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Keto and Bone Health: Here’s What You Need to Know

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FACT CHECKED
  Published on August 18th, 2022
  Reading time: 3 minutes
  Last modified August 18th, 2022
Doing physical therapy for joint and bone health

You might not know it, but bones aren’t static; they’re actually constantly changing living tissues largely made up of collagen and calcium phosphate. Because of this, bone health may change over time, and it’s important to monitor it. In fact, bone-related degenerative diseases like osteoporosis are on the rise in our modern society [1]. The benefits of the ketogenic diet are abundant, and you might be wondering if this lower-carb way of eating also benefits your bones. Let’s look at keto and bone health.

Sugar and Your Bones

Among the foods shown to promote inflammation and worsen arthritis are refined carbohydrates, alcohol, sugar, and trans fats [2].  Inflammation is a key player in a range of chronic diseases and the degradation of bone health.

Studies highlight that eating excessive or even moderate amounts of sugar over time can cause inflammation to surge in the body and this can contribute to arthritis. It’s recommended people with arthritis reduce sugar intake, which is a given when you’re following a ketogenic diet. Going keto means ditching sugar—a primary driver of inflammation [3].

Gout is a type of inflammatory arthritis affecting one joint at a time. Gout occurs when there are higher levels of uric acid in the blood. Studies reveal high sugar consumption, including beverages and foods with high fructose, such as soda and orange juice, increases serum uric acid levels [4]. Purine is released when the body breaks down fructose. When purine is broken down in the body, uric acid is produced, leading to the formation of crystals (monosodium urate) in the joints, fluids, and tissues [5].

Anti-Inflammatory Effects

Lots of people have implemented a ketogenic diet and reported impressive and life-changing results with conditions that affect the bones, such as rheumatoid arthritis. This could be because of the anti-inflammatory effects of the ketogenic diet. Changing what you eat greatly influences your cellular functioning. Ketogenic diets are proven in research to lower inflammation and improve pain. 

Woman with joint and bone inflammation

Beneficial fatty acids that come along with a ketogenic diet can cause positive changes in immune cell function that are advantageous for conditions like rheumatoid arthritis [6] [7] [8].

On the other hand, there are some claims that a ketogenic diet can be harmful to your bone health. However, there’s no substantial evidence that exists to support this claim. A small 2017 study of children with epilepsy showed active children had lower bone mineral density on a ketogenic diet compared to less-active children, but this overlooks strong evidence that anti-epileptic drugs could decrease bone mineral density, clouding the results [9].

A study of elite racewalkers is sometimes used to point out that keto is detrimental to bones, but this study was short and didn’t measure bone mineral density [10].

To counteract this, countless studies with hundreds of participants have concluded there are no adverse bone health effects in adolescents and adults on keto compared to other diets [11] [12].

Monitoring Your Bone Health on Keto

Doctor showing patient bone x-ray

There’s no substantial evidence that keto is harmful to bone health. On the contrary, numerous studies showed no adverse bone health effects in adolescents and adults on keto compared to other diets. A mineral-rich ketogenic diet could improve bone health and general wellness. More research on keto and bone health, particularly in endurance athletes, is needed to reach clearer conclusions.

Going keto ditches all that sugar that promotes inflammation and compromises bone health. Keto has shown promise with inflammatory bone-related conditions like rheumatoid arthritis, as well as a range of other diseases from Alzheimer’s to epilepsy.

If you’re concerned about your bone health, you could ask your doctor to measure your bone mineral density with a DEXA (Dual Energy X-ray Absorptiometry) test.

The quality and nutrient density of your keto diet also matters. Your bones need nutrients like vitamin K2 and magnesium, healthy fats, and nourishing foods like collagen-rich bone broth. Are you eating plenty of nutritious natural whole foods like avocado, chicken, fish, and cauliflower rather than overloading on processed keto snacks? Research shows eating sufficient protein is also advantageous for bones [13].

References

1.

Reginster, J-Y., & Burlet, N. (2006). Osteoporosis: A still increasing prevalence. Bone, DOI: 10.1016/j.bone.2005.11.024

2.

The Arthritis Foundation. 8 Food Ingredients that Can Cause Inflammation. 8 Food Ingredients That Can Cause Inflammation - Arthritis Foundation

3.

Tedeschi, S. K., Frits, M., Cui, J., Zhang, Z. Z., Mahmoud, T., Iannaccone, C…Solomo, H. (2017). Diet and rheumatoid arthritis symptoms: Survey results from a rheumatoid arthritis registry. Arthritis Care & Research, DOI:10.1002/acr.23225

4.

Choi, H. K., Willett, W., & Curhan, G. (2010). Fructose-rich beverages and risk of gout in women. JAMA, 304(20), 2270-2278. DOI:10.1001/jama.2010.1638

5.

The Arthritis Foundation. Fructose and Gout: What’s the Link? Fructose and Gout: What’s the Link? - Gout (arthritis.org)

6.

Masino, S. A., & Ruskin, D. N. (2014). Ketogenic diets and pain. J Child Neurol, 28(8), 993-1001. DOI: 10.1177/0883073813487595

7.

Simopoulos, A. P. (2002). Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr, 21(6), 495-505. DOI: 10.1080/07315724.2002.10719248

8.

Fraser, D. A., Thoen, J., Bondhus, S., Haugen, M., Reseland, J. E., Djoseland, O., Forre, O., & Kjeldsen-Kragh, J. (2000). Reduction in serum leptin and IGF-1 but preserved T-lymphocyte numbers and activation after a ketogenic diet in rheumatoid arthritis patients. Clin Exp Rheumatol, 18(2), 209-14.

9.

Zhang, Y., Zheng, Y-X., Zhu, J-M., Zhang, J-M., & Zheng, Z. (2015). Effects of antiepileptic drugs on bone mineral density and bone metabolism in children: A meta-analysis. J Zhejiang Univ Sci B, DOI: 10.1631/jzus.B1500021

10.

Heikura, I. A., Burke, L. M., Hawley, J. A., Ross, M. L., Garvican-Lewis, L., Sharma, A. P… Ackerman, K. E. (2020). A short-term ketogenic diet impairs markers of bone health in response to exercise. Frontiers in Endocrinology, https://doi.org/10.3389/fendo.2019.00880

11.

Brinkworth, G. D., Wycherley, T., Noakes, M., Buckley, J. D., & Clifton, P. M. (2016). Long-term effects of a very-low-carbohydrate weight-loss diet and an isocaloric low-fat diet on bone health in obese adults. Nutrition, 32(9), 1033-1036.

12.

Krebs, N. F., Gao, D., Gralla, J., Collins, J. S., & Johnson, S. L. (2010). Efficacy and safety of a high protein, low carbohydrate diet for weight loss in severely obese adolescents. Journal of Pediatrics, https://doi.org/10.1016/j.jpeds.2010.02.010

13.

Bonjour, J-P. (2011). Protein intake and bone health. Int J Vitam Nutr Res, DOI: 10.1024/0300-9831/a000063

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