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Keep Those Facts Coming!

A fascinating new study in Aging reaffirms the benefits of appropriate micronutrients on bone density. In this one-year double-blind study, test subjects were given a combination of melatonin, strontium citrate, vitamin D3, and vitamin K2, then compared with a random group that received a placebo. Bone density, bone marker turnover, and health-related quality of life were compared at the start, six months through, and after 12 months.

Compared to the placebo group whose bones lost density, those who took the nutrient combination experienced significant bone density increases (4.3% at the lumbar spine), declines of bone turnover, and better mood and sleep.

What were they taking each day?

• 5 mg melatonin
• 450 mg strontium citrate
• 2000 IU vitamin D3
• 60 mcg vitamin K2 (MK7 form)

Previous studies referenced in the paper have shown bone benefits from all of these nutrients, although this is the first study that has combined them. Rather than uncomfortable side effects, those who took the micronutrients saw their quality of life improve.

How does this compare to the 2012 COMB study? Well, COMB didn’t include any melatonin, which generally helps with sleep. The same amount of vitamin D was used, but more strontium citrate (680 mg) and more vitamin K2 (100 mcg) in COMB. As well, COMB subjects consumed DHA and magnesium, and their bones improved even more: 6% at the lumbar spine. Here’s more about that research.

The new study used a statistically significant but much smaller test group (20 vs 114), made up of postmenopausal women with osteopenia, whereas the COMB study subjects began with worse density – already in the osteoporosis range.

My personal response to this? I will keep going with the approach I’ve committed to: my own combination of micronutrients along with a healthy diet and lifestyle. My bones are with me for the long haul!

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.

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

Strontium: a new kind of weapon

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.