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I passed the test!

First, I should apologize for the long gap between posts. My writing time has been absorbed into 1400 square feet of gardening bliss, which legitimately counts as bone-building activity. But now that we’ve had our first heavy frost, I’m down to a couple of short rows of greens under covers, and it’s time to get back to my desk.

It’s also time to announce that my bones passed their big test – the one that really counts: They held together beautifully when I had a bad fall. The scene was the garden, and the accident involved me recklessly trying to move an oscillating sprinkler while outrunning it to stay dry. I scrambled onto the half-meter high stile to get over a fence, but when my wet feet met the slick top step I crashed down – very hard – my entire weight on my hip onto the packed path. There I lay, stunned and wetter, but suddenly very excited: Nothing broke!!!  I wore a mammoth bruise for a long time, yet wasn’t even stiff the next day. Despite my doctor’s dire warnings, and the High Risk of Fracture on my chart, my bones were able to do their job and absorb the impact.

Now, a year after my bone density T-score of -4, I can reflect on the approach I’ve taken, as my bones seem to be serving me well:

• 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.

Still, I made a note to myself to avoid risky activities like outrunning sprinklers in wet obstacle courses. Instead I should focus on developing true superpowers that will allow me to leap over garden stiles in a single bound.

Calcium Supplements: After the Scary Story

Calcium supplement use may raise heart attack risk

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.

Believable Good News

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

The calcium myth reposted and revisited.

I’ve already said it here: calcium alone can’t save our bones.

But this author says it better, and in more detail. He particularly focuses on food sources of the nutrients we need. Please read this article! Understand the calcium myth; here’s what really makes healthy bones.

Magnesium: one of the most overlooked deficiencies.

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:

Magnesium – One of the most overlooked deficiencies!.

You must meet Boron.

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.

Milk to the rescue? A well-funded myth.

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 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.