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High-protein, low-carbohydrate diets are now widely adopted across urban India, particularly among younger adults seeking weight loss, improved glycaemic control, or increased muscle mass. These regimens are often promoted by fitness professionals, wellness platforms, and social media communities as evidence-based interventions for metabolic health.
While short-term outcomes such as weight reduction and improved body composition are well documented, the long-term impact of these diets on skeletal health remains insufficiently addressed. This is of particular concern in India, where inadequate calcium intake and widespread vitamin D deficiency already place a large segment of the population at risk for low bone mineral density and early onset osteopenia or osteoporosis.
Understanding the Acid Load of Your Plate
Protein is essential for maintaining lean mass, supporting immunity, and aiding post-exercise recovery. However, the biological response to protein is influenced by its source. Diets high in animal protein, particularly red meat and poultry, can increase systemic acid load. This prompts the body to neutralise pH using alkaline stores, including calcium drawn from bones.
In contrast, plant-based proteins such as legumes, soy, nuts, and millets present a lower acid load and offer additional benefits through fibre, phytonutrients, and magnesium content. A 2021 study in The Journal of Clinical Nutrition observed improved bone mineral density in adults consuming higher proportions of plant-derived proteins. These findings are especially relevant in India, where traditional diets already include diverse plant proteins and where reintroducing them may support skeletal resilience.
Hidden Deficits of Calcium and Vitamin D in the Urban Indian Diet
A high-protein diet, particularly one lacking in dairy, can increase calcium loss through urine. This is especially concerning in India, where calcium intake is already insufficient. The Indian Council of Medical Research recommends 1000 mg of calcium daily for adults, yet average intake in urban populations often ranges from 400 to 600 mg.
More than 70 percent of Indian adults are also vitamin D deficient. Factors such as limited sun exposure, air pollution, and indoor lifestyles contribute significantly to this gap. Without adequate vitamin D, calcium absorption becomes inefficient, regardless of dietary quantity.
Reintroducing calcium-dense foods such as ragi, paneer, sesame seeds, and fortified plant-based milks, alongside safe sunlight exposure, can help close these nutritional gaps. In many cases, vitamin D3 supplementation may be necessary after assessing serum levels.
Carbohydrates and Bone Metabolism
The metabolic advantages of carbohydrate restriction are well-known, but its effect on skeletal health is often overlooked. Severely low carbohydrate intake can suppress insulin-like growth factor-1 (IGF-1), a hormone that supports bone matrix formation and osteoblast activity.
This is particularly relevant for active individuals or younger adults following ketogenic or very low-carb diets. Traditional Indian grains such as jowar, bajra, and brown rice not only provide complex carbohydrates but also supply minerals essential for bone remodelling.
Rather than eliminating carbohydrates, shifting towards these nutrient-rich staples may preserve IGF-1 function and improve skeletal outcomes without undermining broader health goals.
Bone Health Requires More Than Nutrients
Bone is a living tissue that responds to mechanical stress. Without movement and load-bearing activity, even the best diet cannot maintain structural integrity. Physical activity stimulates bone formation and slows age-related bone loss.
Despite clear recommendations from the Indian Orthopaedic Association encouraging at least 150 minutes of moderate physical activity each week, sedentary habits remain common in urban India. Integrating yoga, walking, resistance exercises, or functional movements such as stair climbing into daily life can improve bone health across all age groups.
Preventive Screening
Bone loss progresses silently. It is often detected only after a fracture or chronic joint pain appears. DEXA scans, which measure bone mineral density, are underused in younger adults, even those following restrictive diets or experiencing menstrual irregularities.
The Indian Menopause Society has reported an increase in early osteopenia among women under 40. Lifestyle patterns that combine nutritional deficiency, high stress, and physical inactivity are contributing factors.
Routine screening in at-risk individuals offers an opportunity for early intervention. It allows clinicians to address deficits before irreversible structural damage occurs.
A Preventive, Nutrient-First Perspective
High-protein, low-carbohydrate diets can support weight loss, glycaemic control, and lean muscle gain. When designed thoughtfully and monitored carefully, they offer clear clinical benefits. The concern arises when these diets are followed without attention to calcium intake, vitamin D status, carbohydrate diversity, or physical activity.
A bone-first approach does not negate the value of protein-focused eating. It simply ensures the skeletal foundation remains strong enough to support long-term health goals. In the Indian context, this means using culturally familiar foods, encouraging sunlight exposure, and reinforcing movement in daily life.
As food habits become more aspirational and digitally influenced, preventive nutrition must remain rooted in physiological realities. Strength is not just what can be seen—it is what quietly holds the body together.
(The writer is a Sr. Consultant Orthopaedician, Apollo Hospitals, Visakhapatnam)
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