When you think about improving your bone density, what probably comes to mind is resistance training and prioritizing calcium in your diet, or supplementing it.
Unfortunately that may not be enough. At least it wasn’t for me!
At 20-years-old I had poor bone density and didn’t know why. After fracturing my lumbar spine, I was given calcium carbonate supplements and told to go to the gym and focus on resistance training.
After three years of taking my calcium religiously, my bone density was still the same. I saw that there was another type of calcium at the store, citrate, so I bought that instead, and started going to the gym. Almost a year later my bone density had improved, but it didn’t maintain. Years later, when I was no longer doing either, my bone density had regressed back to what it was when I fractured my back.
At this point I was highly trained and had to do a deeper dive into what I could do.
Of course resistance work is important. aaaaBone is stimulated when your muscles and tendons tug on them.
Your physiologic health is also important:
If you are inflamed your body is not going to prioritize your bone density
If you have an unhealthy gut, you might not absorb the nutrients your body needs to keep your bones strong
If you have a poor diet, you may not be providing the nutrients necessary to support your bone density
If you are taking birth control, you are reducing your estrogen which supports bone
If you have menopausal, your hormone levels have reduce which contribute to bone health
Micronutrients
Your bones are mostly made up of:
Water (transports nutrients; maintains cellular activity; supports elasticity)
Living cells
Osteoblast (build new bone)
Osteoclasts (break down old bone)
Osteocytes (mature bone cells that maintain structure)
Protein
Type I Collagen (prevents bones from being brittle)
Minerals
Hydroxyapatite (calcium + phosphate crystals)
Magnesium (regulate formation; vitamin D activation)
Sodium (when high can increase secretion of calcium)
Potassium (alkaline salts neutralize acid and thereby spares calcium excretion)
Manganese (cartilage and bone formation; connection tissue production)
Zinc (osteoblast activity and collagen formation)
Copper (bone flexibility)
Iron (collagen production)
Boron (calcium/magnesium metabolism; regulate vitamin D and estrogen activity)
Silicon (collagen synthesis)
Strontium (stimulates osteoblasts while inhibiting osteoclasts)
Balance is Important
Osteoblasts – Osteoclasts
Taking a medication that inhibits osteoclasts will make the bones too brittle
1:1 Ratio
Many of these micronutrients require a 1:1 ratio in order to support healthy physiology, such as calcium and phosphorus, sodium and potassium
Too much of a good thing can be a bad thing
Excess iron has a negative effect on bone health
Diet vs Supplementation
When you eat a diverse, balanced diet, you will get most of your nutrients from food, but supplementation is often necessary to increase deficient levels, and to provide nutrients missing from the diet
Vitamin D is needed to absorb calcium from your gut
Vitamin K is needed to transport calcium into your bones
Vitamin A is needed to activate the Retinoid X Receptor (RXR) to properly activate the Vitamin D Receptor (VDR)
Take with Vitamin A (liver bovine or cod liver oil), vitamin D3 with K2 to avoid calcium depositing into your soft tissues, versus your hard tissues (bone).
About
Calcium levels are tightly regulated in the body by parathyroid hormone (PTH) and vitamin D, and if intake of calcium is not high enough, levels are maintained at the expense of bone health.
Supplemental calcium has been shown to increase the risk of cardiovascular disease and cardiovascular events. It is thought that supplemental calcium promotes calcification or hardening of the arteries, so it is important to make sure you are taking vitamin K2, consuming enough vitamin A, and also making sure that your vitamin D levels are adequate. All of these will have an effect on calcium metabolism.
Recommended Daily Allowance (RDA) to Avoid Deficiency Symptoms
Adults need between 1000-1200 mg/day.
Best Food Sources
Absorption/Excretion
The absorption of calcium from plant foods is generally lower than it is from animal foods.
Vitamin D increases intestinal absorption of calcium, helps maintain levels in the blood and enables the proper mineralization of bone.
Vitamin K2 activates osteocalcin which regulates calcium metabolism via carboxylation. Carboxylated osteocalcin deposits calcium in bones and the teeth and keeps it away from the soft tissues.
Niacin (B3) plays a role in the mobilization of calcium.
High sodium excretion can lead to higher levels of calcium excretion in the urine.
Supplementation
Whole bone calcium is a good option for supplementation since it would be expected to affect the body in much the same way that dietary calcium would, rather than how calcium supplements do.
NOTE: For people who need calcium but not phosphorus, avoid bone meal. An alternative is calcium citrate, which is low in phosphorus.
Vitamin D is actually a vitamin-like hormone that is largely produced in the skin when it is exposed to ultraviolet radiation.
The best-known role of vitamin D is increasing the intestinal absorption of calcium. It helps maintain calcium and phosphate levels in the blood, and it enables the proper mineralization of bone. It also protects against osteoporosis, rickets, and fracture, and it plays a number of other important roles in the body.
Best Food Sources
Only about 10 percent of vitamin D requirements come from food in the typical diet. The best sources are:
Liver or cod liver oil
Cold-water fatty fish species such as marlin, herring, fatty tuna, rainbow trout, salmon, sardines, and mackerel have about 250 to 1,000 IU of vitamin D per 3.5-ounce serving
Egg yolks—pastured eggs will contain four to six times more vitamin D than conventional eggs
Supplementation
Many people need to supplement because they live in a place where sun exposure really is not an option or their job or lifestyle does not permit it, and they cannot get enough from food.
Individual response to supplementation varies. You should check your vitamin D levels every three to six months and determine your optimal dosage.
1,25(OH)D is the active form of vitamin D called calcitriol.
It is converted from vitamin D2 in the kidneys in small amounts
25(OH)D is not the active form of vitamin D. It is also called calcifediol.
Is the most common lab-test for vitamin D and considered a good marker of vitamin D status
You should not supplement if blood levels are above 50 except in specific circumstances, or if levels are between maybe 30 and 50 or 25 and 50 and you get regular unprotected sun exposure.
Product Recommendation
I prefer cod liver oil because it is a food-based form.
Another option would be vitamin D drops. Sometimes they come with vitamin K2 as well, which is a good combination.
Cod liver oil, vitamin D and K2 should be taken together with a meal that contains fat for better absorption.
You can supplement with 5,000 IU per day if blood levels are below 35.
If blood levels are between 35 and 80, you can take a maintenance dose of 3,000 IU per day, especially during the winter months.
Takeaways
Vitamin K2 is needed to activate proteins, for example, osteocalcin that regulates calcium metabolism via a process called carboxylation. Carboxylated osteocalcin deposits calcium in the bones and the teeth where it is needed and keeps it away from the soft tissues where it can cause problems, so vitamin K2 can prevent and in some cases even treat osteoporosis or bone loss. It also prevents the calcification of soft tissues such as the lining of the arteries, and this lowers the risk of atherosclerosis and heart attacks.
In one study, people with the highest intake of vitamin K2 had a 52 percent lower risk of aortic calcification, 41 percent lower risk of coronary heart disease, 51 percent lower risk of death from heart disease, and 26 percent lower risk of death from all causes. This is a significant effect.
It reduces the risk of fractures by 81 percent.
It prevents the calcification of elastin in the skin.
It is required for the proper function of vitamins D and A. All of the fat-soluble vitamins such as K2, D, and A work together synergistically. Vitamin K2 may prevent the toxicity of vitamins D and A and even prevent some of the deficiency symptoms that can be associated with those nutrients.
It may protect against kidney stones.
It promotes healthy facial bone structure in developing babies.
It is important to note that vitamin K2 is not the same as vitamin K1.
Vitamin K1 is found in leafy greens such as kale and collards. It is primarily used by the body in blood clotting.
Calcium regulation is the primary role of vitamin K2.
Recommended Daily Allowance (RDA) to avoid Deficiency Symptoms
Research is unclear on how much vitamin K2 is optimal for health. There is no upper limit or toxicity level at this point, and some studies, such as the Japanese osteoporosis studies, have used doses between 30 and 45 mg per day. Vitamin K2 is usually talked about in microgram quantities, so that is an enormously high dose, and not only were there no negative effects, there were really positive changes in people with osteoporosis. There is much more of a risk of deficiency of vitamin K2 than there is in overdosing, and again, vitamin K2 also reduces the likelihood of vitamin A or vitamin D toxicity.
Best Food Sources
Food sources are not very abundant for vitamin K2. This is probably why most Americans are deficient in vitamin K2, particularly those who are avoiding animal fats and because of the shift to grain-based animal agriculture, since pasture-raised animals are much higher in vitamin K2 than grain-based animals from factory-farming type of conditions.
Vitamin K2 is mostly found in the fat of animal products and in some fermented soy products.
Our body is very inefficient at converting vitamin K1 to vitamin K2, and very little is absorbed from bacterial production in our guts.
The major forms of vitamin K2 in the diet are:
Menaquinone 4, or MK4
MK4 sources include grass-fed, full-fat dairy products such as butter, cream, and cheese. Certain cheeses in particular, such as Gouda and Brie, are very high in vitamin K2. Poultry liver, such as duck liver and chicken liver, but especially goose liver; pastured egg yolks; and pastured organ meats such as pancreas and kidneys would be expected to be high in vitamin K2 but have not yet been measured.
Menaquinone 7, or MK7
The primary source of MK7 in the diet is fermented food. Natto, which is a fermented soy product that is popular in Japan, is by far the highest source of vitamin K2 in any form. Other fermented foods such as sauerkraut and cheese, are also really good sources of vitamin K2.
Supplementation
The recommended dose for maintenance supplementation is 100 to 1,000 mcg per day. Much higher doses, even in the milligram quantities, have been used in studies for prevention and treatment of osteopenia and osteoporosis, and they appear to be safe and well tolerated.
Vitamin K2 is best combined with optimal intake of vitamins A and D. In supplement form, you can take MK7 or MK4. MK7 supplements are natural extracts from natto. It has a longer half-life, so you can take lower doses such as 100 mcg a day. MK4 supplements are synthetic but believed to be chemically identical to the form found in animal fats. They have a shorter half-life, so larger doses are appropriate, such as 1,000 mcg per day or more.
Some research suggests that MK4 is more effective than MK7 in preventing heart disease and osteoporosis, but both forms are beneficial.
Another option would be high-vitamin butter oil that naturally contains MK4, but there is no guarantee of dosing when you are using the butter oil, and it may be no better than simply cooking with ghee or adding ghee to foods.
Supplementation with vitamin K2 may be contraindicated when on blood thinners such as Coumadin, or warfarin, and it is better to stick with high-vitamin K2 foods in that case.
Takeaway
It plays an important role in bone health, and most of the body’s magnesium is, in fact, stored in bone, more than 60 percent of it.
Recommended Daily Allowance (RDA) to Avoid Deficiency Symptoms
Median intake of magnesium is well below the RDA. It can be difficult to get enough magnesium in the diet since the soil has become progressively depleted in magnesium and anti-nutrients such as phytic acid can inhibit the absorption of magnesium.
RDA of 400 to 420 mg for adult men and 310 to 320 mg for women.
Best Food Sources
Food sources of magnesium include nuts such as pumpkin seeds and almonds, but phytates, or phytic acid, in nuts inhibits the absorption of magnesium. To mitigate these effects, soak and then dehydrate or roast your nuts or seeds before consuming them in order to remove the phytic acid and allow better absorption.
Other high-magnesium foods include dark leafy greens such as spinach and chard, molasses, bananas, and dark chocolate.
Chocolate is a legume, so it does have phytic acid, which would inhibit absorption, but it is generally fermented during the preparation of chocolate products, so I think a pretty good amount of magnesium will be absorbed from dark chocolate. Legumes can also be a good source of magnesium if the client tolerates them, but like nuts, they need to be properly prepared, meaning soaked, in order to remove the antinutrients that can block the magnesium absorption.
Supplementation
Unless you are actively aware of your magnesium intake, you can pretty much assume that they are not getting enough. The optimal range is 500 to 700 mg per day from a combination of food and supplements.
The average American gets less than 250 mg per day from the diet, while people on a more nutrient-dense diet such as a Paleo-type diet probably get closer to 350 to 400 mg. The range of supplementation could be between 100 to 500 mg a day depending on your background intake.
I prefer magnesium glycinate or malate because I have found that they are better absorbed than most other forms of magnesium such as oxide, orotate, or citrate.
Magnesium has been shown to be better absorbed with a higher protein intake.
The side effects of too much magnesium can include loose stools.
Magnesium can also interfere with the following drugs: digoxin, which is a heart medication; nitrofurantoin, which is an antibiotic; certain antimalarial drugs or bisphosphonates for osteoporosis.
Takeaways
Calcium and phosphorus make bone together. Vitamins A, D, and K help send calcium and phosphorus to the right place, the bones and teeth, so they don’t make hard tissue together in soft tissue such as artery plaques or kidney stones.
Increased phosphate in the blood binds to calcium, producing hypocalcemia in the blood. The body senses the low calcium and pulls from the bone stores.The ratio between a high phosphorus and low calcium consumption can lead to lower bone density. The Institute of Medicine states that if calcium consumption does not keep pace with phosphorus consumption, then the bones will be triggered to release calcium from bone at the expense of one’s bone density to balance the phosphorus.
Phosphorus helps maintain normal acid–base balance as one of the most important buffers in the human body. Changes in acid–base balance affect phosphate and calcium.
When you get too much phosphorus, your vitamin D levels and needs tend to go up.
Most people get too much phosphorus. It is found in many foods, is easy to obtain and you are far less likely to have deficiency. When consuming a natural diet, deficiency is almost impossible. But remember, it needs to be balanced with other nutrients.
Aim for a 1:1 ratio between calcium and phosphorus.
Modern diets often contain 2 to 3 times more phosphorus than recommended, prevalent in processed meats, cheese, baked goods, and soft drinks.
Recommended Daily Allowance (RDA) to Avoid Deficiency Symptoms
Manganese is an essential mineral. It assists with the healthy formation of bones and cartilage and supports wound healing by helping form new collagen and skin cells.
Deficiency is less common than toxicity. However, it can happen. Here’s a list of some signs of manganese deficiency:
Poor bone health or formation could look like osteoporosis, or poor skeletal growth in a child, for example, or a skin rash that is called miliaria crystalline on the torso, which looks like red little blisters that become really scaly with healing. Another is low cholesterol, impaired glucose tolerance, slowed growth, such as hair and nails, especially, impaired reproductive function, more pronounced premenstrual syndrome symptoms, low energy, weight loss, and poor ability for wound healing.
Toxicity with manganese usually occurs from high environmental exposures, and it’s not really that common. But it could happen with inhaled manganese, such as a welder might be inhaling manganese dust or ingested manganese as with a possible source of contaminated water.
Recommended Daily Allowance (RDA) to Avoid Deficiency Symptoms
We don’t have enough scientific evidence to set an official RDA requirement for manganese, therefore, the Food and Nutrition Board at the Institute of Medicine set an adequate intake (AI) value.
An adult woman needs about 1.8 milligrams per day, and an adult man needs about 2.3 milligrams per day.
Best Food Sources
The best sources of manganese are plant foods, with a special emphasis on spices. A Paleo diet rich in plant foods and spices will provide adequate manganese.
Carnivore diets may be low in manganese because those who don’t eat enough veggies or don’t like their veggies can have a difficult time getting adequate manganese. But if they focus on getting adequate spices such as cloves, ginger, saffron, cardamom, cinnamon, and turmeric, then they may very well get adequate manganese.
Here are some examples of foods that are high in manganese:
Mussels are the only animal food that is high in manganese.
Other options include nuts and seeds, grains, legumes, and then fruit categories that include pineapples, coconut, grapes, and berries.
And then specific vegetables including potato skins, kale, seaweed, spinach, okra, collard greens, and stinging nettles.
I do want to remind you, related to nuts and seeds and grains and legumes, they need to be properly prepared, such as soaking and sprouting to help release the manganese that can get bound to phytic acid in that food so it’s available for the body to use.
Supplementation
Consider supplementing on the advice of a healthcare provider who can assess your symptoms and/or test your levels. A carnivore-based food plan with little or no plant food might need supplementation. But remember, spices are a great source.
Do not supplement if you have iron deficiency because harmful levels of manganese can reach your brain.
Do not supplement with infants, during pregnancy, or breast-feeding.
Supplementing with manganese and calcium together may slightly decrease manganese bioavailability because the calcium might outcompete it.
Avoid with chronic liver disease. The liver may struggle to eliminate any excess leading to toxicity. That said, if someone supplements, this should be limited to no more than 3 milligrams per day.
Takeaways
Higher potassium intakes are associated with a reduced risk of cardiovascular disease and kidney stones and also increased bone mineral density.
Recommended Daily Allowance (RDA) to Avoid Deficiency Symptoms
People in the United States consume substantially less potassium than they need. According to the National Health and Nutritional Examination Survey in 2013 and 2014, fewer than 2 percent of adults consume adequate potassium.
The average daily potassium intake from foods among adults was 3,016 mg for men and 2,320 mg for women. In contrast, it has been suggested that our hunter–gatherer ancestors had potassium intakes as high as 11,000 mg per day.
Adults require 4,700 mg per day.
Best Food Sources
Potassium is found in a wide variety of plant and animal foods.
Many fruits and vegetables are excellent sources, including potatoes, sweet potatoes, plantains, squash, mushrooms, tomatoes, and bananas.
Certain types of fish such as halibut and salmon also contain potassium.
The body absorbs about 85 to 90 percent of dietary potassium.
It is important to note that many of the plant sources of potassium are also higher in carbohydrates, so those on low-carb diets should pay particular attention to potassium intake and select foods wisely.
Supplementation
Potassium supplementation is rarely necessary and can lead to dangerous mineral imbalances, so it should only be performed with the consent of a doctor who can closely monitor electrolytes. Potassium supplements should also never be used by anyone with impaired kidney function, diabetes, insulin resistance, or those who are using NSAIDs, ACE inhibitors, or beta-blockers.
If your gut is able to tolerate dairy, I highly recommend adding kefir or plain, full-fat yogurt into your rotation, ideally from 100% grass-fed milk. Aside from being rich in calcium, these foods contain other nutrients that shift your bone metabolism in the right direction. As shown in the research, kefir significantly increases hip bone density in just six months and supports osteocalcin.
Supplementation
I’d suggest you take a high-quality probiotic supplement that includes strains like Lactobacillus reuteri, L. casei, or Bifidobacterium longum — all shown to reduce bone loss markers and improve bone density.
