Healthy bones make us strong and independent. Bone loss puts us at risk for fractures, disability, and an end to our freedom.
My grandma Lois was very active and independent into her 90s, until she fell, fractured her pelvis, and was never able to walk again, spending the last year of her life bed-bound in a nursing facility with round-the-clock care. This proud and independent woman that I loved was miserable over the last year of her life. I felt awful seeing how her life ended.
The reality is that with the right nutrients we should be able to avoid this type of life-ending tragedy.
Thanks to the dairy industry, most of us have been taught that calcium is the essential nutrient we must get for strong bones. Yet, calcium is easy to get with or without milk, and if you only meet your calcium needs, that would be inadequate to prevent bone loss and a potentially disabling fracture. Other nutrients are likely more essential.
Vitamin D is my number 1 bone nutrient. Without vitamin D, we do not absorb calcium from food nor are we able to incorporate it into bone. We won’t get adequate vitamin D from food alone, nor from drinking milk (unless you drink about 20 cups per day). We could get our vitamin D from the sun if we spent 1 hour per day wearing skimpy swim attire in mid-day sun in latitudes south of Atlanta, Dallas, and Santa Barbara, although we would also get a sunburn and skin damage at the same time.
For 100,000 years most of us got enough sunshine as hunter-gatherers to make enough vitamin D, but over the last centuries as we shifted to wearing clothing and living indoors, getting enough vitamin D from the sun has made this unrealistic for most of us. Most people need to take at least 2000 IU of vitamin D (preferably in the form of Vitamin D3) daily to meet their needs, and some people may need 3000 to 5000 IU every day.
At some point, all of us should check our vitamin D level with our medical provider to ensure we have an adequate level. Blood levels of 5-hydroxy vitamin D are considered to be deficient when they are below 30 nanograms/milli-liter (ng/mL), but an optimal level should be in the 40 to 60 range.
People with low vitamin D levels are not just at increased risk for bone loss and fractures, they are also at an elevated risk for cancer, auto-immune disease, severe infections, heart disease, fibromyalgia, and dementia.
We do need calcium, and fortunately it is found in a variety of foods. Yes, you can get it from dairy products, but many vegans meet their calcium needs without drinking milk. Green leafy vegetables are an excellent source of calcium, as are beans, nuts, seeds, and whole grains. There are also a variety of calcium-fortified foods, such as soy milk, almond milk, orange juice, coconut yogurt, etc that are great calcium sources.
How much calcium you need varies greatly. The most crucial factor that modifies your calcium need is your acid and alkalinity intake from other foods. People who eat excess amounts of animal protein and grains unintentionally consume lots of acid which pulls calcium from their bones to keep blood acidity neutral. People who eat an abundance of vegetables, fruits, beans, and nuts consume alkalinity, which helps keep calcium in their bones. If at least one-half and hopefully two-thirds of your food consist of vegetables, fruits, beans, and nuts, that is just right. Otherwise, you will need additional calcium intake.
Adding daily exercise (weight-bearing activities like walking and strength training) also keeps calcium in your bones. With inactivity, bones release calcium.
Tobacco use, soda consumption, and excess salt and alcohol intake also cause you to lose calcium.
Calcium needs vary from the WHO recommendation of at least 500 mg daily to other groups that recommend 1000 to 1200 mg daily. Best is to get your calcium from food as it is better absorbed than most supplements, and food sources of calcium do not block other nutrient absorption.
The most common calcium supplement, calcium carbonate, is very poorly absorbed and can cause constipation. The best calcium supplements are bound to protein, such as calcium malate or a chelated form of calcium as they are better absorbed, and they do not cause constipation.
One of the unfortunate myths is that antacids like Tums are a useful source of calcium for your bones. Yes, they are made of calcium carbonate (a source of calcium), but not only is the calcium in calcium carbonate poorly absorbed, you need stomach acid to absorb calcium into your bloodstream. The combination of anti-acid and poor absorption means that you do not absorb much calcium from antacids.
One additional caution with calcium supplements is that they block magnesium absorption. If you take calcium in supplement form, you need to ensure that you take a magnesium supplement as well. Most experts in nutrition recommend a 2:1 to 3:1 calcium to magnesium supplement intake. For example, if you are taking an extra 600 mg of calcium daily as a supplement, you should be taking 200 to 300 mg of magnesium as well.
Magnesium is a mineral that makes your bones strong and your teeth hard. Magnesium helps your body absorb calcium (despite that, calcium can block magnesium absorption) and magnesium helps convert vitamin D into its most powerful and active form.
Magnesium is rich in seeds, nuts, green leafy vegetables, beans, and dark chocolate. Yet nearly 70% of people do not get their recommended 400 mg daily.
Magnesium is essential for many other functions. It lowers blood pressure and blood sugar to healthy levels. It helps you avoid constipation, muscle cramps, and migraine headaches. It prevents serious cardiac arrhythmias and is involved in hundreds of essential reactions within the body. In published research from my clinic, meeting your magnesium needs was also one of the best predictors of shrinking arterial plaque over time.
In my clinic, most of my patients needed to take a supplement with at least 100 to 200 mg of magnesium daily to meet their needs, even once they had been advised what foods to eat—meeting their needs just did not seem realistic without a supplement. The most common magnesium supplement is magnesium oxide, which in some people acts as a GI irritant. I much prefer protein-bound forms of magnesium that are easy on your digestive system and very well absorbed, such as magnesium glycinate, magnesium malate, or chelated forms of magnesium.
Vitamin K helps to keep calcium stored in bones and out of your arteries. People who are vitamin K deficient (sadly most Americans) gradually shift calcium from their bones to their arteries.
The best source of vitamin K from food is dark green leafy vegetables (such as kale, broccoli, Swiss chard, and beet leaves yet please be aware that Iceberg lettuce does not count). 1 cup a day provides a wonderful source of this essential nutrient. There are two forms of vitamin K. K1 found in green leafy veggies and K2, which the body converts from K1. (You can also get vitamin K2 from some foods such as Natto and fermented cheese, but it is very difficult to obtain enough K2 from food to make a clinical difference.)
For people with advanced bone loss (osteopenia and osteoporosis, and in particular people with a previous bone loss related fracture), they can benefit from taking a vitamin K supplement with the most active form of vitamin K, which is K2, in particular a form of K2 called MK-7 (menaquinone-7), with a dosage of 100 to 200 mcg daily.
People who take statin medications to lower their cholesterol likely do so without realizing that statins block the conversion of vitamin K1 to K2. I recommend that people who are taking a statin medication should also take a vitamin K2 supplement daily. (Some multivitamins and vitamin D supplements also provide Vitamin K2.)
Zinc is an essential mineral that helps form protein threads that bind calcium and phosphorus together, like the steel used in concrete buildings. Zinc also improves calcium absorption. Good sources of zinc are beans, seeds, nuts, animal protein, and whole grains, and you can also meet your zinc needs from a good multivitamin.
Other Bone-Supporting Nutrients
There are a variety of other bone supporting nutrients that are essential to your bones, including Phosphorus, Manganese, Vitamin C, Strontium, Chromium, Silica, Copper, Potassium, Vitamin A, B vitamins, and Boron. Fortunately, you can meet your needs for most of these essential nutrients by following a Mediterranean Diet and by taking a good quality multivitamin daily.
As mentioned, the combination of the right nutrients with daily activity is the key to strong bones for your lifetime.
I wish you the best of health!
Steven Masley, MD, FAHA, FACN, CNS
My favorite sources of the following nutrients:
- Calcium (Osteoforce)
- Vitamin D
- Magnesium (glycinate, malate, or chelate)
- Vitamin K2
- Good quality multivitamin with zinc and many of the essential bone supporting nutrients
Please share these blogs with your friends and family!
Send them this link to sign-up to receive my blog posts: www.drmasley.com/