The misconception and dangerous recommendation to “take calcium for your arthritis/osteoporosis/bone health” was started in Part 1 of this topic.
If you missed it, check it out for some of the background. We went over
- Some of the MANY nutrients that are needed for strong bones and joints
- How they work together – how JUST taking calcium can actually increase your risk of calcification of your arteries, kidney stones, and cardiovascular disease.
So now that you know WHICH nutrients you need, let’s talk about where to get them!
I am a fan of “food first,” but I’ve learned enough to realize that “food only” doesn’t always cut it – especially when getting into medical issues where you need therapeutic doses. Those doses can go far above the RDA (safely, with a heath professional monitoring you.) The RDAs are essentially bare minimums that were set for a healthy person just to avoid illness. It is not the amount needed for someone with a current health issue needing to rebuild, nor is it related to an optimal amount. But that doesn’t mean go wildly overboard either – too much of a good thing can be dangerous as well.
Focus on foods first, supplement with guidance, and TEST, DON’T GUESS! Ideally, you would do a micronutrient panel at least annually to ensure your stores are where they are needed.
3: IN THE RIGHT FORM – SAFE & ABSORBABLE
Food should always come first, but when needed, discuss supplements with your nutrition professional. I have had hours of additional training on supplements, and what it taught me is that even dietetic undergrads are lacking a deeper medical understanding – let alone doctors who get VERY little nutrition training, if any! Find someone who goes beyond just the minimum classwork.
Most supplements come in a variety of forms, and this makes a difference in quality and safety. (You can watch/listen to this Gut Check Podcast episode on supplements, and why “you get what you pay for,” so be mindful.)
Don’t be fooled – dairy is not the only option! It is a good source of calcium but I have my hesitations with dairy. It can be a part of a healthy diet, but if you are already dealing with an inflammatory condition (such as arthritis, IBS, gastritis, etc), dairy is commonly inflammatory for many people. So don’t feel like you have to force the diary. Many people find their symptoms ease with reduced dairy intake.
Some food sources:
- ¼ cup sesame seeds (think tahini!): 351mg
- 3.2oz sardines: 347mg
- 1 cup yogurt: 296mg
- 1 cup (8oz) cow milk: 275mg
- 1 cup collard greens: 270mg
- 1 cup spinach: 245mg
- 1oz cheese: 204mg
- 1 cup mustard, beet, or turnip greens: 165-200mg
- 1 cup Swiss chard: 100mg
- 1oz almonds: 76mg
- 1 cup cabbage, broccoli, or Brussels sprouts: 60mg
- 1 orange: 50-90mg based on size
- 4oz raisins or prunes: 45mg
- Beans and lentils also have some, in varying amounts
There are different types of calcium, and often supplement companies will cut corners on cost by using cheaper versions.
Calcium from things like oyster shells, coral, or limestone often have contaminants, and one meta-analysis determined it may be behind heart attack risks.
Calcium carbonate is very affordable – but hard to digest, it needs a lot of acid. And guess what Tums are made from! Calcium carbonate, with the entire goal being to neutralize your stomach acid levels and NOT to be absorbed. And of course if it is only supplying calcium, we’re back to #1 and #2: ALL NUTRIENTS, IN BALANCE.
Also if your stomach acid is blocked, you will have more trouble digesting and absorbing protein and magnesium, which also takes us back to #1 – ALL needed nutrients. So Tums and antacids backfire on this, and long-term use of PPI’s and heartburn meds often create these same issues. (More on the role of medications and gut health in this Gut Check Podcast)
Calcium supplements can also reduce the absorption of iron and zinc, as well as impair the absorption of some antibiotics; and sometimes can cause constipation.
If you do need to supplement, calcium citrate or a chelate tends to be the safest form for all. I use food as my main source, but do have calcium chelate in small amounts in my multivitamin.
I won’t get down into the details here about amounts, timing, or the plant-based vs animal-based details – that will be in a future course. But here are some common food sources:
- 4oz Tuna, Chicken, or Turkey: 35g avg
- 4oz Beef, salmon, lamb, or shrimp: 25g avg
- 1 cup beans, peas, legumes: 15g avg
- ½ cup oats: 14g
- 1 oz nuts and seeds: 9g avg
- 1 cup yogurt: 8g
- 1 egg: 7g
- 1 cup collard greens: 5g
- 1 cup broccoli: 4g
- 1 cup cabbage, cauliflower, or mushrooms: 2g avg
There can be a lot to be said about breaking down types of protein powders and when to use them – whey, casein, whey isolate, collagen, vegan, etc. But for now, we will keep it general. That will be a post for another time.
Aim for quality, to ensure you are getting contaminant-free. Consumer Reports routinely finds protein powders that have less protein (and more carbohydrates!) than the label states; or some have been found contaminated with lead or other toxins. Grass-fed New Zealand cows are best for whey or collagen proteins, as they have better regulation on the legal definition of “grass fed” that what the US allows.
Maintenance doses of collagen range from 10-20g; therapeutic levels of collagen range from 30-50g. Total protein needs range drastically based on personalization.
I use PropelloLife collagen before workouts and rehab/PT, and their whey protein after strength training. (you can get 10% off using this link and promocode DUBLINDIETITIAN. I make no money, I just support them)
Vitamin D comes in two main forms: D2 (“Ergocalciferol”) comes mostly from plants that can synthesize it with the UVB rays of the sun, and D3 (“cholecalciferol”) which is made by the cholesterol in your skin when exposed to the UVB rays (hence, Vitamin D often being called “the sunshine vitamin.”
Do note briefly – we DO need cholesterol! If your doctor has you on statins and is driving your number below 160, we begin to see more issues, including the inability to do the creation of vitamin D by your skin if you don’t have the cholesterol as the precursor to do so. This in turn causes more mood issues and depression, since it’s also a precursor to seratonin.
Some food sources:
- 4oz Salmon (with skin): 511 IU
- 3.2oz sardines (with skin): 175 IU
- 8oz Cow Milk (fortified with Vit D): 124 IU
- 4oz Tuna: 93 IU
- 1 egg: 44 IU
- 1 cup shiitake mushrooms: 41 IU
It’s best to know your lab levels – most doctors can test for you; or we can order a lab together. Too little supplementation, and you can continue to deal with poor absorption, inflammation, weaker bones, etc. Too high, and Vit D overload can be problematic as well. In general, a daily dose of 400-1,000 IU is common for maintenance. I use Vitamin D liquid drops during the winter months, in addition to my Thorne Elite Multivitamin. I try to get daily sunshine when I can.
There are 3 forms of Vitamin K to be aware of: K1 most commonly found in plants; K2-MK-4 found in animal products; and K2-MK-7 found in fermented foods. It’s not entirely known which forms are best for what specific role, so it’s good to get some from each area.
Some food sources:
- 1 cup kale: 1062 mcg
- 1 cup spinach: 888 mcg
- 1 cup mustard greens: 830 mcg
- 1 cup collard greens: 773 mcg
- 1 cup beet greens: 697 mcg
- 1 cup Swiss chard: 573 mcg
- 1 cup broccoli: 220 mcg
- 1 cup asparagus: 91 mcg
- 1 cup green peas: 35 mcg
- 1 cup avocado: 32 mcg
- 1 kiwi fruit: 28 mcg
- 1 cup blueberries: 29 mcg
- 1 cup carrots: 16 mcg
- Small amounts in meat, dairy, eggs, an fermented items
Note: if you are on a blood thinner, you need to discuss vitamin K intake with your dietitian or doctor since Vitamin K helps blood clot. The old recommendation to avoid Vit K is out – but you do need to be CONSISTENT with your Vitamin K intake, so that the blood thinner dose can be modified as appropriate to match your intake.
I do not do Vit K supplements alone unless we’ve done a full nutrient lab panel and know a precise amount. Otherwise, I use food, and then the additional amounts as a part of the Thorne Elite Multivitamin or with a BoneStregnth supplement.
Some food sources:
- 1 oz pumpkin seeds: 190 mg
- 1 cup quinoa: 155 mg
- 1 cup Swiss chard or spinach: 150mg
- ¼ cup sesame seeds: 126 mg
- 1 cup black beans: 120 mg
- 1 oz cashews or sunflower seeds: 115 mg avg
- 1 cup brown rice, pinto beans, or lima beans: 83 mg avg
- 1 oz almonds: 61 mg
- 2 Tbs flaxseeds: 55 mg
- 1 cup collard greens, broccoli, or Brussels: 35mg avg
- 1 cup raspberries: 27 mg
- 1 cup tomatoes: 20 mg
Here is another area where form is critical. Magnesium can come in many different forms, and they and they have different absorption abilities, safety factors, and secondary uses.
Some examples of different types of magnesium with notes:
- Magnesium Oxide: cheap, but poorly absorbed and can cause stomach upset
- Magnesium hydroxide can help with constipation
- Magnesium Glycinate: can help with detox in people who are genetically prone to struggle
- Magnesium Citrate: acidic, which can help with a body’s pH balance if appropriate
- Magnesium Taurate: can be calming
- Magnesium Aspartate or Mg Glutamate: excitatory, so can help with chronic fatigue but caution with ADHD, anxiety, autism
- Magnesium Chloride: better for topical application (ie: lotions to help with muscle spasm, restless leg, fibromyalgia)
- Magnesium Sulfate: Epsom salts, good for muscles and fibro since it bypasses the gut and goes directly into the muscles, but may cause looser stool in some
Magnesium (Mg) is a larger mineral than many others, so it is hard to fit enough of it into a multivitamin without making them excessively large. Even with the Thorne Elite Multivitamin that I use (which has a Mg Chelate), I still take an additional magnesium supplement on heavy training days. I also use a Mg Chloride lotion directly on muscles after multi-hour events to help replenish muscle stores.
So that all certainly shows you it is so much more than just
dairy for calcium for your bones!
4: WITH A SUPPORTIVE LIFESTYLE AROUND IT
A quick tangent with some anatomy and physiology terms…
There are large cells on the surface of your bone called osteoblasts and osteoclasts. OsteoBlasts help Build bone by synthesizing and mineralizing it. On the other hand, osteoClasts Crush down bone. Ok, not literally crush it, but for the mnemonic, it helps. Osteoclasts break down the bone, causing the minerals to be released into the blood stream. This has its purpose, so it should happen in balance, but there are things that accelerate the osteoclast’s actions – meaning, it erodes the bone more quickly than the osteoblasts can rebuild it. (Examine: bones)
INFLAMMTION: Inflammation issues accelerates osteoclast behavior – and any issues with our basic lifestyle increase inflammation. So control inflammation with the anti-inflammatory food list, proper sleep, hydration, deep breathing, appropriate exercise, removal of toxic burden. I often harp on and on about the damage of excess inflammation and its role in nearly all chronic health issues – and bone health is no different. Chronic health issues are caused by – and cyclically continue to cause – inflammation. So having any chronic inflammatory-based condition can also increase your risk of bone loss.
HORMONES: Estrogen also plays a protective role, which is why more osteoporosis is seen after menopause. there can be risks for younger female athletes who lose their period cycle if they are under fueling and/or over training ; or anyone on hormone treatment (birth control, or otherwise) if it skews the standard ratios of sex hormones.
EXERCISE: Weight training – specifically, dynamic movements versus static – increases mechanical loading, which is a stimulus for increasing bone mass. If you are trying to strengthen bones or heal knee joints, avoiding weight on it can delay the healing. Likewise, low lean body mass exacerbates bone loss. But be mindful – “too much of a good thing” is real with exercise. If inflammation is an issue, overtraining is a risk factor. Many people spend ample time in high zone/high intensity training which does work on anaerobic factors and muscle training; but do not neglect the low zone/aerobic training which is less inflammatory in nature.
CALORIC REDUCTION: If you are reducing calories, you may lack some of the needed nutrients as discussed above. Be very diligent in getting all that you need with the reduced calories. Often when an injury is being addressed, you may need to INCREASE total caloric intake, because your body needs extra energy to heal and recover.
GENETICS: And, yes, sometimes genetics can make to more of an uphill battle as well. While genes are not a guarantee of issues, they can increase risk or susceptibility. Some genetic variants increase natural inflammation, reduce ability to detox out environmental toxic burden, slow bone formation, alter sex hormones, and more.
Did you catch all of that? Take some time to review – it is a lot.
Overall, my hope is you take away that bones are complex and trying to oversimplify it by saying “just take some calcium” is an ignorant recommendation that is risky and out of date.
You need to nourish your bones with the right foods and minerals and protect your bones with a healthy lifestyle.
- Use the 7 Day Challenge and starting food list to begin the process of reducing inflammation
- Focus on the above recommended foods to support bone nutrients
- Ensure adequate hydration, sleep, and stress management
- Include weight bearing exercises and dynamic movements in your routines (only do moves you can do without joint/bone pain!)
- Reach out to discuss potential supplements to add
- Get the Micronutrient Panel to see how everything looks, and personalize your food and supplements from there
- Get the MRT test if you need a bigger reversal of symptoms, inflammation, and issues
Dealing with arthritis? Click here to let me know if you’d like to be kept up to date on the upcoming Arthritis Reversal pilot group, or other upcoming courses!
Allen, Susan. “Certificate of Training in Integrative and Functional Medical Nutrition Therapy.” Dietary Supplements. Vitamin D and Minerals. Next Level Functional Nutrition. 2017/2019.
The George Mateljan Foundation. World’s Healthiest Foods, whfoods.com. Accessed Nov 9, 2022.
Goolsby MA, Boniquit N. Bone Health in Athletes. Sports Health. 2017 Mar/Apr;9(2):108-117. doi: 10.1177/1941738116677732. Epub 2016 Nov 30. PMID: 27821574; PMCID: PMC5349390.; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5349390/pdf/10.1177_1941738116677732.pdf
Hull, Michael MSc; Brown, Wyatt. Sicart, Pierre-Alexandre PhD (Ed). Bone Health Supplement Guide. Examine. Sept 2020.
Lanham-New, Susan A. “Importance of calcium, vitamin D and vitamin K for osteoporosis prevention and treatment.” The Proceedings of the Nutrition Society vol. 67,2 (2008): 163-76. doi:10.1017/S0029665108007003; https://pubmed.ncbi.nlm.nih.gov/18412990/
Palermo, Andrea et al. “Vitamin K and osteoporosis: Myth or reality?.” Metabolism: clinical and experimental vol. 70 (2017): 57-71. doi:10.1016/j.metabol.2017.01.032; https://pubmed.ncbi.nlm.nih.gov/28403946/
“Time for More Vitamin D.” Harvard Health Publishing; Harvard Medical School. September 1, 2008. https://www.health.harvard.edu/staying-healthy/time-for-more-vitamin-d. Accessed November 7th, 2022.
“Vitamin K.” Harvard University, The Nutrition Source. Harvard University, T.H. Chan. https://www.hsph.harvard.edu/nutritionsource/vitamin-k/. Accessed November 8, 2022.