Osteoporosis and low bone mass are significant public health issues in our modern-day world. In the United States, 53% of the population over age 50 suffer from osteoporosis and low bone mass; the weak, brittle bones of these individuals put them at a higher risk of experiencing osteoporotic fractures, which are both costly to treat and significantly reduce quality of life. In conventional medicine, the typical treatments offered for osteoporosis are pharmaceutical drugs that inhibit the breakdown of bone and calcium supplementation. However, the crucial role of nutrition in bone health has been largely ignored by the conventional medicine community. In addition to exercise, nutrition may be one of the most important influences on bone health throughout life. Read on to learn about how you can use nutrition to build healthy bones that will last a lifetime.
Bones are dynamic, living tissues
Many of us perceive bones as static structures that are hard and impervious to change. However, bones are actually dynamic, living tissues that consist of protein, connective tissue, minerals, nerves, blood vessels, and marrow. They serve a structural function in the body, provide mobility, support, and protection, and act as a reservoir for minerals. (1)
Bone tissue is built and maintained through a lifelong process called bone remodeling. In bone remodeling, new bone tissue is formed through a process called ossification, and mature bone tissue is removed from the skeleton in a process called resorption. A fine balance between these two processes is essential for maintaining the integrity of the skeleton. In childhood and young adulthood, bone formation exceeds bone resorption; this allows peak bone mass to be achieved. Conversely, when bone resorption exceeds bone formation in adulthood, this can lead to the net breakdown of bone and a weakening of the skeletal system. Humans have been found to achieve about ninety-five percent of our peak bone mass by age eighteen or nineteen, and we may continue to build additional bone mass into our twenties, until a set point is reached. After age forty, people tend to start to lose bone mass. However, this does not mean that you are doomed to poor bone health! Even as an adult, there are things you can do to promote bone health; nutrition is a key intervention that can affect bone health in adulthood. Certain nutrients are needed for promoting bone mineralization and regulating bone resorption. By consuming optimal amounts of these nutrients, you can build and maintain strong, healthy bones. However, if these nutrients are lacking, new bone will not be laid down, and bones will become weaker over time.
Nutrients for bone health
Bone contains approximately ninety-nine percent of the body’s calcium. This is why health professionals emphasize the importance of dietary and supplemental calcium. However, simply popping a calcium supplement will not ensure that you build healthy bones. In fact, a comprehensive analysis of calcium supplementation in a large group of older men and women found that supplemental calcium intakes above and beyond the recommended intake (between 1,000 and 1,200 mg/day for adult men and women, respectively) does not benefit bone mineral density. (2) In addition, calcium supplementation has been associated with an increased risk of cardiovascular disease. This may be due to the fact that direct calcium supplementation without adequate intake of other nutrients needed to “guide” calcium to its proper location in bones (such as vitamins D and K2), leads to deposition of calcium in arteries, causing arterial calcification and an increased risk of heart disease. (3)(4)
Rather than haphazardly recommending isolated calcium supplementation, we need to consider calcium’s role in bone health from a holistic perspective. As I mentioned above, other nutrients help direct the activities of calcium in the body, so that it is deposited in bone rather than blood vessels. Vitamins D and K2 are two such nutrients that guide the activities of calcium. It is possible to obtain these nutrients from food sources, rather than supplements. Leafy greens, almonds, small bone-in fish such as sardines, and cruciferous vegetables such as broccoli and bok choy are high in calcium. If you combine these foods with foods rich in vitamin K2, such as fermented full-fat dairy products and natto, and sun exposure (for vitamin D), it is possible to meet your needs for these synergistic nutrients. However, if you still choose to take calcium supplements, it is especially important to make sure that your vitamin D levels are adequate and that you are consuming vitamin K2, either in food or supplemental form, so that you do not experience the potential adverse effects of isolated calcium supplementation.
In addition, you must consider whether other components of your diet are inhibiting calcium absorption. Phytates, naturally-occurring chemicals that are found in grains, nuts, and seeds can bind up minerals such as calcium and prevent us from absorbing them from food. Oxalates, another family of naturally-occurring compounds in plant foods, also inhibit calcium absorption. I do not recommend consuming a diet high in grains (especially grains that are not prepared properly through soaking or sprouting) if you are looking to optimize your bone health, due to the levels of phytates they contain. Oxalates are a more difficult issue, since they are present in so many different foods. However, research has found that boiling vegetables can significantly reduce their oxalate content. (5)
Vitamin D does countless beneficial things for our health, including our bones. We need vitamin D to build bones and to facilitate the absorption of calcium from our diet. Vitamin D deficiency is an established risk factor for osteoporosis. (6) Conversely, increased sun exposure and the use of tanning beds (for those who can’t get enough sun exposure) are associated with increased serum vitamin D levels and higher bone density. (7)(8) I recommend trying your best to get vitamin D from sunlight. The human body is uniquely designed so that UV light from the sun interacts with cholesterol in our skin to initiate vitamin D production; evidence indicates that oral vitamin D supplements do not have the same effects on the body as does vitamin D produced upon exposure to sunlight. Vitamin D lamps are an FDA-certified viable alternative for increasing serum vitamin D in those deficient in the vitamin. In the winter, I use this vitamin D light box to maintain my vitamin D level.
Relatively small amounts of vitamin D may also be consumed in the diet from foods such as fatty cold-water fish and egg yolks, but these are not sufficient to meet the body’s needs for vitamin D. Personally, I don’t think vitamin D supplementation is necessarily the answer to vitamin D deficiency. Taking large quantities of vitamin D by mouth, a phenomenon that is entirely novel for humans based on our evolutionary history, may have very different and unpredictable physiological effects on the body. (9)
Like vitamin D, vitamin K2 helps guide calcium so that it is deposited in bone, rather than coronary arteries. K2 inhibits the deposition of calcium in arterial walls, thus ameliorating cardiovascular concerns related to calcium supplementation. K2 is a unique vitamin and is nearly nonexistent in the Standard American Diet. You will actively need to seek out food sources of vitamin K2. Good food sources of vitamin K2 include ghee, butter, and full-fat dairy from grass-fed cows, natto, liver, and egg yolks. (10)
Vitamin C helps regulate the deposition of bone and affects the quantity and quality of collagen in bone (vitamin C is intrinsic in the process of collagen production). Positive associations have been found between dietary vitamin C intake and higher bone mineral density and reduced risk of fractures. Vitamin C is plentiful in a wide variety of colorful fruits and vegetables, such as citrus fruits, strawberries, broccoli, brussels sprouts, kiwi, kale, and red and green peppers. (11)
Retinol, or “true vitamin A,” is a form of vitamin that is ready for use by the body, in contrast to pro-vitamin A sources such as beta-carotene. It is found only in animal foods such as egg yolks, fatty fish, and liver. Vitamin A is essential for promoting bone growth. However, when vitamin A consumption is not balanced with vitamins D and K2, it may lead to excess bone resorption. (12) Food sources of retinol often contain the vitamin in combination with vitamins D or K2 – this natural balance ensures that no single vitamin is consumed in excess of the others needed to promote its health benefits. Grass-fed dairy is a rich source of vitamins A and K2, and fatty fish contain vitamins A and D.
Vitamin E is composed of eight different compounds; four of the compounds are called tocopherols, and the other four are called tocotrienols. Tocotrienols specifically may contribute to higher bone density, inhibit bone loss, and promote the healing of bone fractures. (13)(14)(15) Unfortunately, there are not many foods that contain appreciable amounts of tocotrienols. Perhaps one exception to this rule is red palm oil, which is high in tocotrienols as well as the antioxidant beta-carotene, which itself has many health benefits.
Magnesium deficiency contributes to the development of osteoporosis by impairing the formation of bone and increasing the activity of parathyroid hormone, which stimulates the breakdown of bone. Excess breakdown of bone, without concomitant building of bone, leads to osteoporosis. (16)(17) I recommend trying to get as much magnesium as possible from food sources such as dark leafy greens, nuts and seeds that have been soaked and sprouted to reduce phytates, fish, avocados, and dark chocolate.
Protein makes up approximately 50% of the volume of bones, and one-third of the mass of bones. (18) Diets containing protein in the range of 1 – 1.5 g/kg of body weight per day are associated with normal calcium and bone metabolism, whereas intakes below 0.8 g/kg body weight per day are associated with reduced intestinal calcium absorption, and increased parathyroid hormone secretion, which causes calcium to be released from bone. (19) However, there is evidence that optimal protein intake specifically for bone health is likely higher than the current recommended intake outlined above. (20) I recommend consuming complete protein sources such as meat, fish, and poultry, as these contain the full spectrum of amino acids needed by the body. Plant sources of protein, such as grains and legumes, can be combined to offer the full array of amino acids, though these protein sources (especially legumes) can be more difficult to digest for many people and may cause irritation in people with gastrointestinal issues.
Flavonoids are naturally-occurring chemicals found in fruits, vegetables, and herbs. Research has found that flavonoids enhance bone formation, inhibit bone resorption, and influence the differentiation of cells involved in bone growth and maintenance. (21) Consuming a wide variety of brightly-colored plant foods can provide you with plenty of these beneficial compounds.
Colostrum is the first milk produced by mammals after they have offspring. Colostrum is rich in numerous growth factors, vitamins, and minerals. Research suggests that growth factors in bovine colostrum, which is widely available as a supplement, may enhance bone growth and development and facilitate bone repair. (22)(23) My favorite brand of colostrum is by Sovereign Laboratories, and can be purchased through the link below. To read more about the health benefits of colostrum, check out my previous blog post, Colostrum: An Ancestral Superfood for Modern Times.
Add prebiotics to your diet
An article published in the Journal of the American College of Nutrition has revealed that the inclusion of prebiotic fibers, a type of indigestible carbohydrates that feeds beneficial bacteria in the gut, in our diet can improve indices of bone health by influencing the gut microbiota. Beneficial bacteria in the gut mediate the absorption of calcium from foods in the diet. By fueling gut bacteria, prebiotic fibers improve intestinal absorption of calcium, which is needed to build resilient bones and promote optimal bone density. Healthy gut bacteria also stimulate growth of the intestinal mucosa, which increases the surface area of the intestine available for mineral absorption. (24)
Research has found that one year of consumption of short and long-chain inulin fructans (a type of prebiotic) by children increased their absorption of calcium and their whole-body bone mineral density. In a study of adolescent girls, consumption of a galacto-oligosaccharide prebiotic for three weeks led to increased calcium absorption as well as increased levels of Bifidobacteria in their intestines. The prebiotic appeared to help “fuel” the Bifidobacteria, which then proceeded to upregulate the processes that increase intestinal calcium absorption. Prebiotic fibers not only increase calcium absorption, but also increases calcium retention, which refers to the storage of calcium in bone. An appropriate level of calcium retention is crucial for maintaining the integrity of bone. Examples of prebiotic foods to include in your diet are garlic, onions, artichoke, asparagus, and chicory.
Improve your gut health
Finally, gut health is an essential foundation for nearly every aspect of health, including bone health. Studies suggest that dysbiosis, an imbalance of beneficial and harmful bacteria in the gut, may promote the development of osteoporosis by causing systemic inflammation, which has effects on bone growth and turnover. (25) Probiotic supplementation and an anti-inflammatory diet can help restore gut health and thus promote healthy bones.
To sum things up, here are my overall nutrition recommendations for bone health. Whether you are looking to prevent or treat low bone mass or osteoporosis, or simply maintain optimal bone mass, these nutrition recommendations should be a key part of your bone health strategy.
- Eat dark leafy greens, broccoli, bok choy, almonds, full-fat dairy, and bone-in fish for calcium
- Avoid excessive consumption of phytates (in grains, nuts, and seeds) and oxalates (in certain vegetables, nuts, and grains), as these inhibit calcium absorption and may adversely impact bone health.
- Get plenty of sun exposure to promote vitamin D production in your skin. Also, eat fatty cold-water fish and egg yolks for dietary vitamin D.
- Consume foods such as grass-fed ghee, butter, other full-fat dairy products, and natto for vitamin K2.
- Consume a citrus fruits, berries, broccoli, brussels sprouts, and red and green peppers for vitamin C.
- Consider supplementing with tocotrienols, or regularly consume red palm oil (if used in cooking, heat it very lightly to preserve the stability of the tocotrienols it contains).
- Get vitamin A from egg yolks, liver, and fatty fish such as salmon.
- Consume plenty of magnesium from dark leafy greens, soaked and sprouted nuts and seeds, dark chocolate, and avocados.
- Make sure you are meeting at least the daily recommended intake of protein for your body weight (1 – 1.5 g/kg body weight per day).
- Consume flavonoids, which are present in deeply-colored fruits and vegetables.
- Add prebiotic foods to your diet, as these increase the activity of beneficial bacteria in the gut that promote calcium absorption and retention. Prebiotic foods include garlic, onions, artichoke, asparagus, and chicory.