Is the Mediterranean diet good for bones?

There is an amazing amount of research on the Mediterranean diet and its benefits for health, so naturally I get some questions about whether it’s good for bone health, too. 

A brand new meta-analysis suggests that we can emphatically say it’s molto buoni [very good] for bones as well as the rest of the body (Benetou et al., 2018). The study looked at the relationship between adherence to a Mediterranean diet and hip fracture in over 140,000 US and European adults over age 60 (82% of whom were women). It found that those who have moderate to high adherence to a Mediterranean diet had a significant decrease in hip fracture risk compared to those with low adherence. 

Mediterranean diet = Alkaline for Life® diet 

This finding is no surprise, because the Mediterranean diet is based on very similar principles as the Alkaline Diet — a focus on alkalizing plant foods and healthy fats, with limits on meat intake and simple carbohydrates. In many ways, the Mediterranean diet is simply one interpretation of Alkaline eating based on foods and meal patterns common to a certain part of the world.

A look at the extensive literature on Mediterranean diet and health highlights just a few important features: 

As a largely plant-based diet, it’s not only an alkaline option, it also offers health-supporting polyphenols that many studies agree are valuable in fighting cancer, inflammation, and oxidative stress — all factors that contribute to poor bone health (Estruch et al. 2013; Medina-Remon et al. 2017; Terra et al. 2009; Anderson & Nieman 2016; Martinez-Gonzalez et al. 2015). 

It contributes to maintenance of healthy weight and — important for bone health — muscle mass. One recent meta-analysis found that older adults who closely follow a Mediterranean diet had a lower risk of becoming frail and were better able to maintain muscle strength, activity, weight and energy levels (Kojima et al., 2018).

A key component of the Mediterranean diet, olive oil, is associated with increased serum osteocalcin and P1NP concentrations, suggesting a protective effect on bone (Fernandez-Real et al., 2012) — and recent studies found higher consumption of olive oil corresponds to higher bone density (Savanelli et al., 2017).

More benefits to Mediterranean-style eating

It’s pretty clear that the Mediterranean diet is beneficial to bones. So what other health benefits does it offer? Here are just a few:

The Mediterranean Diet is specifically associated with improvements in blood pressure, insulin sensitivity, lipid profiles, inflammation, oxidative stress, and atherosclerosis (Martinez-Gonzalez et al. 2015).

Researchers have found repeatedly that those eating a Mediterranean diet experienced about a 30–60% reduction in cardiovascular risk (Estruch et al. 2013; Bonaccio et al., 2017; Carlos et al. 2018).

Individuals following the Mediterranean diet experienced half as much age-related brain shrinkage as those who did not (Luciano et al. 2017).

A recent study of over 22,000 Spanish men and women noted benefits in terms of type 2 diabetes, weight gain, metabolic syndrome, depression, cognitive decline, and nephrolithiasis (Carlos et al., 2018).

So if you’ve been wondering if infusing your alkaline diet with more Mediterranean flavor and flair would help you support your bone health, wonder no more — it will do that and more!

Anderson JJ, Nieman DC.  Diet quality—the Greeks had it right!  Nutrients.  2016;8(10).

Bonaccio M, Castelnuovo AD, Pounis G, et al.  High adherence to the Mediterranean diet is associated with cardiovascular protection in higher but not in lower socioeconomic groups: prospective findings from the Molisani study.  Int J Epidemiol.  2017 Oct 1;46(5):1478-1487.

Estruch R, Ros E, Salas-Salvado J, et al.  Primary prevention of cardiovascular disease with a Mediterranean diet.  N Engl J Med.  2013;368(14):1279-90. 

Carlos S, De La Fuente-Arrillaga C, Bes-Rastrollo M, et al. Mediterranean Diet and Health Outcomes in the SUN Cohort. Nutrients. 2018 Mar 31;10(4). pii: E439. doi: 10.3390/nu10040439.

Fernandez-Real JM, Bullo 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.  J Clin Endocrinol Metab.  2012;97(10):3792-3798.

Kojima G, Avgerinou C, Iliffe S, Walters K. Adherence to Mediterranean Diet reduces incident frailty risk: systematic review and meta-analysis. J Am Geriatr Soc. 2018; DOI: 10.1111/jgs.15251

Luciano M, Corley J, Cox SR, et al.  Mediterranean-type diet and brain structural change from 73 to 76 years in a Scottish cohort.  Neurology.  2017;88(5):449-455.

Martinez-Gonzalez MA, Salas-Salvado J, Estruch R, et al.  Benefits of the Mediterranean Diet: Insights from the PREDIMED Study.  Prog Cardiovasc Dis.  2015;58(1):50-60. 

Medina-Remon A, Casas R, Tressserra-Rimbau A, et al.  Polyphenol intake from a Mediterranean diet decreases inflammatory biomarkers related to atherosclerosis: a substudy of the PREDIMED trial.  Br J Clin Pharmacol.  2017; 83(1): 114-28. 

Savanelli MC, Barrea L, Macchia PE, et al. Preliminary results demonstrating the impact of Mediterranean diet on bone health. J Transl Med. 2017 Apr 24;15(1):81.

Terra X, Montagut G, Bustos M, et al.  Grape-seed procyanidins prevent low-grade inflammation by modulating cytokine expression in rats fed a high-fat diet.  J Nutr Biochem.  2009;20(3):210-8.