Dairy products, no thanks!

- how to find the best alternatives for strong bones

Many people avoid dairy products because they are lactose intolerant, are vegan, or for other reasons. Milk is a good source of nutrients, especially calcium, but you can easily get enough calcium from other food sources. What is more, it appears that vitamin D, vitamin K2, and the calcium/magnesium ratio is even more important than calcium alone for the structure and maintenance of strong bones. Another thing to remember is that sugar, soft drinks, stimulants, and certain types of medicine can disrupt the bone-building processes. Therefore, having strong bones is about a lot more than dairy products and calcium alone. Finally, don’t forget that daily weight-bearing exercise stimulates bone density.

Milk is a complete “lunch box” designed to provide mammal offspring with all the protein, carbohydrate, fat, vitamins, minerals, growth hormones, and protective compounds it needs. If milk has higher protein content it is typically to ensure rapid growth. That is why there are huge differences in the nutrient content of human breast milk, cow’s milk, dog milk, whale milk, and milk from other mammals.
As long as mammals suckle, they produce lactase, an enzyme that breaks down the lactose in the milk. Once the offspring has been weaned, their lactase production stops, so fully grown animals cannot tolerate milk. Apparently, the same goes for humans. The majority of the world’s population cannot tolerate the lactose in cow’s milk. Interestingly, there are huge geographical differences. Only a few percent of Europeans are lactose intolerant, while the figure is closer to 100 percent in Asia. Around 70 percent of the global adult population cannot tolerate dairy products because of lactose intolerance and they develop gastrointestinal symptoms such as diarrhea. There are also people who are allergic to casein, whey protein, and other types of milk proteins and typically have a delayed reaction. This type of intolerance that is primarily caused by IgG antibodies is rarely noticed. Nonetheless, many people with digestive problems, mucus production, problems with their ears, sinuses, or throats, fatigue, concentration difficulty, or chronic inflammation, often feel a lot better if they limit their intake of dairy products or avoid them altogether. There is also a growing number of vegans who avoid dairy products for various reasons.
So how does one build and maintain strong bones throughout life without milk? And is it bad for you to get too much calcium from dairy products and supplements?

Healthy bones especially require vitamin D, calcium, magnesium, and vitamin K2

Healthy bone tissue contains a number of minerals like calcium, magnesium, potassium, silica, and collagen. It also contains amino acids. Vitamin D is important for the uptake of calcium in the bloodstream. Magnesium is needed to activate vitamin D. Magnesium serves as a door bolt in the membrane of cells and makes sure that nearly all the calcium in the blood enters the cells in bone tissue. We also need vitamin K2 that carries calcium away from the blood vessels and helps embed the calcium in bone tissue.
Magnesium and vitamin K2 are essential for the body’s calcium distribution and are therefore important for preventing both osteoporosis and atherosclerosis.
Vitamin C is important for the production of collagen, a protein that contributes to bone strength.

Vitamin D, sources, and our actual need for the nutrient

There is very little vitamin D in high-fat dairy products, and our diets are generally low in vitamin D, as well. The summer sun is our most important source of vitamin D and vitamin D deficiencies are widespread. For that reason, the Danish Veterinary and Food Administration has issued new guidelines for vitamin D supplementation.
Our actual need for the nutrient hinges on a variety of factors such as sun exposure, age, skin type, BMI, and chronic diseases. It is possible to buy high-dosed (20-100 micrograms) vitamin D supplements.

Calcium, sources, and our actual need for the nutrient

Dairy products contain quite a lot of calcium. You also get calcium from cabbage, spinach, beans and other greens, almonds, nuts, seeds, kernels, fish, eggs, and bone marrow broth. It is even possible to buy oat milk and similar milk substitutes that are enriched with calcium.
Ninety-nine percent of the body’s calcium is stored in bones and teeth, while one percent is used to support metabolic processes such as nerve signal transmission, muscle work, and heart function. It is vital that the calcium in our blood is tightly regulated because even minor irregularities can result in serious symptoms in the nervous system and heart.
The official recommendation for calcium intake in Denmark is 800 mg per day. People older than 70 years, nursing home residents, and people with osteoporosis are advised to take 1,000 – 1,200 mg together with 20-40 micrograms of vitamin D.
There are many countries where people do not consume dairy products, and their calcium intake is therefore much lower. In Japan, the average calcium intake is around 540 mg daily. Still, their rate of osteoporosis and other lifestyle diseases is lower. Anthropologists have found similar trends in African populations.
The explanation lies in the fact that these people get far more magnesium by eating coarse greens, and magnesium is vital for proper calcium distribution and healthy bones.

Magnesium, sources, and our actual need for the nutrient

We get magnesium from kernels, almonds, nuts, oats, beans, cabbage, and other vegetables. There is also magnesium in fish, dairy products, berries, and cocoa beans.
Around half of our magnesium is stored in our bones, while the rest is found in muscles and in nerves and other soft tissues where it supports more than 300 different enzyme processes.
Magnesium serves as a door bolt in the cellular calcium channel. Here, it makes sure that most calcium enters the bone cells where it is needed. What magnesium also does, however, is to keep the calcium concentration down to a minimum in muscle cells and other soft tissues.
If we lack magnesium, we risk that calcium does not reach the bone cells and that increases our risk of osteoporosis. However, without magnesium to regulate the calcium distribution, we also risk that there is too much calcium in soft tissues. Calcium flooding of these cells stresses them and may result in cramps, inflammation, and other serious conditions that can occur if calcium gets into the wrong tissues.
Before the industrialization, the average daily magnesium intake was around 500 mg and was easily achieved by eating coarse greens. Today, most people in Western countries get less than the recommended daily amount. In Denmark, the daily reference intake level for magnesium is 375 mg.

The crucial balance between calcium and magnesium

Scientists still cannot quite agree on the optimal intake of dietary calcium and magnesium or the ratio between the two minerals. In Denmark, the reference intake (RI) level for calcium and magnesium is 800 mg and 375 mg, respectively, which is close to being a 2:1 ratio. However, the Nordic diet with all its dairy products brings the ratio closer to 4:1. A major reason for this is that milk contains 10 times more calcium than magnesium, while cheese contains 25 times more calcium than magnesium. If you take calcium supplements in addition to that, the imbalance between calcium and magnesium grows even bigger and that may have serious health implications.
In countries like Japan, the calcium and magnesium ratio in the diet is close to 1:1. Since large parts of the global population do not consume dairy products and only get around 800 mg of calcium daily from their diets, yet still manage to have healthy bones, it is possible that the Danish reference intake level for calcium exceeds our actual need for the nutrient.

• Magnesium is essential for proper distribution of calcium in the body
• Magnesium even prevents the loss of calcium in situations where the body has too little of the nutrient
• The body therefore needs less calcium when magnesium levels are optimal

IMPORTANT: High-dosed calcium supplements increase the risk of cardiovascular diseases

Many people, including those who avoid dairy products, take extra calcium for their bones. However, according to scientists from Johns Hopkins University School of Medicine in Baltimore, Maryland, people who take high-dosed calcium supplements have an increased risk of developing atherosclerosis and heart disease. This supports earlier research and scientists therefore warn against taking excessive amounts of calcium in supplement form, especially if you take calcium alone.

Vitamin K2 and osteocalcin

In the intestine, vitamin K2 is synthesized from vitamin K1 that we get from dark greens. The conversion requires a healthy and well-functioning gut flora.
Some of the best dietary sources of vitamin K2 are sauerkraut and the Japanese soy product called Natto. Here, the vitamin is converted by bacteria as part of the fermentation process. In old days, people ate far more fermented foods. Luckily, this healthy method for preserving foods has experienced a comeback.
In our blood vessels, vitamin K2 works by activating matrix Gla protein (MGP) that carries calcium from the blood to the bones. Vitamin K2 also helps produce a protein called osteocalcin that adds strength to bone tissue.
Vitamin K2 supplements for preventing osteoporosis typically contain around 90 micrograms of the nutrient. One can also try getting this amount by eating fermented foods. People diagnosed with osteoporosis are advised to take 180 micrograms daily,

Beware of the ”bone thieves”

Building and maintaining healthy, strong bones is not just a matter of getting the mentioned nutrients. It also has to do with lifestyle factors.
The below listed factors are known as ”bone thieves” because they speed up the loss of bone tissue and increase the risk of osteoporosis. The real problem is that they reinforce one another.

Sugar
Many people consume far too much sugar from candy, soft drinks, fruit juice, cakes and cookies, or concealed sugar from different food sources. This can impair their uptake and utilization of calcium. Refined sugar only contains empty calories which means the body has to find other ways to get its B vitamins, calcium, magnesium, and other nutrients to fuel the energy turnover. Bones serve as a ”mineral bank” from which the body can make withdrawals. Too much sugar may also result in excessive acid in the blood, which requires a tightly-controlled pH value. Therefore, the bones release alkaline minerals like calcium and magnesium in the blood, and these minerals are then excreted in the urine.

Soft drinks and Coca-Cola
Besides loads of sugar, soft drinks and Coca-Cola contain phosphorous. Animal studies have shown that phosphorous that is acidic speeds up the loss of calcium from the bones to the blood. This is in order to move the pH value in a more alkaline direction in situations where the kidneys are unable to handle the job. Each Dane consumes 100 liters of fizzy drinks on average every single year, and there is also phosphorous in sugar free soft drinks.

Tobacco and alcohol
It is commonly known that smoking increases the risk of osteoporosis. Also, excessive alcohol intake may interfere with the body’s ability to absorb and utilize calcium and magnesium.

Statins for treating elevated cholesterol
Statins are some of the most widely sold medical drugs. They work as vitamin K2 antagonists and block the production of osteocalcin that is needed for strengthening bone tissue.

Other types of medicine
Anti-depressive medication that raises serotonin levels may reduce bone density. Antacids, a type of diuretics called loop diuretics, blood-thinning medication, tetracycline (antibiotics), and corticosteroids (prednisolone) may increase the excretion of calcium or disrupt the body’s calcium metabolism in other ways.

Chronic stress
Chronic stress raises levels of cortisol that leaches nutrients like calcium and magnesium from bone tissue

Remember weight-bearing exercise every day

It is important to exercise. The impact of running, jumping etc. helps increase bone strength and maintain healthy bones. Any type of activity is useful such as e.g., walking, jogging running, cleaning, gardenwork, fitness, dancing etc. Try to walk for one our every day and carry out many different activities. It is the total sum of all these things that matter.

References:

Clare Collins, University of Newcastle. Don´t Drink Milk? Here´s How to Get Enough Calcium. Scitecdaily.com. February 20, 2020

Dr. Susan E. brown. Rethinking the causes of osteoporosis. Better Bones July 22, 2019

Elisabeth Jäger et al. Calcium-sensing receptor-mediated NLRP3 inflammasome response to calciprotein particles drives inflammation in rheumatoid arthritis. Nature, 25 August, 2020.

Johns Hopkins Medicine. Calcium supplements may damage the heart. ScienceDaily. 2016

Andrea Rosanoff et al. Essential Nutrient Interactions: Does Low or Suboptimal Magnesium Interact with Vitamin D and/or Calcium status. Advances in Nutrition 2016

Mercola. This silent Thief Can Steal Away Your Independence in a Flash. 2017

Fujita T, Fukase M. Comparison of osteoporosis and calcium intake between Japan and the United States. Procb Soc Exp Biol Med 1992

Essa Hariri et al. Vitamin K2 – a neglected player in cardiovascular health: a narrative review. Open Heart. 2021

Mark Richens. Vitamin K2 Plays Key Role in Bone Health. American Bone Health. October 2019

Iver Mynsterrud. Sukkerspising svekker skjelettet. Helsemagasinet Vitenskap og Fornuft. Nr. 3 2017

Wyshak G, Frisch R. Carbonated beverages, dietary calcium, the dietary calcium/phosphorus ratio, and bone fractures in girls and boys. Journal of Adolescent Health. 1994

Ane Bodil Søgaard, Karen Østergaard, Troels V. Østergaard. Mælk og sundhed. Hvad er det du drikker? Books on Demand.

Frida - Parametre (fooddata.dk)