THE MANY ROLES OF BONE
The well-known purpose of bones is to provide the framework of the body; giving both form and structure. In conjunction with joints, tendons and ligaments, bones facilitate movement. Being organs themselves, bones protect other vital organs such as the heart and brain and store essential nutrients, such as calcium and phosphorous, to be released when needed throughout the body. Furthermore, scientists have linked bones as part of the endocrine system, helping to regulate a number of hormone-related activities. Another example of this is in phosphate metabolism and regulating the release of Fibroblast Growth Factor-23. Interestingly, overall bone health can contribute to positive hormone regulation of the protein osteocalcin, known to combat insulin resistance, glucose intolerance and abnormal fat deposition and contribute to improved overall metabolic health.
Furthermore, bones contain both red and yellow marrow. Red marrow is responsible for producing blood components such as red blood cells (important for nutrient and oxygen delivery and waste removal), neutrophil-type white blood cells (immediate response immune cells), platelets (clotting factor), and stem/progenitor cells (important to repair and regeneration of tissue). Yellow marrow is a major storage site for fatty acids that can be used as an energy reserve. It can produce white blood cells but in much fewer quantities. Yellow marrow also converts to replace and/or supplement existing red marrow as needed.
Interesting Fact: It has been known since at least 2005 that Hyperbaric Oxygen Therapy (HBOT) triggers the release of bone marrow derived-stem/progenitor cells. These mobilized stem cells hone in on active signaling that indicates injury, allowing those cells to differentiate (change) into the specific cells needed for regenerative purposes. In 2014, further research indicated HBOT mobilized stem cells showed increased proteins that improved propensity for growth and differentiation (more versatile in where they can be used throughout the body) versus non-HBOT mobilized stem cells. More information on HBOT can be found on the “Hyperbaric Medicine” page.
RISK FACTORS AFFECTING BONE HEALTH
NIH cites that “more than 40 million people either already have Osteoporosis or are at high risk.” By far the most prevalent bone disorder, Osteoporosis is generally more likely to develop in older individuals. Women are at higher risk than men. Being too thin and those who don’t exercise regularly are at increased risk. Diets deficient in key nutrients (see “Nutritional Support” below) can also lead to decreased bone health. A number of other factors can also increase your risk and include:
Alcoholism (alcohol consumption increases calcium depletion)
Caffeine (increases calcium depletion)
Cancer Treatments (chemotherapy and radiation)
Dark Skin (due to decreased vitamin D production)
Diabetes (especially long-term insulin users)
Inflammatory Bowel Disease
Nutritional Deficiencies (see below)
Smoking (reduces calcium absorption; reduces estrogen [an increased risk for women])
THE DYNAMICS OF BONE
Bones are living tissue that are ever changing. The National Institute of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases, describes “bones as a ‘bank’ where you ‘deposit’ and ‘withdraw’ bone tissue.” If “new bone is added (or deposited) to the skeleton faster than old bone is removed (or withdrawn)…. bones become larger, heavier, and denser…. Sometime after age 20… bone withdrawals can begin to go faster than deposits” which can lead to Osteoporosis. Osteoporosis is a disease characterized by “porous bone and low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased risk of fractures.“
As is the case with all living tissue, bones can be nourished and supported to improve overall health, strength and functional capacity. However, it takes time to repair long-term damage. Spongy bone, the more porous structure on the interior, is entirely replaced in 3 to 4 years. The hard, compact exterior of bone is replaced about every 10 years.
NUTRITIONAL SUPPORT FOR BONES
NOTE: Further information on these and other individual supplements, their benefits, potential risks and tips on usage can be found at “Third Pillar: Supplementation.”
Calcium is an essential mineral required to build strong, healthy bones and teeth and to maximize and maintain bone mineral density.
Dietary Sources: Dietary derived calcium is more bioavailable (easier to digest and absorb) and is thus should be the primary source of calcium intake. As often the case, whole food options are best. Processed foods are often fortified with calcium; however, processed foods should be limited or avoided due to other potential health implications. Dairy sources include: milk, buttermilk, whey, “real” cheese (hard, soft and cottage/ricotta) and yogurt. Other whole food sources include: dark leafy greens (spinach, collard / mustard / turnip greens, kale), bok choy, broccoli, figs, leeks, okra, oranges, seaweed. Also nuts, seeds, beans and grains such as almonds, chia seeds, sesame seeds, white beans and oatmeal are good sources of calcium. A few good meat sources are sardines and salmon.
Supplementation: A well-rounded, healthy diet should contain sufficient amounts of calcium. However, “a calcium-poor diet is a primary risk factor for Osteoporosis.” Supplementation of calcium may be necessary if:
- dietary restrictions significantly impair the ability to eat calcium-rich foods
- a medical condition reduces the ability to absorb calcium
- a medical condition requires higher calcium levels
- a medical condition results in diminished calcium levels
- actively treating osteoporosis
If supplementation is required, it is important to stay away from biologically foreign forms of calcium such as limestone, eggshell, oyster shell and bone meal. Most calcium supplements are generally in the form of calcium carbonate or calcium citrate. Both highly absorbed, research shows that calcium carbonate is harder to digest and could lead to acid rebound (increased stomach acid). Therefore, calcium citrate may be the better choice.
NOTE: Calcium absorption and utilization is increased with increased vitamin D levels.
Everyone knows bones need calcium. However, most people don’t know you need vitamin D to facilitate the absorption of calcium (the reason vitamin D is added to milk) and to help regulate serum calcium and phosphate levels. It is believed that in the US, of those who DO NOT supplement, more than half are at risk for vitamin D insufficiency. Vitamin D, unlike most other “vitamins,” is actually a hormone. Not only is it important for bones, but also for immune function, muscle function, cardiovascular health, respiratory health, brain development and function, mood stabilizer and to combat depression, and can assist in cancer prevention. A deficiency can lead to or exacerbate a whole host of health conditions.
Dietary Sources: The best source of vitamin D is to allow the body to produce it through safe sun exposure. Many factors can influence whether one produces sufficient vitamin D. Most people do not get enough unfiltered sunlight to reach optimal vitamin D levels. (UVB rays are easily “filtered” out by glass, sunscreen, clouds and air pollution.) It is near impossible to obtain sufficient vitamin D from food sources; however, the following food sources can contribute to increased levels: Atlantic herring, wild catfish, tuna canned in water, sardines canned in oil, vitamin D fortified milk and yogurt, beef or calf liver, egg yolks and cheese.
Supplementation: If supplementing, use the vitamin D3 form. Furthermore, a lanolin derived version of D3 is more similar to the actual vitamin D produced by the body. Vitamin D requires fat to allow for absorption and utilization; therefore, always consume vitamin D supplements along with a fat-containing snack or meal.
CAUTION: Only use vitamin D2 under close supervision and monitoring by a knowledgeable health care provider. D2 has a higher affinity toward build up to toxic levels since it must first be converted to D3 before the body can utilize it.
Vitamin K is important to bone metabolism and is protective against osteoporosis. There are several forms of vitamin K essential to the effective utilization of calcium throughout the body and to prevent other disorders like calcium based stones and calcification of arteries, veins, organs, etc. In short, vitamin K puts calcium where you need it and keeps it from building up where you don’t. If using “high-dose” vitamin D supplementation and/or have issues with calcium based stones, or other calcification issues, maximizing vitamin K intake is essential.
Dietary Sources: Herbs (basil, parsley, cilantro), dark green leafy vegetables (spinach, collard / mustard / turnip greens, kale), brassica vegetables (brussels spouts, broccoli, cabbage), asparagus, leeks, okra, cucumber, prunes, alfalfa sprouts and mung bean sprouts.
Supplementation: If supplementing, it is important to get one that contains a combination of K1 and both K2 (MK-4) and K2 (MK-7).
CAUTION: Vitamin K can reduce the effectiveness of blood thinners like Warfarin and Coumadin. If you take blood thinners, check with your health care provider.
Magnesium is also essential to bone health. It helps the D3 function properly and thus the calcium too. But it also contributes to the growth and structure of bone.
Dietary Sources: Some of the highest sources of dietary Magnesium are nuts and seeds (especially almonds, sunflower and sesame seeds), regular oatmeal, whole milk, bananas, beets, broccoli, dark green leafy vegetables (spinach, collard / mustard / turnip greens, kale) and peas.
Supplementation: There are many different forms of Magnesium, but there are only a few that are the best choice when supplementing. In fact, most supplemental Magnesium either is poorly absorbed or capable of causing significant GI upset and diarrhea. (Magnesium is the active ingredient in Milk of Magnesia; but unless your goal is to clean out your GI, little of it will contribute to overall health.) Magnesium L-Threonate has been studied for its ability to not only cross the blood-brain barrier to contribute to cognitive health, but also to stay in an unfractured form and reach cell nuclei; thus offering optimal utilization and without GI upset.
Topical Delivery: Magnesium in optimal forms is easily absorbed, bypassing the GI and speeding delivery to the body. Soaking feet or the whole body in an Epsom Salt bath is well known for helping relieve muscle aches and pains. The mode of action for this result is the Magnesium. There are also Magnesium oils and gels that can be applied topically to sore, achy, stiff muscles or painful joint areas to decrease pain and speed healing.
PHOSPHORUS / PHOSPHATE:
Approximately 85% of Phosphorus is found in bone and teeth. It works in tandem with calcium and magnesium to help build, maintain and repair all tissues and cells including bone. Phosphorus helps the body utilize vitamin D, iodine, magnesium and zinc. It also plays a similar role as vitamin K in regulating where and how calcium is utilized in the body.
Dietary Sources: Seeds (pumpkin, sunflower, chia, sesame), fish (salmon, cod, tuna, mackerel, sardines), shellfish (scallops, mussels, crab), nuts (brazil, pine nuts, almonds, cashews, pistachios), pork chops, beef and veal, beans (chickpeas, lentils, kidney, pinto, white beans), eggs and dairy products.
Supplementation: Sufficient Phosphate should be obtained from dietary sources. The need for Phosphate supplementation is extremely rare. Due to potential interactions and side effects, Phosphate supplementation should only be done under the supervision of a knowledgeable health care provider.
Potassium acts as a bone guardian, helping to improve bone mass by regulating calcium content. Potassium also acts as “the skeletal compartment’s first line of defense in buffering metabolic acid loads,” protecting against acidity assaults that can leach calcium from the bones.
Dietary Sources: Fruits (bananas, cantaloupe, kiwi, oranges, strawberries, watermelon), avocado, potatoes (red, white, sweet), squash (acorn, summer squash, zucchini), dark green leafy vegetables (spinach, collard / mustard / turnip greens, kale), bamboo shoots, Chinese and Japanese cabbage, celery, beans (lentils, lima, kidney, pinto, white), and dried fruit (apricots, cranberries, dates, figs, peaches, raisins). Meat can also contain potassium, such as wild salmon, cod and tuna; lean red meat, chicken and turkey.
Supplementation: As with a number of nutrients, potassium is best obtained from dietary sources. A well balanced diet should provide sufficient amounts. Therefore, supplementation of potassium should be limited to those have potassium deficient diets or those who have lost significant potassium due to illness or who have a disease that effects potassium levels or require treatment that reduces potassium content.
In addition to supporting joints and connective tissue, Vitamin C serves two important roles in bone health. It simultaneously suppresses osteoclasts (bone-destroying cells) while increasing production of osteoblasts (bone-building cells), resulting in improved bone mineral density. Unable to be synthesized from other sources and being water soluble, vitamin C must be contributed to the diet on a regular basis to maintain adequate levels.
Dietary Sources: The best sources of vitamin C are papaya, strawberries, pineapple, kiwi, oranges and other citrus.
Supplement Facts: Vitamin C supplementation should be from naturally sourced, multi-sourced vitamin C (preferably in powder form that can be easily added to a beverage).
TRACE MINERALS FOR BONES
Trace minerals are a group of metal ions that, though they exist in minimal amounts in the body, are required in sufficient amounts for optimal functioning. Trace minerals include chromium, copper, iodine, iron, manganese and zinc. Unlike “macrominerals” like calcium, magnesium and potassium that the body uses in much larger quantities, it is easy to overload on trace minerals and cause an imbalanced. It is always best to get the bulk of nutrition from whole food sources; this is especially true with trace minerals and eating a well balanced diet can help reach optimal levels. Both excesses and deficiencies of trace minerals can cause impaired functioning. Therefore, supplementation of trace minerals should be done with caution. Monitoring of levels via labs by a qualified health care provider is recommended.
Furthermore, it is important to keep in mind that trace minerals can be found from other sources besides whole food. One reason to steer clear of “multi- vitamin/mineral” supplements is that they don’t provide sufficient macro-nutrients but often provide more than enough trace minerals. Some people, in an effort to get higher levels of certain supplements, will take more than the recommended serving of these products, not realizing they are risking overload or toxicity of these micro-nutrient trace minerals. Another source of overload can be fortified foods (cereals, baked goods and processed foods). Otherwise considered “healthy” options (such as shakes and bars) can also run afoul if consumed in large quantities.
The following trace minerals have been identified for their important role in achieving and maintaining optimal bone health:
Iron helps convert vitamin D into its active form; thereby assisting in calcium absorption. It helps regulate normal osteoblastic activity and the formation of strong collagen fibers, the foundation of bone. A study in 2003 showed a significant correlation between increased Bone Mineral Density and increased levels of Iron (greater than 20mg/daily). However, Iron supplementation should be monitored via labs to avoid “Iron Overload,” a state of excessive iron that can be detrimental to bone health and can cause a number of other health issues.
Dietary Sources: Dark green leafy vegetables (spinach, collard / mustard / turnip greens, kale), asparagus, bok choy, leeks, tumeric. Eggs, organ meat (liver, giblets) and red meat. Seafood (oysters, clams, mussels, squid), fish (haddock, salmon, sardines, tuna), beans/legumes (chickpeas, lentils, lima, kidney, pinto, white beans), seeds (pumpkin, sesame, squash), dried fruit (apricots, peaches, prunes, raisins).
Supplementation: Iron supplementation should be monitored via labs to avoid “Iron Overload,” a state of excessive iron that can be detrimental to bone health and can cause a number of other health issues.
NOTE: Increase the absorption of iron by consuming iron rich foods along with vitamin C rich foods.
Zinc is an essential trace mineral that stimulates the activity of over 100 enzymes associated with everything from immune health (including activating T lymphocytes [T cells] that attack infected or cancerous cells), wound healing, improving cognitive function and memory, preventing age-related macular degeneration, and facilitating DNA synthesis. In recent years, prevention of osteoporosis has been added to the list of zinc benefits. “Every step of bone metabolism utilizes zinc, and its deficiency is implicated in osteoporosis.” Research is showing how zinc plays as important a role in bone density as does calcium. It has a stimulatory effect of collagen synthesis that “can increase osteogenic effect by stimulating cell proliferation, ALP activity and collagen synthesis in osteoblastic cells.”
Dietary Sources: The riches sources of dietary zinc come from lobster, oyster, egg yolks, beef, pork, lamb, sea vegetables, mushrooms, peanuts and dark chocolate.
Supplementation: Zinc is another nutrient best obtained from dietary sources; however, if your diet is deficient in zinc-rich foods, zinc supplementation is essential. Being a “trace” mineral, it doesn’t take much zinc to make a positive effect on health. Too much zinc can suppress absorption of copper. The recommended daily allowance averages 10 to 15mg/ day depending on age, sex and other factors. Consuming higher doses may require the assistance of a qualified health care provider. The upper limit of zinc supplementation, to avoid possible adverse side effects, is 40mg/day.
Copper is a cofactor to Lysine in its function of contributing to collagen production; important to both bone growth, maintenance and resilience. Copper also plays an important roll in bone function of red blood cell production, a deficiency of which causes its own form of anemia. Copper also contributes to proper iron absorption. Copper also aids in nerve conduction and hormone secretion.
Dietary Sources: The riches sources of dietary copper come from oysters and other shellfish, liver, dark green leafy vegetables (spinach, collard / mustard / turnip greens, kale), legumes, nuts and dark chocolate.
Supplementation: Copper also is best obtained from dietary sources; however, if your diet is deficient in copper-rich foods, copper supplementation may be necessary. It takes remarkably small amounts of copper to make optimal impact. Too much copper, copper toxicity, can have negative effects on emotions/mood, mental function, clarity and memory, and can cause hypothyroidism. Copper excess can also lower magnesium and potassium levels, affecting the sodium/potassium balance which can place the person in chronic “fight or flight” response. The recommended daily allowance averages 1 to 3mg/ day depending on age, sex and other factors. Consuming higher doses may require the assistance of a qualified health care provider. The upper limit of copper supplementation, to avoid possible adverse side effects, is just 10mg/day.
Manganese is used in the formation and maintenance of bones and connective tissue (a deficiency of which causes bone and connective tissue defects). It is a required cofactor for the enzyme Prolidase, important to the creation and integrity of collagen; important to both bones and joints, in addition to other connective tissue such as skin, blood vessels and intestines. Manganese also plays an important role in blood clotting factors.
Dietary Sources: Grains (oats, brown rice, quinoa), dark green leafy vegetables (spinach, collard / mustard / turnip greens, kale), garlic, fruits (bananas, pineapple, tomatoes), berries (blueberries, cranberries, raspberries, strawberries), vegetables (asparagus, bok choy, broccoli, brussels sprouts, cabbage, cauliflower, celery, green beans, green peas, leeks, summer squash, winter squash), sweet potatoes, beets, mushrooms, beans/legumes (black, lentils, lima, kidney, navy, pinto, white), nuts and seeds.
Supplementation: Manganese is best acquired from dietary sources. Though it is an important trace mineral for several aspects of health, high concentrations of Manganese have been associated with neurological disorders similar to Parkinson’s and poor cognitive performance. The recommended daily allowance averages between 1 to 2.6mg/day depending on age, sex and other factors. The upper limit of Manganese supplementation, to avoid possible adverse side effects, is just 10mg/day. It is extremely rare that supplementation is necessary and should only be done with assistance of a qualified health care provider.
Note: Consuming Magnesium at the same time as Manganese can reduce absorption of Manganese.
Approximately one-third of the mass of bones is made up of osteoids, a majority of which contain collagen fibers that support bone resilience. Therefore, the discussion on supporting Joints and Connective Tissue also applies to supporting bone health.
PHYSICALLY SUPPORTING BONE HEALTH
Both weight-bearing (exercise that makes you move against gravity while staying upright) and muscle-strengthening (exercise that uses your body, a weight or some other resistance against gravity) play an important role in building and maintaining strong, dense, health bones. Click HERE to review the National Osteoporosis Foundation recommendations of “Exercise For Strong Bones.”
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