Note: This is general advice. The science of bone metabolism is complicated and I have deliberately kept this article as easy to understand as possible.
Do you have low bone density, or want to maintain dense bones as you age? Often we reach for calcium supplements or more serves of dairy in the belief we are doing the right thing. In truth, we rarely need to ingest more calcium because our bodies don’t always put the extra calcium in the place we want it – in our bones. How can this happen, I hear you ask? That is what this article is about – the cofactors that determine if the calcium you consume goes into your bones, and more importantly, remains there.
Osteoporosis is a progressive bone disease characterised by low bone mass (a decrease in bone mineral content). Osteopenia is the precursor, a warning sign that you could progress to osteoporosis if you do not make any changes to your diet and lifestyle. Osteoporosis is particularly common among postmenopausal women, increasing their risk of fractures and a frail ‘old person’ hunchback. Since many people ignore the warning signs, it can be a death sentence as can heart disease, cancer, diabetes or dementia. Your bone density can be medically assessed by a bone density test. However, your dental health is often a good general indicator. Teeth and bones look similar and have a lot in common, therefore if you have strong teeth and few cavities you are likely to have strong bones too!
Bones are hard, calcified connective tissue, composed primarily of mineral salts that make the bone hard, and collagen fibres that give strength. Like skin, they rebuild and repair during your life. What we eat and drink provides the building blocks for this rebuild and repair.
If eating more calcium-rich food or taking a calcium supplement was the answer to good bone health, how easy it would be! Unfortunately calcium is not the standalone solution, but part of a team, making it vital that calcium works together with the other players. This is not just about calcium but many nutritional cofactors.
What can be harmful? Over-supplementing with calcium, consuming too many foods high in calcium, or not having the cofactors for calcium to be stored in your bone produces an imbalance of calcium to other minerals, such as magnesium and potassium. These minerals are needed – with calcium – in the right ratios for muscle contraction as well as bone health. Calcium that is in excess can be wrongly placed, resulting in kidney stones, bone spurs, bunions and/or plaque.
So, bone health is not simply ensuring you eat enough calcium. These cofactors are involved in ensuring your calcium is absorbed and your body uses it:
- Inflammation and your body’s acidity level – your body needs to be predominantly alkaline
- Hydration – water and electrolytes
- Other minerals need to be in balance with calcium – Potassium, Magnesium and other trace elements like Manganese, Boron, Copper and Zinc
- Vitamins – particularly D and K
- Hormonal Function
Your body cannot make the minerals it requires. You have to consume them! However, consumption is not all, as you have to digest and absorb the minerals, including calcium, and other essential food nutrients so they are useful to your body. Minerals such as calcium are only able to be absorbed if your stomach is a highly acidic environment. The use of antacids and acid blockers disrupt this environment, reducing or preventing absorption.
If you have digestive issues or an inflamed leaky gut, you will not be able to absorb your minerals optimally. For this reason, gluten can also be a factor in osteoporosis. If you are celiac or even if you have a non-celiac gluten sensitivity, and are not avoiding gluten, you will have leaky gut and impaired absorption. It is vitally important to rule out a gluten sensitivity.
Constipation medications, or even psyllium husks, with food can bind up minerals and prevent them being absorbed.
Good digestion will be the subject of a future article. If you have completed my RESTART program, you can use your notes to refresh your memory.
Inflammation and your body’s acidity level
Your body works best when it is slightly alkaline. Your body tightly regulates your blood acidity/alkalinity levels. It is critical for your health that your blood alkalinity remains constant. In healthy people, diet doesn’t significantly affect your blood levels, as your kidneys maintain the blood at the optimal level by changing the acidity of your urine. Calcium can only be deposited into bone, from your blood, when your blood is alkaline.
However, if your blood is constantly too acidic, and the kidneys aren’t up to the job, calcium – an alkaline mineral – is released from bone into your blood to return it to its ideal, very slightly alkaline level.
Chronic acidity can be related to long-term conditions, such as dehydration, diabetes, excessive consumption of carbonated drinks, caffeine and/or alcohol, obesity and the consumption of foods to which you have a sensitivity – common examples being gluten and dairy. Yes, dairy for some people can do more harm than good for their bone health! Most of these conditions involve inflammation. Your body can become more acidic as a result of the inflammatory cells becoming active in your body. These cells constantly need more energy, and glucose is broken down to produce this energy in a process called glycolysis. During this process, lactic acid is produced and its ongoing build-up puts the body in a chronic acidic state.
Good, basic nutritional foundations reduce inflammation. This usually involves removing – as far as practical – processed food, sugar, refined carbs and highly refined fats/oils, while increasing quality protein and good fats. For some people, this includes avoiding gluten or other trigger foods. Fruit and vegetables are alkalising, so eat the rainbow! Around 20-30% of bone is collagen protein, so you need good protein for healthy bones. Omega-3 polyunsaturated fats are anti-inflammatory and found in oily fish, nuts and seeds.
Good hydration ensures blood is fluid enough to efficiently transport calcium throughout the body to other tissues, including bone. Hydration is the combination of enough water and balanced electrolytes. These electrolytes are electrically charged ions such as calcium, sodium and potassium which ensure the smooth transfer of calcium in and out of your body’s cells. Dehydration can be a cause of excess calcium in your blood. You can read more about hydration in one of my previous articles.
Calcium must be in balance with other minerals – particularly potassium and magnesium, but also trace elements like Manganese, Boron, Copper and Zinc. All these minerals are important for the proper use of calcium. Minerals can aggravate each other, zinc and copper for example, or work well together as do magnesium and calcium. Taking a multi-mineral supplement can mean some minerals are not utilised because one blocks another. You may appear to have a deficiency in zinc, but the cause may actually be that copper is too high and stops the zinc being absorbed. This is why it is vitally important that you understand why you are taking a supplement and that you consider the bigger picture!
Magnesium is often lacking in people who are stressed and/or consume sugar and refined carbs, as it is needed by the body to respond to stress and for the metabolism of sugar. Magnesium is usually lacking in processed foods.
My advice would be to get your calcium through your diet. Calcium supplements are rarely needed and in my experience, they result in excess calcium which can lead to deposits in undesirable places, like calcification in your arteries, kidney stones, bone spurs, bunions and/or plaque. Calcium is one of nature’s ‘Band-Aids’, so often wherever there is inflammation, calcium goes too.
Dairy is a source of calcium, but there are many good plant sources too, including tahini (sesame seed paste), chia seeds and all the dark green leafy vegetables.
One of the best ways to ‘supplement’ with minerals, in their natural ratios, is to use bone broth. Bone broth is one of my favourite healing foods and has the added advantage of being beneficial to your gut, joints and skin too. Please contact me if you would like recipes to make your own bone broths or to purchase a high quality ready-made bone broth concentrate.
Calcium metabolism is closely related to the vitamins D and K. These vitamins drive calcium from your blood, into your bones, and lock it in. A lack of vitamin D and/or K means that calcium circulating in your blood cannot get into your bones.
A healthy gut with a good microbiome is highly desirable as it leads to more vitamin D being absorbed, and vitamin K can actually be synthesised by bacteria in a healthy gut. That said, vitamin K is also found in liver, fatty meats and green leafy vegetables. As well as spending time in the sunshine to absorb vitamin D, you can source it from food like liver, egg yolks, and fatty fish such as mackerel or salmon.
Vitamins D and K are fat-soluble vitamins, following the same absorption mechanism as fat. Fat is needed for their absorption, so there is a reason green leafy vegetables taste better with butter! The animal and vegetable food sources of these vitamins are in different forms, and it appears the animal sources are better absorbed by the body and remain longer in the blood.
Once again, supplementation may not be the answer. Vitamin D supplementation, without adequate vitamin K, can result in calcium deposition where you do not want it, in tissues other than bone.
Fats are broken down to fatty acids, and these are necessary for the transport of calcium across the cell membrane into cells.
Fats are also essential for the absorption of the fat-soluble vitamins, which include vitamin D and K.
As mentioned above in Inflammation and your body’s acidity, Omega-3 polyunsaturated fats are anti-inflammatory and therefore beneficial to bone health. They are found in oily fish, nuts and seeds.
Good fats will be the subject of a future article. If you have completed my RESTART program, you can use your notes to refresh your memory.
These are the two important hormones in calcium regulation:
Calcitonin decreases calcium in the blood by depositing more calcium into bone, thereby decreasing calcium absorption from your bones and food, and increasing calcium loss in your urine.
Parathyroid Hormone raises calcium in the blood by removing calcium from bone, resulting in bone breakdown, and increased calcium absorption from your food and decreased calcium loss in your urine. An abnormally functioning parathyroid gland can lead to high levels of calcium in your blood.
Adequate intake of good quality proteins, and good digestion to absorb them, ensures we have the building blocks to make these hormones – as they are made predominantly from protein. Protein is also required to make collagen, the part of bone that gives its strength.
Menopause accelerates bone loss due to the decrease in oestrogen, but less bone is lost if you are in good health and have a good diet leading up to menopause. Post-menopause oestrogen production is transferred from your ovaries to your adrenal glands, if the adrenals have the capacity and are not overly stressed.
In addition, Exercise is a primary factor in bone health. I’m certainly no expert in this area, however, it is well known that using your muscles supports bone health. It is vitally important to do regular resistance exercises to really stress your bones. Any sort of strength training, weight lifting or body weight exercise is beneficial. An added benefit is that you build muscles too, and this can help with balance, making falls less likely. Everybody can fall, but if you have the muscles and improved reflexes, you are more likely to be able to support or brace yourself. So keeping up a good activity level builds your muscle mass and helps maintain your bone mass, as well as making you feel good!
Please don’t be overwhelmed. Bone health nutrition appears complicated, but in reality, you can make a great start by eating a wide variety of unprocessed real food including protein and good fats, being well hydrated, and relaxing while you eat to allow digestion to proceed.
If you would like more specific advice relating to optimising your bone health, please contact me to book a free 20 minute phone consultation. I’d love to help you because I passionately care about applying nutritional wisdom, and the right mindset, to enable you to reach your health goals.