Salt has gotten a bad rap over the years for several health concerns like elevation of blood pressure, heart disease, and even osteoporosis. Past research has suggested, but not entirely proven, that higher salt intake causes calcium to be pulled out of bones and then excreted out of the body which leads to bone loss. A recent review article has debunked this stance and puts the blame on the other “white crystal” – sugar. Once again, salt is not so evil. 

The review article, “Not Salt But Sugar As Aetiological In Osteoporosis: A Review” was published earlier in 2018 in the Journal of the Missouri State Medical Association, Missouri Medicine. Much is already known about the detriment of sugar to weight and blood sugar management, dental health, and heart disease, but we never hear about sugar and bone health. This review article enlightens us on the devastation of sugar to bone health and the need for salt to help bones. Hopefully, this encourages us to make more concerted efforts to help our bones in ways that we may not previously been aware of and avoid the delusion of bone drugs. 

Bones Need Sodium

Our bones act as a reservoir for many minerals and substances, including salt. Salt does many things for the body. In bones, it plays a vital role with maintaining homeostasis between other minerals like calcium and magnesium. Insufficient salt intake disrupts the balance of calcium and magnesium levels in the bone.

A low salt diet can cause the body to pull sodium from bones in order to meet the needs of the rest of the body. This in turn disrupts the balance and subsequent loss of calcium and magnesium. Intake of less than 3,000 mg of sodium per day can increase bone breakdown as low sodium levels trigger and increase osteoclast cell activity. Osteoclasts are cells that remodel and breakdown bone. A low sodium level in the blood is the most common electrolyte imbalance.

Individuals with low salt intake and low sodium levels are more likely to experience loss of balance, difficulty with gait, poor attention, and a four-fold increase in fracture risk after a fall. The effect of inadequate sodium and decreased bone density and difficulty with balance leads to a dangerous combination of falls and fractures.

One teaspoon of salt provides 2,000 mg of sodium. The RDA for adults is about 2,000 mg per day but note that intake of less than 3,000 mg per day has been shown to trigger bone breakdown. Talk with your health care provider if you have salt sensitivity concerns. Chronic ingestion of high amounts of salt intake is not desirable either especially with a diet low in variety and limited fruits and vegetables.

Low sodium levels also reduces vitamin C absorption. Bones need vitamin C for structure and to help manage daily oxidative stress.

Sugar Harms Bones

Sugar intake harms bones in many ways. Sugar ingestion causes bones to release calcium and magnesium out of the mineral reserves in bones which can lead to a deficit not easily overcome. High sugar with high fat intake worsens the assault on bones due to increased amount of inflammation and more activity of osteoclasts.

Sugar increases production of lactic acid in bone tissue which impairs osteoblasts, the bone building cells. Sugar impairs absorption of vitamin D which further interrupts calcium intake and bone health. Sugar, specifically fructose, interferes with how calcium is absorbed and retained by the intestinal tract and kidneys which then affects transport to bones. The conclusion of the review study says, “we have blamed the wrong crystal: it’s not salt, but sugar that presents a greater risk factor for osteoporosis.”

Are You A Bone Loss Statistic?

Some of the latest statistics on low bone mass is alarming. The US National Health and Nutrition Examination Survey in 2015 reports low bone mass in 48 percent of adults and osteoporosis in 16 percent of adults over 65 years of age. Bone loss does not generally cause symptoms until something like a fracture happens and even then it may not be identified. Up to 50 percent of spinal vertebral fractures are incidentally discovered on a chest X-ray or other imaging in patients not previously diagnosed with osteoporosis. It is estimated that one out of four men and one out of two women will have a fracture due to bone loss in their lifetime.

Bone health is complex. It is far more than taking just calcium and vitamin D in a one-a-day formula and expecting great bones. In addition to sugar, numerous factors affect bone health like physical activity level, race, sex, ethnicity, estrogen, mineral intake, probiotics and gut health, Celiac disease/gluten intolerance, leptin resistance, diabetes, and adverse effects from medications like thyroid meds, steroids, and antidepressants. But we can’t ignore the elephant in the room. We continue to consume more sugar than at any other time in history. This recent research makes a sound case that sugar, not salt, is bad for bones.

Understanding Added Sugar Intake

Data from the Centers for Disease Control on sugar shows that more calories from added sugar come from foods rather than beverages and consumed at home rather than other avenues. Men consumed on average 335 calories per day from added sugar while women consume an average 239 calories. Younger adults with lower income consumed more added sugar than older adults. Statistics for sugar consumption and children were similar.

The USDA definition of an added sugar is all added sugars used as ingredients in processed and prepared foods such as breads, cakes, soft drinks, jams, chocolates, and ice cream, and sugars eaten separately or added to foods at the table. Examples of added sugars include white sugar, brown sugar, raw sugar, corn syrup, corn syrup solids, high fructose corn syrup, malt syrup, maple syrup, pancake syrup, fructose sweetener, invert sugar, liquid fructose, honey, molasses, dextrose, and dextrin. It also includes sorghum, sorbitol, maltose, corn sweetener, sucrose, and fruit juice concentrate. Added sugars do not include naturally occurring sugars such as lactose in milk or fructose in fruit, unless the sugar is added to the food item.

Today’s Average Sugar Intake

The average American gets 270 calories or 17 teaspoons of added sugar per day. The government recommends a maximum of 12 teaspoons or 200 calories per day or 10 percent of total calories. Even though this recommendation is lower than the average adult intake, strive for even less.

In the early 1800’s, sugar intake was approximately 18 pounds per person per year and by 1900 it was 60 pounds per year. Present day, average intake of sugar is estimated at 150 pounds per person per year. Here are some examples to put this in perspective.

One teaspoon of sugar is 4.2 grams. One twelve ounce can of Mountain Dew contains 46 grams of added concentrated fruit juice and high fructose corn syrup. Fruit Juice Smoothie from Naked Juice contains 58 grams of naturally occurring fruit sugar per 15.2 ounces. Both types of products contain very high amounts of sugar albeit from different sources with fruit sugar/fructose considered healthy – or is it? Hopefully, this provokes the thought – is this high amount of sugar really a good thing for me? Can I satisfy my nutritional needs with other choices? If I ate the same amount of fruit at one time that goes into a specialty fruit smoothie, how much fruit sugar is that and how would I feel?

Strategizing for Healthier Choices

As you begin to think about plans for a healthier you in 2019, strongly consider a strategy for reducing sugar intake in your diet. Give yourself a visual example to see what the average adult intake of sugar is per day. Set out 17 teaspoons of sugar and then think about how much that is with a week, a month, a year’s worth of intake and so forth. Is this truly what your body needs?

Make some healthier choices with replacing cane or beet sugar, high fructose corn syrup and other highly processed sugar with things like coconut sugar or fresh fruit that has fiber. Cut back on sugar intake with recipes. Downsize food portions. Eliminate the sugar in your tea or coffee. Read food labels. If sugar is listed early in the ingredient list, especially in first 3-4 ingredients, the product will have much higher sugar content.

Choose unsweetened yogurt and add fresh fruit if you want a treat. If you use alternative milks like rice or almond milk, choose the unsweetened forms. Cut down on fruit juice intake by reducing portion size and then dilute it with water. Hidden sugar is found foods that you may not realize such as pasta sauces, crackers, pizza, ketchup, sports drinks, breads, and soups. Avoid artificial sweeteners like saccharine, aspartame/NutraSweet, acesulfame potassium (Ace-K), and sucralose. There is no nutritional value to these foods and are synthetic chemicals. Do a diet diary for three to seven days to track your eating habits. Be honest. This is often a wake-up call.

Follow The Five Rules of The Leptin Diet, as leptin function sets the tone for satiety and metabolism throughout the body. When you do have foods with higher sugar content, make sure that it is not on an empty stomach, but rather as part of a meal. The proteins, fats, antioxidants, minerals and good fibers from the other foods help buffer sugar’s adverse effects. Eat a high protein breakfast and cut out sugar in the morning.

Make sure you replenish the calcium, magnesium, and vitamin D that sugar strips out of bones. Add in vitamins C, D3, K1 and K2 to help the assimilation of calcium, magnesium, and sodium in bones. Other nutritional support such as protein, fiber, chromium, vanadium, B vitamins, vitamin C, glutamine, and good fats with pine nut oil, omega 3 and 6 oils, olive and coconut oil and some saturated fats in the diet can help beat sugar cravings. Many times sugar is added to offset the lack of fat in food. Also, increase water consumption as thirst is sometimes misinterpreted as sugar cravings.

Unprocessed Celtic or Himalayan sea salt contains other natural minerals that are helpful to the body more so than processed table salt. Salt is not evil. Potassium is also needed to balance sodium in the body so make sure you get plenty of potassium rich fruits and vegetables every day or consider supplemental support. Also consider carnosine, r-alpha lipoic acid, and coenzyme Q10 to help support kidney function and salt effects.

We reach peak bone mass in our twenties. We must get our young ones off to a good start and then continue to make good choices each day for a lifetime. A low salt diet with high sugar intake doesn’t help the body, yet this is a common trend. We have been told repeatedly that salt is bad, but salt is truly needed by the body. One case study showed that bone loss was reversed after the patient’s low sodium status was corrected. It is alarming to see the decline in bone health in increasingly younger individuals and to see the sheer number of individuals who will be a statistic of bone loss.

As we are in the midst of the holiday season with all kinds of goodies with sugar, we can take this information and apply it to the New Year and make different choices about sugar consumption. Sugar is linked with major health problems like heart disease, diabetes, cancer, gut problems, and Alzheimer’s disease. Don’t let it silently strip away at your bones either.