Tag Archive | Vitamin D

Bone Weary

Bad sleep? I understand. For many years my typical night was really a series of short naps, with lots of thinking time in between. I welcomed the morning light, not because I felt rested, but so I could call an end to the futility of trying to sleep. My days were foggy, my head ached, my immune system was low, and the irritating people around me thought I was the grumpy one! I really understand the disability of poor sleep.

Dr. Stasha Gominak is an American neurologist whose practice developed around poor sleepers like I was. In the course of treating chronic pain, she discovered that for most of her patients the root cause of their pain would heal if they could sleep well. Although her starting point to improve their nights was sleep apnea machines and sleeping drugs, she found that optimal healing only followed when she could restore natural sleep – which means the right amounts of time in the proper cycles, without drugs or breathing aids. How did she accomplish that?

First, she identified, to her surprise, that all her patients with abnormal sleep were deficient in vitamin D. She discovered that by raising their vitamin D levels she improved their sleep. What’s not to love about a vitamin that helps us sleep?

Her patients didn’t heal right away, though. Then she found the next missing piece: these same patients were also deficient in B vitamins! What was the link to vitamin D? It turns out that the healthy bacteria in our intestines rely on vitamin D in order to make the B vitamins we need. Not enough D? We run out of the B family, and end up with a secondary B deficiency.

What do B vitamins do? The family of B vitamins are needed throughout the body, acting as cofactors for countless metabolic and neurologic processes. They’re essential for the widespread repair work that is supposed to happen while we sleep. We need good D levels in order to sleep deeply, but we need the B family to heal. The more our bodies are affected by inflammation and disease, the more support we need from B vitamins. Not enough B vitamins? Our bodies will succumb to pain, autoimmune conditions, and even mental decline.

Which brings me to osteoporosis. As I’ve written before, we must have optimal D levels in order to properly mineralize our bones. In fact, Dr. Gominak calls osteoporosis a vitamin D deficiency state! Calcium and magnesium, along with the other minerals, won’t settle into their proper places without the support of vitamin D. But a shortage of B vitamins will throw off the delicate dance of the osteoclasts and osteoblasts – cells that clean away old bone while building new bone – and our bones won’t be able to maintain or repair. There really is a scientific explanation to feeling tired right to the bone.

As I’ve described in earlier posts, I made some major nutritional changes in response to my osteoporosis diagnosis. These included raising my vitamin B and D levels, as well as eliminating foods that inhibited my nutrient absorptions. I expected my bones to fare better, but it was an incredible surprise and blessing when I found I was also sleeping well – every night!

So following the cues from Dr. Gominak – and countless other researchers – have a blood test to check your vitamin D level. If your level is low, you can take steps to raise it into a healthy range with a combination of supplements and safe sun exposure. That should improve your sleep. Next, consider taking a vitamin B complex supplement. Your whole body will thank you.

In Defense of Vitamin A

In the bone health world, vitamin A has a bad reputation. Some studies have suggested that it’s toxic to bones because it increases the activity of the osteoclasts. These are the cells that do the important work of cleaning away old bone. If they get carried away, though, there can be a net loss of bone if they outpace the osteoblasts that are working to build new bone.

But recent research has found that this isn’t actually the fault of vitamin A itself, but of a failed partnership. If there’s a shortage of vitamin D or vitamin K2, then A can’t do its job properly; the three fat-soluble nutrients are meant to work together for bone care. If we absorb too much of one of them, that creates a corresponding need for more of the others. Since a huge percentage of people are deficient in both D and K2, this means that for the bones of some people, taking preformed vitamin A can be detrimental.

Too little vitamin A, though, is also a problem. A deficiency can also cause bone loss, as well as impaired vision, dry eyes, and a pre-disposition to a host of diseases, including cancer. The key is having good nutritional balance.

As for my story, I was able to bring my vitamin D level into a healthy range with supplements. Check. And I added vitamin K2 to my diet by eating natto three times a week. Check. My vitamin A, though, persistently tested low, even though I eat a lot of foods with beta-carotene, which is supposed to convert to vitamin A. What was that about? Why couldn’t I raise my level of vitamin A?

It turns out that many people can’t process beta-carotene much or at all, for a variety of reasons. For some, the problem is a diet lacking the healthy fats needed to stimulate absorption. For others, it may be that they drink too much alcohol, or that they have inadequate bile flow. Or their gut ecology may be out of balance, perhaps because of low stomach acid levels, celiac disease, or parasites. And to complicate the issue, a large percentage of the population were just born with a genetic variation that prevents them from absorbing beta-carotene or converting it into the active form.

So what can we do to get enough vitamin A in our systems? First, get tested to determine whether you’re in the majority who need some more. If you are, then make sure you eat plenty of retinol foods. The top of this list is cod liver. The second, third, and fourth options are other kinds of liver. If this makes you shudder, then you may benefit from taking preformed vitamin A, or retinol, as a supplement. It often comes in tiny capsules made from cod liver oil, but you won’t taste a thing. It’s also available in dry tablets. But since vitamins A, D, and K2 are fat-soluble, which means they can build up in our tissues, it’s important not to overdo them.

And here’s a side note if you’re hoping to see your hundredth birthday: vitamin A sufficiency is now recognized as a key contributing factor to longevity.

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.

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.

Vitamin D for Young People

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.

Reference: http://www.sciencedaily.com/releases/2012/03/120305173453.htm

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