The old saying is true… you are what you eat! Most of us already have firsthand experience with how food can influence our physical and mental wellbeing, but have you ever considered how your diet might be impacting your bones?

Just because your bones are hidden from view doesn’t mean that they can be ignored. Maintaining a healthy lifestyle and eating a balanced diet are vital for building strong bones. In fact, your bones’ shape, structure, and function all rely on a diet jam-packed with essential bone-building nutrients. Unfortunately, these nutrients are lacking in too many of our diets.

Researchers have only just begun to fully uncover the relationship between nutrition and your bones. We have known for quite some time that calcium and vitamin D are important for osteoporosis prevention, but these are only the tip of the iceberg! Nutrients including omega-3 fatty acids, vitamins (A,B,C,E,K2), magnesium, potassium, flavonoids, and carotenoids have all been shown to be beneficial.

The basic concept is this… you should strive to eat a balanced diet consisting of plenty of fruits, vegetables, dairy, and high quality protein… while minimizing your intake of processed foods.

This article will explore how you can use nutrition to strengthen your bones. I will highlight each of the bone-building nutrients and how you can find ways to incorporate these into your everyday routine.

Calcium is the most widely discussed bone nutrient… and for good reason! It is an essential mineral that serves as the main building block for strong bones, where 99% of calcium is stored. What you may not know is that calcium also plays a role in muscle contraction, transmitting nerve impulses, blood clotting, and communication between body cells. In order to perform all of these important roles, you need to keep your blood calcium levels between 8.5 and 10.2 mg/dL. This is typically done through diet and supplements, but when your calcium intake becomes deficient, your body will start pulling calcium from the only place it is stored… your bones! Over time, this can lead to brittle bones and fractures.

Research has shown that calcium is the primary building block for healthy bones and is a key component in preventing and treating osteoporosis. Several studies have shown that calcium can slow the natural loss of bone that occurs as we age. A study by the US Preventative Services Task Force also showed that calcium combined with vitamin D may decrease your risk of breaking bones by upwards of 12%!

Despite the fact that just about everyone knows calcium is needed for strong bones, studies have shown that 19.6% of adults do not get the recommended daily amount even if they take a vitamin/mineral supplement! This number only gets worse for those who DO NOT take any supplements, where 37.7% of adults are calcium deficient!

There is certainly room for improvement when it comes to getting enough calcium each day. Dairy products are the biggest bang-for-your-buck, but calcium can also be found in a variety of other foods as well. Remember that your body can only absorb 500 mg of calcium in one sitting, so it is important to divide your calcium intake throughout the day.

  • Tofu (1/2 cup): 434 mg
  • Yogurt (8 ounces): 415 mg
  • Sardines (1 can): 351 mg
  • Cheddar Cheese (1.5 ounces): 303 mg
  • Milk (8 ounces): 300 mg
  • White Beans (1/2 cup): 81 mg
  • Orange (1 medium): 60 mg
  • Kale (1/2 cup): 47 mg
  • Pinto Beans (1/2 cup): 39 mg
  • Broccoli (1/2 cup): 31 mg

Vitamin D is the “ying” to calcium’s “yang.” Even through calcium steals the spotlight when it comes to bone nutrients, vitamin D is just as important. Vitamin D improves your body’s ability to absorb calcium in your gut so that it can reach your bones. Vitamin D has also been shown to have a direct effect on your muscles, where it improves muscle strength and may decrease your risk of falling. If you do not get enough vitamin D, you will only absorb a fraction of your daily calcium intake. When your calcium and vitamin D levels dip too low, your body will begin to pull calcium from your bones in an effort to maintain your blood calcium levels in the normal range, which can weaken your bones over time!

Most studies evaluating the impact of vitamin D on your bones use the combination of calcium + vitamin D, so the results are the same as those listed above for calcium. Vitamin D can help slow natural bone loss over time, and may decrease your risk of breaking bones by upwards of 12%!

It probably comes as no surprise to find out that we do a poor job of getting the recommended amount of vitamin D. Several studies have shown that at least 40-50% of the population is walking around with vitamin D deficiency!

The primary source of vitamin D is the sun. For many, 10-15 minutes of midday sun exposure in the summer can supply a wealth of vitamin D…. But where can you turn during the winter when the sun is no longer strong enough to produce vitamin D? Take a look at this list of vitamin D rich foods. If food sources alone can’t cut it, you may need to consider adding a vitamin D supplement.

  • Salmon (3 ounces): 465 IU
  • Mackerel (3 ounces): 211 IU
  • Sardines (3 ounces): 164 IU
  • Instant Oatmeal (1 packet): 154 IU
  • Orange Juice (8 ounces): 100 IU
  • Fortified Milk (8 ounces): 98 IU
  • Fortified Cereal (1 cup): 50 IU

In recent years, vitamin K2 has gained significant traction in the world of bone health. It now sits next to the likes of calcium and vitamin D as one of the most important nutrients for your bones. Vitamin K2 works with your bone building osteoblast cells to increase osteocalcin levels. In doing so, osteocalcin then improves how efficiently calcium is drawn into your bones and incorporated into bone tissue. This allows your body to use the calcium in your blood to build strong bones. The net effect is this… Vitamin K2 increases the activity of bone building osteoblast cells, and at the same time decreases the activity of your bone breakdown osteoclast cells!

The current research into vitamin K2 and bone health is limited, but several studies have posted promising results. Asian men and women who regularly consume natto (a fermented soybean dish that is rich in vitamin K2) have been shown to have a slower rate of bone loss over time compared to those who exclude natto from their diet. In addition, some larger studies dating back to 2006 have shown that vitamin K2 can decrease your risk of breaking bones! This is further supported by the fact that vitamin K blocking medications (Coumadin/Warfarin) are known to increase your risk of breaking bones.

The true incidence of vitamin K2 deficiency is not known because it is not a commonly tested nutrient. It is thought that vitamin K2 deficiency is widespread in Western countries because the typical Western diet lacks foods high in K2. Asian populations that regularly eat natto are most likely to avoid deficiency.

How can you increase your daily intake of vitamin K2? Here is a list of the vitamin K2 content of different types of foods. As you will see, this list is limited. It may be worthwhile to consider adding a vitamin K2 supplement to your bone health arsenal if you are concerned that you may be deficient!

  • Natto (100g): 1103.4 mcg
  • Goose Liver Paste (100g): 369 mcg
  • Hard Cheese (100g): 76.3 mcg
  • Goose Leg (100g): 31 mcg
  • Curd Cheese (100g): 24.8 mcg
  • Egg Yolk (100g): 15.5 mcg
  • Butter (100g): 15 mcg
  • Chicken Breast (100g): 8.9 mcg
  • Bacon (100g): 5.6 mcg

Magnesium is one of the most important minerals in your body. It plays a role in over 300 different biochemical functions, including the formation of protein and nucleic acids, energy production, signaling between cells, regulating electrolytes (including sodium, potassium, and calcium) as well as aiding in bone structure and strength. Sounds like magnesium should be a priority for us all, right? Unfortunately, around 50% of the population is not consuming enough magnesium to meet their daily needs!

60% of your body’s magnesium supply is stored in your bones, while 39% is found in soft tissues and 1% in your bloodstream. Magnesium works with calcium to form hard mineral crystals known as hydroxyapatite. These directly influence the shape and structure of your bones. Magnesium also acts as a buffer to counteract any changes in blood magnesium levels. When blood magnesium levels drop (because you do not get enough through your diet!) magnesium is pulled from your bones to raise it back into the normal range.

You need to maintain your magnesium levels in the proper range because if they dip too low or become too high, this can have negative consequences for your bone health. When magnesium levels are too low, the hydroxyapatite crystals in your bones become larger and more brittle, which can lead to weaker bones! Studies in both rodents and humans support the idea that low magnesium levels may increase your risk of breaking bones. The relationship between ELEVETED magnesium levels and your bones is less understood. What we have discovered through studies such as the Women’s Health Initiative Study is that those with the highest magnesium intake actually had an INCREASED risk of breaking their wrist bone!

If you need to increase your magnesium intake, then you should eat more green vegetables, nuts, seeds, and unprocessed cereals. Check out the list below to discover how much magnesium is in different types of foods.

  • Spinach (1 cup): 157 mg
  • Chard (1 cup): 154 mg
  • Bran Cereal (1/2 cup): 112 mg
  • Pumpkin Seeds (1/8 cup): 92 mg
  • Brown Rice (1 cup): 86 mg
  • Almonds (1 ounce): 80 mg
  • Peanuts (1/4 cup): 64 mg
  • Black Beans (1/2 cup): 60 mg
  • Soy Milk (1 cup): 61 mg
  • Whole Wheat Bread (2 slices): 46 mg
  • Banana (1 medium): 32 mg
  • Salmon (3 ounces): 26 mg

Potassium is an essential mineral and electrolyte which is needed for a number of body functions. Potassium plays a role in transmitting nerve impulses for muscle contraction and heart function, while also aiding in energy production and carbohydrate metabolism. Despite the importance of potassium, studies indicate that the typical western diet just doesn’t cut it… as few as 2% of the US population is consuming enough potassium!

The nutrition world has given potassium a considerable amount of attention over the years—and for good reason! Low potassium intake is associated with plenty of health conditions that we would all like to avoid. Among them is osteoporosis, but the details about this relationship are not completely understood.

Here’s what we know so far. Potassium is found in fruits and vegetables, which also contain precursors to bicarbonate which makes them alkaline (the opposite of acidic). The typical Western diet is quite acidic since it is rich in fish, meats, and cheese. This acidity needs to be neutralized, and the body achieves this through the lungs, kidneys, and bones. There is still debate regarding how involved your bones truly are in this process. Researchers have been able to show that in response to increased acidity, your bones may release alkaline calcium salts to neutralize the acidity back to normal levels.

This means that if you get the recommended amount of potassium through food and supplements, the calcium in your bones may be spared. Overall, we would expect less bone breakdown and increased bone density in people who have higher potassium intake, and there have been a few studies which support this concept. Men and women with higher potassium intake lose bone at a slower rate than those who are deficient!

Just about everyone associates bananas with potassium, but few of us would be able to stomach the 11 bananas it takes to reach our daily potassium requirement. Check out the list below to find other food sources that are high in potassium.

  • Potato With Skin (1 medium): 926 mg
  • Plums (1/2 cup): 637 mg
  • Raisins (1/2 cup): 598 mg
  • Prune Juice (6 ounces): 528 mg
  • Lima Beans (1/2 cup): 485 mg
  • Acorn Squash (1/2 cup): 448 mg
  • Banana (1 medium): 422 mg
  • Spinach (1/2 cup): 420 mg
  • Raisin Bran Cereal (1 cup): 362 mg
  • Orange Juice (6 ounces): 372 mg
  • Tomato (1 medium): 292 mg
  • Almonds (1 ounce): 200 mg

Vitamin C is more than just the “orange juice vitamin” that people like to take in mega doses in hopes that it may cure their cold. It is an essential vitamin that we need for a number of important body functions– including maintaining healthy bones. Vitamin C protects your bones in two ways– by acting as a potent antioxidant, and also helping to build strong bone collagen.

Antioxidants protect your bones by neutralizing free radicals, which are naturally formed but highly unstable molecules that can attack your body and alter its structure and function. Picture vitamin C as a small army around your bones, waiting to fend off free radicals! Research has shown that when free radicals attack bone, they increase bone breakdown activity by osteoclast cells while at the same time decreasing the bone building activity of your osteoblast cells. Mice deprived of vitamin C quickly developed osteoporosis, which was reversible when vitamin C is added.

Did you know that 40% of your bone consists of collagen and water? Vitamin C is required for collagen production, which improves bone quality by providing a scaffold or framework for mineralized bone to be created upon. This means that vitamin C deficiency can directly weaken the structure of your bones!

The good news is that we do a much better job of getting the recommended amount of vitamin C compared to many of the other essential bone nutrients. As a result, the rate of vitamin C deficiency has been falling steadily over the years—from 13% in the early 1990s to only 7.1% in 2009.

Since your body is unable to store vitamin C, it is important for you to eat plenty of vitamin C rich foods. Below is a list of fruits and vegetables that contain a significant amount of vitamin C.

  • Sweet Red Pepper (1/2 cup): 95 mg
  • Kiwi: 91 mg
  • Strawberries (1 cup): 85 mg
  • Kale (1 cup): 80 mg
  • Orange Juice (1 cup): 60-90 mg
  • Grapefruit Juice (1 cup): 60-70 mg
  • Orange (1 medium): 70 mg
  • Broccoli (1/2 cup): 51 mg
  • Potato (1 medium): 17 mg
  • Tomato (1 medium): 16 mg
  • Spinach (1 cup): 8 mg

Similar to vitamin C, vitamin E primarily functions as an antioxidant—protecting your body’s cells from the damaging effects of free radicals, slowing the aging process, and minimizing your risk for certain diseases (including osteoporosis!). You would think everyone would want to maximize these health benefits, but the typical western diet is low in vitamin E… with over 90% of men and women not consuming the recommended daily amount!

Few studies have been designed to isolate the relationship between vitamin E and your bones. We have established a basis for how antioxidants improve bone health, but PROVING it takes time, money, and a dedicated team of researchers which aren’t always readily available. Of the studies that have been conducted, some have had encouraging results. One study found that higher vitamin E intake in Chinese women was associated with increased bone density at the spine and hip! A separate study was less promising, as vitamin E had little effect on bone building and bone breakdown.

At the very least, if you are one of the 90% that is not getting the recommended amount of vitamin E, you need to step your game up! A variety of plant sources contain vitamin E, including vegetable oils, nuts, seeds, and leafy green vegetables. Take a look at this list to find ways to incorporate more vitamin E into your day.

  • Sunflower Seed Kernels (1 ounce): 7.4 mg
  • Almonds (1 ounce): 7.3 mg
  • Sunflower Oil (1 tablespoon): 5.6 mg
  • Sweet Potato (1 cup): 4.2 mg
  • Tomato Sauce (1 can): 3.5 mg
  • Peanut Butter (2 tablespoons): 3.2 mg
  • Cranberry Juice (1 cup): 3.0 mg
  • Canola Oil (1 tablespoon): 2.4 mg
  • Peanuts (1 ounce): 2.4 mg
  • Olive Oil (1 tablespoon): 1.9 mg
  • Spinach (1/2 cup): 1.9 mg
  • Broccoli (1/2 cup): 1.1 mg

Selenium is an essential trace mineral that is found naturally in soil and water. Like vitamins C and E, selenium has been shown to be a necessary building block for potent antioxidants which helps protect your body from the damaging effects of free radicals. It has also been shown to improve your immune system, protect against arthritis, maintain normal thyroid function, and also play a role in male and female fertility. Fortunately, selenium deficiency is very rare, with only small subsets of people in Asia, Africa, and Europe being at risk.

Researchers have discovered that selenium deficiency poses a significant threat to your bones. In fact, it leads to a perfect scenario for weak bones… It decreases the function of your bone building osteoblast cells, increases the activity of your bone breakdown osteoclast cells, and one study even showed that those with a lower intake of selenium were more likely to fracture their hip!

The link between antioxidants and bone health is certainly promising, and a clear connection is undeniable. If you are looking to improve your bone health through nutrition, it makes sense to at least get the recommended daily allowance of antioxidants through your diet or supplements.

Selenium is found in a variety of sources including nuts, fish, whole wheat grains, meat and dairy. Take a look at the following list to find ways to improve your selenium intake.

  • Brazil Nuts (1 ounce): 543 mcg
  • Tuna (3 ounces): 92 mcg
  • Oysters (3 ounces): 65 mcg
  • Shrimp (3 ounces): 47 mcg
  • Salmon (3 ounces): 39 mcg
  • Egg Noodles (1 cup): 38 mcg
  • Pork (3 ounces): 32 mcg
  • Beef (3 ounces): 30 mcg
  • Chicken (3 ounces): 26 mcg
  • Brown Rice (1 cup): 19 mcg
  • Whole Wheat Bread (2 slices): 16 mcg
  • Egg (1 large): 15 mcg

Weight Bearing Exercise

Exercise is an important part of living a healthy lifestyle, but did you know that it may also play a role in building strong bones and minimizing your risk of fracture? One form of exercise, known as weight bearing exercise, has been shown to have many bone health benefits. Don’t be fooled by the name, it doesn’t mean that you have to spend hours pumping iron in the gym. These are exercises that you perform while on your feet that work your bones and muscles against the force of gravity. With regular weight bearing activity, your bones become stronger as they adapt to the stress of impact and pull of your muscles.

Types Of Weight Bearing Exercise

The sky is the limit when it comes to the variety of weight bearing exercises available for you to choose from. And don’t stop at just one! Variety will add excitement and engagement, which will help combat boredom while also stressing your bones and muscles in new ways. Exercising in groups can be a fun way to socialize and improve bone health at the same time. Below are lists of low-impact and high-impact exercises for you to consider.

Low-impact exercises are easier on your bones and joints and are an excellent option for those who wish to stay active but are unable to participate in high impact workouts.

  • Elliptical training machines
  • Low-impact aerobics
  • Stair-step machines
  • Walking (either outside or on a treadmill)

High-impact exercises place more stress across your bones and are ideal for those wishing to get the maximum benefit out of weight bearing exercise. Always consult your physician before starting a new exercise program.

  • Climbing stairs
  • Dancing
  • Hiking
  • Brisk walking, Jogging, hiking
  • Jumping rope
  • Step aerobics
  • Tennis or other racquet sports
  • Team sports (soccer, softball, basketball)
  • Yard work, like pushing a lawnmower or heavy gardening
  • Weight training
  • Exercising with a weighted vest

How Often Should You Exercise?

If you haven’t exercised in a while, don’t try to be a hero your first time in the gym. It is best to start slowly and gradually increase your level of activity over time. The ultimate goal is to perform weight bearing exercise for a total of 150 minutes each week – or approximately 30 minutes, 5 times per week.

What Research Says About Weight Bearing Exercise For Osteoporosis

  • Research evaluating different forms of exercise (including brisk walking, body weight exercises, and weightlifting programs) have demonstrated that a combined exercise program can improve bone density by 3.2% compared to those who do not exercise.
  • Secondary benefits can include improved strength, joint mobility, endurance, and balance—all of which can contribute to a decreased risk of falling
  • No studies have been adequately designed to determine if weight bearing exercise alone can decrease your risk of breaking bones

Who Would Benefit From Weight Bearing Exercise?

  • If you have osteopenia or osteoporosis, but do not yet qualify for osteoporosis medications
  • If you are not interested in medications, or cannot take them due to side effects
  • If you are unable to participate in whole body vibration
  • If you wish to improve strength, endurance, and balance
  • Weight bearing exercise is an excellent adjunct therapy for anyone with osteoporosis

What Are Disadvantages/Side Effects Of Weight Bearing Exercise?

  • This form of exercise may not be safe if you have heart, nerve, or muscle disease.
  • Exercise may aggravate underlying joint problems, including arthritis.
  • Weight bearing exercise requires consistency and effort. It is not as easy as taking a pill or standing on a vibrating platform.
  • If you have had a compression fracture in your spine, certain exercises (particularly those that involve forward bending and abdominal “crunches”) may increase your risk of sustaining another compression fracture and should be avoided.
  • It is best to consult your medical provider before starting a new exercise program.

Whole Body Vibration Therapy

Whole body vibration therapy involves sitting or standing on a device that sends waves of vibration through your entire body. It has been shown to stimulate your muscles and bones, which leads to improved muscle strength, balance, and circulation necessary for key nutrients to reach your bones. Studies indicate that vibration therapy may even increase the activity of your bone building osteoblast cells. This makes an excellent addition to a comprehensive osteoporosis treatment program, particularly if you are not able to participate in other forms of weight bearing exercise.

What Research Says About Vibration Therapy For Osteoporosis

  • Vibration therapy can improve bone density by 1.5% to 4.3% over time
  • Vibration therapy can improve muscle strength and balance, which may reduce falls
  • No studies have been adequately designed to determine if vibration therapy alone decreases your risk of breaking bones

Who Would Benefit From Vibration Therapy?

  • If you have osteopenia or osteoporosis, but do not yet qualify for osteoporosis medications
  • If you are not interested in medications, or cannot take them due to side effects
  • If you are unable to participate in other forms of weight bearing exercise
  • If you wish to diversify your weight bearing exercise routine
  • Whole body vibration is an excellent adjunct therapy for anyone with osteoporosis

What Are Disadvantages/Side Effects Of Vibration Therapy?

The greatest disadvantage of vibration therapy is the cost of the device. Quality vibration machines routinely cost between $1,000 – $3,000. However, when this expense is compared to the cost of treating a fracture, it perhaps becomes more reasonable.

The long-term effects of vibration therapy are not well known in patients with osteoporosis. Studies reporting on the effects of vibration therapy do not always comment on side effects associated with use of the machines. When reported, possible side effects include:

  • Muscle aches
  • Dizziness
  • Episodes of low blood pressure
  • Plantar fasciitis
  • Itchiness
  • Blurred vision
  • Ringing in the ears

Choosing A Vibration Machine

Vibration machines are available for a variety of people with different needs, including athletes, astronauts, those with osteoporosis, and more. As you can imagine, the design of these machines will vary based on the needs of the individual. I would consider the following features when selecting a vibration machine for osteoporosis.

  • Low intensity vibration platform (25-35 hz)
  • Handles for balance
  • Vibration protocol: 10 minutes at least 3 times per week
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