​​Supporting Healthy Bone Density with Nutrition: 14 Tips for Healthier Bones

 

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Supporting Healthy Bone Density with Nutrition 

The fear is real. You turn 55-years-old, have a bone density test, and find out that after years of taking great care of yourself, you have serious bone loss. This can be shocking and frustrating news!

Bone loss can be categorized as either osteopenia or osteoporosis. Osteoporosis is when the bones become porous and weak and can break much easier. Osteopenia is the milder stage of bone loss before osteoporosis. The problem with osteoporosis is that certain types of fractures such as spine and hip are associated with increased mortality, and all bone fractures affect quality of life by causing pain, decreased mobility, and function.

One in three women over aged 50 will have osteoporosis and most of these women will experience a fracture. Osteoporosis doesn’t only happen to women; men are at risk too. Osteoporosis is a silent condition and has no symptoms. The only way to find out if you have bone loss is to do a bone density test called DXA test.

You may feel relieved to find out that nutrition and weight-bearing exercises can help to halt or slow bone loss. The ideal scenario is to prevent bone loss in the first place. Armed with the right information you can start to make changes before the condition becomes severe.

Peak bone mass is reached between age 25-30, sometimes ages 16-30 years. (2) After this, if you are not actively promoting healthy bone density you may start losing bone mass sooner than you think.  

I personally am at a high risk for bone loss with celiac disease. Fortunately, I have always been aware of how to prevent bone loss, and I have been able to maintain a healthy bone density despite my risk factors. I love sharing this information with others because bone loss can be life-altering if you don’t address it early. 

 

If you want to decrease your risk of bone loss, please read on for bone strengthening lifestyle and nutrition tips that might surprise you.  



Risk Factors for Bone Loss:

Risk factors for bone loss include aging, (2) low levels of estrogen, (2) low testosterone in men (3) , poor nutritional intake, malabsorption diseases such as Celiac’s disease, hyperparathyroidism, lack of weight bearing exercise, (2) elite levels of cycling (non-weight bearing activity with minerals being lost through sweat), and use of steroids. Additionally, pregnancy and breast-feeding require higher calcium and mineral needs so if this need is not met then the mother can be at higher risk for bone density loss. (2) Women who have had hormone related cancers with subsequent hysterectomy, and no hormone replacement therapy may be in a high-risk category for bone loss.

Some medications such as diuretics and steroids can cause nutrient depletions that may contribute to bone loss. You have the option to discuss your medications with your physician and a dietitian and find out what nutrients you need to supplement to protect against bone loss and other health conditions while taking these medications.

Another risk factor I always look for is any gastrointestinal symptoms such as gas, bloating, constipation, diarrhea, or reflux as these symptoms may signal underlying malabsorption or cause people not to eat dairy products that can be one of our main sources of calcium.

 

The Good News on Nutrition and Bone Density:

 

Research has shown that key nutrients along with resistance exercise can greatly support healthy bone density. (4) Although supplements can play a helpful role, eating a whole-foods well- rounded diet, and the type of exercise you do is of utmost importance to maintaining healthy bone mineral density. Supplements cannot provide the full spectrum of nutrients that exist in food, and we may not yet know all the nutrients that are vital to bone health. A balanced diet can protect you not only from bone loss, but also from cancer, diabetes, obesity, and heart-disease, and can promote better mental well-being and better gut function.

 

14 Nutrition Tips for Healthy Bone Density:

 

  1. Get Plenty of Protein. Aim for about 30 grams or three to four ounces of animal protein per meal for a female. (4) A high protein diet (30% of calories) along with 1600 mg of calcium from food, combined with exercise, was shown to significantly improve bone health. (4) Mixed protein sources are best for maintaining bone health, so this includes meat, dairy, beans, and nuts. (4)


    While the consumption of animal protein helps ensure that nutrients such as iron, zinc, B6 and B12 are adequate, those who are vegan can use supplementation to help ensure nutritional adequacy. (6,11) Eat 3 servings of fish or seafood per week as omega 3 fatty acids are also important for healthy bones. It should be emphasized that the consumption of meat has NOT been shown to cause bone loss. (3)


    Muscle loss, called sarcopenia, can accompany bone loss. (5) Ensuring adequate protein intake and doing resistance exercise can help prevent both sarcopenia and bone loss.

 

2. Include Nuts and Beans. Eat 1/4 cup of nuts or seeds daily. Nuts contain protein, fiber, healthy fat, vitamin E, copper, zinc, manganese, magnesium, and selenium. (4)

 

Several times per week eat around 1/2 cup beans or other legumes such as lentils. Legumes contain protein, fiber copper, zinc, manganese, magnesium, and protein.

 

3. Aim For Two Servings of Fruit Daily. Fruit provides vitamin C and potassium that help with bone density. (4) Prunes are a good source of potassium and can count toward your fruit servings, but they do not contain much vitamin C. Always think of eating a variety of foods so add vitamin C rich fruits such as kiwi, orange, pineapple, cherries/berries to your day along with prunes.

Apples are a good source of boron which is helpful with maintaining bone density.

4. Include Wholegrains. Eat 1-2 servings of whole grains daily such as oats, buckwheat, brown rice for zinc, manganese, B vitamins, vitamin E.

 

5. Aim For 2-3 cups of Vegetables Daily. Eat 2-3 cups of brightly colored vegetables and make 1 cup of these dark leafy greens. Vegetables provide Vitamin A (beta carotene), Vitamin K, potassium, vitamin C, folate plus many more nutrients.

 

6. Consider Jarlsberg Cheese. It may be a little premature to recommend Jarlsberg cheese as more research needs to be done to confirm beneficial findings, but it likely won’t cause harm to include this in your diet. (5)

 

Jarlsberg cheese may help decrease bone loss. Eating 2 ounces per day of Jarlsberg cheese for 6 weeks compared to 2 ounces of camembert cheese for 6 weeks had a stimulating effect on osteocalcin (a hormone associated with healthy bones and teeth) and other parameters used to measure bone health. Jarlsberg cheese also lowered HbA1C levels (measure of blood sugar) compared to the camembert cheese used in the study. (5)

 

7. Include Magnesium Rich Foods. While calcium gets most of the media attention for bones, magnesium is very important for bone health. Thirty to forty percent of menopausal women are deficient in magnesium and most of the population does not consume enough magnesium. (7) Lower serum concentrations of magnesium are associated with osteoporosis. (7) Magnesium insufficiency decreases bone building activity (osteoblasts) and increases bone breakdown (osteoclasts), interferes with parathyroid activity, vitamin D function, and promotes inflammation. (7) Magnesium is required for vitamin D synthesis and activation. (7) Magnesium also helps with relaxation of the muscles, the mind, sleep, healthy blood pressure, and preventing constipation. (7) Magnesium rich foods include dark leafy green vegetables, nuts, seeds, wholegrains, beans.

 

8. Consider Eating Prunes. Research shows that 50 grams (or 6 prunes) daily prevents bone loss in the hip and protects from hip fractures in menopausal women. (9) Several studies have shown the benefit of eating prunes for bone density for both men and women. The latest study was a 12-month study published in the American Journal of Clinical Nutrition, on 235 women, average age of 62 years. Those in the prune group maintained hip bone mineral density, whereas the control group that was receiving calcium and vitamin D, had 1.1% loss of hip bone mineral density and a higher risk of fracture than the prune group. (8) Prunes have key nutrients for bone health including boron, potassium, and vitamin K. (8)

 

9. Don’t Forget Vitamin K Foods: Vitamin K comes in different forms, K1 and K2 and low levels of both in the diet are associated with higher risk of bone fractures and lower bone density. (11) K1 is found in leafy greens and helps with blood clotting. (11) Vitamin K2 is found in small amounts in cheese and natto, and eggs, and it is helpful in keeping calcium from building up in your soft tissue such as arteries and directing calcium to the teeth and bones. (11) Vitamin K2, particularly MK-4 and MK-7 are helpful in maintaining bone density and a healthy heart. (11) Foods that contain vitamin K include leafy green vegetables, prunes, dairy fat like butter, cream, and cheese. Think of eating broccoli with butter and cheese. Now we’re talking!! Greens and dairy fat are also a good source of vitamin A for your immune system and bone health. If you are already experiencing bone loss, your health care provider will likely recommend a supplement of vitamin K2.

 

10. Include Potassium Rich Foods. Potassium is a key nutrient for healthy bone density and was significantly associated with decreased risk of osteoporosis in the lumbar spine in postmenopausal women. (12) Most people do not get enough potassium.   The theory for why potassium helps with bone density is that it provides acid-base balance and helps to prevent the loss of calcium through urine. (12) The Recommended Daily Allowance (RDA) for potassium is 2300 mg per day for women and 3000 mg per day for men. Six prunes per day provides 400 mg, 4 ounces of salmon is 712mg, 1 cup of broccoli is 457 mg, 1 cup of plain Greek yogurt is 300 mg, 6 ounces of tomato juice is 600 mg. If you ate these every day that would provide you with almost 2500 mg of potassium. Potassium is helpful for managing blood pressure, exercise stamina, promoting a balanced mood, and preventing achy, crampy muscles. Potassium should be obtained through diet rather than taking supplements.

 

11. Include Calcium Rich Foods. Calcium is one of the main minerals that comprises bone and teeth. Calcium also helps with blood clotting, muscle contraction, heart rhythm and nerve conduction. (13) If you don’t eat enough calcium in the diet, the body obtains calcium by taking it from your bones, and thus causing bone loss. If you do not consume enough calcium in your diet, have a malabsorption disease such as Celiac’s disease, or you need to remain on steroids for a health condition, you need to discuss taking calcium supplements to prevent bone loss with your health care provider. Taking high doses of calcium can have unwanted side effects such as constipation, kidney stones and increase risk of heart disease so supplementation needs to be done judiciously. (14) Calcium rich foods include calcium fortified orange juice, yogurt, milk, cheese, and some dark leafy greens such as kale, collard, mustard greens, spinach and canned salmon and sardines that contain the bones.


12. Discuss Vitamin D With Your Doctor.   Vitamin D when combined with calcium helps to prevent osteoporosis and fractures. (16) It may be helpful to have your vitamin D levels checked by your doctor in both summer and winter and adjusting your supplementation accordingly. Supplementation should be determined on an individual basis. Some people need as little as 400 IU per day and some need a much higher amount to reach optimal serum levels of vitamin D. Vitamin D levels can be affected by gallbladder issues and malabsorption. Too much vitamin D can cause calcification of soft tissues such as arteries and heart valves as well as kidney stones, so this is a vitamin that needs to be monitored. Vitamin K when taken with Vitamin D may help to prevent soft tissue calcification.

 

13. Get Professional Nutrition Advice.  Your doctor may not be trained in nutrition and/or may not realize that the medications you are taking will cause depletion of key nutrients that can contribute to bone loss. So, be your own advocate. In addition to working with your doctor, make sure you also work with a functional dietitian/nutritionist who can research your medications and any nutrient depletions they may cause, and can analyze your diet to make sure you consume enough nutrients. The standard American diet is rich in processed foods and low in nutrients, so it is beneficial for everyone to have nutritional counseling.

 

Consider having nutritional testing done through a functional medicine dietitian to see if any of your levels of nutrients are low. While your diet may be adequate for the “average” person, you may have special nutrient needs based on your medications, genetics, extreme exercise, or an issue with digestion and absorption that may put you at a higher risk for bone loss.

 

14. Aim for a Healthy, Strong Body. Take pride in a strong body with muscle mass to maintain healthy bone density. Maintaining a healthy weight means not too low of a weight. Hip fracture rate was 46% higher in women with body mass index (BMI)<23.5 kg/m2 compared to BMI>23.5/kg/m2. 11 For reference a 5’3” woman weighing 133 pounds has a BMI of 23.9/kg/m2, which is in the safe zone. You can look up your BMI online by using a BMI calculator.

 

What Else Should You Do?

 

In addition to diet, maintaining good muscle mass and balance reduces the risk of hip fracture. Swimming, cycling, and walking, though healthy, may not provide adequate stimulus to bones. (15) Resistance exercises includes the use of free weights, weight machines, medicine balls, elastic bands, and different movements. (15)   Certain types of yoga as well as exercise that uses your own body weight (push-ups/pull-ups) also count toward resistance exercises. High impact activities like running and jumping and some types of dancing are beneficial for maintaining bone mass. (15) The World Health Organization (WHO) has made global recommendations for people older than 65 to include muscle strengthening activities two or more days per week. (15) Of course, this should be extended to those younger than 65 years of age for good health to prevent bone loss in the first place.

  

I hope you’ve found these tips helpful. I know this can feel overwhelming and I am here to offer you support. Feel free to schedule a discovery call with me to explore which nutrition and lifestyle tips are right for you and your body. 


 

Summary

 

· Eat a balanced diet with key foods

· Work with a dietitian/nutritionist to dial in your diet and run nutritionally related lab work

· Do resistance exercise twice weekly or more

· Discuss medications with your doctor and dietitian and identify nutrient depletions caused by your medications that may contribute to bone loss

  

 

References:

 

1. CDC: Hip Fractures Among Older Adults. Retrieved on 8/15/22

https://www.cdc.gov/falls/hip-fractures.html

 

2. American Academy of Orthopedic Surgeons. Healthy Bones at Every Age.

Retrieved on 8/15/22  from: https://orthoinfo.aaos.org/en/staying-healthy/healthy-

bones-at-every-age/

 

3. Hermann M. Behre, Sabine Kliesch, Eckhard Leifke, Thomas M. Link, Eberhard

Nieschlag, Long-Term Effect of Testosterone Therapy on Bone Mineral Density in

Hypogonadal Men, The Journal of Clinical Endocrinology &amp; Metabolism, Volume 82,

Issue 8, 1 August 1997, Pages 2386–2390, https://doi.org/10.1210/jcem.82.8.4163

 

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Retrieved on 8/15/22 from https://www.healio.com/news/primary-

care/20220811/norwegian-cheese-makes-a-difference-the-benefits-of-eating-jarlsberg-

daily

 

6. Menzel J, Abraham K, Stangl GI, Ueland PM, Obeid R, Schulze MB, Herter-Aeberli

I, Schwerdtle T, Weikert C. Vegan Diet and Bone Health-Results from the Cross-Sectional

RBVD Study. Nutrients. 2021 Feb 21;13(2):685. doi: 10.3390/nu13020685. PMID:

33669942; PMCID: PMC7924854.

 

7. Rondanelli M, Faliva MA, Tartara A, Gasparri C, Perna S, Infantino V, Riva A,

Petrangolini G, Peroni G. An update on magnesium and bone health. Biometals. 2021

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33959846; PMCID: PMC8313472.

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8. Wallace TC. Dried Plums, Prunes and Bone Health: A Comprehensive Review.

Nutrients. 2017 Apr 19;9(4):401. doi: 10.3390/nu9040401. PMID: 28422064; PMCID:

PMC5409740.

Retrieved on 8/15/22 from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5409740/

 

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Koltun, Connie Rogers, Mario G Ferruzzi, Cindy H Nakatsu, Connie Weaver, Prunes

preserve hip bone mineral density in a 12-month randomized controlled trial in

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Volume 116, Issue 4, October 2022, Pages 897–910,

https://doi.org/10.1093/ajcn/nqac189

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abstract/116/4/897/6633654

 

10.  Webster, J., Greenwood, D.C. &amp; Cade, J.E. Risk of hip fracture in meat-eaters,

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https://www.hsph.harvard.edu/nutritionsource/calcium/

 

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bone mineral density: systematic review and meta-analysis. The BMJ, 351.

https://doi.org/10.1136/bmj.h4183

 

 

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