative risk of bone loss (RR
= 0.32, P=0.028, two-tailed Fisher exact test) for the resistance exercise group was statistically
different from the aerobic group.
Conclusions: Women following The Hallelujah Diet can best improve their bone strength by
engaging in resistance training and vigorous weight-bearing exercise. All post-menopausal
women need to use about 5,000 IU of vitamin D daily to help optimize their health. More may
be needed. If supplemental calcium is recommended by a health care practitioner, the most
soluble, highly assimilated calcium is calcium aspartate anhydrous, sold as EZorb calcium
(Elixir Industries).
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The Hallelujah Bone Health Study
Michael Donaldson, PhD
Hallelujah Acres Foundation
Background
Osteoporosis is the disease of brittle, porous bones. Osteoporosis is pervasive in the USA
one in two women and one in four men will experience a bone fracture due to osteoporosis.
Dietary and lifestyle interventions are primary recommendations prior to beginning drug
therapy.
Factors that are important for osteoporosis include calcium balance, adequate protein intake,
intake of fruits and vegetables that provide alkalizing minerals and compounds (to spare
calcium from being used to neutralize metabolic acid), vitamin D (for optimal uptake of
calcium), vitamin K (for carboxylyation of osteocalcin), elevated homocysteine, imbalance of
progesterone and estrogen, poor or weak digestion, exercise and activity level, and the use of
low mineral water. Because osteoporosis is a multi-factorial disease, it requires a multi-
factorial approach to reversing bone destruction.
The purpose of this study was to reveal the method by which small-framed women (the most
vulnerable subpopulation) could follow The Hallelujah Diet and maintain bone strength or
even gain bone strength if they were found to have low bone density.
Description of the Study
Female Health Ministers were recruited at the Health Minister Reunion in April 2006.
The study was presented in a general meeting, and women were given time to ask
questions before giving informed consent the following day. We targeted women who
were petite, though a few women who were not petite also joined the study. A McCue
CUBA clinical quantitative ultrasound machine was used to measure bone strength every
year for 3 years. The McCue CUBA machine has been validated as a method for
measuring bone strength. Scores with the McCue CUBA correlate with DEXA (dual-
energy x-ray absorptiometry) with a correlation coefficient of about 0.70 to 0.80 (Cook et
al. 2005; Ohishi et al. 2000; Robinson et al. 1998; Taal et al. 1999). However, its
predictive score for osteoporosis and osteopenia are not specific enough to replace a
DEXA scan. The McCue CUBA has stronger negative predictive score than positive
predictive power (Taal et al. 1999). This means it is better for detecting the absence of
osteoporosis than confirming a positive diagnosis. The McCue CUBA gives a T-score,
which compares bone health status to young women, as well as a Z-score, which
compares the BUA to an age and sex-matched group. Height, weight, blood pressure, and
pulse rate were also measured yearly.
Food intakes and lifestyle choices were queried with a two-page questionnaire. Typical
diet (raw vegan, Hallelujah Diet, vegan, lacto-ovo-vegetarian) and length of time on
current diet were recorded. Intakes of meat, vegetable juice, BarleyMax, salads, fruit,
nuts and seeds, legumes, fiber products, salt intake (unrefined vs. refined, not quantity),
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flax seed oil, and water were each scored on a five-to-six-point scale of frequency of
consumption. Use of dietary supplements was given, with space to write in any specific
supplements other than B12, natural progesterone cream, and calcium/magnesium.
Lifestyle questions focused on leisure activity (light, moderate, intense activities
preferred), occupational activity (sitting, on feet a lot, light industrial, heavy lifting),
sunshine exposure (frequency per week and length of time each occurrence), type of
exercise routine (aerobic or weight training / resistance), specific usual exercises (nine
choices, plus room to fill in others), and amount of exercise performed weekly (frequency
and length of each session). In the final year participants were asked if they had
experienced any fractures or broken bones in the last 3 years.
Women with T-scores in the osteopenia or osteoporotic range were encouraged to make
several changes to improve bone strength and density: consume B-Flax-D daily, spend
more time in sunshine in summer (for higher levels of vitamin D), eat at least one more
serving of dark leafy vegetables per day than previously eaten, get weight bearing
exercise daily, eat legumes at least three times a week, and drink Willard Water (and later
WaterMax) re-mineralized water instead of distilled water.
Women who attended had their blood levels of vitamin D measured in 2008 and 2009 by
an independent laboratory (LabCorp, Burlington, NC). Between April 2008 and April
2009, recommendations for increased vitamin D (5,000 IU/day) and supplemental
calcium citrate (1,000 mg/day) and magnesium glycinate (400 mg/day) were made for
women with T-scores in the osteoporotic range.
Results
Recruitment and Follow-Up
Fifty-seven women with an average age of 57 were recruited in 2006. Another 11 women
joined the study in 2007. Forty-seven women had at least two measurements while only 29
women (average age of 58) had measurements on at least 3 occasions. Twenty women had
measurements all 4 years of the study (years 0, 1, 2, and 3). Many women did not return to the
Health Minister Reunion for a variety of reasons. Most of the results reported here are based
on the 29 women who had at least 3 measurements, including at least 1 measurement of
vitamin D levels (27 of the 29 women had their vitamin D levels checked at least once).
Adherence to Protocol
Most of the women were following what would appear to be a bone-healthy diet at the
beginning of the study. They consumed an abundance of green salad and even some green
smoothies. Consumption of meat was almost nil, except for a few who occasionally ate meat
approximately once per month. Many were already consuming one or two servings of
legumes weekly.
Overall, there was little change recorded in their diets over the 3-year period. It is possible that
the 12-question survey didn’t capture changes that were made. Approximately half of the
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women reported the same intake of juice, BarleyMax, salad, fruit, nuts, and seeds at the end of
the study as at the beginning.
Change in legume intake was more significant. Eight of 29 women (27%) had the same intake
of legumes as at the beginning. In 2007, among this group of 29 women (25 of whom were
present in 2007), there were none who decreased legume intake and 13 who had increased
legume intake, indicating an effort to adhere to the protocol of the study. By the end, seven of
the women had reduced their intake of legumes below the initial reported consumption rate.
Bone Strength Measures
In 2006, the ultrasonic bone strength measures indicated that there were 8 women with normal
T-scores, 12 with osteopenic T-scores, and 9 with osteoporotic T-scores among the 29 women
that had at least 3 data points over the course of the study. Among all attendees in 2006, there
were 11 women with normal T-scores, 26 women with osteopenic T-scores, and 20 women
with osteoporotic T-scores. This snapshot of scores does not indicate whether each woman is
decreasing, maintaining, or increasing bone strength.
0
1
2
3
4
5
6
7
Osteoporotic Osteopenic Normal
Number of People
Worse
Same
Better
Figure 1. Change in Bone Strength, Classified by Beginning Bone Strength Classification.
Time trends for bone strength values are reported here for the 29 women with at least 3
measurements. Compared to an absolute standard of the BUA (Bone ultrasonic attenuation),
fourteen women decreased in bone strength, 8 remained the same, and 7 increased in bone
strength (see Figure 1). Compared to normal values for women of their same age (relative
bone loss) 12 women decreased relative bone strength, 10 remained the same, and 7 women
increased relative bone strength. (For these comparisons, a change of ± 2 BUA units or ±5%
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Expected Value was considered to a significant change.) As expected the relative bone loss is
slightly less than absolute bone loss because “normal” women typically lose bone density over
their lifetime.
Fewer women who were classified in the osteoporotic range worsened during the study (3/10)
compared to women in the osteopenic range (6/11) or women in the normal range (5/8) (see
Figure 1.) It appears that the women with more severe conditions took their plight more
seriously, and others may have taken their bone health a bit more for granted.
Vitamin D Levels
Vitamin D levels were measured in 2008 and again in 2009. Many of the women reported
spending time outdoors in the sunshine at least a few days a week, and several of the women
lived in the southern USA. The results were surprising, as seen in Figure 1. Optimal levels of
vitamin D are 40 ng/ml and higher. Safe levels are below 100 ng/ml, perhaps even a bit
higher. Even with encouragement to use supplementary vitamin D, many women still did not
have optimal vitamin D levels. Despite taking 4,000 to 5,000 IU/day of vitamin D3, a few
women still did not get above 35 ng/ml. For the 19 women who had vitamin D measures both
years, the average value rose from 24.3 to 31.3 ng/ml. Only 3 women had levels above 40
ng/ml with another 6 between 30 and 40 ng/ml. Low levels of vitamin D may contribute to
weaker bones through decreasing the calcium absorption from food.
Figure 2. Vitamin D Levels in the Hallelujah Bone Health Study.
0
1
2
3
4
5
6
7
8
<5 <10 <15 <20 <25 <30 <35 <40 <50 <100
Vitamin D Level, 25(OH)D, (ng/ml)
Number of People
Optimal Levels
Start Here
Dangerous Levels
Below Here
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Water Intake
We hypothesized that low mineral drinking water might contribute to bone loss over a long
period of time. In 2006, 22 of the 29 women with at least 3 measurements were using distilled
or reverse osmosis water. Only 7 of the same women were doing so in 2007 and only 5 in
each of 2008 and 2009. No conclusion could be reached regarding this hypothesis in this
observational study. It is one of several factors that play a role in bone health.
Correlations between Bone Strength and Diet and Lifestyle
Since many factors determine bone strength, it was difficult to single out any one factor that
really made a difference. It was clear that some women maintained or increased bone strength
while others lost bone strength. Eating habits were very similar and most of the women had
regular exercise programs. No single factor correlations were found between change in bone
strength and change in body mass index, in vitamin D level for 2008 or 2009, in blood
pressure, in pulse rate, in the product of frequency and duration of exercise, nor in a measure
of how much vegetable juice, BarleyMax, salads, fruits, nuts, seeds, fiber, and flax oil the
women consumed. The changes in bone strength were not correlated with any changes in
dietary 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 strength
measures.
Correlation between Resistance Exercise and Bone Strength
Exercise type was the one factor that explained a significant portion of the variation between
which women gained bone strength and which women lost bone strength. Women who
reported doing resistance training during any period of the 3-year study were separated in the
analysis from women who never reported doing resistance training (among the 29 women
with at least 3 measurements). When these women were separated then into groups who either
gained or maintained bone strength and those who lost bone strength based on a 5% change in
expected value (similar to the Z-score, a relative bone strength measure compared to women
of the same age), it was clear that the women who practiced resistance training had an
advantage in keeping their bone strength. Five of 21 women who engaged in resistance
training lost bone, while 6 of 8 women who reported only aerobic type exercise lost bone
strength (see Table 1). The difference between these two groups was significantly different
when tested with the appropriate statistical test, the two-tailed Fisher exact test (P=0.028). The
relative risk of bone loss was 0.32 for the resistance exercise group. The amount of risk of
bone loss attributable to lack of resistance exercise was estimated to be 68% for those who did
not do it.
Because of the small number of women in the study, there is a wide range of possible error in
this number. The attributable risk possibly could be anywhere from 50 to 80%. Still, this
number illustrates that approximately half of the risk of bone loss could be mitigated just by
doing resistance exercises.
When women who only reported once doing resistance training but not in other years were
grouped with the aerobic exercising women, the results were still in favor of resistance
training as a powerful predictor of bone strength (P=0.052). Of the 13 women who reported
resistance training more than once, only 2 of them lost bone strength, while 9 of 16 women
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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 bone
Maintain / Gain Bone
Resistance
5
16
Aerobic
6
2
RR = 0.32
P = 0.028
Table 2. Resistance or Aerobic Exercise for Bone Strength?
Only women with more than one year of resistance exercise reported.
Lost bone
Maintain / Gain Bone
Resistance
2
11
Aerobic
9
7
RR = 0.27
P = 0.052
Discussion
In 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 the
type of exercise she engaged in. The differences between individual diets were not large, so
that even though dietary choices make a difference in bone health, the differences between
individuals’ diets in this study were not significant. Therefore, the impact of dietary choices
was not detectable. However, the purpose of this study was to determine how a woman can
implement The Hallelujah Diet and maintain or even gain bone strength. The answer is
resistance and vigorous weight-bearing exercise. It wasn’t the amount of protein, the amount
of green leafy vegetables, the use of vitamin D or calcium supplements, or even the kind of
water consumed that was the principal bone factor. From other studies we know that these
other factors are important, but this study indicates that resistance exercise, when added to The
Hallelujah 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. Do
you get enough protein for your bones on The Hallelujah Diet? Is there enough calcium for
strong bones on The Hallelujah Diet? It does help to have legumes to increase the protein
intake some, but legumes and extra protein by themselves will not make an individual’s bones
stronger.
Yes, there can be enough calcium on The Hallelujah Diet. Yes, there is adequate protein. A
small amount of nuts, seeds, and legumes will ensure that protein and minerals are sufficient.
(Natural plant protein rich foodsnot soy protein isolateare also mineral rich.) A diet of
fruits, vegetable juice, and raw vegetables alone may not have enough protein, but that is not
really The Hallelujah Diet. Yes, you can build strong bones and follow The Hallelujah Diet.
The answer is more about lifestyle, however.
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Calcium
A recent population study from the United Kingdom found that vegans who had a daily
dietary intake of less than 525 mg of calcium were at elevated risk of bone fractures (Appleby
et al. 2007). Daily dietary intake of more than 525 mg of calcium was protective, and there
was no increased risk. Bhuddist nuns in Vietnam were compared with an omnivorous control
group 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 the
control 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 other
factors, as appears to be the case in the Hallelujah Bone Health Study. It is still wise to
consume sufficient calcium, which can be obtained from eating a sizable portion of leafy
greens, other vegetables, nuts, seeds, and legumes. In our diet survey of Hallelujah Acres
Health Ministers the daily average calcium intake for women was 577 ± 156 mg (Donaldson
2001). Women with above average calcium intake wouldn’t have any problem, but any
woman with below average calcium intake may be at an increased fracture risk. A DEXA
scan would really be necessary at the individual level to determine personal risk. If a woman
had already been diagnosed with osteoporosis or osteopenia, it would seem wise to use all
available options to reduce the risk of fracturing a hip. Exercise, as vigorous as possible, is the
first and most important recommendation. It is wise to optimize vitamin D levels and to follow
the other recommendations of this study, especially increased intake of salad greens and
legumes. However, some women may want more calcium in the form of a supplement. What
is the best form of supplemental calcium?
In this study we recommended supplemental vitamin D and calcium citrate, along with
magnesium glycinate to women in the second year of the study that had low levels of vitamin
D and osteoporotic bone strength scores. Since that recommendation further investigation has
led to the comparison of AdvaCal (calcium hydroxide and calcium oxide with heated algal
ingredient) and EZorb calcium (calcium aspartate anhydrous). AdvaCal is supported by
several 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 yielded
excellent results (Tang et al. 2007). Increases in bone density were achieved with 520 mg of
calcium as calcium aspartate anhydrous, compared to no increase with 1,500 mg of calcium as
calcium citrate.
EZorb calcium is much more soluble than calcium citrate or AdvaCal, not only in an acidic
pH, but all the way up to pH 11. This means that EZorb calcium can be assimilated in the
acidic stomach environment, but it won’t form an unabsorbable precipitate in the small
intestine and it won’t interfere with the absorption of other minerals. Bioavailability of
calcium citrate is around 40 to 45%, while the bioavailability of EZorb calcium was 92% in
one lab study in rats (Tang 2000). For this reason Ezorb calcium is now the recommended
form of calcium for people who want a little more calcium. It is more expensive, but the body
is able to utilize it all, it is effective at lower doses, it doesn’t interfere with absorption of
anything else, and it really works.
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Figure 3. A comparison of solubility of calcium as
(left to right) calcium citrate, AdvaCal, and EZorb.
200 mg of elemental calcium from each source
was mixed with 10 ml of distilled water and then
allowed to settle. The EZorb calcium instantly
formed a true solution, while calcium citrate and
AdvaCal only formed a suspension.
Vitamin D
In this study we also documented that many
women have low vitamin D levels. Without
supplementation none of the women had optimal
levels of vitamin D. Low levels of vitamin D will
decrease the uptake of calcium as much as 65%
from the small intestines (Heaney et al. 2003).
From the study just cited it appears that optimal
uptake of calcium begins at a vitamin D level
around 32 ng/ml. Clearly, the majority of women
in this study had suboptimal uptake of calcium
because of low vitamin D levels. Even with
supplementation of 4,000 to 5,000 IU of vitamin
D3 per day not all women achieved optimal levels. This indicates that supplementation of
vitamin 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 through
synthesis in the skin. As people age, their efficiency of vitamin D manufacture decreases. A
70 year old only makes about 25% as much vitamin D from the same sun exposure as a 20
year old (Holick 2004). This fact is not emphasized enough. Whereas 20 minutes of sunshine
may yield a significant dose of vitamin D for a youth, that same 20 minutes will not be enough
for an elderly person’s vitamin D needs.
Since vitamin D is required for many body systems beyond the bone structure, there are many
benefits to achieving and maintaining optimal vitamin D levels. We did not sample enough
women 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 available
through Hallelujah Acres to determine the blood level of vitamin D to ensure that this
important aspect of one’s health is optimized. Sunshine is free and supplemental vitamin D is
very 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 (Faloon
2009).
Comparison with other studies
A 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.
10
We found similar results in some women, but also found evidence that bone strength could be
built using The Hallelujah Diet. The answer is in the exercise more so than in the dietary
intakes, according to the results we found here.
Many studies have shown that exercise (in particular weight bearing exercise or resistance
training) builds bone structure. Intervention studies have shown exercise to improve bone
mass 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 hip
fracture in Great Britain (Cooper et al. 1988). The same result was found among urban
Chinese (Lau et al. 1988) who had a much lower intake of calcium. In a 21-year study of
3,200 men aged 44 or older researchers found that those who engaged in vigorous physical
activity 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 to
walking as exercise found evidence for benefit for the hip at the femoral neck, but no benefit
for the lumbar spine (Martyn-St James & Carroll 2008). They concluded, in agreement with
this report, that “other forms of exercise that provide greater targeted skeletal loading may be
required to preserve bone mineral density in this population.”
Comparisons of resistance exercise and aerobic exercise have been mixed for effectiveness for
building bone density. Results depend on the intensity of the exercise because any exercise
that builds muscle will also build the associated skeletal structure. A review in 1999 concluded
that resistance exercise rather than aerobic exercise more consistently has been shown to help
bone density (Layne & Nelson 1999). Resistance and strength exercises are still the
recommended type of exercise for maximizing bone strength (N. Schmitt et al. 2009).
Drug Therapy
Building bones through exercise has superior effects compared to using bisphosphonate drugs
to stabilize existing bone structure. The bisphosphonate drugs prevent the breakdown of older
bone, but do not stimulate the osteoblasts to lay down new bone structure. Those who take
these drugs end up with high bone density but older, more brittle bone. Exercise improves
bone structure by encouraging the remodeling and strengthening of bone by the mechanisms
designed for that purpose, rather than inhibiting natural processes. Side effects of
bisphosphonate drugs are a further complication. One serious complication is the high risk of
osteonecrosis of the jaw following any dental extractions or implantations while using
bisphosphonate drugs (AAOMS 2009). This infection of the jaw can lead to a partially healed
focal infection that harbors anaerobic bacteria that will continually poison the bloodstream.
Individuals should not undergo tooth extractions while using any bisphosphonate drug. Recent
studies have also linked bisphosphonate drugs to increased risk of atrial fibrillation in women
(Black et al. 2007; Heckbert et al. 2008).
Limitations of this study
This study was an observational study. There were some recommendations for dietary
changes, but the only significant dietary changes for most people were an increase in legumes
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and the use of re-mineralized water. Many of the women were already following the other
recommendations. 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 usually
live. Thus, the results can be directly applied to other women following The Hallelujah Diet in
the real world. This study shows that maintaining or even gaining bone strength is possible
while following The Hallelujah Diet.
On the other hand, the study’s results are limited because we only know associations, rather
than direct cause and effect. From this study alone, one cannot conclude with absolute proof
that resistance exercise causes greater bone mass and strength. The association is strong, but
an observational study can never provide conclusive evidence. Another limitation is the
method of recording people’s usual dietary and lifestyle practices. We used a simple food
frequency questionnaire querying only the most relevant foods. A dietary record would have
better captured food intake, but would have increased the participants’ burden. Exercise could
have been captured by a journal method as well, rather than by a simple questionnaire. This
may have improved the precision of the study. This study was very limited in terms of finding
results of various dietary practices because participants’ diets were so similar. Such
information must be found in other studies.
Conclusion
There were four major findings from the Hallelujah Bone Health Study:
1. Strong healthy bones are not an automatic result for every woman following The
Hallelujah Diet. While some of the women did have normal strength bones, and even
above average for their age in some cases, many women had low bone strength. Some
of this may be the result of previous diet and lifestyle choices before adopting the
Hallelujah Diet.
2. Following the Hallelujah Diet won’t guarantee that you will continue to build
strong healthy bones. It is possible, but here again, many women lost measurable
bone strength over the course of the three years.
3. Vitamin D levels for mostly older women, even in the southern USA, are not near
optimal levels. Everyone living in the USA needs to use a vitamin D supplement
because casual or even purposeful sunshine exposure is not sufficient for elderly
people to optimize vitamin D levels.
4. The most important factor in improving bone strength identified in this study is
resistance training, or weight bearing exercise. Approximately half or even more of
the risk of losing bone strength was due to lack of resistance training. In this study, the
diets of the participating women were very similar so that no significant dietary factors
could be identified. It isn’t that diet isn’t important, but these women were generally
following diets that supplied adequate nutrition for building healthy bones. The
limiting factor appeared to be exercise that provided stress to the bones. Within the
study there was definite variation between which women improved, which ones
maintained, and which ones lost bone strength. The type of exercise the women
participated in could explain most of this variation.
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The take-home message is simple. Weight bearing exercise using weights or other resistive
exercise methods is necessary to make bones stronger. Aerobic conditioning is great for the
cardiovascular system, but bones require increased stress to get a molecular signal to build
stronger bone matrix. So, if you want strong bones, you have to give them extra weight
through exercise that works against gravity. Simple walking isn’t enough to do it.
Types of Exercises to Build Stronger Bones
There are three principles to keep in mind in picking the type of exercises to help you build
stronger bones:
1. Muscle and bone are built at the same time. To the extent that any exercise builds
muscle, it will build the associated bone at the same time. Walking doesn’t build much
muscle, and it doesn’t build much bone either. It is a good, mild exercise that anybody
can begin with, but intensity has to be increased a lot to build stronger bones. High
intensity exercise will do more to build muscle and bone simultaneously.
2. Any muscles that don’t get exercised won’t be built up, and the underlying
skeletal structure will also be weakened. All parts of the body need exercised.
3. Exercises that increase the force of gravity or use weights that increase your
work against gravity will build bone more than exercises that don’t work hard
against gravity.
Physiology experts recommend weight bearing, strengthening exercises along with exercise
that increases balance. Maintaining balance helps prevent disastrous falls. If you are in good
shape you can do high impact weight bearing exercises like jogging, running, jump rope, and
high impact aerobics, as well as high intensity sports (or whatever intensity you can enjoy). A
great low-impact resistance exercise is the Fit10 program, which some of the women in this
study have been using. Bicycling, swimming, and walking help cardiovascular fitness, but
they don’t help your bones very much. Wearing a weighted vest, such as the X2vest
(x2vest.com) for a couple of hours a day has been proven to be very helpful. However, fancy
equipment isn’t necessary for building strong bones. Dr. Joel Fuhrman (a boardcertified
family physician who specializes in preventing and reversing disease through nutritional and
natural methods) recommends bone-building exercises that you can do at home without any
new equipment. Exercises such as chair squats, toe lifts, back arches, jump lunges, and magic
jump roping (no rope required) help you improve both balance and strength. All of these
exercises will be helpful. Keep the principles mentioned above in mind and use an exercise
program that fits you and that will build up balance and strength. This will be an immense
help to build strong bones.
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ResearchGate has not been able to resolve any citations for this publication.
Article
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A randomized, prospective, double-blind test was carried out to compare the effects of heated oyster shell-seaweed calcium (AAA Ca), calcium carbonate, and placebo in 58 elderly, hospitalized women with the mean age of 80 divided into three groups. Group A received 900 mg/day Ca as AAA Ca, Group B 900 mg/day Ca as CaCO3, and Group C placebo besides regular hospital diet containing approximately 600 mg Ca/day for 24 months. From the 25th to the 30th month, all groups were given AAA Ca. Lumbar spine and radial bone mineral density (BMD) were measured at 3-month intervals. Urinary Ca/Cr and serum alkaline phosphatase, intact and midportion serum parathyroid hormone (PTH), and calcitonin were also measured at intervals. From the 6th to the 24th month of the study, the ratio of lumbar spine BMD (L2-L4 by DPX, Lunar) to the basal pretest value was consistently and significantly higher in Group A than Group C but not higher in Group B than in Group C. PTH, measured 12 months after the beginning of the study, was lower in Group A than in Group C, but no significant difference was found between Groups B and C. At 3 months after the placebo was switched to AAA Ca in Group C, serum PTH was significantly decreased from the level during placebo supplement. Morning urine Ca/Cr decreased in Groups A after 18 months and in B after 12 months, but not in C. Serum alkaline phosphatase decreased in Group A significantly compared with Group C, but not in Group B. AAA Ca appears to be effective for increasing BMD in elderly subjects.