“But I have always taken my calcium and vitamin D! Why do I have osteoporosis? “
This is what I often hear from frustrated and disappointed women who have just been told about the results of their declining bone density measurements. The misconception here is that there are only a small number of important bone nutrients.
In reality, there are at least 20 nutrients that are directly essential for the development and maintenance of healthy bones. If even one of these nutrients is in short supply, bone health will suffer and attaining optimum bone health will be impossible.
How to start boosting bone nutrition
Building stronger bones is a journey. Where do you start? To help you start to increase your intake of bone nutrients, I narrowed the 20 key bone-building nutrients to the 7 most important ones that you can start working on through your diet or through a supplement. The chart below describes what the bone nutrients are needed for, good food sources, and details on the amount of this nutrient you should consume every day.
If you want to read more about these nutrients and more, you see my article here. And, because so many of you have asked for a supplement with extra calcium and magnesium, I’ve reformulated my Better Bones Basics with more of each, plus optimal amounts of the other key nutrients.
Learn more about all 20 key bone nutrients as researched by Dr. Susan Brown
Click each nutrient to see what she has written on each one!
Heaney, R., & Weaver, C. 2003. Calcium and vitamin D. Endocrinol. Metab. Clin. N. Am., 32 (1), 181–194, vii–viii. URL (abstract): http://www.ncbi.nlm.nih.gov/pubmed/12699298 (accessed 05.20.2008).
Brown, S. 2008. Vitamin D and fracture reduction: An evaluation of the existing research. Alt. Med. Rev., 13 (1), 21–33. URL (PDF): http://www.thorne.com/altmedrev/.fulltext/13/1/21.pdf (accessed 05.22.2008).
Holick, M. 2006. High prevalence of vitamin D inadequacy and implications for health. Mayo Clin. Proc., 81 (3), 353–373. URL: http://www.ncbi.nlm.nih.gov/pubmed/16529140 (accessed 05.13.2008).
Hanley, D., & Davison, K. 2005. Vitamin D insufficiency in North America. Symposium: Vitamin D Insufficiency: A Significant Risk Factor in Chronic Diseases and Potential Disease-Specific Biomarkers of Vitamin D Sufficiency. J. Nutr., 135 (2), 332-337. URL: http://jn.nutrition.org/cgi/content/full/135/2/332 (accessed 05.13.2008).
Holick, M. 2005. The vitamin D epidemic and its health consequences. J. Nutr., 135 (11),2739S–2748S. URL: http://jn.nutrition.org/cgi/content/full/135/11/2739S (accessed 05.13.2008).
Bischoff–Ferrari, H., et al. 2007. Calcium intake and hip fracture risk in men and women: A meta-analysis of prospective cohort studies and randomized controlled trials. Am. J. Clin. Nutr., 86 (6), 1780–1790. URL (abstract): http://www.ncbi.nlm.nih.gov/pubmed/18065599 (accessed 06.17.2008).
Steingrimsdottir, L., et al. 2005. Relationship between serum parathyroid hormone levels, vitamin D sufficiency, and calcium intake. JAMA, 294 (18), 2336-2341. URL: http://jama.ama-assn.org/cgi/content/full/294/18/2336 (accessed 06.17.2008).
Dawson–Hughes, B., et al. 1997. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. NEJM, 337 (10), 670-676. URL: http://content.nejm.org/cgi/content/full/337/10/670 (accessed 06.17.2008).
Dawson–Hughes, B., et al. 1990. A controlled trial of the effect of calcium supplementation on bone density in postmenopausal women. NEJM, 323 (13), 878–883. URL: http://www.ncbi.nlm.nih.gov/pubmed/2203964 (accessed 05.13.2008).
Brown, S. 2006. “Bone nutrition.” In Scientific Evidence for Musculoskeletal, Bariatric, and Sports Nutrition, ed. I. Kohlstadt, p. 458. Boca Raton, FL: CRC Press.
Knapen, M., et al. 2007. Vitamin K2 supplementation improves hip bone geometry and bone strength indices in postmenopausal women. Osteoporos. Int., 18 (78), 963–972. URL: http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=17287908 (accessed 05.14.2008).
There are so many nutrients that contribute to bone health, but one that fascinates me is a form of Vitamin K2 called MK-7. This “super nutrient” is found in select foods and is a great compound to help improve bone health and — as more and more research shows — heart and arterial health.
MK-7 rivals bone drugs — without the toxicity
First, let’s talk about MK-7 for bone. A study last year (Zhu et al, 2017) found that MK-7 stimulates bone tissue and osteoblast precursors; so clear-cut are the effects that one Canadian researcher (Schwalfenburg 2017) noted that vitamin K2 “may be a useful adjunct for the treatment of osteoporosis, along with vitamin D and calcium, rivaling bisphosphonate therapy without toxicity.”
Notwithstanding my own perspective on whether bisphosphonate therapy is effective, this is a pretty extraordinary statement for a medical researcher to make!
MK-7 for healthy hearts and arteries
The benefits of MK-7 for reducing arterial hardening and cardiovascular disease are being explored by researchers at the same time. The results so far have been extremely encouraging.
As a recent three year clinical trial using 180 mcg of MK-7 reported, “long-term use of MK-7 supplements improves arterial stiffness in healthy postmenopausal women, especially in women having a high arterial stiffness” (Knapen et al., 2015). More recently, a 2017 study in kidney transplant patients — who commonly suffer from vitamin K2 deficiency — found that 8 weeks of MK-7 supplementation reduced arterial stiffness (Mansour et al. 2017).
As the Zhu study of MK-7’s effects on bones noted, MK-7 assists calcium in becoming mobilized out of the blood vessels and into the bone. Less calcium build up in blood vessels can mean less arterial stiffness. Vitamin K, it turns out, is crucial to as many as 17 different proteins that maintain bone and cardiovascular health (Wen et al., 2018).
Vitamin K2 requires a healthy microbiome to thrive
But there’s another interesting facet to this story. Another 2017 study (Ponziani et al., 2017) showed that people with small intestinal bacterial overgrowth had higher risk of arterial stiffness.
Here’s the thing: Vitamin K2 is produced by our intestinal bacteria, and a healthy microbiome will produce enough to support both bone and heart health. People with bacterial overgrowth, however, have altered vitamin K2 metabolism. That is, the body’s microbiome can’t produce what’s needed to maintain health if the gut is experiencing bacterial overgrowth.
Where to find vitamin K2
So let’s suppose you want to increase your vitamin K2 supply, and you’re not sure whether your microbiome is up to the task. Where do you look for a booster of K2?
One simple answer: Cheese.
Long-chain menaquinones like MK-7 are quite often found, in the Western diet, in true aged cheese, particularly hard cheeses like cheddar or Swiss, which are richer in menaquinones than soft cheeses. However, as one researcher notes, “the actual menaquinone content varies substantially and is dependent on the type of cheese, the time of ripening, the fat content and the geographic area where the cheeses are produced” (Vermeer et al., 2018).
With vitamin K status as a risk factor for cardiovascular disease and osteoporosis, for those who can handle dairy, cheese (and also yogurt) can prove a valuable adjunct to maintaining heart- and bone-supporting vitamin K2 status.
If dairy is not something you can tolerate, look at fermented vegetable foods like natto, sauerkraut, kimchee, and the like. Just as the bacteria in your gut produce vitamin K2, the bacteria in fermented foods do the same. Additional high quality, natural MK-7 is available as a high quality nutrient supplement.
Knapen MHJ, Braam LAJLM, Drummen NE, et al. Menaquinone-7 supplementation improves arterial stiffness in healthy postmenopausal women: double-blind randomised clinical trial. Thromb Haemost 2015; 113(05): 1135-1144.
Mansour AG, Hariri E, Daaboul Y, et al. Vitamin K2 supplementation and arterial stiffness among renal transplant recipients—a single-arm, single-center clinical trial. J Am Soc Hypertens 2017;11(9): 589-597.
Ponziani FR, Pompili M, Di Stasio E, et al. Subclinical atherosclerosis is linked to small intestinal bacterial overgrowth via vitamin K2-dependent mechanisms. World J Gastroenterol 2017;23(7):1241-1249.
Vermeer C, Raes J, van’t Hoofd C, Knapen MHJ, Xanthoulea S. Menaquinone content of cheese. Nutrients 2018;10: 446; doi:10.3390/nu10040446
Wen L, Chen J, Duan L, Li S. Vitamin K‑dependent proteins involved in bone and cardiovascular health (Review). Mol Med Rep 2018;1:3–15. DOI: 10.3892/mmr.2018.8940
Schwalfenburg GK. Vitamins K1 and K2: The emerging group of vitamins required for human health. J Nutr Metab 2017: 6254836. DOI: 10.1155/2017/6254836.
Zhu M, Ma J, Lu S, Zhu Y, Cui Y, Tan H, Wu J, Xu Y. Vitamin K2 analog menaquinone-7 shows osteoblastic bone formation activity in vitro. Biomedical Research 2017; 28 (3): 1364-1369.
One thing we know about bone is that it responds to increased weight load by getting stronger. So the recent findings of an Australian bone clinic that studied women doing high-intensity weight lifting really shouldn’t surprise us. But just look at these results!
What happens when older women weight lift?
The clinic studied 101 postmenopausal women with a T score below –1; 44 were classified as having osteoporosis and the remaining 57 were considered to have osteopenia. A bit more than one-fourth of them had already had a fracture.
The women were divided into two groups, experimental and control; they exercised twice a week for at least 8 and up to 12 months, but the kinds of exercise they did were different. For the control group, a low-intensity, home-based exercise regimen that emphasized balance and mobility, but not heavy weight loading, was used. They did lunges, calf raises, and stretches with no more than 3-kg weights in their hands — common types of exercises recommended for older women seeking to maintain fitness and bone strength.
The experimental group, on the other hand, underwent supervised, 30-minute sessions of high-intensity resistance training at 80–85% of the “1 rep max” weight — that being the weight they could only lift only once with maximum effort. The exercises included deadlift, overhead press, and back squat along with jumping chin-ups with drop landings. These types of exercises are not usually recommended for older women, and prior studies of weight-bearing exercise for bone mass improvement used moderate loads rather than high loads, as in this study.
The bigger the load, the stronger the bone
The study’s results were striking:
• The high-intensity group gained an average of 2.9% BMD in the lumbar spine, while the control group lost an average of 1.2%.
• The high-intensity group gained on average 0.3% BMD in the femoral neck, while the control group lost on average 1.9%.
• The high-intensity group gained 13.6% femoral neck cortical thickness, while the control group lost 6.3%.
Some of the individual outcomes were truly amazing. One 59-year-old-woman who trained for a total of 12 months saw an increase of 10.5% in the hip and 8.8% in the lumbar spine!
I just heard about even more record-breaking gains from “C.F.” — one of our clients. Motivated to find a way to reverse her ongoing bone loss, C.F. — a 67-year-old woman — combined our Better Bones, Better Body Program with supervised high-intensity strength training. In just 1.5 years she gained a whopping 21.5% in the neck of the hip, 10% the total hip and 5.6% in spine — moving her totally out of the osteoporosis category! Her doctor was so astonished she called me to ask what we were doing. This is a bone density gain that is unprecedented and we will soon be make available to you the details of our client’s full program.
The benefits of high-load weight lifting for older women
Given that we’ve known for years that bone responds to the load placed on it, why hasn’t high-load weight lifting ever been looked at before in women?
As the authors of this study point out, it’s a common misconception that women with low bone mass risk developing spinal fractures if they use heavy weights or free-weight exercises — but this study shows that isn’t true. Only one woman in the study had any sort of injury — a mild muscle strain in her lower back that probably occurred from an error in technique (which is very important in free-weight lifting) rather than the amount of weight she used. Keep in mind, these women were carefully taught the proper form for lifting and highly supervised. Should you try a high-intensity resistance program yourself, be sure to work with a qualified training.
What all this tells us is that even in women who are actively losing bone, high-intensity weight-bearing exercise offers more benefits in reversing the trend than low- or moderate-load weight-bearing exercise.
At the Center for Better Bones, we view exercise as an important part of a natural approach to building and strengthening bone. Learn about our Better Bones, Better Body Program to find out how you can start building serious bone naturally.
Watson SL, Weeks BK, Weis LJ, et al. High-intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis: The LIFTMOR Randomized Controlled Trial. Journal of Bone and Mineral Research 2018; 33(2): 211–220. DOI: 10.1002/jbmr.3284