How to Eat for Better Bones on the Mediterranean Diet

One of my wonderful readers suggested the topic for today’s post, and I’m very excited to address it! I’m tackling the topic of diet and bone health, particularly from a Mediterranean diet point of view. Thankfully, there is quite a bit that we can do to protect our bones from getting weaker over time.

A decline in bone density - usually during adulthood - leads first to osteopenia, which is a thinning of the bones. Osteopenia can then progress to osteoporosis, which means “porous bones”. This is when people are most prone to broken bones - particularly after falling, but sometimes for no apparent reason at all. Often, broken bones occur in this stage simply because the bones are no longer strong enough to handle the everyday wear and tear of life.

What causes osteoporosis, though?

Is our diet all to blame?

Fortunately and unfortunately, no.

The #1 determinant of bone health is estrogen. When estrogen levels drop, bone health suffers as a result. This is why osteoporosis most commonly hits around the time of menopause for many women. Another common time that this occurs is when a woman has anorexia nervosa and drops to an unhealthy weight, leading to low estrogen levels, an absent menstrual period, and osteopenia or osteoporosis.

There are some things we can do to promote bone health with diet, however, so thankfully it’s not 100% out of our hands.

That’s what we’re going to talk about today. I’m going to discuss a little of the research that supports the Mediterranean diet for bone health, and then discuss specific aspects of the Mediterranean diet that could be the reasons why it’s good for bones.

I’ll also share little glimpses into how this looks in my everyday diet. :)


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Mediterranean diet

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Some findings recently presented at the 2018 meeting of the Endocrine Society suggest that the more closely women adhere to the Mediterranean diet, the better their bone and muscle mass will be in middle age. In another study, adults were followed for 15 years starting at age 60. It was found that those who followed the Mediterranean eating pattern most closely had a 22% lower risk of hip fracture during the study period compared to those who did not follow it.

This begs the question, “What are the specific components of the Mediterranean diet that are responsible for its bone health benefits?” Here are a few possibilities.

Olive oil

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This potential factor was really surprising to me! It turns out that one prominent theory of the tie between better bone health and closer adherence to the Mediterranean diet is that it comes from eating so much olive oil! Who knew, right?!

It is just a theory and hasn’t been extensively studied in humans, but it appears that the polyphenols (a type of antioxidant) in olive oil stimulate the production of osteoblasts, which are essentially bone-builders. Think of them as hard-working construction workers whose job is to build up your bones. Basically, the more of these guys there are, the better!

I use extra virgin olive oil (the extra-virgin kind is only pressed once, and thus has more polyphenols than other kinds) in or on just about everything! Any time a recipe calls for a different kind of oil, I use olive oil instead. I even did this tonight when making pancakes!

They still turned out to be delicious. I know you were wondering. ;)

I’ve mentioned this before, but a 16-ounce bottle of extra virgin olive oil is only $4 at Aldi! This is such a steal! To sweeten the deal even more, their olive oil carries the North American Olive Oil Association seal, which means that it’s the real deal! I’m obviously sold on it. ;)

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Cruciferous and leafy green vegetables

Two types of vegetables, cruciferous and green leafy vegetables (which often overlap), may be another contributing factor.

One study of 144 post-menopausal women found that those with the highest intakes of vegetables and plant calcium had better bone density than those with lower intakes. Interestingly, some of the best plant sources of calcium include broccoli, collard greens, kale, and bok choy, which are all green leafy vegetables in the cruciferous family. These are prominent in the Mediterranean diet.

Cruciferous (meaning sulfurous) vegetables are also rich in vitamin K, which we’re learning might be critical for preventing fractures. This often-overlooked vitamin has emerging research to support its benefits for bone health.

My favorite way to eat green leafy vegetables is sautéed in extra virgin olive oil with some salt, pepper, and a clove of minced garlic, and either served as is or baked into eggs for quick breakfasts. So easy and good! I try to make sure I eat some form of green leafy or cruciferous vegetable every day. :)

Fermented dairy

The Mediterranean diet doesn’t put much emphasis on non-fermented dairy products, like milk and cream. It does, however, place an emphasis on moderate amounts of fermented dairy, including yogurt, kefir, and cheese. I’m a big fan of these foods. :)

These foods are excellent sources of calcium, vitamin K (though it’s in K2 form, which is not commonly measured in foods), and vitamin D (this is actually added to dairy products and is not found in them naturally). All of these nutrients are key for bone health.

What’s more is that there seems to be some benefit of fermented dairy over non-fermented dairy for bone health. I studied this topic for a project in grad school because it was right in the middle of a time when the media was talking about how dairy might not be the Holy Grail of bone health that we always thought it was.

Research on the topic still really isn’t conclusive, but after reviewing the available evidence myself, I came to the tentative conclusion that maybe it’s fermented dairy we should be focusing on most in our daily eating pattern.

Fermented dairy is full of natural probiotics. These are good bacteria that help promote a balanced and healthy microbiome (the community of trillions of microorganisms in the human digestive tract). These bacteria digest the natural sugars in milk and ferment them in the process. Probiotics may actually improve calcium absorption or bone formation!

Kefir has shown some interesting bone-boosting effects, and so has yogurt.

For now, I pretty much only use milk in recipes, but still drink it straight when I’m randomly craving a glass every month or so (milk was my favorite drink as a child and I still love it :)).

I do drink an 8-ounce glass of kefir almost every day and use various kinds of cheese on top of pasta, pizza, and eggs multiple times per week. I believe that this is enough for my bones and also aligns with the Mediterranean eating pattern.

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Food isn’t everything

I want to leave you with this.

When I first started studying nutrition, I believed that “food as medicine” was THE answer to all of our health problems. As I studied more (and experienced life a little more), I learned that although food can be very powerful and healing to the body, it simply is not the answer to every health problem.

There are numerous factors that play into bone health, including hormone changes associated with normal aging, genes, activity level, and even sun exposure (most of the bone-building vitamin D in your body is made in response to direct sunlight).

When we’re thinking about bone health and all other areas of health, it’s key to remember the whole picture, especially the parts that we can control: food, movement, sleep, stress, and sunlight. :)

What was the most surprising bone-building food mentioned in this article for you? I’d love to discuss this topic more with you in the comments below!