Can You Eat Your Way to Stronger Bones?
All the bones inside a living body are continually being broken down and rebuilt. In fact the entire human skeleton is replaced about every ten years. In view of this turnover, what is the role of diet and nutritional supplements in supporting bone strength? Which vitamins, minerals and other nutrients are essential for good bone health? In addition to exercise there are about 20 different nutrients that important to maintain bone health and strength. What foods and supplements are best sources?
Calcium and Vitamin D – Nutrients Working Together
Research shows that adequate intake of both calcium and vitamin D is absolutely essential to strengthen bones and thereby reduce the risk of fractures.
Andrea Singer, M.D., clinical director, National Osteoporosis Foundation, stated in a recent magazine article that getting enough vitamin D through food and sunlight alone can be a difficult challenge. The risk of deficiency is especially critical in the farther northern latitudes during winter months. Dr. Singer notes that a supplement may be necessary, especially then, for some people to bridge the nutrition gap. To optimize absorption, she recommends that you take the full amount of vitamin D supplement all at once with your largest meal of the day. In a recent study at Cleveland Clinic researchers found that such supplemental intake helped boost blood levels up to 50%, even for previously absorption-resistant subjects.
According to a 2016 position paper from the National Osteoporosis Foundation, calcium has the strongest research evidence of all nutrients for its role in supporting healthy bones. With calcium, Dr. Singer states that while it may be good to get the nutrient through food sources, the daily recommendation can be problematic to reach through dietary intake alone. You may wish to consider a calcium supplement here also to make up any shortfall. If so, just remember: with this nutrient, it is always better to take half of your supplement with breakfast and the rest at lunch since it may be difficult otherwise for your body to absorb the full amount all at once.
Intake Recommendation – Vitamin D
at least 600 I U daily (vitamin D3 is the preferred form for supplement) if you are under 70 years old or 800 to 1000 I U if you are older. There is, however, currently some controversy about this calculation by the Institute of Medicine. A 2014 Canadian analysis and a 2015 study by U. S. experts, both published in Nutrients, report a statistical error in the original calculation and suggest that the current recommendation may be too low. For certainty, consider asking your doctor to test your vitamin D blood level. It should be at least 32 ng/ml to support good bone health.
Intake Recommendation – Calcium
women: 1000 mg/day until menopause or 1200 mg afterwards; men: 1000 mg until age 71 or 1200 mg afterwards
For best results remember, too, when you consume calcium, there should also be vitamin D present at the same time. The two work together synergistically. Components of one increase the benefit of the other. Vitamin D helps your body better absorb and utilize the bone-boosting calcium. Without vitamin D, less than 10% of the consumed calcium is actually absorbed.
Be sure, also, to read the nutrition label on food packages. This way you can check the level of fortification and/or enrichment with both of these nutrients. Remember: Not all versions of the same edible are “created equal“ when it comes to calcium and vitamin D enhancements.
— See sidebar for good sources of calcium and vitamin D and also for high-quality nutrition supplements —
Magnesium
Magnesium is incorporated into the structure of bone, giving resiliency and protecting against fractures. It is also essential for converting vitamin D to its active form in the body. If you include a calcium and vitamin D supplement, be sure to take a magnesium supplement too. High calcium intake causes increased magnesium loss.
Sources of Magnesium
Excellent food sources for magnesium include nuts, seeds, leafy green vegetables, whole grains and legumes.
Intake Recommendation
310 mg/day for females ages 19 to 30 years or 320 mg/day for females 31 and older (including those who are lactating); 350 – 400 mg/day during pregnancy; 400 mg/day for males ages 19 to 30 years or 450 mg/day for males 31 and older
Another Powerful Pair of Nutrients – the B Vitamins: Folate (B9) and Cobalamin (B12)
Vitamin B12 and folate nutrients work together to support bone health by helping to control the synthesis of homocysteine, a compound that stimulates the breakdown of bone. Research shows a clear link between a high level of homocysteine and risk of osteoporosis in older adults.
Sources of Folate
Best sources of folate include leafy green vegetables, broccoli, asparagus and legumes
Intake Recommendation – Folate
400 mcg/day for females (600 mcg during pregnancy; 500 mcg when lactating) and 400 mcg/day for males
Sources of Vitamin B12
For best intake of Vitamin B12 consume plenty of meat, fish and other animal products. Fortified foods including breakfast cereals and nutritional yeast can also make a significant contribution.
Intake Recommendation – Vitamin B12
2.4 mcg/day for females (2.6 mcg during pregnancy; 2.8 mcg when lactating) and 2.4 mcg/day for males
Vitamin K
Vitamin K, renowned mostly for its role in blood clotting, also helps the body to synthesize the protein needed for healthy bone formation. It has a role, too, in regulating calcium in the body by keeping the mineral in bones and out of arteries. Proteins from vitamin K, which are found in bones, work closely with calcium to help promote bone mineralization. Although vitamin D is the main generator of bone-forming cells, vitamin K is crucial in binding these cells together and mineralizing the bond. Not only does it strengthen the bones, but it also helps prevent bone fractures. Women with adequate daily intakes of vitamin K are less prone to osteoporosis and bone fractures later in life.
Vitamin K Research
A recent study compared the effects of vitamins D and K on calcium absorption. Researchers discovered that the two actually work together in a complementary way. Vitamin D appears to stimulate absorption of calcium in the gut. Vitamin K seems to reduce the amount of calcium subsequently excreted during digestion. Combining all three nutrients together for intake at the same time probably offers the very best opportunity for optimal bone health.
Individuals who are vitamin K deficient have repeatedly proven to have a greater risk of bone fracture. The Nurses’ Health Study followed more than 72,000 women for 10 years. The study found that those whose vitamin K intakes were lowest had a 30 percent higher risk of hip fracture than those with the highest vitamin K intakes. Eating a serving of lettuce or other green, leafy vegetable daily cut the risk of hip fracture in half when compared with eating only one serving a week.
Another study included more than 800 elderly men and women participating in the Framingham Heart Study. Researchers found that participants with the highest dietary vitamin K intakes had a 65 percent lower risk of hip fracture than those with the lowest intakes. They found no association, though, between dietary vitamin K intake and bone mineral density.
Sources of Vitamin K
There are two ways to obtain vitamin K. First, some foods contain preformed vitamin K. These food sources include green leafy vegetables like kale, spinach and green leaf lettuce or cruciferous vegetables like Brussels sprouts, broccoli or cabbage as well as fish, meat and eggs (in small amounts). Such foods contain a form of vitamin K called K1 that is the most active form. Second, the bacteria that live in our gut also make some vitamin K in a form called K2, which is slightly less active than K1. Vitamin K2 helps prevent calcium from depositing in arteries (the process of atherosclerosis) and instead directs more calcium to bones, where it helps bind the mineral to the skeleton.
You can meet your need for vitamin K with foods like kale, onions/scallions, Brussels sprouts, broccoli, cabbage, Swiss chard, spinach, collards, soybeans and edamame, asparagus, leeks, okra and pickles/cucumbers. Other good sources include blueberries, wheat bran, olive/soy/canola oils or dried fruits such as prunes. K2 is found in natto (fermented soybeans), cheese, grass-fed meat and liver. Also consider amping up your favorite recipes with vitamin K-rich herbs and spices. Include basil, thyme, parsley and chili powder for a flavor boost.
Intake Recommendation
90 mcg/day for females (including those who are pregnant and lactating) and 120 mcg/day for males
CAUTION!
If you take anticoagulant drugs, do not take vitamin K supplements or increase your dietary intake without consulting your doctor beforehand.
Potassium
Potassium may be more so known for facilitating communication between muscles and nerves or for removing cellular waste. It turns out, though, that the mineral also seems to have a significant role in aiding bone health. It neutralizes certain acids that would otherwise remove bone-building calcium from the body.
Sources of Potassium
Load up on potassium by eating foods like sweet potatoes, white potatoes (including their skins), orange juice and other citrus fruits, bananas, fruits from vines (blackberries, grapes, cantaloupe, honeydew melon), apricots, figs and dates, prunes and raisins. Frequently include milk and yogurt, seafood (clams, halibut, tuna, rockfish, cod), tomato juice or sauce, beans (white/kidney/lima), chickpeas, lentils, split peas, root vegetables (carrots, beets, turnips), winter squash, avocados and greens such as spinach, beet greens and Swiss chard.
Intake Recommendation
adults (18 years and up) 4700 mg per day, breastfeeding women 5100 mg/day
Creatine
In recently published nutrition research (August, 2015) D. Chilibeck based his study on 47 postmenopausal women between the ages of 50 and 64. He suggests that supplementation with creatine combined with resistance training may result in significant improvement in bone density. More research is currently underway to determine the effectiveness of this approach. There are not yet any valid studies on long-term side effects of creatine supplementation. Before you jump onto the creatine bandwagon, you might want to follow future research developments as they unfold.
Sources of Creatine
Strictly speaking, creatine is not an absolutely essential nutrient. About half of the creatine in the human body is endogenously produced, synthesized in the kidney, liver and pancreas from the amino acids glycine and arginine. Creatine is mainly stored in muscles, but about 1.5 to 2% of the body’s creatine is converted to creatinine daily.
The other half of creatine in the human body comes from dietary sources at a rate of about 1 gram per day from an omnivorous diet. Wild game is considered to be the richest source of creatine, but lean red meat and fish (particularly herring, salmon and tuna) are also good sources. Some small studies suggest that total muscle creatine is significantly lower in vegetarians than non-vegetarians, as expected, since vegetables are not a primary source of creatine. Subjects from both populations, though, do show the same levels after using supplements.
Creatine supplementation became popular in the 1990s for enhancing athletic performance and building lean body mass. Supplements are commonly sold as powders; however, liquids, tablets, capsules, energy bars, fruit-flavored chews, drink mixes and other preparations are also available.
Intake Recommendation
The following supplement doses have been studied in scientific research with adult subjects:
- For athletic performance (by mouth): Many different dosing regimens have been used; however, most use a short-term “loading dose” followed by a long-term maintenance dose. Loading doses are typically 10 to 35 grams daily for 4 to 10 days. Maintenance doses are typically reduced afterward to 2 to 9 grams daily.
CAUTION!
Certain drugs, including diabetes medications, acetaminophen and diuretics, can have dangerous interactions with creatine. Combining the stimulants caffeine and ephedra with creatine can increase the risk of side effects.
Creatine supplementation is not recommended for people with diabetes or with kidney or liver disease. Others who should avoid taking it are children under age 18 and women who are pregnant or breast feeding. Do not use creatine if you are taking any medication or supplement that could affect your blood sugar.
Be aware: Creatine causes muscles to draw water from the rest of your body. If you take creatine supplements, be sure to drink extra water to avoid dehydration. Also, if you are taking creatine, do not exercise in the heat.
No matter how healthy you are, always let your doctor know before you take creatine or any other supplement.
Probiotics
Early research suggests that probiotics, too, may help to prevent bone loss. According to Clifford Rosen, M. D., director at Center for Clinical and Translational Research at Maine Medical Center, a supplement with at least 1 billion CFUs of lactobacillus is likely to be beneficial.
Conclusion
Whether you opt to include nutrition supplements, to seek out fortified foods or simply to increase your intake of nutrients from conventional food sources, the choices you make today will have an impact on your bones for years to come.