Prevent fragile bones early in life

- and read more about why too much calcium and overconsumption of dairy products can be harmful

Fragile bones, also known as osteoporosis, is an insidious scourge. Science has its eyes on calcium and vitamin D, but osteoporosis may also be a result of getting too little vitamin K2 and magnesium, both of which are nutrients that must be properly balanced with calcium. If not, calcium may do more harm than good. Carbonated beverages, stimulants, and medicine (including statins) may also interfere with the bone-building processes. Therefore, strong bones require a lot more than calcium, and it is also important to remember daily, bone-challenging exercise.

Our life expectancy is increasing, and we want to enjoy life, be physically active and be able to take care of ourselves. For this to happen, we need a strong skeleton that even protect the heart, the lungs, and the brain against physical damage. Osteoporosis that leaves the bones increasingly porous and delicate does not show on the outside. Once the disease reaches a certain stage, wrists, ankles, and hips break extremely easily, and in many cases the top vertebrae collapse, causing a hunched or stooped posture. Many older people sustain hip fractures from simple falls, and in the United States alone, around 20 percent die within a year from accompanying complications.

Younger and middle-aged people who eat unhealthy diets or exercise in such a way that it deteriorates their bones rather than the opposite may also be affected osteoporosis. The important thing is to strengthen our bones at all ages and pay attention to those factors that are known to weaken our bone tissue. If we fail to pay attention, it may be too late. You can read more about this in the following sections:

Bones are living tissue and easy to influence

Beware of “bone thieves”

Calcium, vitamin D, and dairy products

Magnesium’s interaction with calcium

Vitamin K2 and osteocalcin

Remember sport and exercise – but don’t overdo it

Bones are living tissue and easy to influence

Bones contain more than calcium, magnesium, and other minerals. They also consist of blood vessels, nerves, and cells. The following two cell types control our bone structure from cradle to grave:

Osteoblasts are bone-building cells that produce a hormone called osteocalcin, which strengthens bone tissue. Vitamin K2 contributes to the process. The amount of osteocalcin in the blood is used as an indicator of bone metabolism.

Osteoclasts break down worn-out bone cells. They also remove calcium from bone cells when there is too little calcium in the blood. The mechanism ensures that blood concentrations of calcium are kept comparatively constant. The same is the case with the blood’s pH value. Osteoclasts excrete calcium in the blood in situations where the kidneys are unable to excrete excess acid.

Did you know that osteoclasts remove calcium from the bones as a way of regulating the pH value of the blood in cases where the kidneys are unable to get rid of excess acid?

The processes involved in building and breaking down bone

During our childhood and adolescence, our bones are modelled. Throughout our entire life, old, worn out bone tissue is replaced by new bone tissue (bone remodeling). As long as the bone-building processes are more effective than the processes that break down bone tissue, we are able to maintain healthy bones. However, the deteriorating processes slowly take over from the age of around 30-35 years. In addition to that, there are other factors and “bone thieves” involved that may speed up bone loss.

Beware of ”bone thieves”:

The following “bone thieves” have one thing in common: They speed up bone deterioration and increase the risk of osteoporosis. This is particularly bad in situations where several “bone thieves” support each other.

Chronic stress

Chronic stress increases levels of the adrenal hormone cortisol that leaches nutrients such as calcium and magnesium from the bones.

After menopause

After menopause, women may lose up to 20 percent of their bone mass in the five to seven years following menopause due to hormonal factors. According to the Canadian endocrinologist Jerilynn Prior, the breakdown of bone mass has a closer link to the reduced levels of progesterone and estriol than to the ovarian hormone estradiol. Many women lose bone mass without experiencing any problems.

Cholesterol-lowering statins

Statins, one of the most widely used medical drugs, inhibit vitamin K2 and the production of osteocalcin, which adds strength to bone tissue.

Other types of medicine

Anti-depressive medicine that increases levels of serotonin may reduce bone mass, according to a new study. Antacids, certain types of diuretics (loop diuretics), blood thinners (Maravan), tetracycline antibiotics, and corticosteroids such as prednisolone may increase the excretion of calcium or interfere with the body’s calcium metabolism in other ways.

Tobacco and alcohol

Smoking is a known risk factor of bone loss. Exceeding the alcohol guidelines issued by the health authorities may also interfere with the body’s ability to absorb and utilize calcium and magnesium.

Soft drinks and coca cola

Animal studies show that the content of phosphorus in soft beverages, which gives the tangy flavor, increases the loss of calcium from bone tissue to the bloodstream. The body does this to make the pH value more alkaline when the kidneys are unable to handle the task. There is even phosphorus in sugar-free soft drinks and cola light.

Too much protein and too few vegetables

Animal protein – including meat and low-fat cheese – contains a lot of sulfur and phosphorus that increase the acidity of the blood. On the other hand, potassium, magnesium, and calcium have the opposite effect. We should therefore make sure not to eat too more protein than we need. Instead, we must choose alkaline foods such as vegetables and fruit (in fact, our intake of these foods has been drastically reduced).

Calcium, vitamin D, and dairy products

Bones and teeth store about 99 percent of the body’s calcium reserves. The remaining one percent is reserved for metabolic purposes. Blood levels of calcium are tightly controlled. Even minor deviations may result in serious symptoms in the heart and nervous system.
Vitamin D is important for the uptake of calcium from the digestive tract.
The parathyroid glands make parathyroid hormone (PTH) that can increase calcium levels in the blood by releasing calcium from the bones and reducing calcium excretion from the kidneys. That way, our bone tissue serves as a deposit and a calcium source at the same time, ensuring a constant calcium concentration in our blood.
In other words, the body is more focused on regulating the blood’s pH value than adjusting the amount of calcium in bone tissue, which essentially serves as a mineral bank.
Calcium is found in dairy products, seaweed, stinging nettles, green vegetables, cabbage, beans, parsley, spinach, almonds, nuts, seeds, kernels, eggs, and bone broth. In addition, water contains a lot of calcium. The harder the water, the more calcium.

Most people cannot digest cow’s milk, and they do fine without it

As long as mammals are breastfed, they produce an enzyme called lactase that breaks down the lactose (milk sugar) in breast milk. Once they have been weaned, they stop making lactase. Actually, no fully-grown animals can digest milk, and evidence suggests that the same is the case with us humans. The majority of people in the world are unable to digest the lactose in cow’s milk. This lacking ability, however, only affects a few percent of Europeans, while nearly 100 of people in Asia are affected. Around 70% of the world’s population is therefore not able to digest cow’s milk, yet people are perfectly able to build and maintain strong bones by consuming their original diet, just like any other mammal. Especially northern Europeans and their descendants have maintained the ability to produce lactase throughout life. Nonetheless, the consumption of dairy products was generally quite low in Denmark until the middle of the 18-hundreds where agriculture shifted towards animal production. Actually, our ancestors got along just fine very little milk and milk derivatives until about 200 years ago. The big question is therefore how to preserve strong bones without milk. In fact, is it unhealthy to consume too much calcium from dairy products and supplements?

Too much calcium sequesters vitamin D and inhibits the uptake of iron

Most of our vitamin D is made in our skin in a process where UVB rays from the sun convert a form of cholesterol. From here, vitamin D is carried to the liver and stored as 25-hydroxy-vitamin D. When we need vitamin D (this is controlled by PTH from the parathyroid glands), the vitamin D is converted by the kidneys into an active form called 1,25-D. This form of vitamin D determines how much calcium our body absorbs from the intestine. If, however, a meal (possibly including supplements) contains too much calcium, the parathyroid glands reduce their release of PTH and active 1,25-D vitamin in order to control the pH value of the blood. This means that there is less active vitamin D in the blood and less potential for the vitamin to carry out its different functions. The downregulated vitamin D levels can have serious consequences because there are vitamin D receptors in all our cells, and vitamin D deficiencies are widespread in the first place – especially during the winter period.
It is therefore safe to conclude that it is not good to consume too much calcium from dairy products or other sources such as supplements. In fact, we should attempt to get our calcium from a variety of different food sources (preferably with somewhat smaller calcium concentrations) that also provide magnesium.
What is more, too much calcium from dairy products or calcium supplements inhibits the uptake of iron.

Magnesium’s interaction wich calcium

Approximately half of the magnesium in our body is stored in our bones. The rest is found in muscles, nerve tissue, and other soft tissues, where the nutrient supports more than 350 different enzyme processes. Magnesium has a “doorman function” in the calcium channels of the cell membranes. In bone cells, magnesium keeps the door open and allows as much calcium as possible to enter the cells. In muscle cells (and soft tissue), on the other hand, magnesium only allows a little calcium to enter.
If our magnesium levels are too low, we may not be getting the right amount of calcium into our bone cells and that increases our risk of fragile bones. A magnesium deficiency also increases the risk that too much calcium gets into the cells in the soft tissues. This stresses the cells, causing cramps and other serious problems because of the cells being flooded with calcium.

High-dosed calcium supplements increased the risk of cardiovascular disease

Many people take calcium to make their bones strong. However, researchers from the Johns Hopkins School of Medicine in Baltimore, Maryland, say that people who take large quantities of calcium in the form of supplements increase their risk of developing atherosclerosis and heart trouble. Their observations support earlier studies, and the bottom-line message is to avoid taking large quantities of calcium, especially if calcium is not taken together with other nutrients.

The relation between calcium and magnesium

Studies show that both too little and too much calcium and magnesium may be bad for you, but the jury is still out on the question about optimal amounts and the proper ratio between the two minerals. In Denmark, the reference intake level (RI) for calcium is 800 and 375 mg respectively, which is close to a 2:1 ratio. However, the calcium-magnesium ratio in Nordic diets comes closer to 4:1.
In Japan, the calcium-magnesium ratio is close to 1:1, which is because the Japanese do not consume dairy products and only get around 400-500 mg of calcium per day. On the other hand, they get more magnesium from eating vegetables.
Because many people around the globe who do not consume dairy products get along just fine on less than 800 mg of calcium per day, there is a chance that the reference intake for calcium in our part of the world is higher than our actual need.

Widespread magnesium deficiency

There is a lot of magnesium in kernels, almonds, nuts, whole-grain, cabbage, and other compact vegetables. An estimated 50-80 percent of the Americans lack magnesium and evidence points to a similar magnesium deficiency in Denmark. Magnesium deficiency is often a result of eating an unbalanced diet and refined foods. Also, a large intake of soft drinks, alcohol, and other stimulants plus using diuretics and being stressed can leach the body of this essential nutrient. Insulin resistance, the condition where cellular uptake of glucose is impaired, may also lower magnesium levels in the body, and it is often a combination of the factors listed above that can make the problem worse.

Vitamin K2 and osteocalcin

We need plenty of vitamin K2, a nutrient that helps transport calcium from the blood vessels to the bones and teeth where it is needed. In the blood vessels, vitamin K2 works by activating matrix Gla protein (MGP), which removes calcium, thereby preventing atherosclerosis.
As mentioned, vitamin K2 also helps produce osteocalcin, a bone-strengthening hormone, which it does by means of a process called carboxylation. The amount of osteocalcin in the blood is used as an indicator for bone metabolism.
Vitamin K2 is synthesized from vitamin K1 in the intestine and it requires a well-functioning intestinal microflora. Good sources of vitamin K2 are sauerkraut and the Japanese soy product Natto. In these foods, the vitamin is produced by bacteria during fermentation. In earlier times, we consumed far more fermented foods. Luckily, this type of diet is regaining popularity.
Henrik Hey, a Danish medical doctor and osteoporosis expert from Vejle Sygehus, recommends 180 micrograms of vitamin K2 daily (in supplement form) to people who suspect they have a risk of fragile bones or atherosclerosis. Half that dose (90 micrograms) serves well for prevention, and there is even the possibility of consuming more vitamin K2 from fermented foods, which is a less expensive solution. Patients who take blood-thinning medication (Marevan) should not use vitamin K2 supplements.

Remember exercise and sport – but don’t overdo it

Bone is living tissue and calls for physical activity to stimulate blood circulation and to stimulate the bone-modeling processes of osteoblasts. We also need good muscles to protect our bones. Health authorities recommend 30 minutes of physical activity every day, preferably the type of exercise where we carry our own weight and, better yet, strain our bones. Resistance training should be carried out at least twice a week. Weight-bearing activities include walking, playing tennis, climbing stairs, dancing, skipping rope, lifting weights, and doing push-ups.

Warning: Too much sport may cause osteoporosis

Prolonged high-intensity training combined with low energy intake contributes to elevated levels of cortisol, a corticosteroid that increases the breakdown of bone tissue. Researcher and clinical dietician, Anna Melin, explains that the most serious complication seen with low energy intake is the elevated risk of premature osteoporosis, which increases the risk of vertebrae and wrist fractures. Osteoporosis is not a condition that you notice until the damage occurs. Normally, it affects people from the age of 70 years and older, especially women.
The low energy intake combined with high-intensity training is a big problem because it deprives the body of nutrients that are of vital importance to bone health.

References:

Johns Hopkins Medicine. Calcium supplements may damage the heart. ScienceDaily. 2016
https://www.sciencedaily.com/releases/2016/10/161011182621.htm

Andrea Rosanoff et al. Essential Nutrient Interactions: Does Low or Suboptimal Magnesium Interact with Vitamin D and/or Calcium status. Advances in Nutrition 2016 http://advances.nutrition.org/content/7/1/25.full

Mercola. This silent Thief Can Steal Away Your Independence in a Flash. 2017
http://products.mercola.com/calcium-supplement/

Okyama et al. Statins stimulate atherosclerosis and heart failure: pharmacological mechanisms. PubMed.gov 2015
https://www.ncbi.nlm.nih.gov/pubmed/25655639

Andrea Rosanoff et al. Essential Nutrient Interactions: Does Low or Suboptimal Magnesium Interact with Vitamin D and/or Calcium status. Advances in Nutrition 2016
http://advances.nutrition.org/content/7/1/25.full

Mark J Bolland et al. Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial. BMJ 2008
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2222999/

Fujita T, Fukase M. Comparison of osteoporosis and calcium intake between Japan and United States. PubMed. 2002
http://ebm.sagepub.com/content/200/2/149.short

Helen Saus Case. Magnesium demper hyperaktivitet blant AD/HD-barn. Det norske helsemagasin Vitenskap og fornuft. 2017

Sara Sig møller, Anna Melin, Åsa Tornberg og Anders Sjödin: Lav energitæthed og hormonforstyrrelser blandt kvindelige atleter. Dansk Sportsmedicin 2013. Institut for idræt og ernæring. Københavns Universitet, Lunds Universitet

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https://www.youtube.com/watch?v=5guQwhRhV60&feature=youtu.be

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