The right foods and supplements are an indispensable part of bone rebuilding. But, before you dive into dietary changes and expensive supplements, you ought to rule out any significant cause of your bone loss and address it aggressively.
Common Causes of Bone Loss
A perfect diet and the best supplements can’t fully overcome an influence such as one of these:
- Medications – common contributors to bone loss; read the side effect printout and consult your pharmacist. Steroids are especially harmful, including steroidal nasal sprays. Look up “negative side effects” online for all your prescription and OTC medications.
- Low levels of estrogen and testosterone – common in men and women over 45. Both hormones are powerful bone-building hormones. Both men and women ought to consider testing estrogen and testosterone and consider bioidentical HRT (hormone replacement therapy).
A faulty study done in the early 2000’s showed HRT as increasing the risk of cancer and heart disease for women. Millions of women still don’t know this study was found to be flawed, and in fact previous and subsequent research shows HRT to be protective against heart disease.
Consult a naturopath or get your MD connected with a pharmacist from a compounding pharmacy who is knowledgeable about bioidentical HRT for advice on testing and treatment. Doses should depend on a combination of blood values and symptoms, not just one or the other.
- Thyroid hormone levels too low or too high – I recommend evaluation by a naturopath experienced in treating both thyroid and adrenal issues, even if you’ve already been evaluated and whether you’re on medication for either thyroid or adrenals.
- Insomnia – bone rebuilding occurs mostly during sleep, so poor or inadequate sleep interferes with normal bone health. Common causes include sleep apnea, neurotransmitter imbalances such as depression, and food or airborne allergies. Allergies often cause nervous system agitation that isn’t obvious but can interfere with quality and quantity of sleep.
- Weak digestion – poor digestion interferes significantly with bone health. Chronic bloating, gas, diarrhea, constipation (even if managed), acid stomach/GERD (even if managed) and getting full quickly are all indications of poor digestion.
- Smoking – do whatever it takes to quit! I recommend 1-800-QUIT-NOW. The people are professional, non-judgmental and knowledgeable. They also provide some financial assistance for nicotine patches to get you started.
Inflammation Promotes Bone Loss
Osteoporosis is an inflammatory condition, so reducing inflammation helps slow down bone loss. Consider one month of an anti-inflammatory diet such as The Whole30. If you can afford it, eat meat and dairy foods from grass-fed cows. These foods are anti-inflammatory. Avoid grain-fed meat and dairy, which are inflammatory.
Over-hybridizing and chemical sprays have changed American wheat into an inflammatory food. Sugar is highly inflammatory, and so is any food you’re allergic to.
Foods and Supplements
Nutritious food is critical to maintain healthy bones, but diet alone rarely provides all the nutrients necessary for rebuilding. Part of the reason for this is age. Starting in our 50’s, we begin a continuous decline in digestion and metabolic functions, including lowered production of hydrochloric acid for digestion and a slowing of metabolic functions such as adrenals and thyroid. This makes bone rebuilding more challenging than for a younger person.
If you want to get as many bone-rebuilding nutrients as you can from foods, you can do some initial searching to determine how much your diet will contribute. You may not have time to make bone broth, but you can easily lean in to the foods that have generous amounts of the nutrients you need.
On the other hand, if you want to simply add supplements to your existing diet, this can work, too. In this case, be sure you do a rough count of your calcium intake from dairy and only take enough supplemental calcium to get the amount needed. Be aware of the information below about getting too much zinc as well. Other than calcium and zinc, you’re unlikely to overdose on any of the nutrients listed here.
To assess your intake of bone-rebuilding nutrients from foods, go online. For each of the nutrients listed in this handout, search for “list of foods high in (the nutrient)” or “top ten foods high in (the nutrient)”. From these lists, create a list of the foods you like or are willing to try. Then, do your best to consistently bring more of these foods into your diet.
You can also search on the amount of any nutrient in a specific food. Search for “amount of (the nutrient) in (the food)”. The answer often comes up immediately above the search results.
Calcium from foods is better absorbed and utilized than calcium from supplements. Studies show that 800 mgs calcium from food contributes more to bone density than 1000 mgs from pills. Count the calcium in your regularly-eaten, high-calcium foods and your multiple vitamin-mineral before deciding if you need a calcium supplement.
Milk is a highly adulterated food, but fermentation makes the nutrients more available. So, if you tolerate any dairy, cheese and yogurt are usually better choices than milk. That is, unless you have access to raw milk from grass-fed cows or goats.
If you have dairy intolerance, you might try milk, cheese, butter and yogurt from a2 cows. This includes certain breeds of cows whose milk contains a different protein than a1 cows. A1 cows are the source of almost all dairy foods in the U.S. You may tolerate a2 dairy products even if you don’t tolerate a1 dairy products.
One cup of milk has about 300 mgs calcium. One oz. of aged hard cheese (e.g., cheddar) provides about 200 mgs, as does 1 cup of cottage cheese. One cup of yogurt has anywhere from 250–400 mgs calcium, so check the label.
Try to get as much calcium as you can from non-dairy sources. Good sources are kale, bok choy, collard greens, broccoli, white beans, almonds and okra. A little vinegar on those greens will help calcium absorption. Sardines, amaranth, chia seeds, sesame seeds and oat straw tea are excellent sources. One cup of broccoli has 180 mgs calcium and just 1 oz of sesame seeds has 227 mgs. A tea of oat straw and nettles for daily drinking is a great way to get several of the nutrients needed for bone rebuilding.
I rarely recommend more than 600 mgs of supplemental calcium a day and often less depending on the diet. Excess calcium contributes to hardened arteries, kidney stones, gallstones and bone spurs. If you’re getting the other nutrients and digestive support you need for bone health, you shouldn’t need more than 600-800 mgs from diet and supplement.
In supplements, calcium has several forms. The best-absorbed form is calcium lactate. Avoid calcium carbonate; it’s poorly absorbed and can be hard on the kidneys. You won’t absorb more than about 500 mgs. of calcium at the day accordingly.
Calcium tends to be constipating, while magnesium is stool-softening, so if starting a calcium supplement slows your bowels, get more magnesium to return stools to normal consistency. This usually means a magnesium supplement, with doses spread over the day. Be sure your bowels are moving every day, even if it means taking some magnesium in pill form.
Foods rich in magnesium include all meats and poultry, tuna, salmon, halibut, mackerel, legumes, coconut milk, seeds (e.g., pumpkin, sesame, sunflower), nuts (e.g., almonds, cashews, filberts), cocoa and chocolate, certain grains and grain fractions (bulgur, wheat germ, wheat bran, oats, oat bran, brown rice, rice bran, quinoa, amaranth, barley), beets, horseradish, Swiss chard, sweet potatoes, corn and peas. The magnesium in animal foods is better absorbed than the magnesium in plant foods. Magnesium tends to loosen stools, but don’t expect all magnesium-rich foods to help with constipation or low stool volume. In fact, nuts tend to slow down the bowels, even nuts high in magnesium.
Many Americans are low in magnesium and could benefit from taking a supplement to see if they feel better. Symptoms of less-than-optimal magnesium levels include leg cramps, restless legs, constipation, chocolate cravings, light sensitivity, high startle reflex, migraines, and irritability/trigger temper. Of course, all these symptoms can have other causes. Both low calcium and low magnesium can be the cause of leg cramps, but inadequate magnesium or a high calcium-to-magnesium ratio are the most common causes.
The best absorbed forms of magnesium are magnesium lactate (always dairy free, despite the name) and magnesium glycinate.
Individual need varies, but optimal supplementation usually ranges around 300 – 600 mgs a day. The old guideline is a 2:1 ratio of calcium to magnesium (e.g., 500 mgs. calcium and 250 mgs. magnesium). Most Cal-Mag supplements provide this 2:1 ratio. However, many people, especially those with fair colorings (red/blonde hair as a toddler, green/blue eyes, fair skin), need a 1:1 ratio or even more magnesium than calcium. One way to approach this is to start with a 2:1 ratio and then increase magnesium over several days, up to bowel tolerance (the onset of soft stools). You might also adjust your magnesium intake based on any symptom you have of low magnesium, as described above.
The best sources of trace minerals are vegetables and fruits, but our soils and foods don’t provide the levels they used to. A great way to get more trace minerals is bone broth. You can purchase it locally or online or make your own. Bone broth also provides collagen, a protein essential to bone, cartilage, skin, hair and fingernails.
Standard Process makes Organically Bound Minerals, my favorite trace mineral supplement. Follow label instructions of 1 tablet/meal. Be careful about buying it online, as Standard Process doesn’t sell their supplements online, and other sellers often mark the price way up. Multiple vitamin-mineral supplements don’t supply enough trace minerals for rebuilding bone.
Like all vitamins, vitamin D is not a single substance. It’s a complex of at least 5 substances that work together to perform vital functions. Vitamins D2 and D3 are the forms most used by the body. Almost all vitamin D supplements are now vitamin D3. Both D2 and D3 must be further converted by the kidneys into the active form used by our cells.
UV light changes cholesterol in the skin into a form of vitamin D, which is then absorbed into the bloodstream and sent to the liver. There, it’s be converted to the D3 form and sent out to the bloodstream to help various cells, including those of the immune system.
Because of major changes in our foods and habits such as daily bathing, congested livers from hydrogenated fats, poor capillary circulation from sedentary lifestyle and the widespread use of sunscreen, even people with regular, generous exposure to sun usually have inadequate levels of vitamin D. Vitamin D deficiency is now recognized as a world-wide problem for all ages.
The only significant food source of vitamin D is fatty fish such as salmon, tuna and mackerel. Farmed salmon has tested as providing only about ¼ of the vitamin D found in wild salmon. Some cheeses, beef liver and egg yolks contain small amounts. A supplement is almost always needed. On the one hand, negative influences have caused us to need supplementation. On the other hand, we’re lucky to be able to easily find a supplement and thus help our health in many ways.
Count all sources of vitamin D, including your multiple vitamin-mineral, any bone support supplements and any cod liver oil. Count vitamin D from D-fortified foods such as milk and orange juice if you eat these frequently.
Optimal dosing is usually 3,000 – 5,000 IU’s (International Units) per day. Don’t exceed 10,000 IU’s per day for more than a month. Your physician may recommend dosing as high as 50,000 IU’s by pill or injection once a week until low levels are corrected. Just be sure the doctor orders a blood test (25-hydroxy vitamin D) within 3 months to avoid excessive intake. Because vitamin D can be toxic in excessive amounts, you should have your level tested about every 3-4 months until your level is stable on a specific, regular dose, and then tested once a year.
A common laboratory reference range is 25 – 80 ng/mL, but 50 – 70 ng/mL is the optimal range for bone rebuilding and maintenance. Some physicians tell patients that anything within the reference range is fine. Be assertive and tell your doctor you want your levels to be at least mid-normal range and preferably upper-normal range because of bone rebuilding.
Again, like all vitamins, vitamin K is a complex of several vitamins. Vitamin K1 mainly functions to promote blood clotting. If you’re on a blood thinner, consult your physician before taking any supplement containing vitamin K1, and be aware that some vitamin K2 supplements include vitamin K1. There is no need to take K1 in a supplement, since Vitamin K1 needs can be met by frequently eating dark green vegetables.
Vitamin K2 is the most important form for bone, blood vessels and other tissues. The only food sources of K2 are from bacteria found in certain fermented foods and a few specific meats and dairy products. Natto, a fermented soybean product, has the highest Vitamin K2 content. Natto can be used as a food in cooking or taken in supplement form. Other sources include grass-fed meats, grass-fed cow and goat cheeses, grass-fed butter and egg yolks and livers from pastured poultry.
My favorite Vitamin K2 supplement is Vitamin Code Raw K-Complex from Garden of Life, but there are other good ones on the market, mostly made from natto. Even people who are sensitive to soy will usually tolerate natto, because it’s a fermented product. Soy should also be organic to avoid GMOs.
Take a minimum of 200 mcg/day and a maximum of 100 mcg for every 1000 IU’s of Vitamin D that you take.
Omega-3 Fatty Acids
The best sources of Omega-3 fatty acids are grass-fed meats, pastured poultry, grass-fed butter, fatty fish (e.g., salmon and cod) and legumes/beans. Because most of our meat and poultry is grain-fed, and few people eat fish or beans frequently, most people’s diets are too low in these essential fatty acids. Getting both animal and plant sources is ideal.
Good animal sources are salmon, salmon oil, cod liver oil, grass-fed meats and grass-fed butter. Good plant sources are flaxseed and hemp seed oils. You can take some of each or alternate one bottle of an animal source, then one bottle of a plant source.
Three very high-quality brands that are mercury-free are Cod Liver Oil from Standard Process, Pure Icelandic Cod Liver Oil from Dropi and Blue Ice Fermented Cod Liver Oil from Green Pastures. Capsules don’t need to be refrigerated, but a liquid supplement should be. Avoid “fish oil” supplements that aren’t salmon oil or cod liver oil, as they are made from fish flesh oils that contain almost no Omega-3 fatty acids with synthetic fatty acids added.
Optimal intake is about 3,000 mgs oil per day. Most gelcaps of cod liver, flaxseed, krill and hemp oils provide 1,000 mgs each, so 3 capsules a day is a common and effective dose.
Hydrochloric Acid (HCL) aka Betaine Hydrochloride
Betaine hydrochloride is the supplement form of hydrochloric acid (HCL). If you can purchase only a few supplements for bone rebuilding, betaine hydrochloride ought to be one of them.
Hydrochloric acid isn’t found in foods. It’s made in the stomach, and it’s essential for digestion and assimilation of proteins and minerals, the two building blocks of bone. Few people aged 50 and older are producing adequate HCL.
Betaine Hydrochloride comes in a range of potencies, often around 600 mgs per pill. Optimal dosing ranges widely for individuals, from about 600 – 1200 mgs per meal.
Most people can start with 600-650 mgs per meal. However, If you have a sensitive stomach, it’s a good idea to start with a low potency supplement, such as 150 – 400 mgs. per tablet or capsule. If you’re starting with a low-potency HCL, you can roughly follow this schedule: 1st 3 days = 1 tablet/meal at lunch and dinner (L & D) only and none at breakfast (B). Next 3-5 days = 1 tablet at B, 2 at L & D. Continue working up, switching to a 600-650 mg/pill supplement as you increase your dose.
I don’t usually recommend taking more than 1200 mgs. per meal, even though many practitioners recommend the highest dose that doesn’t produce any negative symptoms. Tolerance varies widely, and symptoms of overdose can show up days or weeks after establishing a high dose. Watch for burning, nausea or discomfort. Burning can be esophageal, abdominal, anal, urethral, labial or vaginal. If you experience any of these, reduce your per-meal dose until you have no negative symptoms. If discomfort is severe, stop the HCL.
I recommend taking HCL early in the meal. Specifically, this means soon after the first several bites. Take HCL at the same time as calcium and other minerals for better mineral absorption. Take extra HCL when eating meats; especially red meats. Avoid taking HCL after eating, because it will sit on top of the food you ate and may wick up the esophagus as it dissolves, causing nausea or burning.
There are many fruit and vegetable sources of vitamin C. Search online for lists of vitamin C-rich foods. Be aware that prolonged storage, heat from cooking and exposure to water or air can cause destruction or loss of vitamin C from foods.
If your diet isn’t providing 300 mgs a day or more, consider a supplement. Choose a whole foods vitamin C supplement, such as one made by MegaFood or Garden of Life. Vitamin C occurs in nature as a complex that includes bioflavonoids, hesperidin, and rutin. Ascorbic acid alone is not vitamin C!
Optional Supplements That Can Help
- 1) Electrolytes. These are unbonded, charged minerals that float in the blood and other body fluids. They’re key in maintaining electrical conductivity and fluid movement throughout all tissues. Good electrolyte levels promote healing because they boost capillary circulation, helping nutrients and other healing substances reach all cells. The body’s most critical electrolytes include sodium, potassium, chloride, bicarbonate, calcium and magnesium.The only food naturally high in sodium is milk. Our main source of sodium is salt. Contrary to popular opinion, salt is not something most people need to avoid. In fact, many people today are too low in sodium and need to salt their foods more. A low blood sodium level can cause problems as serious as a high sodium level. Common symptoms of low sodium are ankle edema, fatigue, low blood pressure and heat intolerance.Some people with high blood pressure can salt without any negative effect on their blood pressure. Anyone can figure this out for themselves by experimenting with their salt intake and monitoring their blood pressure. Ideal blood pressure is 120/80. So, unless you know that you don’t tolerate salt due to high blood pressure or some other reason, salt your foods regularly to taste with Himalayan salt or unrefined sea salt. Celtic Sea Salt from Selina Naturally is a very good salt.For potassium, eat potassium-rich foods such as apricots, potatoes, bananas, tomatoes, and dark leafy greens. Search online for lists of potassium-rich foods.You can also get an initial boost of nutrient delivery to your bones from 1-3 months of an electrolyte supplement. They’re usually sold as concentrates you dilute in water. Good brands include E-lyte from Body Bio and Matrix Electrolyte Powder from BioPure.
2) Zinc. We need this trace mineral to produce hydrochloric acid. Good food sources include oysters, beef, lamb, pork, chicken, pumpkin seeds, cashews, cocoa, chocolate and currants (dried grapes). You may not get enough zinc from foods to produce adequate stomach acid. Zinc is a good add-on, though not essential if you’re taking betaine hydrochloride (see above). If you must choose between the two, choose betaine hydrochloride.
The dose for zinc is 25-30 mgs once a day. Excess zinc can cause copper deficiency, so take a zinc supplement only for the first 2-3 months to give your HCL recovery an initial boost.
3) Digestive Enzymes. Inadequate enzyme production is common, and good digestion is key to rebuilding bone. Enzymes break down food, so nutrients are available for assimilation. Consider taking 1 pill per meal, perhaps 2 with dinner or your biggest meal.
You may not need an enzyme supplement long term, so consider taking them for the first few months, and then see how your digestive system feels when you discontinue them. If you are taking at least 600 mgs of betaine hydrochloride (HCL) per meal, you may not need enzymes.
4) Vinegar Water. Vinegar can aid in the assimilation of calcium and other minerals and improve digestion. Vinegar water helps digestion but can’t substitute for hydrochloric acid. If you use both, you may need to reduce the amount of one or both so as not to cause any symptoms of over-acidity.
I recommend Bragg Organic Apple Cider Vinegar, but whatever the brand, it needs to be raw, unfiltered and organic (apples are heavily sprayed).
Some people don’t tolerate vinegar. If you do, you can try drinking 1-2 teaspoons in 8-10 oz. water,
1-3 times a day, preferably 15 minutes before a meal. Prepare vinegar water fresh or fix a quart or more and keep in the refrigerator. Or, just add vinegar to cooked vegetables, salads or soups.
You can put vinegar in or on foods or drink vinegar water, but don’t drink vinegar straight. It can be hard on tooth enamel. And, rinse your mouth with water after eating anything acidic. Don’t brush your teeth within 30 minutes of eating anything acidic, because acidic foods cause a temporary softening of tooth enamel.
Be sure to salt more generously during any stretch of days that you drink vinegar water daily or add significant vinegar to foods, because vinegar pulls sodium from the body. Sodium is needed for bone rebuilding and other key body processes, and a low blood sodium level can cause as many problems as a high sodium level, including susceptibility to heat stroke, low blood pressure and edema.
5) Collagen. This is the main protein of bone. Our collagen production and repair weakens as we age. This supplement can make a difference in bone health as well as health and strength of hair, skin and nails. I recommend Collagen Hydrolysate from Great Lakes Gelatin Co.
This recipe is from Linda B. White, M.D. Make an herbal blend with equal parts of oatstraw, horsetail shoots, nettle leaf, raspberry leaf, dandelion leaf and red clover flower tops. Boil 1 quart of water. Take the pan off the stove and allow it to cool a minute or two. Add 4 Tbsps. of the blend. Cover and steep 30-60 minutes, then strain. Keep covered or refrigerated. Drink 3-4 cups a day.
Bone-Rebuilding Supplement Regimens
If you want to eat a healthy diet but not fuss over specific foods, or if you have multiple food sensitivities, you may decide to depend largely on supplements for your bone rebuilding. My favorite regimen is based on using mostly Standard Process supplements, available from many naturopaths and some nutritionists and chiropractors, including me. Ask your health care providers if they have an account with Standard Process if you want to conveniently purchase these. Standard Process supplements are top quality and wonderful for bone health. You may also use other brands (see suggestions below). Always check supplement labels for any ingredients you’re allergic to.
- Standard Process Supplements These are average doses and may differ from what would be ideal for you.
- Standard Process: Calcium Lactate – 3 tablets/meal (370 mg calcium/day, less if you eat dairy)
- Standard Process: Calcifood – 1 wafer twice/day (200 mg calcium/day)
- Standard Process: Biost, a special bone-rebuilding formula that includes glandulars – 1 tablet/meal for 1st 2-3 months, then discontinue if desired (expensive)
- Standard Process: Ostrophin PMG, a special bone-rebuilding formula that includes glandulars – 1 tablet/meal for 1st 2-3 months, then discontinue if desired
- Standard Process: Organically Bound Minerals – 1 tablet/meal, take long term (life-long)
- Standard Process: Cod Liver Oil – 1 capsule/meal (3,000 mg/day) for Omega-3’s and some vitamin D. (May substitute another brand. A great one is Green Pasture’s Blue Ice Fermented Cod Liver Oil.)
- Standard Process: Betaine Hydrochloride or Zypan – Either one will work. Betaine Hydrochloride provides 150 mg of HCL per tablet, and Zypan provides 350 mg per tablet. Zypan has some added advantages for those with poor digestion. Either is a good low-dose supplement for starting, but then work your way up to a higher dose of another brand. Another brand: I highly recommend Betaine Plus HP from Biotics Research. Or just be sure to choose one that contains pepsin as well as betaine hydrochloride. Gentian root is also a nice addition.
- Apex Energetics: Ultra D 5000 – provides 5,000 IU’s per teaspoon. Must keep refrigerated. Truly a great supplement.
- Garden of Life: Vitamin Code Raw K-Complex – 2-5 capsules/day. Or try another brand made from natto.
- Garden of Life: Vitamin Code Raw Vitamin C – 1 capsule 2 times a day. Or other brand but must be a whole foods Vitamin C as described in the Vitamin C section above.
- Other brand: Magnesium Glycinate – Start with about 200 mg twice a day. Avoid using citrate, carbonate or oxide forms. Your need depends on how much calcium you’re taking and your bowel tolerance. Adjust dosing to bowel tolerance as described in the Magnesium section above. Standard Process makes Magnesium Lactate, which is also a great supplement but more expensive than you need and requires too many pills per day for most people.
Other Good Supplements
All these quality supplements are available at Natural Grocers in Bend,or online.
- Calcium Lactate by NOW (calcium)
- Magnesium & Potassium Aspartate by NOW (magnesium)
- Magnesium Glycinate 400 by KAL (magnesium)
- Chelated Magnesium by Country Life (magnesium for those with slow bowels)
- Plant-Sourced MINERALS by Natural Vitality (trace minerals)
- Balanced Minerals by Mega Food (trace minerals)
- Vitamin K2 by Source of Life “Garden Certified Organic” line (vitamin K2)
- MK-7 by Jarrow (vitamin K2)
- Vitamin D3 5000 IU by Natural Factors (vitamin D3)
- Vitamin D3 5000 IU by Jarrow (vitamin D3)
- Liquid Vitamin D3 by Solgar (liquid form of D3, refrigerate after opening, can use in shakes)
- HCL with Pepsin 250 mgs by Solaray (low dose betaine hydrochloride/HCL)
- HCL with Pepsin 650 mgs by Solaray (regular dose betaine hydrochloride/HCL)
- FLAX OIL by Barlean’s (Omega-3 fatty acids aka Omega 3’s)
- Flaxseed Oil Made with Organic Flax by Natural Factors (Omega-3’s, Omega Factors line)
- Arctic Cod Liver Oil by Nordic Naturals (Omega-3’s)
- MAXI-ZYME by Country Life (digestive enzymes)
- Super Enzymes by NOW (digestive enzymes, also provides some HCL and ox bile, which are very helpful for digestion of proteins and fats, respectively)
HCL for Digestion and Bone Health
Hypochlorhydria and the Use of Hydrochloric Acid
Bone Broth for Healthy Bones