Bone Health.

Our body is constantly renewing its bone mass, but as we age, this process – like many other – slows down and we start to lose bone mass quicker than it can be replaced. This results in the overall reduction on bone mass. Peak bone mass is achieved between the ages of 30-35. Until then, the rate of bone breakdown and formation are equal and the body mass remains constant. As we get older, the rate of bone breakdown increases and eventually becomes greater than the rate of bone formation, at which point the bone mass begins to decline.

Osteoporosis, which means ‘porous bone’, is a common disease in which the bones gradually become weak and brittle, resulting in fractures, the most common of which are fractures of the hip, wrist and spine. Osteoporosis is a serious problem as it affects 1 in 3 women and 1 in 12 men over the age of 50. Low oestrogen levels, low calcium and vitamin D intake, lack of exercise, being underweight or overweight, excess alcohol consumption and smoking increase risk of osteoporosis development. Women are more prone to this disease with the onset of menopause, due to the lack of oestrogen, which plays an important role in maintaining bone mass. Hormonal imbalance disorders, such as hyperthyroidism (overactive thyroid) also increase the risk of osteoporosis development. People with gastrointestinal disorders, such as coeliac and Crohn’s disease are at risk too due to poor mineral absorption. It has been established that a diet rich in calcium, vitamin D and other key nutrients, combined with regular physical activity might help to maintain bone density and prevent osteoporosis from development.

The importance weight bearing exercise.

Perhaps the most important measure one can take to prevent osteoporosis is to exercise and maintain healthy weight. Weight bearing exercise such as jogging, walking, weight lifting and plyometrics help to build muscle, which is crucial for body weight support, as muscles help to reduce the strain on bones and joints. This helps to maintain and increase the bone mass.

Diet.

I will go against popular nutritional advise here and will not recommend dairy products. A lot of studies has been done recently to suggest that consumption of dairy does not provide adequate amounts of calcium, on the contrary – it hinders its absorption due to a particular protein found in dairy. This is a very large and controversial topic that deserves a separate post, so I won’t go into it now. Generally, a diet rich in low GI fruits (such as figs and plums), dark green leafy vegetables, oily fish, nuts, seeds and tofu should provide plenty of calcium, vitamin D and other vitamins, minerals and phytonutrients necessary for bone mass support.

  • Vitamin D sources: sunlight (in moderation), eggs (yolks), oily fish and seaweed. Many dairy alternatives, such as soy milk and vegetable spreads are fortified with vitamin D and calcium, but vegetarians and vegans should consider taking a supplement. D2 is a vegan variation of vitamin D.
  • Calcium sources: broccoli and other green leafy vegetables, sesame seeds and chickpeas (tahini and hummus are excellent), sunflower seeds, poppy seeds, almonds and other nuts. Tinned salmon and sardines with soft bones are good sources of both calcium and vitamin D, but it should be consumed in moderation.
  • Magnesium sources: dark green leafy vegetables, nuts (especially almonds), whole grains, very dark (sugar free) chocolate or cacao nibs, raw cacao powder, beans and lentils.
  • Vitamin K: green leafy vegetables are the best source. Go crazy on kale, spinach, spring greens, beet greens, etc.
  • Isoflavones: unprocessed soy products from non GMO soy, such as soy milk (unsweetened), tofu and tempeh, and soy beans are the richest sources. Processed soy products, such as vegetarian burgers, sausages, soy sauce and soy protein do not contain isoflavones. Legumes, such as chickpeas are also a good source.

Supplements for bone health.

  • Vitamin D deficiency greatly affects bone mass and lack of it is associated with increased risk of osteoporosis. In severe cases, vitamin D deficiency leads to rickets and osteomalacia (weak or ‘soft’ bones). Vitamin D works in synergy with calcium and  is crucial for its proper utilisation. It also maintains normal blood calcium levels. When levels of calcium in the blood decrease, vitamin D is converted into its active form – calcitriol. Calcitriol increases the absorption of calcium, stimulates the release of calcium from bone and decreases urinary excretion of calcium.  This is why taking just calcium on its own is not enough for bone health. Vitamin D plays a role in many other processes in the body and has recently been associated with longevity. Although the typical recommended dose is 1000iu, it is beneficial to take up to 4000iu of vitamin D3 per day.
  • Calcium is a major component of bone in the form of calcium phosphate salt called hydroxyapatite. Evidence suggests that bone mass gain and loss is related to calcium intake. Taken together with vitamin D, calcium supplementation has demonstrated in clinical trials to reduce the risk of fracture and bone loss and reduce the risk of osteoporosis. 700 to 1200mg of calcium bisglycinate daily is a good amount to take or 1800mg of calcium citrate.
  • Magnesium is an important structural component of bone, that plays a role in bone mineral metabolism. Inadequate level of magnesium in blood is known to result in low levels of calcium and negate some vitamin D actions. 300 to 500mg of magnesium oxide a day is enough.
  • Boron also plays a role in mineral metabolism. It affects calcium, phosphorus and vitamin D. It also affect oestrogen and testosterone, which influence bone turnover. It must be in amino-acid chelate form and 2mg daily is enough.
  • Vitamin K is involved in the conversion of inactive osteocalcin to its active form. Osteocalcin is the major non-collagen protein in bone, which helps to attach calcium molecules to the protein bone matrix.
  • Hormones. Isoflavones (phytoestrogens) are plant compounds that mimic oestrogen in the body. They are found in large quantities in soy and are particularly beneficial for women with reduced oestrogen levels after the menopause. Those allergic to soy, can take Red Clover, Black Cohosh or Kudzu root supplement. One might also consider taking hormones such as DHEA and Melatonin after the age of 40.
  • Copper supports mineral density and is required for copper-dependent enzyme – lysyl oxidase –  to work in order to support collagen structure within a bone. Copper sulphate is best, 1.5mg daily.

Any good bone support formula would include all of the above nutrients, apart of isoflavones, which can be taken separately. Calcium, magnesium, copper and boron should be amino-acid chelated for better absorption or in the form of citrates, picolinates or aspartates.

Other good supplements to consider for maintaining none health: Zinc (citrate) – 12mg, Manganese (citrate) – 3mg, folic acid – 200mcg, TMG (tri-methyl-glycine) – 100mg, vitamin B6 – 15mg, silica 200mg and an amino-acid L-Lysine, which can be obtained by eating protein.

Although supplements are best taken with food, sertain fibers might inhibit mineral absorbtion. Make sure that you do not take any supplement for bone health while eating foods containing wheat bran, psyllium, guar gum and pectin. It is also best to take mineral supplements before bedtime as calcium and magnesium promote sleep.

Things to avoid.

  • Large doses of preformed vitamin A (over 5000iu/1500mcg a day) for a prolonged period of time are associated with an increased risk of osteoporosis, fractures and decreased bone mineral density. It is best to supplement with beta-carotene instead and avoid any liver products, including cod liver oil.
  • Consumption of cola and other carbonated drinks has been associated with bone loss due to the content of phosphoric acid and caffeine. High phosphate levels in the blood reduce the formation of the active form of vitamin D (calcitriol).
  • Caffeine is diuretic, thus excessive caffeine (and other diuretics) consumption may result in urinary loss of calcium and other nutrients.
  • Too much or too little protein.  While the adequate intake of protein is very important for general health and bone density, especially for active people, too much protein increases urinary excretion of calcium, which lowers overall calcium levels in the body. Low protein intake can also be negative for bone health, since protein is needed for healthy muscles, that reduce the strain on bones and joints.
  • Smoking and tobacco products.
  • Red meat, because eating aminal protein has been linked with the development of osteoporosis. This hase been noted in one of the biggest osteoporosis research groups ever, with 85.000 participants.

Other things to avoid or reduce are alcohol and sugar.

It is important to prevent osteoporosis, because once it is occurs – it is extremely difficult and costly to treat.

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