written by Dr. Kara Menzer
Natural Bone Builders
Now that you know why bone density is important, here’s what you can do to build them:
Bone-building Vitamins and Minerals:
Give your bones the nutrients they need to stay healthy!
- Calcium: Over 40% of people in the United States do not get enough calcium from their diet (1)! Your Recommended Dietary Allowance (RDA) of calcium is determined by your sex and your age. Most adults need either 1000mg or 1200mg per day (kids need even more!). Ask your doctor about your specific calcium needs. While dairy foods are high in calcium (milk, yogurt, cheese, whey protein), several plant-based foods pack a calcium punch like chia seeds, white beans, almonds, lentils, amaranth, and some leafy greens (2).
- Vitamin D: In addition to fatigue, depression, and susceptibility to infections, low vitamin D can also cause low bone density. Sunshine is the primary way our bodies get vitamin D and unfortunately Seattleites are generally sunshine deficient. Very few foods in nature contain vitamin D. Fatty fish (such as salmon, tuna, sardines, and mackerel) and fish liver oils are among the best sources of Vitamin D (3). Small amounts of vitamin D are found in liver, cheese, egg yolks, and mushrooms. Farmed salmon contains significantly less than wild salmon — one of the many reasons to get wild caught fish (4)!
- Vitamin K: There are two types of vitamin K. Vitamin K1is found in green leafy vegetables, while vitamin K2 is synthesized by bacteria in the gut (yet another reason to love your gut flora!). Vitamin K2 is critical for formation of bones and soft Natto (fermented soybeans) is the richest source of dietary vitamin K2, though some is found in beef, liver, egg, dairy and fermented vegetables like kimchi. Fun fact: Grass-fed cows yield higher vitamin K2 in milk and butter than grain-fed cows (5)!
- Strontium: Strontium is a mineral that, like calcium, builds up inside of bones. Strontium is found naturally in rivers, oceans, lakes, and soil, and only trace amounts are found in foods. Foods highest in strontium include seafood, wheat bran, and root vegetables. Some countries use a synthetic medication version of strontium to treat osteoporosis, though this is not commonly used in the United States. (6)
- Boron: Boron is a trace mineral essential for the growth and maintenance of bone, as well as for wound healing (7). Some research indicates that people who take large amounts of Vitamin D supplements without seeing an improvement in vitamin D lab markers may be deficient in boron. Foods high in boron include avocado, red kidney beans, lentils, raisins, hazelnuts, and dried fruits.
- Potassium: Dietary potassium may neutralize acid load and reduce calcium loss from the bone, increasing bone density (10). Low potassium (hypokalemia) can also be caused by low magnesium. The adequate intake (AI) for potassium is 4,700mg in healthy individuals. Yes, bananas are a good source of potassium, but avocado and sweet potato are even higher!
- Magnesium: Famous for use in digestion, sleep, muscle cramps, migraines, and mood, magnesium is often overlooked for bone health. Magnesium is key for happy calcium and vitamin D levels. And in a 20-year study of 2,245 middle-aged men, men with higher levels of magnesium were 44% less likely to have bone fractures (8).
Magnesium deficiency is common in the US because Americans tend to eat less magnesium-rich foods like nuts and leafy green vegetables. Another challenge is that industrial farming practices are reducing the amount of magnesium in the soil and causing magnesium deficiencies in the plants we eat (9). Because of this, many people are unable to get adequate magnesium from diet alone and may need additional supplementation. Foods highest in magnesium include avocado, nuts, legumes, seeds, whole grains, leafy greens, bananas, and dark chocolate.
Ask your doctor about your individual nutrient needs for bone health. Some of these vitamins and minerals can be tested in the blood for deficiencies. Some nutrients are easy to get in the diet, and others usually require additional supplementation.
Hormones & Bone Health:
Hormones are chemicals that travel through our bloodstream to send messages all over the body, including the brain, pituitary gland, testes, ovaries, thyroid and parathyroid glands. Many hormones affect our bone density. Two major players are estrogen and testosterone. Both estrogen and testosterone are produced and active in all sexes.
- Estrogen: Estrogen is a hormone produced by ovaries, fat, and adrenal glands that protects bone density. When estrogen production declines or is blocked, such as with menopause, after a surgery that removes the ovaries, or taking certain anti-estrogen medications, the risk of osteoporosis dramatically increases (11). Hormone Replacement Therapy (HRT) with estrogen has been shown to slow bone breakdown and increase bone mineral density in early and late postmenopausal women (12).
- Testosterone: Testosterone, a hormone made by the testicles, ovaries, and adrenal glands, also has important bone-building actions. Testosterone naturally lowers as we age, though some people (of all sexes!) may have too low of testosterone at a younger age. Age-related testosterone deficiency is the most important factor of bone loss in elderly men (13), and new research shows that low testosterone levels are strongly associated with low bone density even in relatively young men (14). Testosterone Replacement Therapy has been shown to increase bone density.
Despite the benefits of hormone replacement therapies on bone density, these medications can have risks and side effects, and are not appropriate for everyone. Talk to your doctor about the many different options for optimizing your hormones for bone health!
Bone Health and Exercise:
There are two types of exercises that are important for building and maintaining bone density: weight-bearing and muscle-strengthening (15). Both are important for building and protecting bones. Weight-baring exercise includes dancing, high-impact aerobics, walking or running uphill, hiking, and using a stair-stepper. Muscle-strengthening exercise includes lifting free weights or kettlebells, using resistance elastic bands, using weight machines, and doing functional exercises with your own body weight, like push-ups, pull-ups and planks. Yoga and Pilates can also improve strength, balance, and flexibility. Tai Chi is a slow movement Chinese martial art that uses poses, meditation and breathwork – and it has great research on building bone density (16). We recommend incorporating at least 30min of these types of exercises twice per week to keep bones healthy.
Connect with our doctors here at Natural Medicine of Seattle to explore these options for healthy bones!