OPTIMIZE BONE HEALTH—YOUR PLAN TO PREVENT OSTEOPOROSIS FRACTURES.
As men and women age, they lose bone density and the risk for debilitating fractures increases. Several preventative measures will help to maintain strong bones and prevent the risk of fractures. The two most important factors for bone health are activity and nutrition.
Bones need vibration to stay strong. Send a healthy fit adult to the space station in outer space, and they risk losing a lifetime of bone density in just a few months; now you know why they have a mini gym in the space lab for astronauts.
Bones need physical stress to stay strong, not surprisingly, weight bearing exercises (walking, running, elliptical machine use) and strength training (weight lifting, Pilates) are fantastic for your bones. Taking bone nutrients (calcium, vitamin D, etc) alone is not enough to maintain bone density.
Are you getting enough activity? Most experts recommend walking 10,000 steps daily (as measured on a pedometer). This is equivalent to walking about 3 miles every day.
Your bones need four primary nutrients to stay strong and prevent fractures: calcium, magnesium, vitamin D, and vitamin K (plus trace elements found in a high quality multivitamin). My favorite pill that contains all four is OsteoForce. For details on bone nutrition, keep reading:
Bone Nutrition Outline
- How much Calcium do you need?
- What is the best type of Calcium supplement? Are some absorbed and tolerated better than others?
- Should you always take Calcium with Magnesium?
- How much and what type of Magnesium do you need?
- How much Vitamin D do you need?
- Do you need to check a Vitamin D level?
- What if you get Vitamin D, but you don’t get Vitamin K?
- Why do you need vitamin K?
- How much Vitamin K do you need for your bones and arteries?
- What are food sources for vitamin K?
- How much Calcium do you need? Calcium needs vary by lifestyle. If you do everything right, you will do well with only 800 mg of calcium daily, but if you do most things wrong, 1,500 mg daily will keep you from fracturing later in life. I recommend that you select one of the choices that best matches your lifestyle:
- You do everything right and you need 800 mg of calcium daily: meaning you get 45 minutes of weight bearing exercise 5-6 days per week, you lift weights 2-3 times per week, you don’t smoke, do not drink more than 1-2 servings of alcohol at a time, you get at least 1,000 IU of vitamin D and 500 mcg of vitamin K daily, you do not eat excessive animal protein or salt (>10 ounces meat-poultry-fish daily, >2,000 mg salt daily), and you eat at least 5 cups of fruits and vegetables every day. Sadly, this is only about 5% of Americans.
- You do most things wrong, or, you already have osteopenia or osteoporosis and thus you need 1,500 IU of vitamin D daily: you don’t exercise; you get excessive amounts of alcohol, tobacco, animal protein, and/or salt; and you don’t get your 5 cups of fruits and vegetables every daily. This is about 20-30% of Americans today.
- Most often, you are somewhere in between and you should get 1,000 to 1,200 mg of calcium daily.
Once you know your calcium requirements, calculate how much calcium you get from food. See the table below. To simplify it, think of plain yogurt at 400 mg of calcium per cup. Milk, calcium-fortified soy milk, almond milk, & orange juice all have 300 mg of calcium per cup. Green leafy veggies (except spinach) have 100 mg per cup. Beans have 100 mg per cup. On a typical day (not a good or bad day), how much calcium do you get through your food?
Food Item Calcium content (mg)
Non-Fat Yogurt (8 ounces) 415
Non-Fat Cow’s milk (8 ounces) 300
Soy & Rice milk (Calcium fortified-8 ounces) 300
Orange juice, calcium fortified 300
Soy beans (edamame, 1 cup) 261
Sardines in tomato sauce (3.5 ounces) 240
Broccoli, cooked (1 cup) 175
Kale, and other cooked greens (1 cup) 100-150
Seaweed (dry Hijiki or Wakame) 100-160
Tofu (1/2 cup) 130
Navy beans (1 cup, cooked) 128
Garbanzo beans (1 cup) 80
Almonds (1 ounce) 75
Carrots (1 cup) 35
Brown rice (1 cup), or oatmeal cereal, (1 cup) 20
Whole wheat bread (1 slice) 20
Now that you know your calcium requirement and your dietary intake, you can calculate how much calcium to add daily to meet your needs. If your dietary intake is lower than your requirement, either add more calcium rich foods daily or take a supplement.
What is the best type of Calcium Supplement?
- Protein-bound calcium or calcium chelate (e.g. calcium malate chelate or calcium glycinate chelate) are by far the best absorbed and cause little to no gastrointestinal symptoms.
- Calcium carbonate is the worst type of calcium as it may contain lead, must be consumed with food, has limited absorption, and causes constipation.
- Calcium citrate is normally lead-free, but has limited absorption and can cause constipation.
Should you always take Calcium with Magnesium?
Absolutely. Please keep three facts in mind:
- Most people are magnesium deficient
- Taking calcium blocks magnesium absorption
- Magnesium is critical for hundreds of health issues, in particular blood pressure and blood sugar control, preventing constipation & muscle cramps, plus preventing fatal cardiac arrhythmias.
So yes, if you take calcium, you should take it with magnesium. Many high quality calcium supplements come with calcium and magnesium in a 2:1 to 3:1 ratio, which is an excellent choice.
- My favorite form of calcium and magnesium is OsteoForce, with a nice protein-bound form of calcium & magnesium, plus extra vitamin D and vitamin K. If you already get your vitamin D and vitamin K from other sources, then try our Calcium Malate Chelate and Magnesium Malate Chelate aiming for a 2:1 ratio.
- How much Magnesium do you need? Most people need about 400 mg daily. If you aim for 800 mg of calcium daily, then 300-400 mg of magnesium should be enough for you. If you aim for 1500 mg calcium daily, then 500-750 mg of magnesium is needed.
- Does the type of Magnesium matter? Absolutely! There are many different types of magnesium, and the most common is magnesium oxide, which is a cheap form that often causes gastrointestinal distress (typically this is the type used to clean out your bowel before surgery or a colonoscopy). The best absorbed and best tolerated would be a protein bound form of magnesium, or the second best choice would be magnesium citrate.
Vitamin D is essential for calcium absorption and bone mineralization.
- Vitamin D also impacts many critical aspects of health and proper intake is associated with reducing the risk of cancer, auto-immune disease, heart disease, and many other health issues.
How much vitamin D do you need? (See Get Your Vitamin D for details)
- Most people need at least 1000 IU of vitamin D3 (cholecalciferol) daily. As we age, or if we have other health issues (bone density loss, auto-immune disease, cancer risk) then some people may need 2000 to 3000 IU daily. Talk to your medical provider before taking more than 2000 IU daily long term, although if your level is low, typically people take 5,000 IU daily for 2-3 months to bring their levels back to normal before continuing on 2,000 IU daily long term.
Vitamin D facilitates the absorption of calcium, helping to support healthy and strong bones. It also promotes bone mineralization. Get regular sun exposure (about 20-30 minutes a day is adequate), and take 2,000 IU of vitamin D per day – look for supplements that provide D3 (cholecalciferol) rather than D2 (ergocalciferol).
Should you check your Vitamin D level with a blood test?
- If you have complicated medical problems, such as gastrointestinal problems, osteopenia or osteoporosis, auto-immune disease, cancer, then yes I suggest you check a level to ensure you are between 40-70.
- Healthy people getting the dosages recommended above do not require this, although I check this at least once in all my patients to ensure they are at optimal levels. Absorption rates vary substantially and at times I am surprised how low some of my patient’s levels are.
Do you need to take Vitamin K with Vitamin D?
- There are theoretical concerns that adding vitamin D, which helps calcium absorption, to a vitamin K deficient person will increase arterial calcification. As there is a great deal of scientific merit behind this concern, I think it is critical to meet your vitamin K needs if you take vitamin D.
Why do you need Vitamin K?
- Vitamin K was first identified to be essential for normal clotting, otherwise one might bleed to death after a minor cut.
- Over time, we now realize that vitamin K is also essential for bone and artery health. Without vitamin K, bones lose calcium and arteries become stiff and hard as they cannot get rid of calcium from their arterial walls.
How much Vitamin K do you need for your bones and arteries?
The minimum for proper clotting is around 100 mcg per day (90mcg for women, and 120 mcg for men). Yet for your bones and arteries, they function much better with at least 250 mcg of Vitamin K daily, and most experts in this field suggest that for optimum function you get 1,000 mcg daily. If you eat 1 cup of cooked greens, that provides ~1000 mcg of Vitamin K daily, while 1 cup of broccoli, onions, or beets provides about 250 mcg of Vitamin K.
Ten Years Younger options for Vitamin K:
- –OsteoForce: 250 mcg Vit K/tablet
- –Multivitamin with joint or arthritis support: 775 mcg Vit K/pack once daily
- –Multivitamin with bone support: 1000 mcg with 1 pack taken twice daily
- –Vitamin D 2000 IU daily with 200 mcg Vit K
Vitamin K Content in Food:
|Food Content||Measure||mcg of K1|
|Kale, cooked, drained||1 cup||1,062|
|Collards, cooked drained||1 cup||1,059|
|Spinach, cooked(or ~7 cups raw)||1 cup||889|
|Beets, cooked||1 cup||697|
|Broccoli, cooked||1 cup||220|
|Brussels sprouts, cooked||1 cup||219|
|Onions, raw||1 cup||207|
|Cabbage, cooked(or ~ 3 cups raw)||1 cup||163|
|Asparagus, cooked||1 cup||144|
|Lettuce, iceberg||1/4 head||33|