- Exercise: I changed my gym workout, now choosing the treadmill over an elliptical trainer. This causes more impact to my bones, which should challenge them to grow stronger. I’ve continued using weight machines to work my lower body, but now choose free weights for upper body work, and do those exercises standing up so my spine can carry the extra weight. On days I don’t get to the gym I go for a brisk walk. Keep moving.
- Supplements: I added strontium citrate (680 mg per day), Vitamin K2 (100 mcg per day of the MK7 or menaquinone form), silica, and 3 mg per day of boron. I was already taking B complex, a balanced mineral supplement, fish oil, magnesium, Vitamin D, and Vitamin C.
- Diet: I gave up most dairy products. Yup, to improve my bones I stopped drinking milk. I found out through testing that I’m sensitive to milk (not that I noticed any symptoms) which means it would have tended to cause inflammation, and that is bad for bone health. Also, dairy products metabolize to form acidic residue, which increases bone loss. I get my calcium from leafy greens, nuts, and salmon, with about 600 mg per day from a supplement. (The 1500 mg per day supplement my doctor recommended is way too much!) I put more emphasis on making and drinking mineral-rich bone broths. I already ate a lot of vegetables, and that hasn’t changed. I had already given up gluten, and any foods that contain it. Since lower body weight is one of the major risk factors for osteoporosis, I gave myself permission to abandon my life-long pursuit of weighing a little less. That must have been effective, as I have gained about 3 kg, and mostly feel fine with that :).
- Reading: I devoured some excellent books that helped form my understanding. My favourites are Your Bones by Lara Pizzorno, The Whole Body Approach to Osteoporosis by R. Keith McCormick, The Myth of Osteoporosis by Gillian Sanson, and Vitamin K2 and the Calcium Paradox by Kate Rheaume-Bleue.
- Support: I joined an online community of people who share what they’re learning about osteoporosis. I also continue to meet with a local Health Pursuits Reading/Study Group where lots of wise people have spurred me on with their insights into natural approaches.
- Drugs: I have not taken any. I don’t plan to take any. Since I haven’t needed to return to my nice well-meaning doctor who told me I had no choice but to take Actonel, she doesn’t know. I have a choice, and I’m exercising it by venturing into realms that are beyond her training.
- Followup bone density test: Although I was told I would get an automatic recall, that hasn’t happened. I considered initiating the appointment myself, but then wondered: What would I do differently if I got a worse test result? I’m already doing everything I know how to improve my bones. Since I’m very numbers-oriented, I know I’d obsess over the new scores, way beyond their accuracy or their ability to predict fractures. So I’ve let it go, and I’ve stopped having bad dreams in which I’m about to get my retest scores. One day, if the test centre calls, I’ll go for a repeat test. But I am more than a test score.
Children don’t spend any time thinking about their bones. So here’s some news for those who care for children: Make sure they get enough vitamin D. A recent study published in the Archives of Pediatrics and Adolescent Medicine found that low vitamin D levels were associated with stress fractures.
The study followed 6,712 athletic girls aged nine to sixteen for seven years, monitoring dairy, calcium, and vitamin D intakes. Over the seven years, 3.9 % developed stress fractures. Those with the highest vitamin D intake, though, suffered the fewest fractures.
This agrees with the correlation that many researchers are finding between bone health and vitamin D levels, and points to the need to protect bones even in childhood.
I recently listened to a fascinating lecture by Dr. Stasha Gominak on vitamin D. She’s a neurologist who has identified a most interesting connection between low vitamin D levels and poor sleep quality. She makes so many fascinating comments on the subject that I recommend you listen to all four parts of the lecture. However, something she brought to my attention that particularly relates to this post about children is the extent to which our vitamin D intake from sun exposure (the optimum kind of D) has dropped in one generation.
When I was growing up in the 60s and 70s no one in my suburb had central air conditioning; we played outdoors, and when the house got really hot we even ate outside, with no gazebo. We hadn’t yet heard of sunscreen, so our skin was fully exposed to the sun. Kids walked or biked to their destinations, and we were free to wander the neighbourhood. Our favourite activities involved a lot of moving around, usually with others, especially since there was nothing to watch on TV for most of the day. At least for the summer, we got all the vitamin D we needed (as well as a good bit of bone-building exercise).
By contrast, when my children came along in the late 80s the house was pleasantly cooled, so they stayed indoors a whole lot more to keep comfortable. Whenever they were outside we made sure they were slathered in sunscreen, effectively preventing their skin from making that essential vitamin D. Furthermore, since the world had grown much more aware of predators and other nasties, we drove them around as much as we could. And by then VCRs and video games gave them a lot of indoor entertainment. All told, in the name of improving their lifestyle, we deprived them from what’s proving to be a vital vitamin in preventing a dizzying number of diseases.
My conclusion from reading about vitamin D? When possible I must get 15 minutes per day of sun exposure on bare skin, no sunscreen. If I had children now I’d make sure they did, too. The rest of the year, supplements are essential.
Now back to the study I mentioned above. To the surprise of researchers, those with the highest dairy and calcium intakes also suffered the most fractures:
“In contrast, there was no evidence that calcium and dairy intakes were protective against developing a stress fracture or that soda intake was predictive of an increased risk of stress fracture or confounded the association between dairy, calcium or vitamin D intakes and fracture risk,” the authors comment.
The authors also note that in a stratified analysis that high calcium intake was associated with a greater risk of developing a stress fracture, although they suggest that “unexpected finding” warrants more study.”
Yup, calcium is not the key bone-builder. Make sure you get your vitamin D.
A new Canadian study has followed a group of people just like me: those who are responding to osteoporosis purely with lifestyle adjustments, without taking bisphosphonate drugs. Medical researchers from the University of Alberta and University of Calgary prescribed six micronutrients and an exercise program, then tracked the results. I’m delighted to see that over the year of the study the bone density of the participants increased more than it would have with the standard pharmaceutical drugs.
Of course, one reason I like this study is because it seems to validate my approach. Another is that no drug company funded the work, and for me that adds credibility. The authors appear to be squeaky clean with regard to conflicts of interest that may have skewed the results.
On the negative side, the sample wasn’t entirely representative of the low-bone-density population; the authors worked exclusively with people the doctors call “non-compliant”, who had already decided not to use the recommended drugs. Some had abandoned the drugs after experiencing continued decline of their density while taking them. Others had explored their options and just wanted a non-pharmaceutical approach. To me that suggests a cohort that is more health-aware than the average population, more likely to do their own critical investigations, eat a better diet, and resort to fewer pharmaceutical products in general. Really, though, I’m not concerned about the non-representative sample: when it comes right down to it, all I want to know is what will work for ME and the people I care for! And with that prescription I will comply.
Lifestyle adjustments in the study
So what did the participants do? Here’s the list:
Table 1: Combination of micronutrients (COMB) Protocol for Bone Health.
|COMB protocol for bone health|
|(1) Docosahexanoic acid or DHA (from Purified Fish Oil): 250 mg/day|
|(2) Vitamin D3: 2000 IU/day|
|(3) Vitamin K2 (non-synthetic MK7 form): 100 ug/day|
|(4) Strontium citrate: 680 mg/day|
|(5) Elemental magnesium: 25 mg/day|
|(6) Dietary sources of calcium recommended|
|(7) Daily impact exercising encouraged|
In earlier posts I’ve already talked about vitamins D and K2, strontium, magnesium, and calcium. Although I take fish oil containing DHA for general good health, I hadn’t heard that it’s particularly helpful for bones. According to the study: “Both DHA and vitamin D are involved in the regulation of many genes and…associated with improved bone strength.”
As for the exercise component, the authors said: “Patients were also instructed to commence and maintain a regimen of daily impact exercises such as jumping jacks or skipping where possible as impact has been associated with prevention of bone density loss.”
How much did it help?
The mean improvement in BMD (bone mineral density) was impressive: 3% in the hip, 4% in the neck of the femur, and 6% in the spine. That was contrasted with a continued decline in BMD among the study dropouts, and substantially lower improvements using bisphosphonate drugs. Unlike the drugs, the study protocol delivers no side effects.
What will I change?
I’m already taking the micronutrients suggested by the study, although in different amounts. My calcium is not exclusively from food sources, as I consume very little dairy food, and I’m not confident that I can meet all my requirements all the time with my diet. These days I take 200 mg of DHA, 6000 IU of D3, 100 micrograms of K2, 340 mg of strontium citrate, 420 mg of magnesium citrate, and 1000 mg of a calcium supplement. I plan to leave those as they are for now. At the moment I get impact exercise three or four times a week at the gym, with some walking in between, and heavy gardening all summer. That didn’t prevent osteoporosis in my case, but adding some jumping jacks into my non-gym days is worth a try.
Combination of Micronutrients for Bone (COMB) Study: Bone Density after Micronutrient Intervention
In the early 1960s when my first baby tooth fell out I made a big decision: rather than leave it under my pillow for the tooth fairy, I helped my mother put my tooth in an envelope to send it away. Before long a small package arrived in the mail addressed to me. Inside was a button with the picture of a gap-toothed child, and the words, “I gave my tooth to science”.
What did “science” do with my tooth? It turns out I was part of the Montreal Baby Tooth Survey that was tracking the concentration of radioactive strontium-90 in the population. At that time, as the nuclear arms race heated up there was widespread concern about the dangers of radiation that was being absorbed in bones. And the most available supply of bone that could be used for testing was discarded baby teeth. Correlating these with the date and place of birth, researchers could determine how much radiation was affecting people in the year those teeth were formed.
Now I have a new interest in strontium. Rather than hoping to minimize it, I’m deliberately adding it to my bones. One important distinction: this time it’s not the radioactive isotope, but a naturally-occurring salt called strontium citrate. This strontium is an abundant mineral that is chemically similar to calcium, and absorbed by bones in comparable amounts. Once inside, it increases the activity of the bone-building cells (osteoblasts) while slowing down the clean-up cells (osteoclasts).
Strontium-rich foods include beets, brazil nuts, and cabbage, and a typical daily intake is estimated at 1 – 5 mg. A wide variety of studies have shown that intakes quite a bit higher than this – between 340 and 680 mg per day – build significant bone density, while reducing fractures. The effect is so pronounced that the pharmaceutical companies have grasped the possibilities and found a way to combine naturally-occurring strontium that can’t be patented with a synthetic compound that can to make a drug called Protelos, made of strontium ranelate. So far this drug is only marketed in Europe, so Canadians like me can enjoy the benefits of the cheaper, safer over-the-counter form.
Because strontium competes with calcium for absorption, it must be taken hours after calcium-rich foods. If I don’t snack in the evening I can take it at bedtime; otherwise I’m trying to take it in the night when I get up to the washroom.
There is some controversy over strontium as a bone-builder because the necessary dosage so far exceeds the amount of strontium a person would normally consume. Still, despite long-term safety studies, the only issues that have come up so far have been with the expensive synthetic prescription version, which leads to increased incidence of blood clots and drug hypersensitivity syndrome.
One important warning if you choose to take strontium citrate for your bones: make sure you always ingest more calcium than strontium.
Here’s a link to an excellent post on magnesium by a natural health practitioner. She knows a lot more about this than I do, so to save rewording her work so I can pretend I came up with it myself, here it is:
Never heard of boron? Then your bones may thank you for reading this.
Boron is a trace mineral that affects many of our metabolic processes. Of particular interest to me at the moment is that it plays key roles in our calcium status and bone density. It turns out that boron is a vital cofactor in the body’s use of Vitamin D and magnesium, helping us to metabolize them. Too little boron? That seems to demineralize bones, flushing precious calcium and magnesium into our urine, just as if we were nutritionally deficient.
The good news is that we can get boron from lots of foods: almonds, walnuts, avocados, broccoli, potatoes, pears, prunes, honey, oranges, onions, chick peas, carrots, beans, bananas, red grapes, red apples and raisins are some of the best sources. The bad news? The actual boron content of those foods depends on the soil in which they’re grown.
In these days of factory farming and well-traveled foods it’s not possible to keep track of how much boron we’re actually getting. Still, if you eat a diet rich in a variety of fruits, vegetables, nuts, and seeds you may well average the recommended 3 mg per day. Estimates of the typical American diet – emphasizing milk, meat, grains and junk – fall far short of that.
It would be easy to recommend that we each take a boron supplement for bone insurance. But isn’t the higher road a balanced diet? It has infinitely more benefits, too.
Vitamin D is known as the sunshine vitamin, because it’s created in our skin in response to sunshine. What an amazing system – our bodies know how to make what they need with just one necessary addition! In my part of the world, though, I spend at least two thirds of the year with everything except my face and hands covered up, so that vital ingredient is missing. While we can store Vitamin D for periods of time, eight months is way over the limit. Essentially everyone in my latitude is deficient in this vitamin by the time we can peel off our parkas.
What difference does it make? Well, we need this vitamin to prevent practically any disease we don’t want, starting with cancers and cardiovascular disease. The Vitamin D Council site contains a wealth of well-documented information about Vitamin D.
And wouldn’t you know: Vitamin D deficiency is a factor in osteoporosis, because D is needed in order for calcium from the diet to be absorbed in the intestines. Without enough absorbed calcium, the body robs calcium from its best storage supply – the bones. Not enough calcium in the bones? Low density.
In recent years there’s been a lot of controversy over how much Vitamin D is enough. It seems the pharmaceutical companies recommend the lowest amount, and natural practitioners the highest. (Regular medical doctors rely on the drug companies for recommendations.) Everyone agrees, though, that most of us need way more than we’re getting.
So what’s a northerner to do through the long winter? Ideally, the ultimate approach would be to spend every second week at a tropical resort lapping up the rays, but my lifestyle can’t accommodate that. It’s not possible to get all the Vitamin D we need through diet, either; we’re left with supplements. The most absorbable form is D3, or cholecalciferol. We’re each biochemically unique, but through regular testing of my levels I’ve found that I need about 6000 IU per day of this through the winter, and about 3000 IU per day through the summer, just to keep me from deficiency. (That’s just me, so do your own research and don’t copy!) Be sure to always take Vitamin D with a bit of fat to help its absorption, as D is fat soluble.
Trying to build bone density? Keep on top of your Vitamin D.