- 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.
Did you catch this headline? Last week all the media outlets reported the results of a German nutrition study that tracked 24,000 people over an 11-year period. Participants who took calcium supplements had almost double the heart attacks of those who didn’t take calcium. The authors concluded that we should ditch the supplements and meet our calcium needs from food sources. While that is generally a very good approach with most nutrients (a handful of supplements can’t atone for a junky diet!), there’s some missing information here: How much calcium were the un-supplemented participants getting from their diets? How much of what forms of calcium were the others taking, and how much were they also getting from their diets? What were their bodies able to absorb?
More important, were they taking vitamin K2? As I mentioned before, it’s responsible for directing calcium to our bones, and away from our arteries. Although bacteria in our intestines can convert some vitamin K1 (the renowned blood-clotter) into K2, even if we ate several cups of leafy greens a day, without a good serving of Japanese natto or a supplement, we’d still be deficient. If the calcium-popping participants weren’t also taking K2 then it’s not surprising their arteries were overloaded.
And what were the participants’ vitamin D levels? There’s an important partnership between vitamin D and vitamin K2; too little of one prevents the other from doing its best work. If the supplementing group had vitamin D levels in any way typical of people in Germany’s northern latitude – their calcium may well have wandered into their hearts.
And what were they all eating? Adding calcium supplements to a highly-processed diet might well have compounded other issues.
In the absence of definitive answers, how is a diligent bone-lover to respond? It was just months ago that my own doctor advised me to take 1500 mg per day of calcium supplements, with no discussion of how I eat or any other supplement than magnesium; I don’t feel at all inclined to go back and ask for her updated advice, especially since she also insisted I take bisphosphonate drugs!
The approach that makes sense to me is to continue with a non-processed diet, based largely on a wide variety of fresh vegetables, with some meat, fish, nuts, fruit, eggs, yogurt, cheese, healthy fats, and non-gluten grains. Consistent with the COMB study I mentioned before I also take K2, D, magnesium, and fish oil. (That report recommended strontium citrate, which I took for a month. However, I figured out it was the cause of some daily headaches that developed, so stopped. I’ll try strontium again soon, as other support nutrients may be better balanced now.) I also take silica, boron, a multi-mineral supplement that includes 500 mg calcium, a vitamin B complex, and vitamin C.
When new information comes out it can be hard to make sense of it. Personally, after reflecting on this news I don’t find it too scary after all.
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
As I reeled under the news of my low bone density, I grappled with guilt: If only I’d drunk more milk. Now, I used to have some each day, and during my pregnancies I meticulously counted four glasses a day, without fail. Cheese and unsweetened live yogurt have always been favourite foods, too. Yet, I’d internalised the media message: weak bones = too little milk, so on news of my osteoporosis I concluded I just hadn’t done enough. My fault.
But then I discovered a confusing piece of news: countries with the highest dairy consumption also have the most osteoporosis! Yes, despite milk’s legendary calcium content, those who drink the most have the weakest bones. So what’s with that???
Our bodies are about 1-2% calcium, mostly stored in our bones and teeth. Milk contains lots of calcium, and we can absorb about 32% of the calcium from dairy products, which is fairly good. As it turns out, though, our bones need more than just calcium. For one, they must have magnesium; too little of this mineral alters the way the body metabolizes calcium, and the hormones that regulate calcium. But calcium and magnesium compete for the same absorption channels in the body, so too much of one will lead to a deficiency of the other; with our dairy-rich western diet, that loser is invariably magnesium, already in short supply. Magnesium’s deficiency will keep the body from using the calcium that shut it out in the first place!
Another major problem concerns the acid-base balance inside us. We’ve all heard of the problems of acid rain: if precipitation is too acidic – usually from industrial waste released into the air – when it hits the ground it leaches minerals out of the rock. Scientists have called this “osteoporosis of the lakes”, because it is so similar to a process in the body that can leach minerals out of our bones. In our bodies, this acid/base (pH) balance is affected by the foods we eat. I’ll explain more about this later, as it’s a very big topic. But in short, most fruits, vegetables, nuts, and seeds leave an alkaline residue in the body, while meat, grains, and dairy products acidify the body. In this delicate balance, the typical western diet leaves us very vulnerable.
So in response to my diagnosis, I have reduced my milk consumption, reduced grain intake, and increased magnesium sources, such as nuts.
Who ever convinced us to entrust a single food group with the health of our bones in the first place? I haven’t uncovered the definitive answer to that, but I can guess it’s someone who benefits from the dairy industry’s success. It certainly isn’t the consumers.