When I was on the “dairy is bad” bandwagon, I believed all the claims—that it caused inflammation, gut issues, would make you sick, ruin your life, etc., etc.
But there’s another health claim that continues to get attention in the wellness community: dairy consumption increases the risk of osteoporosis and fractures.
If you grew up before the early 2000s, when dairy was touted as a calcium-rich superfood for building healthy, strong bones, this 180-degree spin on things probably left you dumbfounded.
So which is it? Does dairy increase our risk of osteoporosis and fractures? Or does dairy decrease our risk?
Today’s newsletter will help answer those questions by examining the latest research.
🗣️I want to give a big shout-out to plant-based eating expert and nutritionist Simon Hill for bringing awareness to this topic and carefully combing through the research in this dairy deep-dive podcast episode with Dr. Alan Flanagan.
I found this interview super enlightening because Simon and Dr. Flanagan take a balanced approach by addressing both sides of the dairy and osteoporosis argument with two keystone studies we’ve borrowed for today’s newsletter.
My cowriter, Taylor (@foodhappywithtaylor), pulled some interesting studies that further amplify the nuances on each side.
Let’s jump in!
Dairy and Increased Risk of Fracture: What Does the Research Say?
The link between dairy intake and increased risk of osteoporosis and fracture primarily comes from observational research showing that countries with the highest dairy intake also have the highest rates of hip fractures (1,2).
However, observational studies must be interpreted with a level of nuance. Many of these studies do not account for confounding factors like vitamin D status, overall diet quality, and physical activity—major contributors to bone mineral density and fracture risk.
That means we must take these results with a grain of salt since all factors aren’t being controlled for.
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Findings from a Large Swedish Cohort Study on Milk Intake, Fracture Risk, and Mortality
This study is responsible for much of the debate surrounding dairy consumption, osteoporosis, and fracture risk.
In women, the study reported no benefits for milk consumption and fracture risk, a 15 percent greater likelihood of all-cause mortality for every glass of milk consumed daily, and a 93 percent greater likelihood of death for three or more glasses of milk consumed daily compared to less than one (2).
Of course, there’s more that fits into the equation of bone density, fracture risk, and all-cause mortality besides milk intake (hence, “all-cause” mortality), but the researchers don’t make that clear. Moreover, fermented dairy was anti-inflammatory, and each serving was associated with a 10–15 percent lower fracture risk (3).
Why were milk intake and all-cause mortality highlighted over fermented dairy and reduced fracture risk? It’s hard to say. However, based on the research presented in last week’s newsletter, there does appear to be a pattern emerging: fermented dairy is protective against inflammation and beneficial for overall health in people that can tolerate it.
Dairy and Reduced Risk of Fracture: What Does the Research Say?
For every study that says dairy intake is associated with an increased risk of fractures, there are ten more that say the opposite to be true. It could be that the former is less stress-tested in the literature, but let’s see what we can gather from the research.
A 2018 review found that higher consumption of yogurt and cheese was linked to a 25 percent and 32 percent lower risk of hip fracture, respectively. The evidence on milk intake, specifically, was not as strong (4). Another paper reported that postmenopausal women with higher yogurt intake (about one-to-two servings per day) had a 24 percent lower risk of hip fractures versus no yogurt intake (5).
Note: healthy user bias could be responsible for this effect because people who eat yogurt also tend to follow a healthy diet and lifestyle. It’s hard to know for sure how much this comes into effect.
Finally, a 2020 review published in Osteoporosis International reported a 22 percent lower risk of hip fracture in those with higher consumption of yogurt but not milk or cheese. In the US, milk intake was associated with a lower risk of hip fracture (one glass per day) compared to Scandinavian regions, likely due to the fortification of US milk with vitamin D (6).
Findings from a Large (and Well-Designed) Randomized Controlled Trial
The research on dairy intake and fracture risk is mostly observational; however, a 2021 randomized controlled trial sought to establish causation in a cohort of nearly 7,200 elderly adults in nursing homes (7).
Researchers gave the intervention group milk, yogurt, and cheese to increase their daily calcium (1142 mg) and protein intake (1.1 g/kg body weight). The control group continued to eat their normal diet (700 mg of calcium and less than 1 g of protein per kg of body weight). Each group had adequate vitamin D levels.
After a year, the dairy group had 33 percent fewer total fractures, 46 percent fewer hip fractures, and 11 percent fewer falls than the control group. This study suggests that dairy may help bone mineral density by providing calcium, protein, and other essential nutrients in populations that are likely deficient.
My Top Takeaways from the Research
So, what does all of this mean? Here’s a summary of what we know:
- Total dairy intake likely helps protect against osteoporosis and fracture, especially in individuals with calcium, protein, and vitamin D deficiencies.
- Fermented dairy, particularly yogurt, likely protects against osteoporosis and fracture risk.
- There’s insufficient evidence to suggest that milk alone protects against osteoporosis and fracture. However, vitamin D-fortified milk is likely more protective than non-fortified milk.
- More research is needed to determine if cheese intake is linked to reduced fracture risk. Some studies show no effect, while others show that European cheeses could have a protective effect (5,8,9).
The Role of Dairy’s Nutrient Matrix in Bone Health
The nutrient matrix of dairy could be responsible for its potential benefits on bone health. Not only is dairy a good source of calcium, but it’s also an excellent source of phosphorus, protein, magnesium, vitamin K2, and vitamin D (if fortified), critical nutrients for bone strength.
Fermented dairy offers amazing benefits of its own. It contains prebiotics and probiotics that help lower inflammation and promote a healthy gut microbiome, and its protein and calcium aid in stimulating bone growth and mineralization (10).
Final Thoughts
Dairy delivers a perfectly packaged source of macro- and micronutrients for bone health, but it is no magic bullet. Increasing bone mineral density and staving off osteoporosis and fracture risk is a collective effort that requires good nutrition and weight-bearing exercise.
Resistance training is just as important for bone health and needs to be prioritized, especially as we get older. Just 20–30 minutes two or three times a week can provide significant benefits for bone health.
I applaud Simon for taking on this topic, especially because he comes from a vegan/plant-based background. There are plenty of topics I disagree with him on, but in the case of dairy, I super appreciate him breaking down the many nuances in the current research.
Simon and Alan are big fans of plant milk. Right now, it’s hard to say if you can get the same benefits from fortified plant milk and yogurts as regular dairy. I would be interested in seeing future studies test if the effects of dairy on bone health are due to its unique nutrient matrix.
That’s it for this week!
Here’s to your bone health,
Dhru Purohit