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PART 2: HOW TO EAT FOR STRONGER BONES (AND OTHER FACTORS THAT IMPROVE BONE HEALTH)
We are now into part 2 of The Complete Guide To Strong Bones.
In part 1, we covered all about healthy bones, osteopenia and osteoporosis. From how our bones work to what comprises strong bones (density and quality), why bones become weaker and how to test bone strength. If you haven't already, make sure to check out Part 1: What You Need To Know To Get Stronger Bones before continuing with this section.
We also established that bones do get weaker and lose density as we get older. However, loss of bone strength is NEVER due to aging alone! There are always other factors beyond age contributing to weaker bones, which you can take control over. Meaning, there are many things you can do to improve your bone strength and prevent fractures.
In this part (part 2), we will cover factors that may be putting you at risk of weaker bones. What factors to do more of (or start doing) to improve your bone health, and we will cover all about nutrition for stronger bones (including all about the different vitamins and minerals), which, as you'd know, is so important in good bone health.
As with anything health-related, improving your bone strength does take some time and work. However, once you get the hang of what's required, it all becomes much easier.
Take your time going through this part and implement the strategies best you can to improve your bone strength and help prevent any fractures.
Now, let's get into it!
WHAT WE’LL BE COVERING IN PART 2:
WHAT YOU SHOULD CHANGE FOR STRONGER BONES STRENGTH
HOW TO GET STRONGER BONES - HOW TO PREVENT BONE LOSS AND FRACTURES NATURALLY
NUTRITION: EATING FOR STRONGER BONES
KEY NUTRIENTS FOR STRONGER BONES (MICRONUTRIENTS)
6 BEST FOODS FOR STRONGER BONES
WHAT YOU SHOULD CHANGE FOR STRONGER BONES
CAUSES OF WEAKER BONES
The first step towards improving your bone health (and your health) starts with making some necessary lifestyle changes.
Before we cover what healthy habits are beneficial for bones that you should be doing more of, let’s look at some factors that may need to be stopped (or limited) first that are putting your bones at risk.
Some of these factors are more obvious, such as smoking or excessive alcohol consumption, while others are less known, like caffeine, stress, and even certain foods.
Let’s now look at these factors to cut out or limit.
SMOKING (TOBACCO) & EXCESSIVE ALCOHOL CONSUMPTION
I’m sure it’s no surprise that there is a clear link between cigarette smoking and excessive alcohol consumption, and reduced bone density. There is also a clear link between these factors and an increase in fractures. [1 - 4]
If you do smoke or drink in excess, this step should be the first priority to improve your health and your bone strength.
Quitting these habits, especially after some time doing them, can be difficult, but it is not impossible. There are many successful plans out there that can help, which you can speak to your doctor about.
EXCESSIVE CAFFEINE
A daily cup of coffee is something enjoyed by many!
Coffee contains small amounts of many essential nutrients necessary for a healthy body, including B vitamins, magnesium and potassium.
Ask different doctors or nutritionists, or check the research, and you'll find people and studies on both sides on the "is it healthy?" debate. Some will say it's good for your health, and others will say it's not good.
Like alcohol, issues may arise if consumption is excessive. A study published in The American Journal of Clinical Nutrition claims that caffeine intake in amounts >300 mg/d (roughly three cups of coffee) accelerates bone loss at the spine in elderly postmenopausal women.
If you have an excessive intake of caffeine, or caffeine leaves you anxious and stressed out, or it affects your sleep, I think it's safe to say it's most probably not doing you any favours, and reducing it could improve your health.
STRESS
Another factor that contributes to bone loss is none other than stress.
When it comes to improving health, eating healthily and exercising is usually emphasised. On the other hand, reducing stress is less spoken about, even less for improving bone health.
Reducing stress, however, is just as important as healthy eating and exercising for our health and bone health.
When under stress, our body goes into survival mode.
In this state, we are in a higher state of arousal and alertness, and energy production is increased to deal with the threat or 'perceived' threat.
Our body gets this extra energy by promoting a catabolic state (breaking down) of fat, muscles and bones for fuel (energy) to deal with the threat. [5]. This increased fuel consumption highlights the importance of adequate nutrition, along with reducing stress for bone health.
The increased alertness also explains why people have a hard time sleeping when stressed or are worried about something.
Furthermore, when a stress response is triggered, our hormones change in response to this.
In part 1, we saw that an estrogen deficiency plays a role in osteoporosis, but other hormones, including progesterone, testosterone, dehydroepiandrosterone (DHEA), and estradiol, also play a role in our bone health.
Lack of these essential hormones triggers a decline in bone mineral density, which is often a result of high stress levels. [6, 7, 8]
Another hormone that plays a role in our bone health is one you may have heard the name of before, that being cortisol.
Cortisol is our body's primary stress hormone. It is a vital hormone that plays a critical role in dealing with threats to our body.
When a threat is detected, our nervous system will signal the adrenal glands to produce cortisol. It will then begin circulating our body (in our blood), doing what it has to do to help return everything to normal.
When the threat is gone, cortisol has done its job and levels in the blood will decrease.
What happens, however, when stress levels are always high? Cortisol levels remain high in your body.
Many studies link high cortisol levels to decreased bone density. [9, 10, 11]
When cortisol levels remain high, the hormones beneficial for strong bones are at lower levels.
Cortisol also blocks calcium, an essential nutrient in bone cell growth, from being absorbed. [11] (More on calcium in the next section of the article).
As you can see, getting your stress under control is a must for good bone health.
I have noticed that a lot of the time, most people don't even know they're under constant stress when they are. They've become accustomed to the higher stress state. It's usually not until they see the benefit of stress reduction techniques that they then realise the stress they were under.
We are all under stress in some form or another; even crossing a busy road, switching on the TV or getting on social media these days usually sparks a stress response.
Day-to-day stress is completely normal. The goal here isn't to strive towards an entirely stress-free life, that would be practically impossible! But learning how to manage high-stress situations will benefit your mind, body, and bones.
Regulating your sleeping habits, practising mindfulness, or taking a stroll in nature are some ways, of many, to reduce stress. It's about finding what works for you. We will touch on this more in the next section.
INFLAMMATION
Another factor that can contribute to weaker bones is inflammation.
Before we go into how to decrease the inflammation in your body, let’s take a quick look at what inflammation is.
Let’s say you catch a cold or unknowingly eat a peanut you’re allergic to. What happens next is that your body sounds the alarm to make it known that there are unwanted intruders in your system. This is the cue for white blood cells to attack the intruders and defend your body from potential harm.
So, basically, inflammation is your body fighting infections, toxins, injuries, and similar threats. When we eat certain foods, don’t get enough sleep or exercise, or suffer too much stress for long periods, our bodies become chronically inflamed.
Chronic (long term) inflammation can lead to many health issues, including poor bone health.
Evidence shows that inflammation, especially chronic inflammatory diseases, are closely linked to bone loss. Inflammation can decrease bone formation and increase bone resorption.
Further studies have found that pro-inflammatory cytokines (molecules in your body that favour inflammation) are implicated in bone remodelling and may play a significant role in the development of osteoporosis.
The good news is the inflammation can be successfully reduced by making a few conscious and healthy lifestyle changes. Introducing a healthy diet and cutting back on inflammatory foods (such as processed foods and trans fats) is a step in the right direction.
Other things you can do to fight inflammation include getting enough sleep, exercising regularly, and reducing stress.
We’ll talk more about proper nutrition, exercise, and stress reduction in the following sections.
POOR FOOD CHOICES
The next factor that plays a role in weakening bones is the type of food we eat.
We all know the 'junk' foods that taste good but are doing our health no favours. However, there are also compounds found in natural foods which you may not be aware of that make some healthy foods not the best choice for strongest bones.
In this section, we'll look at the junk food to avoid and what to be aware of in natural foods so you can make better food choices for better bone strength.
PROCESSED FOODS & REFINED VEGETABLE OILS: THEIR ROLE IN POOR BONE HEALTH
The first foods to avoid are … you probably know what I'm going to say here ... the processed, junk stuff.
Many studies have shown diets high in processed foods (common in western diets) are associated with decreased bone density and osteoporosis. [12-16]
These foods are high in vegetable oil which increases the inflammation in your body. As discussed in the previous section, there is a clear relationship between inflammation and bone degeneration. [17, 18]
Processed foods are full of sodium and other additives harmful to your health and are devoid of much-needed nutrients necessary for healthy bodily processes.
The are also full of refined sugar. Overconsumption of refined sugars potentially increases the risk of osteoporosis. [19].
Processed foods include confectionery, biscuits/cookies, soft drinks (soda), processed meat, french fries, mayonnaise and other condiments, pastries and other highly processed desserts.
Note: There are always healthier alternatives (or versions) of these foods with better ingredients, so it does not mean you have to live without them.
[To read more on processed foods, vegetable oils and choosing healthier alternatives - click here]
On the other hand, diets high in natural nutrient-dense foods improve bone density and are protective against fractures. [20, 21, 22, 23].
Higher adherence to diets comprised mainly of nutrient-dense foods (for example, the Mediterranean Diet) is associated with a lower risk of hip fractures. [22]
By cutting out processed foods from your diet (or limiting them the best you can) and switching to real, natural foods, you make a massive leap towards better bone health. We will discuss nutrition in greater detail in the next section of this article.
However, before we get deep into nutrition, there is something else you should be aware of to help you make better food choices for improved bone health. That is...
ANTI-NUTRIENTS
We’ve seen that a nutrient-rich diet is hugely important for strong bones.
When grown in healthy soil or when eating their natural diet (for animal-based foods) - natural foods are the most nutrient-dense foods you can eat.
However, some foods we eat have a natural built-in defence mechanism, which, when consumed, inhibits the absorption of essential nutrients. These compounds are known as anti-nutrients.
Mother Nature just had to make this all more confusing, didn’t she! :)
Anti-nutrients are mainly in plant foods (primarily leaves, grains, legumes, vegetables, seeds and nuts). These chemical compounds are a natural way plants defend themselves from predators (animals, insects, and fungi).
There are several anti-nutrients in foods we eat, including:
Phytates (Phytic Acid) - Present in whole grains, seeds, legumes and nuts. Phytates may decrease the absorption of iron, magnesium, zinc and calcium. [24, 25]
Lectins - Present in most plant foods, mainly legumes (beans, soybeans and peanuts) and grains (wheat/gluten) and even animal foods. Lectins may interfere with the absorption of certain minerals and may alter gut function and increase inflammation [26]
We can't avoid lectins because they are present in pretty much all foods. However, it is important to cook and prepare foods to decrease the lectin content.
Goitrogens - Found in cruciferous vegetables (E.G., broccoli, cauliflower and kale etc.). Goitrogens can prevent the absorption of iodine and can interfere with thyroid function. [26]
Oxalates - High in green leafy vegetables and tea. Oxalates can bind with calcium preventing it from being absorbed. [27]
Tannins - Tannins are found in tea, coffee and legumes. Tannins can bind with iron preventing it from being absorbed. [26, 28]
Now, you're probably reading this and are a bit concerned that many of these foods you knew to be healthy might not be the best for your bone health.
So, what's the deal? Should we try to avoid them?
Well, yes and no.
Anti-nutrients aren't inherently bad for us. Let's look at tannins as an example. Tannins are biomolecules found in fruits, legumes, tea, and coffee. They have been shown to have antioxidative properties, antibacterial effects and can protect against heart disease and cancer. [28]
Conversely, tannins are considered anti-nutrients because they can inhibit iron absorption. [28]
In regards to stronger bones, why is this important? Because some foods may not be the best choice to obtain needed nutrients.
Let's take calcium as an example. We know calcium is an essential nutrient for bone strength. Spinach is a food high in calcium. However, it also has a high oxalate content, inhibiting calcium absorption, making it not a good choice to increase calcium levels. We will discuss calcium in the following sections of this article.
It's good to be aware of (anti)nutrients in our foods, especially if following a restrictive diet, as certain food choices may not be giving you the required nutrients for best bone health (and overall health).
But we definitely shouldn't discard whole food groups, especially when there also proven health benefits. It is a good idea to eat a balanced diet (with all food groups) to ensure you are getting and absorbing adequate nutrients.
Furthermore, when these foods are cooked or prepared in other ways (e.g. fermentation or soaked) and not eaten raw, most anti-nutrients are removed.
We'll look at nutrition and what to eat for the best bone health in the following sections.
HOW TO GET STRONGER BONES
HEALTHY HABITS FOR STRONGER BONES
We've now gone through what to eliminate for better bone health.
It’s now time to look at what to be doing more of to improve your bone strength and help prevent any fractures.
The first is….
SUNLIGHT
One of the most instrumental things you can do to protect your bones is to.….. go outside!
Sunlight is the absolute best source of vitamin D, and we all know how vital vitamin D is for our health and strong and healthy bones!
A deficiency in vitamin D is strongly associated with osteoporosis. [31]
Without this crucial vitamin, our bodies wouldn't be able to absorb the calcium we so desperately need to build strong bones.
Do your best to get more sunlight each day, avoiding the hottest part of the day during the summer months. Studies show that sensible sun exposure (even just 5-10 minutes of exposure on the arms and legs or the hands, arms, and face, 2 or 3 times per week) and increased vitamin D in the diet (or through supplements) is a reasonable approach to guarantee adequate vitamin D.
Remember supplements are not to substitute natural sunlight and diet, so if possible, try to use what Mother Nature has provided us.
We'll discuss the importance of vitamin D and other nutrients needed for bone health later in this article.
SLEEP
Lack of sleep can weaken your bones. [30, 31]
One study, published in the Journal of Bone and Mineral Research, found that getting five or fewer hours of sleep at night can cause lower bone mineral density and increase the risk of osteoporosis.
Other research has shown, any disruption in our circadian rhythm (the process that regulates our sleep-wake cycle) can impair bone formation. It looks like the main culprit behind this is what's often called the sleep hormone - melatonin.
Melatonin is an endogenous hormone produced by the pineal gland and is responsible for controlling our sleep-wake cycle. Our body produces melatonin during the night, alerting our brains that it's time to go to sleep.
Melatonin has many functions aside from regulating our sleep. Studies show that melatonin is in charge of regulating our bone metabolism and improving bone formation by promoting osteoblast activity (remembering back to part 1 - the cells that build bone up) and decreasing bone resorption.
In simpler terms, melatonin helps develop bone tissue (and teeth), and the less we have of it, the more we are at risk of suffering issues with our bones.
So, start improving your sleep each night. Make it another priority. Click here for some tips on how to get a better night's sleep.
REDUCING STRESS
Reducing stress is one of the best ways to fight inflammation and protect your bones. As I mentioned earlier, avoiding stress altogether is downright impossible; however, finding healthier ways to respond to stressful situations is something you can do!
Making a conscious effort to cut out stress in your life or to make sure to take some time out of your day to reduce your stress, which could be as simple as taking a bath, reading a book, going for a walk in nature or along the beach, will help improve your bone health.
There are also many great techniques, programs and books that can help you get on top of your stress. Some proven and popular techniques are Meditation, Yoga and Tai Chi.
These techniques may not be for you, and that's ok! Decreasing stress is all about finding what feels good to you personally. Explore other avenues and see what works for you.
If you're still stuck, ask yourself, "What makes me happy and relaxed?" Whether it's gardening, baking, journaling, or just basking in the sunlight on your front porch - do what feels right to you, and do more of it!
Another way to reduce stress is through breathing exercises.
Breathing exercises are an easy and quick way to reduce stress.
There are various breathing techniques available, and you can try different ones until you find one that suits your needs best.
Here is one breathing technique you can use.
Lie flat on your back with your knees bent (you can lie on a bed or use pillows for more support and comfort). Or sit in a comfortable chair.
Place your left hand on your chest and your right hand on your belly.
Start to slowly inhale through your nose, allowing your breath to flow to your belly (you should feel your stomach rise as it fills up with air).
Hold your breath for a couple of seconds and then pucker your lips and exhale until your belly is flat.
Practice a few times a day for 5 - 10 minutes.
Additionally, this meditation technique which when done once a day for only ten minutes, can vastly improve your mental health and help you reduce stress.
NUTRITION: EATING FOR STRONGER BONES
GETTING THE RIGHT NUTRITION
What we eat has a significant impact on our body as a whole; healthy food provides energy, fuels our brains, builds DNA, repairs muscles, and keeps our bones healthy.
Proper nutrition is crucial to improving bone strength and preventing bone diseases.
In this section, we'll discuss the basics of nutrition for better bone health.
We'll focus on how much and what you should be eating. We will also look at the key nutrients for stronger bones in detail. I'll also let you know six foods that I have chosen to add to your diet for better bone health and the best supplements for bone health.
So let's get started with the first step for eating better for stronger bones.
GETTING ENOUGH CALORIES
When it comes to maintaining an ideal weight, the focus is usually on weight loss and the prevention of obesity. This usually includes limiting portion sizes, reducing calorie intake, and being more physically active.
However, when it comes to bone loss, the problem is more so undereating.
Supplying your body with adequate calories from nutrient-dense foods is instrumental for your health and your bones.
To get through each day, our body needs fuel (energy) for the running of normal bodily processes. Everything your body can do.
If we don't eat enough, we don't supply our body with the nutrients it needs to function at its best.
In Part 1, we established that our bones are constantly being broken down and rebuilt. This process exerts a lot of energy, and it's up to us to refuel our bodies to restore the energy we lost. The bones in our bodies are made up of minerals, and do you know where those minerals come from?
They come from eating high-quality, nutrient-dense foods.
Suppose you are not replenishing your body with adequate energy and nutrients (Eg calcium). In that case, the body will respond by releasing the nutrients from other areas of your body (fat, muscles and bones).
When you are overworking yourself, overexercising, or under stress, the effects are compounded. Your body is burning up more of this fuel.
As you are starting to see, it's imperative to be eating adequate amounts of the right type of food.
Using an example, a meal consisting of some biscuits and soft drink is vastly different from a meal made up of vegetables, rice and some fatty fish in terms of total calories and nutrients.
Which one of these two meals do you think will supply your body with more energy and the proper nutrients to thrive?
If you chose the latter, then you're right. The most nutrient-dense foods are found in nature and by eating more of the right foods, you're doing a great deal in helping your body thrive.
So, how many calories should you be getting each day?
According to the Dietary Guidelines for Americans, older adults generally have lower calorie needs but similar or even increased nutrient needs compared to younger adults.
The amount of calories you need differs a bit between men and women and depends on physical activity levels (ranging from sedentary to active.)
Females older than 60 require about 1600-2200 calories per day depending on the level of physical activity
Males older than 60 require 2000-2600 calories per day depending on the level of physical activity
The general consensus is to never allow your calories to go below 1400 calories per day.
If you're not sure you're making up the right amount of calories or you're having trouble eating better, let your doctor know or organise to see a nutritionist.
MACRONUTRIENTS (PROTEINS, FATS & CARBS)
When we hear the words protein, fats or carbohydrates, these are macronutrients.
These nutrients are what our bodies use in the largest amounts, and they're responsible for providing us with calories, or in other words - energy.
PROTEIN
When it comes to protein, several studies point to a positive effect of high protein intake on bone mineral density or content.
Protein makes up about 50% of bone volume, making it a crucial component for bone health. This absolutely makes sense when you consider that bones are mostly made out of collagen, the most abundant protein in our bodies.
Recent epidemiological data demonstrate reduced bone density and increased rates of bone loss in those who follow a low-protein diet.
Furthermore, a meta-analysis found that in older people with osteoporosis, higher protein intake is associated with higher bone mineral density, a slower rate of bone loss, and a reduced risk of hip fracture.
How much protein should you eat?
In one of my previous articles, we went in-depth about protein, the importance of eating enough protein, and how to add enough protein-rich foods into your diet.
We also mentioned that the Australian Dietary Guidelines recommend that 15-25% of our total energy intake should come from protein.
The recommended daily intake (RDI) of protein for older adults according to Australian Dietary Guidelines is as follows:
Women over 70 should have at least 57g of protein per day
Men over 70 should have at least 81g of protein per day
A study conducted by the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) suggests an optimal dietary protein intake of 1.0-1.2g/kg body weight with at least 20-25g of high-quality protein at each main meal.
Furthermore, the European Society for Clinical Nutrition and Metabolism (ESPEN) offers practical guidance for optimal dietary protein intake and exercise for older adults over 65. According to their research, healthy older adults should get at least 1.0 to 1.2g protein/kg body weight/day.
Older adults who have acute or chronic illnesses should aim at 1.2 to 1.5g protein/kg body weight/day, while individuals with severe illness or injury should possibly get even more than that.
Ensure you are getting adequate protein in each meal, each day.
FATS
Fats are an essential part of our diet and not to be feared. But all fats are not created equal!
The best way to ensure you’re choosing the right fats for your health and bones is to learn to differentiate between good fats and bad fats.
I've talked in previous articles about vegetable oils and the dangers they pose to our health and also our bone health.
Refined vegetable oils, including (but not limited to) sunflower, corn, peanut, canola, and grapeseed oil, are made from predominantly polyunsaturated fats.
There are two main types of polyunsaturated fats: omega-3 fatty acids and omega-6 fatty acids.
To maintain good health, our bodies require an optimal balance of both of these essential fats. According to research, the optimal ratio of omega-6 to omega-3 fats is 4:1 or less. However, Western diets typically contain much more omega-6 fatty acids compared to what our bodies need.
Excess consumption of omega-6 fats leads to an inflammatory state in the body, which we have already discussed is detrimental to overall health and bone health. [32]
The easiest way to restore the disrupted balance is to cut back on omega-6 fatty acids, mainly vegetable oil and processed foods and consume more omega-3 rich foods while.
[To read more on this - CLICK HERE]
There are four types of dietary fats:
Saturated fats - beef, lamb, pork, whole milk, cream, butter, cheese
Monounsaturated fats - olive oil, nuts (almonds, cashews, pecans etc.), avocados, nut butter, olives.
Polyunsaturated fats - walnuts, fish (salmon, mackerel, herring, trout), seeds
Trans fats - cakes, cookies, crackers, icings, margarine, and microwave popcorn. The bad fats.
Stay away from trans and make sure to get plenty of healthy unsaturated and saturated fats in your diet and you’ll be improving both your health and your bone health.
CARBOHYDRATES
Just like fats, carbohydrates are often misconstrued as something terrible to be avoided at all cost. This, of course, again is far from the truth.
Carbohydrates are the primary source of energy in our bodies. They're found mostly in plant-based foods in the form of sugar, starches, and dietary fibre.
The carbohydrates to be limited are again the refined, processed carbohydrates found mainly in processed foods including lollies, soft drinks, cereals and cakes.
There are many healthy sources of carbohydrates that are an excellent addition to any diet. These being:
Vegetables. leafy greens, root vegetables and tubers etc
Fruits. citrus, tropical, berries etc.
Tubers. Potatoes, sweet potatoes, yams etc.
Nuts & Seeds. Macadamias, brazil nuts, almonds, pumpkin seeds etc
Whole grains. Oats, rice, quinoa etc
Legumes. Beans, lentils etc.
Studies show a positive link between carbohydrates such as fruits and vegetables and bone health.
The Australian Dietary Guidelines recommends 5-6 servings of vegetables a day for people 65+ and 2 servings of fruit.
As you can see, proteins, fats and carbohydrates make up a healthy, well-balanced diet, and they all play a role in improving our bone health.
The aim is to eat adequate calories filled with good sources of healthy protein, fats and carbohydrates.
We’ll now look at the key micronutrients important for health, which will give you a better understanding of what foods to add in to your diet.
KEY NUTRIENTS FOR STRONGER BONES (MICRONUTRIENTS)
As the name suggests, micronutrients (in contrast to macronutrients) are the nutrients our body requires in smaller amounts.
Micronutrients refer to the vitamins and minerals we need that are essential to keep our whole body healthy and, yes, of course, our bones.
So, why are vitamins and minerals so essential for our bones?
Any deficiency of certain essential nutrients can cause bone issues.
Multiple studies have confirmed that calcium and vitamin D are vital to fracture prevention. At the same time, further research emphasises the importance of magnesium, potassium, vitamin C, vitamin K for optimal bone health.
Evidence suggests that intake of phosphorus, a component of bones responsible for providing structure, is positively associated with both bone mineral content (BMC) and bone mineral density (BMD,) as well as reduced risks of osteoporosis in adults.
Several other nutrients, namely iron, zinc, and vitamin C, have been known to aid enzymes in regulating optimal bone structure for bone health. Research is clear that vitamin C deficiency is linked to the development of osteoporosis and increased risks of fractures. Similarly, reduced iron intake has been associated with an emerging threat for bone disease, while zinc has been used as a therapeutic agent in bone regeneration.
Micronutrients are crucial for maintaining optimal skeletal health, and their role should not be underestimated.
Below we will cover the micronutrients required for optimal bone health, their role, and what foods they are contained in.
CALCIUM
The most abundant mineral found in our bodies, calcium, plays the most significant role in bone health.
It is estimated that 99% of the body's calcium is found in the bones and teeth. Unfortunately, our bodies are unable to produce this essential micronutrient on their own, so we need to rely on other sources of calcium to keep our bones strong.
If you remember from Part 1, bone remodelling is a continuous process heavily influenced by two types of cells: osteoblasts and osteoclasts.
Once the osteoclasts break down the tissue in bones, the minerals found in those bones, namely calcium, are then released and transferred into the blood. Before the remodelling process is finished, our bones are not the sturdy and rigid structures we expect them to be, and that's where calcium comes in.
As the osteoblasts rebuild (or mineralise) the bone, calcium phosphates are deposited. This calcium crystallises into what's known as hydroxyapatite. Hydroxyapatite makes up about 65 per cent of bone tissue and is the main component that provides rigidity to the bones.
As you can see, having adequate amounts of calcium in the body is necessary for optimal bone formation. If the body experiences a calcium deficiency, our bones become fragile and more brittle.
One study claims that chronic calcium deficiency resulting from inadequate intake or poor intestinal absorption is one of several important causes of reduced bone mass and osteoporosis. The study concludes that adequate dietary calcium should be consumed in all stages of life. In early life so that genetically programmed peak bone mass can be reached, and in later adulthood so that the skeletal mass can be maintained and age-related bone loss minimised.
Another article, by The American Journal of Clinical Nutrition, suggests that the average elderly person is in negative calcium balance and accordingly losing bone mass.
Calcium is readily available in many different foods, including dairy products (milk, cheese, and yogurt) and plant-based foods (leafy greens, edamame, broccoli, Brussel sprouts). However, not all sources are created equally.
To understand this better, we need to look beyond just the calcium content in each food and focus on calcium bioavailability. The bioavailability of calcium refers to the actual amount of calcium that is absorbed by the body and into the areas it is meant to go - in this case, the bones. Basically, not all calcium we ingest gets absorbed by the body!
Even though certain foods might have a higher calcium level, depending on their calcium bioavailability, they might not be a great source of this essential micronutrient. To put things into perspective, cow's milk has a bioavailability of about 30% absorption. One cup (250ml) of cow's milk contains approximately 300 mg of calcium, so by drinking one cup of milk, you'll be getting somewhere around 100 mg of calcium altogether.
Each food item has a different calcium bioavailability.
A big reason affecting the bioavailability of certain foods lies in what we discussed above - anti-nutrients.
Although plant foods are sources of calcium, they also have compounds that will bind themselves to the calcium and prevent it from getting absorbed.
Not to worry though, there are many ways to get your required amounts of calcium.
HOW MUCH CALCIUM SHOULD YOU BE GETTING EACH DAY
According to the National Institutes of Health, the recommended daily intake (RDI) of calcium for men and women over 70 is 1200mg per day.
BEST SOURCES OF CALCIUM:
Dairy
Cheese
Parmesan = 330mg calcium per 28.4g (Oz),
Swiss Cheese = 225mg calcium per 28.4g (Oz)
Cottage cheese 23.5mg per 28.4g (Oz)
Milk (305mg Calcium per cup)
Yoghurt & Kefir (Yoghurt = 110mg calcium per 100g), Kefir
Sardines & Canned Salmon (both have soft edible bones)
(sardines canned with bones = 325mg calcium per 85g (3 oz) can)
Leafy greens* and legumes
Collard Greens (270mg calcium per cup cooked)
Bone Broth
Nuts and Seeds - (almonds, poppy, and sesame seeds)
*Please note: Some greens (e.g. spinach) are high in the anti-nutrient oxalate, which means the calcium is less available and not absorbed by your body.
SHOULD I TAKE A CALCIUM SUPPLEMENT?
It is always best to get your nutrients from food. However, it could be possible you are not getting enough calcium.
If you are having trouble reaching your recommended daily calcium intake, your doctor may recommend taking a calcium supplement to increase your calcium levels.
An effective way to supplement calcium could be eggshell calcium.
TOO MUCH CALCIUM IN YOUR BODY
Another concern is having too much calcium in your body (known as hypercalcemia).
Depending on the severity of the condition, hypercalcemia affects kidney function, digestive health, brain and heart health, and bone and muscle weakness.
Hypercalcemia usually occurs in those who are ingesting a lot of calcium through food and on top of this supplementing calcium.
As we will discuss in the next section, vitamin D deficiency is common. Vitamin D aids the absorption of calcium (and phosphorus). If you're not getting adequate amounts of vitamin D and other minerals (e.g. magnesium), your calcium may not be going to the places where it should, leading to increased calcium levels.
Your doctor will measure your calcium and other vitamin levels on your regular doctor's visits.
VITAMIN D
As touched on briefly above, along with calcium, vitamin D is by far the most important micronutrient for bone health. Even if you're getting enough calcium, it could be going to waste if you're deficient in vitamin D.
Without this essential micronutrient, our bodies wouldn't be able to absorb calcium, magnesium, or phosphate effectively.
According to research, vitamin D insufficiency and deficiency are now recognised as a major cause of metabolic bone disease in the elderly.
Further evidence indicates that vitamin D not only improves bone mineral density but also enhances muscle function leading to a decreased number of falls.
So, what are the best sources of vitamin D?
Sunlight is by far the best source of vitamin D, and most people are not getting adequate amounts.
In food and supplements, vitamin D has two main forms, D2 (ergocalciferol) and D3 (cholecalciferol). Vitamin D3 is only found in animal foods.
The best food sources of vitamin D include:
Fatty fish (salmon, mackerel, herring, sardines) - Vitamin D3
Egg yolks - Vitamin D3
Cod liver oil - Vitamin D3
Mushrooms - Vitamin D2
Certain foods are also fortified with vitamin D.
Vitamin D supplements are a good alternative for those who don't get enough sunlight or can't get it from food.
Aim to get around 15-20 minutes of sun daily, avoiding the hottest parts of the day in the summer months.
If you're following a vegan diet, as vitamin D3 is only found in animal products (which means supplements are derived from animal foods), it's important to get adequate sun exposure.
MAGNESIUM
When it comes to improving bone strength, we usually hear less about magnesium than we do with vitamin D and calcium. It can be argued, however, that magnesium is the most important component for bone health as it aids in the absorption of both calcium and vitamin D.
Studies show that magnesium deficiency is linked to low-grade inflammation and endothelial dysfunction, which are significant for bone remodelling.
It’s also been shown that lower magnesium intake is associated with lower bone mineral density of the hip and whole body.
Getting adequate magnesium is a must.
The recommended dietary allowance of magnesium is 320mg for women over 51, and for men over 51, it is 420mg. [33]
The best sources of magnesium:
Fish (salmon, mackerel, pollock, halibut)
Vegetables (spinach, swiss chard, edamame, okra, potatoes)
Whole grains (quinoa, wheat germ, bran cereal, buckwheat)
Nuts and legumes (beans, peas, tofu, flaxseed, peanut butter, cashews, almonds)
Dark chocolate (woohoo!)
Magnesium can also be safely supplemented, and soaking in a bath of Epsom salts is also an effective way to increase magnesium levels.
VITAMIN K
Vitamin K is another nutrient necessary for bone health.
Several studies have demonstrated that vitamin K deficiency is linked to low bone mineral density or increased fractures.
Human intervention studies have shown that vitamin K can increase bone mineral density in those with osteoporosis and reduce fracture rates. The same studies show that vitamin K may benefit bone health, especially when co-administered with vitamin D.
There are two main forms of vitamin K found in our diet: vitamin K1 and vitamin K2.
Vitamin K1 is mainly found in leafy green vegetables, while K2 is found in fermented foods and animal products.
To get adequate amounts of vitamin K, we must incorporate a mix of foods containing both vitamin K1 and K2 in our diet.
Best sources of vitamin K:
VITAMIN K1 SOURCES
Leafy greens - kale, mustard and collard greens, swiss chard, spinach
Vegetables - broccoli, Brussel sprouts, green beans, peas
Fruits - prunes, kiwi, avocado, dry figs, berries, grapes, pomegranate
VITAMIN K2 SOURCES
Natto - A Japanese dish made from fermented soybeans
Dairy - hard and soft cheese, whole milk, butter
Meat - beef liver, goose liver, chicken liver, chicken, pork
Egg yolks - Pasture-raised eggs
Sauerkraut
POTASSIUM
Potassium is responsible for a lot of key processes in our bodies.
Potassium is most notable for its relation to sodium, as the two electrolytes are in charge of maintaining fluid balance in our cells. It is also believed that potassium may have a favourable effect on bone mineral density.
A study investigating the association of potassium intake and BMD among older Korean adults shows that higher dietary potassium levels can improve bone health and reduce the risk of osteoporosis.
A similar study found that dietary potassium intake was positively associated with BMD in postmenopausal women and men over 50.
Best sources of potassium:
Fruit and fruit juice (bananas, honeydew, apricots, grapefruit, dried fruit)
Vegetables (spinach, broccoli, potatoes and sweet potatoes, mushrooms)
Fat-free dairy products (milk, yogurt)
Fish (tuna, cod, trout, halibut, rockfish)
Beans and nuts (pinto, kidney, soybeans, almonds, hazelnuts, Brazil nuts)
ZINC
Zinc is necessary for the development and maintenance of healthy bones by stimulating bone formation and mineralisation. [34]
Best sources of zinc:
Seafood (oysters, crab, lobster)
Meat (organ meat, red meat and poultry)
Beans and nuts (pumpkin seeds, cashews, chickpeas, almonds, peas)
Dairy products (yogurt and cheese)
Oysters contain more zinc per serve than any other food.
Some breakfast cereals are fortified with zinc.
Some plant foods are good sources of zinc, others not so much as they contain phytates which inhibit its absorption.
An article published by the Laboratory of Endocrinology and Molecular Metabolism in Japan concludes that zinc supplementation has a potent effect in the prevention and therapy for osteoporosis.
The recommended dietary allowance of zinc is 8-11mg [35]
BORON
Boron is a little known micronutrient that has shown to have some powerful effects on our health. It has shown benefits in improving wound healing, cognitive performance and has demonstrated therapeutic effects in cancer. [36]
Boron has also demonstrated to be essential for healthy bones and joints. [36, 37]
Although the full extent of boron’s mechanisms is widely unexplored, research suggests that its role is most likely to be associated with its interactions with other nutrients such as calcium, magnesium and vitamin D.
Boron is mainly found in plant-based foods such as prunes, raisins, avocados, peaches and apples. Other good sources of boron include peanuts and peanut butter, and broccoli. The World Health Organization estimates that an “acceptable safe range” of boron intakes for adults is 1–13 mg/day [38].
COPPER
Found in almost all body tissues, copper is another essential mineral our body needs to function properly.
Similar to boron, the role of copper in bone health is not fully explored, but findings point to a positive relationship between the micronutrient and bone health.
Studies show that lower serum copper levels are significantly associated with decreased bone mineral density in the total femur and femoral neck.
Different studies on animals and humans have found that rats fed a copper-deficient diet had reduced bone mineral content and reduced bone strength, whilst severe copper deficiency in humans caused various skeletal abnormalities.
Copper is found in various foods such as beef liver, oysters, mushrooms, cashews, potatoes, tofu, sunflower seeds, and dark chocolate.
VITAMIN B
There are different types of B vitamins, and they all play a role in bone health.
Best sources of vitamin B-6
Fish and shellfish, liver, meat, poultry, nuts, green leafy vegetables, whole grains, fruit, legumes, green leafy vegetables.
Best sources of vitamin B-9
Green leafy vegetables (asparagus, brussel sprouts, broccoli), citrus fruits, legumes, seeds, liver, poultry, eggs.
Best sources of vitamin B-12
Organ meats, seafood (shellfish, fish, sardines), meat, dairy, eggs.
Vitamin B-12 is only found in animal foods unless a food has been fortified with it.
PHOSPHORUS
Second to calcium, phosphorus is the most abundant mineral found in our bodies.
When combined with oxygen, the two micronutrients form what is called hydroxyapatite, the main inorganic constituent of tooth enamel and bones. As such, phosphorus plays an essential role in the formation of bones and teeth.
Phosphorus deficiencies are rare unless due to a malabsorption issue or if following a vegan diet.
The problem more so if a high level of phosphorus, which can occur when eating a diet high in processed foods. This mineral is found in a lot of processed foods as an additive.
As the evidence points out, adverse effects of high dietary phosphorus on bone health have been observed in animal and human studies. This is because excess phosphorus levels cause the body to pull the calcium out of the bones, subsequently weakening them.
One way to limit the intake of dietary phosphorus, and ensure you’re maintaining a good balance of the mineral in your body, is to limit the consumption of processed foods and soft drinks (sodas) that contain phosphates.
Again, making healthier food choices is the key.
Micronutrients are essential elements that play a significant role in bone health. I could have covered more of these nutrients, as many play a role in bone health, however, we have covered the main ones involved in bone health and tracking every nutrient in your diet is difficult.
The best way to get the nutrients your body needs for optimal bone health, covering all the nutrient bases, is by eating a diet full of real, nutrient-dense foods from various fruits, vegetables, AND animal foods.
Opt for organic foods when you can, choose grass-fed meat, and wild-caught seafood and pasture-raised eggs over other options.
There are websites that can help you track calories and nutrients. Although they are not completely accurate, they can help give you a better idea of your eating patterns. One such website is cronometer.com.
BONE HEALTH AND PLANT-BASED/VEGAN DIETS
Here are some things to take note of if following a vegan diet:
Eating only plant-based foods makes it more difficult to get all the necessary vitamins and minerals required for optimal bone health.
It is also more difficult to do get the necessary calories and adequate protein and fats to support your body’s needs. Some examples:
Vitamin B12 is critical for bone health, and it's primarily found in animal products. May need to supplement B12 if following a plant-based diet.
Vitamin D is essential for calcium absorption, which is crucial for bone health. Again, supplementing may be necessary if following a plant-based diet.
Calcium can be found in leafy greens like kale, bok choy, and broccoli, but it's more difficult to get enough calcium from plants alone.
Make sure you are not undereating and also getting the recommended amounts of all macronutrients (and micronutrients) in your diet. A nutritionist can help with this.
You may not be absorbing nutrients due to the anti-nutrients in the food. Keep this in mind when choosing food types.
I recommend seeing a nutritionist before jumping into a plant-based diet (or any diet).
BEST FOODS FOR STRONGER BONES
Remember to improve our diet we want to be eating enough calories, but we want to ensure those calories are not foods with limited nutritional value. We want these foods to be nutrient-dense foods.
Below are 6 foods, which I have chosen, as the best foods you can include in your diet to help support bone health (and your health).
1. HARD CHEESES (E.g. Parmesan)
A great source of protein, healthy fats and filled with many healthy nutrients important in bone health. Including calcium, phosphorus, magnesium and vitamin K2.
Hard cheeses are an easier source of dairy to digest for those with dairy intolerances. This is due to the minimal amount of lactose compared to other forms of dairy and the aging/fermentation process the cheese undergoes that helps break down the casein.
2. PASTURE-RAISED EGGS
Pasture-raised eggs are known as nature’s multivitamin and for good reason.
Eggs are abundant in vitamins, minerals and other healthy nutrients. Including, quality protein, omega-3 fatty acids, vitamins A, D, E, K2 and B-12, antioxidants and choline. All essential for health and strong bones.
3. BONE BROTH
Full of essential amino acids and collagen important for strong bones.
Also full of much-needed vitamins and minerals including calcium, phosphorus, magnesium, potassium, zinc, vitamin k2, boron selenium and manganese.
For a healthy bone broth recipe - CLICK HERE.
4. SARDINES
A good source of protein and omega-3 fatty acids. Omega-3 fatty acids are important in decreasing inflammation in the body.
Also a great source of calcium due to their soft, edible bones and a great source of vitamin B-12 and D.
They also contain many minerals important for optimal health, including iron, magnesium, niacin, phosphorus, potassium and zinc.
Ensure you choose sardines packed in a healthy oil (olive oil) or spring water.
5. PRUNES
Several studies have shown eating prunes has been linked to reduced risk of osteoporosis and osteopenia.
Prunes contain several vitamins and minerals that have bone-protective effects, most notably - boron, and also magnesium, phosphorus, vitamin K and potassium.
6. DARK CHOCOLATE
A big reason I chose this was that it tastes great!
But along with the taste, a good quality bar of dark chocolate with a higher percentage of cocoa is packed full of healthy minerals, including magnesium, copper, manganese, potassium, phosphorus, zinc, selenium and iron.
It is said that a chocolate craving is indicative of a magnesium deficiency.
7. SUNLIGHT
Don’t eat the sun, but make sure to get some sun each day. :)
BEST SUPPLEMENTS FOR STRONGER BONES
It's always best to get your nutrients from the food that you eat.
However, there may be times you're not getting the necessary nutrient requirements for healthy and strong bones.
Speak to your doctor before supplementing, and your doctor can advise you on what supplements may be a good idea for you to take.
Not all supplements are created equally, so make sure you're buying the best quality ones.
Here are some supplements that may aid in improving your bone health.
A MULTIVITAMIN
A good quality multivitamin containing magnesium, vitamin D (if required) and other essential nutrients such as B-vitamins, zinc, boron and copper may be beneficial for you.
Make sure to speak to your doctor before choosing a multivitamin.
CALCIUM
If you're low on calcium, your doctor may recommend you take a calcium supplement.
Eggshell calcium may be a better source of calcium.
WHEY PROTEIN AND MILK BASIC PROTEIN
A protein deficiency is a clear cause of osteoporosis (and muscle loss).
Studies have shown that milk whey protein, especially its basic protein fraction (milk basic protein), contains components capable of promoting bone formation and inhibiting bone resorption.
Additionally, whey protein is filled with other essential nutrients beneficial for healthy bones.
If you have a hard time getting adequate protein and nutrients, this may be something that could assist.
If thinking about supplementing this, make sure to get a high-quality powder. One sourced from grass-fed cows and not filled with harmful additives.
COLLAGEN
I recommend bone broth to help get your collagen needs. However, supplementing collagen may also be beneficial to your bones.
Our bones are comprised largely of collagen (around 25-30% of the dry weight of bone is collagen).
Collagen supplementation has been shown to have a positive therapeutic effect on osteoporosis and osteoarthritis. [39]
One study in particular by the Department of Nutrition, Food and Exercise Sciences links calcium and collagen to a reduced risk of bone loss in osteopenic, postmenopausal women - decreasing the risk of osteoporosis.
Another study on collagen supplementation in 131 women (average age 63 years) was "associated with a favourable shift in bone markers, indicating increased bone formation and reduced bone degradation".
Again, if thinking of supplementing this, make sure to get a high-quality powder. One sourced from grass-fed cows and not filled with harmful additives.
OTHER FACTORS OF NOTE
We have now discussed many factors that can cause bone loss and how you can improve your bone strength through nutrition.
Before we get onto Part 3 (which will be out soon), where we cover exercise for stronger bones, there are two other factors, gut health and aspirin, that have also shown to play a role in bone health and treatment.
THE IMPORTANCE OF GUT HEALTH FOR STRONGER BONES
Having a healthy gut plays a role in improving bone health.
Our body contains millions of tiny living organisms, which, all together, are called the human microbiota.
The microorganisms live all over our body, including the skin, the nose, the mouth and ... in the gut.
As unsettling as it may sound, it is nothing to be concerned about. Sometimes microorganisms do cause illness, but predominately, they provide essential functions required for human survival.
Our gut is where most of these tiny microbes live. As a result, the gut microbiome, also known as gut microflora, has a vast influence on the whole body. Contrary to popular belief, the microbiome isn't just in charge of digestion; it impacts our immunity, nutrition, diseases, and even behaviour.
There's been plenty of research on this topic over the years. Evidence shows that an unbalanced gut microbiome is linked to various conditions such as heart disease, diabetes, obesity, asthma, cancer, eczema, and...yes, you've guessed it - bone health.
Research shows that modulation of the gut and its microbiome can affect bone density and strength.
Emerging evidence suggests that introducing probiotics might have a favourable effect on reducing the risk of osteoporosis. .
This shows that maintaining optimal gut health could significantly help avert bone conditions, and other health conditions.
Optimising these microbes to work in our favour starts with implementing healthy eating habits and boosting our immune system through exercise
ASPIRIN
Aspirin can be found in just about any home. We use it to treat headaches, mild fevers, and inflammation. Aspirin has also found use in the prevention of heart disease due to its blood-thinning properties. However, emerging evidence speculates that aspirin might be a helpful tool in the fight against osteoporosis and fractures too.
An exploratory meta-analysis of observational studies found that aspirin use was associated with 17% lower odds for any fracture and a higher total hip bone mineral density for women.
Similar results were observed for lumbar spine bone mineral density in women and men. A review on the relationship between aspirin and bone health suggests that aspirin possesses bone protective effects.
Another study confirmed that regular use of aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) may have a modest beneficial effect on bone mineral density in postmenopausal women.
Obviously, this doesn’t imply you should start popping aspirin every day. I am simply highlighting that aspirin has shown promising results in improving bone strength and preventing fractures.
Again speak to your doctor to know if this could be something trialled for you and ALWAYS speak to your doctor before taking any medication.
In part 3, we will cover all there is to know about exercise and bone health, including what you should be doing for improved bone health and what movements to avoid with osteoporosis that may be putting you at risk of a fracture. And, we will also go through some exercise programs (with videos) that you can follow to help promote bone strength.
PART 3: EXERCISE AND STRONGER BONES
SOURCES
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