Calcium supplements have been shown to be a health RISK, with no benefit to improving bone density.
When I worked in pharmacy, I was shocked at the number of calcium supplements purchased. Some people were told by their doctor to take them, others had seen ads on TV and figured they should be taking them.
Studies suggest that calcium supplements do nothing for bone density and preventing fractures, but actually may increase the risk of cardiovascular disease, kidney stones, prostate cancer, and early death.
EARLY DEATH!
A study published in BMJ showed a 40% higher risk of death for women taking 1400 mg calcium over a long period of time and a 157% higher risk of death if those women were taking a 500 mg supplement daily, compared to women with moderate daily calcium intakes (600-1000 mg).
Dangers of taking supplements
Another risk of taking any supplement is heavy metal and toxin content.
This is why I only prescribe correctly made naturopathic script only supplements. I know these products are correctly made, batch-tested, and safe. If you are an iHerb shopper - beware.
When supplements are cheaper, either the core ingredients are of poorer quality, or they are not activated and as bioavailable, or the expense of batch testing is waived.
Numerous quality control investigations have found worrying discrepancies in supplements, from the incorrect core ingredients to unsafe levels of toxins. Incorrect ingredients is a common issue in herbal supplements, as plant identification can be easily done incorrectly. Plus most brands don't test for phytochemical content in the end product - the very thing you are taking a supplement for in the first place! My most trusted brands are MediHerb and Metagenics, as I know they batch-test every product in their own pharmaceutical-grade lab. Yes, it makes for a dearer product, but it is totally worth it.
So how can you improve your bone health?
Well, bones need more than calcium. You should aim to get your calcium needs from your diet (bone broth, bone in fish, dairy, cruciferous vege, almonds, seeds, and dark leafy green vege.) If you need a supplement, there are more bioavailable forms, such as Calcium citrate tetrahydrate, and Hydroxyapatite.
Knowing the dose you need varies according to diet, and stage of life. A naturopath can help you figure that out.
However, you must have other nutrients in your body to ensure that calcium goes into the bones, and not into the soft tissues like the arteries and kidneys. If you have thickening joints, that shows that calcium is incorrectly depositing in the body.
How much calcium should I take?
The Recommended Daily Intake (RDI) in Australia for adults between 19 to 50 years of age is 1000mg/day. This increases to 1300mg/day for either women over 50 years of age or men aged over 70 years. You should aim to get this through your diet, and only supplement if needed with quality supplements that also contain all the needed co-factors to get that calcium into your bones.
For people avoiding dairy, extra care must be taken.
Here’s how much calcium is recommended at different ages:
Children
1-3 years — 500mg per day
4-8 years — 700mg per day
9-11 years — 1,000mg per day
12-18 years — 1,300mg per day
Adult women
19-50 years — 1,000 mg per day
51 years and older — 1,300 mg per day
Adult men
19-70 years — 1,000mg per day
71 years and older — 1,300mg per day
Calcium-Rich Food List
I recommend that clients use an app to track their nutrition for 1 - 2 weeks to get a true feel of how much calcium they get. If they aren't meeting their needs, then a correctly chosen supplement is warranted.
Apps that I like are MyFitnessPal and Chronometer.
Food | Serving | Calcium Serve (milligrams) mg |
Milk, regular | I cup serve 250ml | 304 |
Milk, reduced fat | I cup serve 250ml | 367 |
Regular soy milk | I cup serve 250ml | 309 |
Tofu, firm fortified | I cup serve 250ml | 832 |
Natto | 1 cup | 380 |
Regular Natural yoghurt | 200gm tub | 386 |
Cheddar Cheese | 1 slice | 160 |
Camembert | 1x 25gm wedge | 121 |
Sardines, canned in water | 90 grams | 486 |
Red Salmon, canned in water | 90 grams | 203 |
Tahini | 1 tbsp | 66 |
Almonds | 10 almonds | 30 |
Dried figs | 3 figs | 80 |
Bok Choy, raw | 1 cup | 65 |
Silverbeet, boiled | ½ cup | 87 |
Lebanese raw cucumber | 1 cup | 68 |
Chickpeas | 1 cup cooked | 90 |
Dairy-Free Calcium Options
As you probably noticed, dairy is a big source of calcium for people. And herein lies the rub. Studies have shown that menopausal women relying on cows dairy for calcium intake suffered MORE bone loss than those that did not. But other studies have shown the opposite - you gotta love that about 'science', and that's why I don't blindly believe scientific studies. There are way too many variables, and studies need to take a reductionist approach to get a result, so those variables are often missed, ignored, or disegarded.
A 2014 study published in BMJ found that higher rates of milk consumption was associated with an increased risk of bone fractures. More than 105,000 men and women who drank 3 or more glasses of milk per day had nearly double the risk of death and cardiovascular disease and a 44% increased cancer risk compared to women who drank one glass per day or less.
Eek.
Issues with dairy
I've run hundreds of food intolerance tests, and dairy is nearly always a top driver of inflammation.
Lactose and/or casein are a problem for many people - especially people with any immune system disruption. And I must say, this has become a bigger issue with covid.
The other issue is what is done to our dairy before we drink it. Humans evolved with raw dairy, not pasteurised and homogenised dairy. Homogenisation separates the milk fats into tiny particles that do not separate - so you don't get the cream settling on the top. But this is not natural at all. Those tiny fat particles can easily crosse the gut barrier, which is a bigger concern with the amount of leaky guts people have these days. That fat molecule triggers an immune response, driving autoimmune diseases.
Then there is the animal welfare issue as well, which I won't go into....
So let's look at non-dairy calcium sources.
Soy would have to be a top tip for women in menopause, with Natto the true superfood of them all.
I tend to steer clear of fortified foods, as the form of calcium is not the best. Instead, calculate your diet with an app, and then supplement wisely if needed, ensuring you also are getting ample nutritional co-factors.
Natto
Natto is a traditional Japanese food made from soybeans fermented by Bacillus subtillis natto.
We want to aim between 150 - 500mcg a day - aim for the higher range if you need to enhance bone healing or density.
100 grams of natto has 1103.4mcg!
Food Sources of Vitamin K2
Goose Liver Paste 369.0 mcg
Egg Yolk (Netherlands) 32.1 mcg
Goose Leg 31.0 mcg
Egg Yolk (United States)15.5 mcg
Butter15.0 mcg
Chicken liver (raw)14.1 mcg
Chicken Liver (pan-fried) 12.6 mcg
Chicken breast 8.9 mcg
Chicken leg 8.5 mcg
Ground beef (medium fat) 8.1 mcg
Bacon 5.6 mcg
Calf liver 5.0 mcg
Whole milk 1.0 mcg
Salmon 0.5 mcg
Mackerel 0.4 mcg
Egg white 0.4 mcg
Skim Milk 0.0 mcg
Hard cheeses 76.3 mcg
Soft cheeses (brie) 56.5 mcg
Curd Cheeses 24.8 mcg
Cheddar cheese 10.2 mcg
Sauerkraut 4.8 mcg
Several nutrients needed for bone health include;
Vitamin D - vitamin D deficiency (<30-50 nmol/L) is one of the most common causes of osteomalacia, an osteoporotic-related condition defined by impaired skeletal mineralisation. This is due to the widespread effects of vitamin D that indirectly and directly support bone health, such as increasing calcium and phosphate absorption via the intestines and renal absorption of calcium; as well as interacting with vitamin D receptors on bone-forming cells that enhance skeletal mineralisation.
Vitamin K2 (not to be mistaken for K1) Vitamin K2 activates the proteins that put calcium into our bones (a protein called osteocalcin) and keeps it out of our soft tissues, which include our brains, arteries, heart and kidneys (a protein called matrix Gla protein).
Silica
Collagen
Boron plays a role in calcium balance through a number of different mechanisms, in particular, helping to reduce urinary calcium excretion and enhance calcium absorption.[50]
Zinc may modulate the anabolic effect of insulin-like growth factor I (IGF-1) in osteoblasts, and may enhance the proliferative effect of estrogen on these cells.
Magnesium status has been directly associated with vitamin D status in post-menopausal women and influences vitamin D metabolism via its effects on vitamin D binding protein and hydroxylation enzymes that mediate vitamin D activation. Magnesium also acts as a cation with an alkaline or basic pH, which may assist in the regulation of acid-base homeostasis to promote bone retention.
You also need to have some B2, B6, Folate, B12, Vitamin C, and Vitamin E in there.
The Gut-Bone Axis
The gut also plays a role. Seriously - what isn't the gut connected to!
Numerous preclinical trials have investigated the relationship between the gut microbiome and bone health.
The gut microbiome affects postnatal skeletal development and skeletal involution. Alterations in microbiota composition and host responses to the microbiota contribute to pathological bone loss, while changes in microbiota composition that prevent, or reverse, bone loss may be achieved by nutritional supplements with prebiotics and probiotics.
An exciting probiotic only available in consultation has research is Biome Osteo Probiotic. It provides probiotic strains which may help to promote bone health in adults, clinically trialed in post-menopausal women.
Menopause and your bones - osteoporosis and osteopenia
Osteoporosis is associated with decreased bone strength, increased bone fragility, and a consequent increase in fracture risk. Osteoporotic fractures usually result from falls from a standing height or less, in individuals with decreased bone strength.
Approximately 3% of men and 13% of women in Australia aged 50 to 69 are osteoporotic, rising to 13% and 43% for men and women older than 70 years of age. 55% of men and 49% of women between 50 and 69 years of age are osteopenic, with a similar prevalence in the over 70 years old.
It is estimated that by 2022 approximately 62% of men and 72% of women older than 50 will have osteoporosis or osteopenia.
Declining estrogen levels that occur postmenopausally are the most common driver of bone loss, accelerating losses in bone structure within five to eight years. Oestrogen is involved in maintaining bone structure due to its regulatory effect on osteoclast apoptosis. In estrogen deficient states, an osteoclast’s cellular lifespan is extended and therefore able to resorb more bone, resulting in a high-turnover state, which leads to losses in bone mass.
Low muscle mass/strength: Bone mass is regulated by muscle-derived mechanical forces and changes in muscle mass/strength negatively impact bone mass. Specifically, increases in mechanical loading of skeletal muscle results in an increase in skeletal muscle mass (supporting bone strength), while a decrease in mechanical loading leads to a reduction of skeletal muscle mass (resulting in BMD atrophy). Losses in muscle mass also increase fracture risk due to the higher propensity for falls.
Hormones and Bone Health
And then we have hormones. A team of hormones regulates bone metabolism and works to maintain bone homeostasis, which is why bone density becomes an issue for both men and women over 50.
Parathyroid hormone (PTH): A calcium-regulating hormone that controls the level of calcium in the blood and stimulates both resorption and the formation of bone.
Calcitriol (1,25 dihydroxy vitamin D): Also a noted calcium-regulating hormone, calcitriol is produced from vitamin D and is required for calcium absorption.
Calcitonin: Another calcium-regulating hormone that protects against excessive blood calcium levels during early childhood by inhibiting bone turnover and decreasing reabsorption.
Estrogen: Estrogen is a key regulator of bone remodeling in women and men and acts on both osteoclasts and osteoblasts.
Testosterone: Testosterone is important for skeletal growth. It is also a source of estrogen in the body as it can convert into estrogen via an enzyme called aromatase. This enzyme is produced in fat cells, so the more fat you have, the more aromatase you make, and this is a big issue in overweight people who can suffer from estrogen dominance. (Hmmm, I'll do a blog on this soon!)
Growth hormones: Growth hormone and its production of the insulin-like growth factor (IGF-1) influences bone formation.
Thyroid hormones: These hormones are required for skeletal maturation and influence adult bone maintenance. Sadly, medical screening misses early and intermediate thyroid issues, so if you have symptoms, get some private testing done. BOOK HERE to talk with me.
Cortisol: Stressed much? Then get your cortisol checked, but only via a saliva sample. Large amounts of this adrenal gland hormone block bone growth. Glucocorticoid-induced osteoporosis is the most common secondary cause of osteoporosis.
Insulin: Important for bone growth, insulin signaling regulates both bone formation and bone resorption.
Leptin: This circulating hormone has direct and indirect influences on bone metabolism that research continues to elucidate. This is another hormone made inside your fat cells. And you thought fat cells did nothing! They actually are very active little cells!
How smoking affects your bones
In both women and men, smoking is a moderate risk factor for osteoporosis as well as vertebral and non-vertebral fractures. Several mechanisms have been proposed to explain the differences in BMD between smokers and non-smokers, including appetite suppression (impeding mineral intake and absorption), increased concentrations of free radicals that may contribute to bone resorption, and altering levels of adrenal cortical hormones (which in excess can reduce BMD). Preliminary research indicates that smoking cessation is helpful in reducing bone loss.
Alcohol and bone density
Excessive alcohol intake (drinking alcohol daily, or consuming >10 standard drinks per week) is associated with increased fracture risk. Heavy alcohol intake is associated with disrupting calcium and bone homeostasis, which leads to reduced BMD and increases the incidence of fracture.
Alkaline or Acidic - How it affects your bones
The acid-base theory postulates that bone acts as a primary buffer system for basic components in foods, such as calcium, phosphate, potassium, and magnesium, while acid ions in foods act as proton (H+) donor, and that bone loss and osteoporosis may ensue due to a release of alkaline salts from bone to maintain acid-base balance.
Acid-producing foods include;
meats
fish
hard cheeses
cereal grains
salted foods
legumes
Alkalising foods are fruits and vegetables. (pictured)
Long-term exposure to an acidic environment may induce calcium loss, leading to the decline of BMD and subsequently to osteoporosis-related fractures. Research supports the positive effects of low dietary acid loads quantified by potential renal acid load (PRAL) algorithms in maintaining muscle mass in women between 18 and 79 years of age. In elderly women (>75 years old), lower net endogenous acid production and higher potassium intake was correlated with higher heel BMD measurements.
Hopefully this shows you that cherry picking supplements is not a good idea, and even if your doctor recommends something, you should also have a naturopath on your team to guide supplement choices.
Naturopathic treatment options for healthy bones
This blog has had a deep dive into the ins and outs of bone health, and as you have seen, there is a LOT to it! A naturopath takes all these factors into consideration. But there is so much more to it as well. The right diet, guidance to help you move into a healthier lifestyle, support for weight loss if needed, stress management, and accountability are big parts of my job.
Initially, we have an initial appointment. In this appointment, I may recommend some testing. Some you may get through your GP, but many tests I need for my review are not covered by Medicare and are an out-of-pocket expense. This is all explained in the consult, and a treatment plan with short, medium, and long-term goals is created.
Follow-up appointments are generally every 4 weeks for 3 months, or longer if your health situation is more complex.
To finish up, here is a review from one of my long-term clients.
"... since the treatment plan commenced, I can see the positive
results in my face as the pained expression has gone, I feel the results in my body as my
energy and mobility has improved, and I am almost totally pain free, with only slight twinges.
I am, and will forever be grateful and thankful, for that chance meeting with Tanya, as she
has turned my health around, and given me my life back again. Thankyou Tanya! ..."
Kathryn O
Thank you for reading my blog! If you have any questions about this topic, feel welcome to email me.
To your best health, vitality in body, and joy in mind!
Tanya Kurzbock
ATMS provider number - #27459
Adv Dip Naturopathy
Adv Dip Nutritional Medicine
Adv Dip Western Herbal Medicine
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