Advertisement

The Negative Effect of a High-Protein–Low-Calcium Diet

  • Peter BurckhardtEmail author
Chapter
  • 1.5k Downloads

Abstract

The interdependent influence of the protein and the calcium intake on bone health has been conclusively studied. For obtaining a positive bone effect from nutritional protein, an adequate calcium intake is required, and vice versa. A high-protein intake was first considered as potentially negative for bone, but this fear was not defendable anymore when it became evident that a high-protein intake increases urinary calcium excretion because it stimulates calcium absorption. Protein deficiency was shown to be detrimental to bone, not a high-protein intake. However, some large follow-up studies demonstrated that the combination of a high-protein intake with a low-calcium diet increases fracture risk. This particular nutritional profile seems to be rare, but some cross-sectional studies seem to confirm that.

Keywords

Protein intake Protein/calcium ratio Fracture risk 

References

  1. 1.
    Orwoll ES. The effect of dietary protein insufficiency and excess on skeletal health. In: Burckhardt P, Heaney RP, editors. Nutritional aspects of osteoporosis. Serono symposia. New York: Raven; 1991. p. 355–70.Google Scholar
  2. 2.
    Heaney RP. Effects of protein on the calcium economy. In: Burckhardt P, Heaney RP, Dawson-Hughes B, editors. Nutritional aspects of osteoporosis 2006, B.V. Internet congress series, vol. 1297. Amsterdam: Elsevier; 2007. p. 191–7.Google Scholar
  3. 3.
    Darling AL, Lanham-New SA. Dietary protein and bone health: the urgent need for large-scale supplementation studies. In: Burckhardt P, Dawson-Hughes B, Weaver C, editors. Nutritional influences on bone health. London: Springer; 2010. p. 17–26.Google Scholar
  4. 4.
    Heaney RP, Layman DK. Amount and type of protein influences bone health. Am J Clin Nutr. 2008;87(Suppl):1567S–70.PubMedGoogle Scholar
  5. 5.
    Barzel US, Massey LK. Excess dietary protein can adversely affect bone. J Nutr. 1998;128:1051.PubMedGoogle Scholar
  6. 6.
    Darling AL, Millward JD, Torgerson DJ, Hewitt CE, Lanham-New SA. Dietary protein and bone health: a systematic review and meta-analysis. Am J Clin Nutr. 2009;90:1674.PubMedCrossRefGoogle Scholar
  7. 7.
    Lau EMC, Kwok T, Ho SC. Bone mineral density in Chinese elderly female vegetarians, vegans, lacto-vegetarians and omnivores. Eur J Clin Nutr. 1998;52:60–4.PubMedCrossRefGoogle Scholar
  8. 8.
    Sellmeyer DE, Stone KL, Sebastian A, Cummings SR. A high ratio of dietary animal to vegetable protein increases the rate of bone loss and the risk of fracture in postmenopausal women. Am J Clin Nutr. 2001;73:118–22.PubMedGoogle Scholar
  9. 9.
    Meyer HE, Pedersen JI, Laken EB, Meyer AT. Dietary factors and the incidence of hip fracture in middle-aged Norwegians. A prospective study. Am J Epidemiol. 1997;145:117–23.PubMedCrossRefGoogle Scholar
  10. 10.
    Kerstetter JE, O’Brien KO, Insogna KL. Dietary protein affects intestinal calcium absorption. Am J Clin Nutr. 1998;68:859–65.PubMedGoogle Scholar
  11. 11.
    Kerstetter JE, O’Brien KO, Caseria DM, Wall DE, Insogna KL. The impact of dietary protein on calcium absorption and kinetic measures of bone turnover in women. J Clin Endocrinol Metab. 2005;90:26–31.PubMedCrossRefGoogle Scholar
  12. 12.
    Roughead ZK, Johnson LK, Lykken GI, Hunt JR. Controlled high meat diets do not affect calcium retention or indices of bone status in healthy postmenopausal women. J Nutr. 2003;133:1020–6.PubMedGoogle Scholar
  13. 13.
    Hunt JR, Johnson LK, Roughead ZKF. Dietary protein and calcium interact to influence calcium retention: a controlled feeding study. Am J Clin Nutr. 2009;89:1357–65.PubMedCrossRefGoogle Scholar
  14. 14.
    Misra D, Berry SD, Broe KE, McLean RR, Cupples LA, Tucker KL, et al. Does dietary protein reduce hip fracture risk in elders? The Framingham osteoporosis study. Osteoporos Int. 2011;22:345–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Pedreraa JD, Canala ML, Postigoa S, Lavadoa J, Hernandez ER, Rico H. Phalangeal bone ultrasound and its possible correlation with nutrient in an area of high protein intake. Ann Nutr Metab. 2001;45:86–90.CrossRefGoogle Scholar
  16. 16.
    Tanakaa M, Itoha K, Abea S, Imai K, Masuda T, Koga R, et al. Relationship between nutrient factors and osteo-sono assessment index in calcaneus of young Japanese women. Nutr Res. 2001;21:1475–82.CrossRefGoogle Scholar
  17. 17.
    Nakamura K, Hori Y, Nashimoto M, Okuda Y, Miyazaki H, Kasai Y, et al. Dietary calcium, sodium, phosphorus, and protein and bone metabolism in elderly Japanese women: a pilot study using the duplicate portion sampling method. Nutrition. 2004;20:340–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Lacey JM, Anderson JJB, Fujita T, Yoshimoto Y, Kukase M, Tsuchie S, et al. Correlates of cortical bone mass among premenopausal and postmenopausal Japanese women. J Bone Miner Res. 1991;6(7):651–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Metz JA, Anderson JB, Gallagher Jr PN. Intakes of calcium, phosphorus, and protein, and physical activity level are related to radial bone mass in young adult women. Am J Clin Nutr. 1993;58:537–42.PubMedGoogle Scholar
  20. 20.
    Vatanparast H, Bailey DA, Baxter-Jones ADG, Whiting SJ. Effects of dietary protein on bone mineral mass in young adults may be modulated by adolescent calcium intake. J Nutr. 2007;137:2674–9.PubMedGoogle Scholar
  21. 21.
    Recker RR, Davies KM, Hinders SM, Heaney RP, Stegman MR, Kimmel DB. Bone gain in young adult women. JAMA. 1992;268:2403–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Zhang Q, Ma G, Greenfield H, Zhu K, Du X, Foo LH, et al. The association between dietary protein intake and bone mass accretion in pubertal girls with low calcium intakes. Br J Nutr. 2010;103:714–23.PubMedCrossRefGoogle Scholar
  23. 23.
    Burckhardt P, Wynn E, Krief M-A, Bagutti C, Faouzi M. The effects of nutrition, puberty and dancing on bone density in adolescent ballet dancers. J Dance Med Sci. 2011;15(2):51.PubMedGoogle Scholar
  24. 24.
    Shapses S, Robins SP, Schwartz EI, Chowdhury H, et al. Short-term changes in calcium but not protein intake alter the rate of bone resorption in healthy subjects as assessed by urinary pyridinium cross-link excretion. J Nutr. 1995;125:2814–21.PubMedGoogle Scholar
  25. 25.
    Kerstetter JE, O’Brien KO, Insogna KL. Dietary protein, calcium metabolism, and skeletal homeostasis revisited. Am J Clin Nutr. 2003;78(Suppl):584S–92.PubMedGoogle Scholar
  26. 26.
    Kerstetter JE, Wall DE, O’Brien KO, Caseria DM, Insogna KL. Meat and soy protein affect calcium homeostasis in healthy women. J Nutr. 2006;136(7):1890–5.PubMedGoogle Scholar
  27. 27.
    Maalouf NM, Moe OW, Adams-Huet B, Sakhaee K. Hypercalciuria associated with high dietary protein intake is not due to acid load. J Clin Endocrinol Metab. 2011;96(12):3733–40.PubMedCrossRefGoogle Scholar
  28. 28.
    Cao JJ, Johnson LK, Hunt JR. A diet high in meat protein and potential renal acid load increases fractional calcium absorption and urinary calcium excretion without affecting markers of bone resorption or formation in postmenopausal women. J Nutr. 2011;141:391–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Spencer H, Kramer L, Osis D, Norris D. Effect of a high protein (meat) intake on calcium metabolism in man. Am J Clin Nutr. 1978;31:2167–80.PubMedGoogle Scholar
  30. 30.
    Lutz J. Calcium balance and acid–base status of women as affected by increased protein intake and by sodium bicarbonate ingestion. Am J Clin Nutr. 1984;39:281–8.PubMedGoogle Scholar
  31. 31.
    Dawson-Hughes B, Harris SH. Calcium intake influences the association of protein intake with rates of bone loss in elderly men and women. Am J Clin Nutr. 2002;75:773–9.PubMedGoogle Scholar
  32. 32.
    Rapuri PB, Gallagher JC, Haynatzka V. Protein intake: effects on bone mineral density and the rate of bone loss in elderly women. Am J Clin Nutr. 2003;77:1517–25.PubMedGoogle Scholar
  33. 33.
    Zhong Y, Okoro CA, Balluz LS. Association of total calcium and dietary protein intakes with fracture risk in postmenopausal women: the 1999–2002 National Health and Nutrition Examination Survey (NHANES). Nutrition. 2009;25:647–54.PubMedCrossRefGoogle Scholar
  34. 34.
    Feskanich D, Willett WC, Stampfer MJ, Colditz GA. Protein consumption and bone fractures in women. Am J Epidemiol. 1996;143:472–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Dargent-Molina P, Sabia S, Touvier M, Kesse E, Bréart G, Clavel-Chapelon F, et al. Proteins, dietary acid load, and calcium and risk of post-menopausal fractures in the E3N French women prospective study. J Bone Miner Res. 2008;23:1915–22.PubMedCrossRefGoogle Scholar
  36. 36.
    Sahni S, Cupples A, Mclean RC, Tucker LL, Broe KE, Kiel DP, et al. Protective effect of high protein and calcium intake on the risk of hip fracture in the Framingham offspring cohort. J Bone Miner Res. 2010;25:2770–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  1. 1.Hirslanden Clinic/Bois CerfLausanneSwitzerland

Personalised recommendations