Most people think of bones as something rather ‘dead’ – simply the scaffolding on which to hang the rest of the body. Bones are made from a matrix of collagen, produced by vitamin C, into which bone-building minerals such as calcium, magnesium and potassium are deposited. Although they seem the strongest and most enduring part of us, our bones are in a constant flux, endlessly being destroyed and re-created. Cells called osteoclasts are the bone destroyers, whereas the osteoblasts create new bone – but age slows down this sequence of destruction and renewal.
Strategies for improving bone-mass density either focus on stimulating growth, helping to push minerals into the bone, or on preventing its breakdown. Weight-bearing exercise – such as walking – combined with eating sufficient protein, for example, stimulates bone growth. Getting enough vitamin D helps calcium to be absorbed into the bone, while the hormone oestrogen and drugs called bisphosphonates inhibit bone breakdown. B vitamins assist your body’s methylation, and keep your homocysteine level ideal, which also helps to inhibit bone breakdown. The usual drugs offered are bisphosphonates but they are remarkably ineffective.
The amount of vitamin D you have in your blood may also play a major role. Not only does research show that 75 per cent of people on bisphosphonates don’t respond at all if they have the kind of low levels very common in the UK (below 50 nmol/l) but also getting double that amount would mean that you would be seven times more likely to have a favourable response to the drug.1 It only costs your doctor a small amount – a fraction of the cost of a drug prescription– to have your vitamin D levels tested, but if your doctor doesn’t want to test you, you can do it yourself at www.vitamindtest.org.uk.
Vitamin D is vitally important for bone health
Osteoporosis becomes more common as you move north, suggesting a link between sunlight (which produces vitamin D in the body) and this condition. The vital role of vitamin D is well known. It helps deposit calcium and other minerals into the bones’ collagen structure. Numerous studies have shown that the combination of vitamin D – at a daily intake of around 20–30mcg a day, along with 1,000mg-plus of calcium – improves bone mass density and reduces the risk of fractures.
It is certainly possible make all the vitamin D you need from sun, depending on how near the equator you are, the season and your skin colour. In the UK, 20 to 30 minutes a day in the summer, with as much of your skin exposed as you are comfortable with, will keep you healthy. But between October and March the sun will provide very little and getting enough from your diet is challenging. Few would be prepared to eat the three portions of oily fish a week and at least half a dozen eggs it would require. So to get the 30mcg that many experts now recommend as the minimum, you will need supplements. You get vitamin D drops providing 25mcg per drop. One or two of these a day can really boost your vitamin D levels. They are well worth trying for a couple of months if you do have muscle or joint pain, or osteopenia or osteoporosis.
Just taking calcium isn’t the answer
‘Bones are made of calcium, and milk is rich in calcium, so drink milk to strengthen bones.’ It’s a good story, but it’s very misleading. A recent review of studies giving calcium supplements finds that calcium alone doesn’t significantly reduce risk of fractures in postmenopausal women2 unless vitamin D is also given, and it doesn’t increase bone mass density in children either. Marion Nestle, Professor of Nutrition at New York University, has long campaigned for good food and has also exposed the vested interests behind junk food. She is one of a growing number of experts who point out that there is no clear correlation between rates of osteoporosis and calcium intake from milk.3
Another recent study found that calcium alone, or even with vitamin D, slightly raised the risk of a heart attack,4 while a third study found that getting more than 750mg was a waste of time. But such studies rarely consider the vitamin D levels of the patients, when low levels are linked with a greater risk of heart attack. What is more, giving a single mineral or vitamin is rarely effective.
In relation to calcium, your diet should provide around 800–1,000mg. The average intake is 900mg, because most people have a lot of dairy products. If you don’t have dairy products but do eat seeds, nuts and beans on a regular basis you should still achieve 800mg calcium plus other bone-friendly minerals such as magnesium. To get the ideal 1,000mg intake means supplementing a further 100–200mg, which is what should be in your daily multivitamin–mineral.
Some nutritionists recommend getting 1,200–1,500mg of calcium later in life, which means supplementing a further 400–700mg of calcium in total. There’s nothing wrong with this provided you also supplement the co-factor bone-building nutrients, which include magnesium, zinc, boron and vitamin D.
A good multivitamin–mineral should provide these, plus at least 40mcg of vitamin K. This often-forgotten vitamin helps bone formation by stimulating a protein called osteocalcin, which also fixes calcium into the bone. Leafy green vegetables such as spinach, Swiss chard and Brussels sprouts are rich in vitamin K and are also good sources of calcium and magnesium. There are also bone-friendly formulas that might be worth taking as well to ensure you get the optimal levels for bone support.
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