Vitamin D, Osteoporosis Vitamin? Or Something Else?

Vitamin D…is it the new Calcium? There’s no question that your body needs Calcium AND vitamin D to make strong bones, but I’ve seen some health care professionals recommend that we ALL take calcium supplements, especially after menopause, to prevent bones from becoming brittle. The issue is, recently studies have shown that the supplemental calcium is doing more harm than good by contributing to atherosclerosis, or hardening of the arteries, which leads to heart attacks. 

osteoporosis

So then, in another effort to control hip fractures, physicians started recommending that EVERYONE take vitamin D to keep bones strong, and then a meta-analysis just came out showing that there is not a statistically significant benefit to taking large doses of vitamin D if you aren’t deficient. (If you have been prescribed vitamin D because you are deficient, BY ALL MEANS, please keep taking it!) Given this information, it appears that prescribing vitamin D for the widespread “prevention” of osteoporosis doesn’t work, and it is costing us large amounts of money in supplements and could potentially be doing some harm if people are overdosing on vitamin D. So what SHOULD we do to prevent Osteoporosis?

There is no panacea

First of all, there is nothing that you can take in pill form that is going to cure and prevent everything. Unfortunately, the manufacturers of these vitamins, minerals and other supplements want you to believe that their supplement is the answer to life. If you only take this pill, you will be beautiful, have amazing skin, eat less, weigh less, work out more, get your dream job and live happily ever after. Don’t fall for their marketing tricks! Instead, you can figure out what works for your body and what your body needs. The truth is, some people need vitamin D supplements and some people don’t. It’s not something that every single person should take. If you want to jump through all the science-y stuff and get straight to my recommendations, Click Here.

Vitamin D deficiency symptoms

Unfortunately, most people who have vitamin D deficiency are asymptomatic, or may have mild symptoms that they attribute to other things. They are also symptoms that are associated with a million other things, like fatigue, tiredness, bone and muscle pain and/or weakness, etc. Source

Get tested for vitamin D deficiency

I recommend to ALL of my patients who are having any type of health problems including weakness or fatigue to get tested for vitamin D deficiency. It’s a very simple blood test that is SO easy to perform and can be very telling. I, personally, have been deficient in vitamin D during several times of my life and was given a supplementation regimen until I came back above the goal. If you are pregnant, have darker skin, live in a northern climate with less sunshine, or stay out of the sun all the time because you stay indoors or cover your skin (with cloth OR sunscreen!), you may be at risk for vitamin D deficiency. A simple blood test will tell you. But say you have plenty of vitamin D stores, consume enough calcium, and are still worried about your bones? What can you do?

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source: http://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/#h4

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Bone health isn’t about just calcium and vitamin D

So now that we know that popping vitamin D and calcium pills may or may not fix our bones or prevent osteoporosis (at least not without affecting other systems), what can we do? The truth is that bone health deals with SO MUCH MORE than just calcium and vitamin D. If calcium and vitamin D solved all bone problems we would have the best rates of bone disease with our 612 pounds per person per year milk (about 1.5 gallons/week/person! Yikes!) consumption which is rich in calcium and fortified with 115-124 IU vitamin D per serving. However, that is not the case. It is estimated that 1 in 2 Americans will have or be at risk for developing osteoporosis by 2020. That number is too high considering our high milk intake! Consider, though, other countries who are less….well, processed. 

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In this map, the red means risk of fractures is >15%, yellow means it’s between 10-15%, and green means it’s less than 10%. 

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 Map Source

What is it that they’re eating in Colombia, Spain, Australia and the Phillipines that is so great at reducing risk of bone disease?! 

Spanish diet – a mediterranean diet high in fish, nuts, legumes, eggs, fruits, vegetables, cheese, tomatoes and olive oil. Moderate intake of wine and meat. Here’s a list of traditional Spanish recipes.

Colombian diet – includes large amounts of meat (!), seafood (as it is right on the ocean), coffee, fruit, beans, cheese, eggs and coconut.

Australian diet – high in meat, seafood, eggs, fruit and vegemite, a spread that is similar to nutritional yeast.

Filipino diet – high in meat, fat, seafood, vegetables, rice and coconut.

So what’s the deal? Well, here are some things that are common veins among these diets that are crucial for bone health. Most importantly, though, is to eat a traditional diet with tons of unprocessed, traditionally prepared foods.

Omega-3 Fatty Acids

A recent study published this past summer via Ohio State University looked at women’s consumption of omega-3 (commonly referred to as n-3) fatty acids as well as omega-3 to omega-6 ratio and rates of osteoporosis. It turns out the women who ate larger amounts of omega-3 fatty acids had lower rates of osteoporosis. Another important factor to look at is omega-3 to omega-6 ratio. The higher amounts of omega-3 in relation to omega-6 means lower risk of bone disease. That means you could eat all the fish and seafood you wanted, but if you were eating large amounts of omega-6 seed-oils like safflower oil, grapeseed oil, peanut oil, nuts and seeds, you would be increasing your omega-6 fatty acid so much so that the omega-3’s would be overpowered and wouldn’t perform as expected. This is because omega-3 fats and omega-6 fats compete for the same enzymes, which is why the ratio is so important.

So where do you get omega-3 fats? Seafood!! Fish and other sea creatures have the largest amounts of omega-3 fats and the longest chains of omega-3 fats (i.e., DHA and EPA). The longer the chains, the better, because our bodies are not great at converting shorter chains found in walnuts and flaxseeds to the longer chains that are biologically active in our body (DHA and EPA). Notice that all of the countries in the list of the least amount of bone fractures have diets high in seafood.

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Minerals

Boron

Boron is not a mineral you typically think “YES! I need boron for my Bones!”, but it’s true! According to this study, albeit a small study, eating boron rich foods improved bone mineralization in post-menopausal women. It is interesting to read this study, though, because it was a very controlled environment where the women were fed different diets by the scientists and all urine was collected as well. The women who were given 3 mg of Boron daily had markedly lower excretion of magnesium and calcium, suggesting that bone re-mineralization was increasing. Also, there is some evidence that boron can help alleviate arthritic symptoms. Boron is found in fruits, vegetables, nuts and legumes, so following a high-plant diet is the best way to get plenty of boron. (Peanut butter and raisins are two great sources of boron in the American diet.) Of course I always, always recommend food above supplements, and if you are eating a nutrient-dense diet based on fruits and vegetables, you likely don’t need a Boron supplement. Before beginning a supplement regimen, speak with your physician; however, if you have trouble eating boron-rich foods for one reason or another, here is a supplement you can take: 

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Magnesium

It has been shown that Magnesium blood levels are lower in post-menopausal women with osteoporosis. Whether this has to do with absorption or intake, that is the question and more research is needed to figure that out. I work with dialysis patients, and a couple of years ago I went to a conference all about dialysis patients, updates, nutrition, etc. One of the physicians there who was also a faculty member at a major university in Colorado had done a significant amount of research on magnesium, and had found that dialysis patients with higher levels of serum magnesium lived longer. A fascinating fact, but still just a correlation with no evidence of cause. Nevertheless, magnesium is an important mineral for your body and contributes to bone health and prevention of cardiovascular disease, but whether that is JUST the magnesium that is affecting health, or whether it is a confounding factor (i.e., a factor that happens at the same time but doesn’t always mean it is the reason for it) of a nutrient dense diet, we don’t know. What we DO know is eating vegetables is good for you ;), so eat up! 

Magnesium rich foods (try to include these in your diet BEFORE taking a supplement): coffee (Colombia, anyone?), fish sauce (common in the Philippines), Spinach, Beet Greens, Tea, Bitter Melon (totally Filipino), kelp

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Vitamin K2

Perhaps the most under-researched and under-emphasized vitamin, vitamin K2, a fat soluble vitamin, is absolutely crucial to bone health. Found in fatty meat, eggs, liver and other animal products, this is also a vitamin that has decreased in our diets because of the low-fat diet recommendations that have overpowered our nutrition system for the past 30 years. In one study looking at the relationship between vitamin K2 and osteoporosis, participants who had osteoporosis received a 45 mg vitamin K2 supplement vs. the control group which received a placebo. While the study group did not increase their bone density, they did have a statistically significant decreased rate of bone fractures, which is important to note. Here’s a scientific article explaining possible mechanisms for my science-geek friends.

Unfortunately vitamin K2 has not been well studied and so its sources are not well defined, other than saying that it is present in fatty animal foods like egg yolks, butter, liver, chicken and beef. Also, vitamin K2 is produced by bacteria who convert vitamin K1 (found in leafy greens) to K2, so some hard and soft cheeses are rich in vitamin K2 as well as natto, a traditional Japanese fermented soybean dish, and possibly sauerkraut due to the fermentation of the cabbage.
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Overall Recommendations 

Do not follow a low-fat diet

As can clearly be seen by our need for vitamin K2, plus other fat soluble vitamins, a low-fat diet is clearly not a good idea. Furthermore, traditionally eschewed foods like butter, organ meats and cheeses are actually really important for bone health.

Eat your leafy greens

Leafy greens are great for mineral intake like magnesium, iron and calcium. You actually can get plenty of calcium from just leafy greens and broccoli, despite the recommendation for 3 servings of dairy a day. I am not hating on dairy; I love to have a serving of yogurt for the great probiotics every day, but I do not think dairy is the solution to all bone problems; you have to get your leaves in, too.

Fermented foods rock

Natto is a great example of this, but other fermented foods like sauerkraut, cheese, yogurt, etc., could be instrumental in helping you keep your bone density because of the bacterial conversion of vitamin K1 to K2. Also, fermented foods tend to be better tolerated by people than their non-fermented counterparts, to keep that in mind.

Eat a varied diet full of nutrient-dense foods

Lastly, the more varied your diet is, the better. Make sure you are trying new things often or at least switching up the same ol’, same ol’. If you’re craving something different, go out on a limb and try it. You may really be benefiting your health by getting some nutrient or phytochemical that you didn’t even know (and science didn’t even know) you needed.

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