The connection between blood glucose and bone health

June 06, 2019 by Joel Fuhrman, MD

In addition to following a diet that is made up of whole plant foods, it’s important to keep the glycemic load of your diet in mind. Using more beans, nuts, and seeds as major calorie sources, instead of grains and potatoes, reduces the overall glycemic load of the diet. As more and more research is conducted, we are learning that blood glucose levels are relevant to most chronic illnesses, not just diabetes. 

Type 2 diabetes increases fracture risk

Evidence suggests that patients with type 2 diabetes are at greater risk of bone fractures.1  Among patients with type 2 diabetes, poorer glycemic control is associated with impaired bone turnover, meaning slower replacement of old bone tissue with new bone tissue.2,3  This suggests that elevated blood glucose could weaken bone.4  

Hyperglycemia harms bones

Bone tissue constantly rebuilds itself. Bone-building cells called osteoblasts and bone-resorbing cells called osteoclasts work together to maintain bone mass and bone strength, striking a balance between building new bone and breaking down old bone. 

Elevated blood glucose impairs the bone-building effects of osteoblasts. A study in healthy women found that a single bout of hyperglycemia resulted in measurable decreases in markers of osteoblast activity.5  This impaired bone building structurally compromises bone, leading to elevated fracture risk. For example, another study found that patients with inadequately controlled type 2 diabetes had higher fracture risk (compared to healthy people and those with adequately controlled type 2 diabetes) and altered bone architecture in the femur – thinning in the middle and thickening at the ends – which suggests susceptibility to fracture.6 

In addition to compromising bone turnover, elevated blood glucose accelerates the production of advanced glycation end products (AGEs), which drive oxidative stress and damage collagen in bone tissue. Production of the bone-derived hormone osteocalcin is also diminished in T2D and in response to hyperglycemia. In addition to its bone-building activities, osteocalcin is involved in metabolism; a form of osteocalcin prompts insulin release and increases insulin sensitivity in muscle and fat tissue. Hyperglycemia also promotes calcium loss via the kidneys and reduces osteoblasts’ responsiveness to vitamin D.7 

Nuts, seeds, and beans can help

In a vegan or near-vegan diet, when high-glycemic foods like potatoes, rice, and white flour products are used as the staple calorie sources, the glycemic load of the diet can get excessively high. Lower-glycemic calorie sources like beans, nuts, and seeds help shift the glycemic load of the diet lower, which, as mentioned earlier, affects many aspects of health, including bone health. 

How almonds may promote bone health

Nuts may contain additional phytochemicals that promote bone turnover, according to an interesting study. Healthy volunteers consumed three different meals, each containing the same number of calories; the meals were made up primarily of almonds, potatoes, or rice. Cultured osteoclast precursor cells were then treated with serum from the volunteers. Serum taken after the almond meals reduced the number of osteoclasts formed and osteoclast-specific gene expression and reduced calcium release from bone cells. No effects of the potato or rice meals were detected. This suggests that phytochemicals derived from almonds help to keep the balance between osteoblast and osteoclast activity.8  This could be due to anti-inflammatory or antioxidant phytochemicals, as there is evidence that the anti-inflammatory effects of other polyphenols (such as plum polyphenols) help prevent bone loss, and oxidative stress is known to stimulate osteoclast activity, leading to bone loss.9 

A vegan diet in itself is not enough. A focus on high-nutrient foods, including lots of green vegetables, beans, nuts, and seeds, keeps glucose and insulin favorable while providing nutrients crucial to bone health

  1.   Oei L, Zillikens MC, Dehghan A, et al. High bone mineral density and fracture risk in type 2 diabetes as skeletal complications of inadequate glucose control: the Rotterdam Study. Diabetes Care 2013, 36:1619-1628.
  2. Rianon NJ, Smith SM, Lee M, et al. Glycemic Control and Bone Turnover in Older Mexican Americans with Type 2 Diabetes. J Osteoporos 2018, 2018:7153021\
  3. Kulkarni SV, Meenatchi S, Reeta R, et al. Association of Glycemic Status with Bone Turnover Markers in Type 2 Diabetes Mellitus. Int J Appl Basic Med Res 2017, 7:247-251.
  4. Sanches CP, Vianna AGD, Barreto FC: The impact of type 2 diabetes on bone metabolism. Diabetol Metab Syndr 2017, 9:85.
  5. Levinger I, Seeman E, Jerums G, et al. Glucose-loading reduces bone remodeling in women and osteoblast function in vitro. Physiol Rep 2016, 4.
  6. Oei L, Zillikens MC, Dehghan A, et al. High bone mineral density and fracture risk in type 2 diabetes as skeletal complications of inadequate glucose control: the Rotterdam Study. Diabetes Care 2013, 36:1619-1628.
  7. Sanches CP, Vianna AGD, Barreto FC: The impact of type 2 diabetes on bone metabolism. Diabetol Metab Syndr 2017, 9:85.
  8. Platt ID, Josse AR, Kendall CW, Jenkins DJ, El-Sohemy A: Postprandial effects of almond consumption on human osteoclast precursors--an ex vivo study. Metabolism 2011, 60:923-929.
  9. Arjmandi BH, Johnson SA, Pourafshar S, Navaei N, George KS, Hooshmand S, Chai SC, Akhavan NS: Bone-Protective Effects of Dried Plum in Postmenopausal Women: Efficacy and Possible Mechanisms. Nutrients 2017, 9.

Joel Fuhrman, M.D. is a board-certified family physician, seven-time New York Times bestselling author and internationally recognized expert on nutrition and natural healing, who specializes in preventing and reversing disease through nutritional methods. Dr. Fuhrman coined the term “Nutritarian” to describe his longevity-promoting, nutrient dense, plant-rich eating style.
For over 25 years, Dr. Fuhrman has shown that it is possible to achieve sustainable weight loss and reverse heart disease, diabetes and many other illnesses using smart nutrition. In his medical practice, and through his books and PBS television specials, he continues to bring this life-saving message to hundreds of thousands of people around the world.


Comments (0):



06/12/2019 08:08 PM

Thank you for this insightful article.  My husband (67 years old) and I (approaching 65)have our yearly wellness checkups the same time each year.  We are primarily Nutratarians with little alcohol.  I advised my husband to get Vitamin D levels checked as well as B12.  At 5.6", 135 pounds he has excellent lipid levels, blood pressure and pulse rate.  But the HC1 level remains high (5.9) and Vitamin D low (33.9 ng/mL).  He exercises daily (lap swimming and jogging).  I advised him to swim without a swim shirt to get more sun, but being very careful not to burn (melanoma survivor).  I am hoping this will assist in his D levels.  We are not sure what to do about the sugar levels.  He is very strict about ANY refined sugar/food intake but likes to eat fruit.  Perhaps reducing the fruits would be a good idea?  

I would like to thank you Dr. Fuhrman, for all the education you have shared via your website and youtube.  I have listened to every lecture you have presented.  Having struggled with food addictions most of my life, I no longer crave since I have followed your lifestyle diet. A side benefit is 20 pounds less of me and feeling more fit and vibrant each year. We are skiing expert slopes, hiking, swimming, gardening -- enjoying our life and state of health more than ever!

Dr. Ferreri replies:

10/04/2019 05:21 PM

Dr. Fuhrman recommends vitamin D levels approximately 30-45 ng/ml. For the specific blood sugar questions, you'd need to use  Ask the Doctor: 


06/12/2019 08:39 PM

I have osteoporosis, DM and an adenoid on my adrenal gland. I produce too much cortisol. Is there any hope of building bone density?


06/13/2019 11:16 AM

Thanks for this article.  I have noticed that when my blood sugar is up not only do my hands get stiff and sore but my bones hurt too.




06/15/2019 08:36 AM

New research studies indicate some form of fatty liver contributes to type 2 diabetes nuts, beans and seeds may also reduce fatty liver as well.


10/02/2019 03:05 PM


I have pre type 1 diabeties. I am 54 years young. I am 5’2” and 115lbs.   I have been a nutratarian for 8 years. I am allergic to almonds  I have been eating no salt or oil,  roasted peanuts. Are these as bennifical ? I also eat raw pumpkin and sunflower seeds. Tree nuts seem to give me problems.  What do you suggest ?

Thank you 

Dr. Ferreri replies:

10/04/2019 05:18 PM

Raw pumpkin, sunflower, and hemp seeds are a good substitute for raw nuts. Daily flax and/or chia seeds are also recommended. Peanuts are associated with reduced heart disease risk similar to tree nuts; peanuts are a good food, though roasting does produce some acrylamide, so they're not as good as the raw seeds. 


10/05/2019 12:14 PM

Dr Ferreri thank you so much for replying back to my question. Have a great day. 


11/27/2019 06:27 AM

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03/30/2021 06:53 AM

My interests are bizarre and dark magic, but I've been involved in one form or another for years (including being part of the Shadow Network vidmate).