Osteoporosis is a progressive skeletal disease characterized by demineralized porous bones full of holes and a weakened support matrix prone to fracturing. In America, one in two women and one in four men will break a bone due to osteoporosis. Worldwide, the disease results in 9 million fractures a year; a figure that is expected to increase exponentially by 2050 alongside an aging global population. (1,2)
Bone matrix is composed of cross-linked collagen fibers that act as both strong scaffolding and storage space for hard mineral salts composed mostly of calcium and phosphorus. Bone also stores other minerals in lesser amounts such as magnesium and fluoride. In storage, calcium and phosphorus combine to form a compound called hydroxyapatite that together with a healthy collagen matrix gives bone its characteristic strength and durability.
We think of bones as static entities but in reality, they are in a constant state of “remodeling” in which minerals are removed, or “resorbed” as needed and replaced to form new bone. Our bodies favor the formation of new bone until we are in our mid 30s and then the process reverses and we start resorbing too much, and/or forming too little. Over time, the matrix weakens and holes develop where minerals used to be and bones become osteoporotic.
Severe osteoporosis presents with bones that have the potential to break not only from a major incident such as a fall but even from the most minor infraction such as a sneeze! Most people have no idea that they have osteoporosis since the disease progresses silently. In fact the first symptom is often a fall with a resulting fracture.
Variables such as gender, diet, genetics, overall health status, and lifestyle choices all affect how much bone we build in our younger years, and how much we hold onto as we age.
Risk Factors for Osteoporosis
- Age: Risk is highest for those 65 years and older
- Gender: Women are four times more likely to develop osteoporosis than men
- Amenorrhea in women due to inadequate calorie intake and excessive exercise
- History: Parental history of osteoporosis and personal history of fracture
- Menopause (women)
- Testosterone deficiency (men)
- Sedentary lifestyle
- Nutrient and/or calorie deficient diet
- Vitamin D deficiency
- Alcohol Abuse
- Long term use of corticosteroids (such as for asthma), stomach acid reducing medications, and antidepressants (SSRIs such as prozac)
Health Conditions Associated with Osteoporosis
- Autoimmune disease: RA, lupus, MS, thyroid disease, and ankylosing spondylitis
- Digestive and Gastrointestinal disorders: celiac disease, inflammatory bowel disease (IBD), and weight loss surgery
- Parkinson’s disease
Paleo and Osteoporosis
Anthropologists have found that our hunter-gatherer ancestors had heavier, stronger bones than we do today. (3,4) Why do modern humans have lighter, weaker skeletons that become osteoporotic with age?
Although heredity is a major determinant of bone density, as we find with other chronic diseases of civilization, the evidence points to our lifestyle behaviors as major influencers as well. The infrastructure of our modern lifestyles; how we eat, exercise, work, sleep, and handle stress promotes chronic disease, including osteoporosis. The good news, is that with a little Paleo proactivity we can build a new lifestyle infrastructure giving our bones strong legs to stand on!
Paleo Basics for Healthy Bones
Here in the Western world dairy is our largest source of calcium, and the USDA Dietary Guidelines inform us that milk, cheese, and yogurt are our best dietary options for this important bone building mineral. However, when we look at the anthropological record, and observe the traditional diets of many cultures around the world, we find that those with the highest dairy intake actually have the highest fracture rates!
Our Paleolithic ancestors had bigger, stronger bones than we do and ate no dairy other than breast milk in infancy. Contemporary hunter-gatherer societies with virtually dairy-free diets such as the Kitavans do not develop osteoporosis and many populations around the world where the traditional diet includes very little dairy, such as in Peru, India, and Asia, all have osteoporosis rates well below ours. In fact, countries with the highest dairy consumption such as Finland, Sweden, and the United States have some of the highest osteoporosis rates in the world (2).
The RDA for calcium for adults is 1000 – 1200 mg/day and 1300 mg/day for pregnant and lactating women. However, it’s likely our bones require less than this. (5) In an in-depth discussion of our calcium needs in their book Perfect Health Diet, doctors Paul and Shou-Ching Jaminet point to research that shows the lowest bone fracture rates occur with calcium intakes between 700 and 900 milligrams per day. (6)
It’s easy to get this much calcium on the Paleo diet, if you’re mindful about it and eat your greens as well as some bones. Greens and bones? Yes, calcium is very well absorbed from these foods, with bones (such as the soft ends off soup bones or small soft fish bones), collard greens, canned salmon with bones, and turnip greens, all providing more absorbable calcium than milk! Sardines with bones are a very close second to milk with bok choy, broccoli, kale, and mustard greens following. (7)(8)
Filling your plate with a cup of collard greens, a cup of broccoli, and a serving of fish with bones will provide over 700mg calcium in just one meal! You’re also getting calcium in smaller amounts from nuts and seeds as well other vegetables.
Fat-Soluble Vitamins A, D, and K2
These vitamins are all essential to the bone remodeling process. Vitamins A and D play roles in resorption and formation and need to be in the right balance for proper bone metabolism. (Too much vitamin A without adequate vitamin D can be harmful.) (9, 10)
Vitamin K2 ensures that the calcium in our diets gets deposited into bone where it’s needed instead of into soft tissue such as our arteries where it can contribute to heart and vascular disease.
To get adequate and balanced amounts of vitamin A, D, and K2 from your diet the Jaminets recommend three egg yolks a day and ¼ pound liver a week. If you don’t like liver and you just can’t bring yourself to eat it regularly, 1 tsp of cod liver oil a day is a way to supplement Vitamin D in the right proportion to vitamin A. For additional Vitamin D, add 30 minutes of sunshine a day when possible. Additional sources of vitamin A in the form of carotenes include dark green and orange vegetables (eat these with a bit of healthy fat for better absorption) and good sources of vitamin K2 include foie gras or goose liver, natto, pastured meats – especially the dark meat of chickens, ghee, grass-fed butter, and hard cheeses if you eat dairy.
Boron helps preserve bone stores of magnesium which is important since magnesium is essential for hundreds of physiological functions and if our dietary intake falls short of our needs, we make up the deficit by taking it from bone. Boron also supports calcium and vitamin D metabolism. (11)
Boron is found in many fruits and vegetables and foods high in magnesium include dark green leafy vegetables, nuts and nut butters, pumpkin seeds, avocado, banana, and dark chocolate.
Collagen protein makes up 90 percent of bone matrix and dietary collagen intake has been shown to increase bone density and have a therapeutic effect on osteoporosis. (12) The bones, skin, joints, tendons, and ligaments of grass-fed animals are loaded with healthy collagen and that’s one of the main reasons why bone broth is so good for you!
Vitamin C is essential for collagen synthesis and maintenance of bone matrix. (13) Vitamin C also increases the absorption of iron from our gut, another nutrient important for collagen synthesis. (14). Fruits and vegetables are great sources of this important bone building vitamin.
Supplements can help you achieve recommended amounts of hard-to-get bone building nutrients such as vitamin D, K2 and magnesium. If you’re considering supplementation for bone health, I recommend that you to speak to your health care provider or a nutritionist to make sure it’s the right thing for you.
Exercise is key for bone health because like muscles: you use them, or lose them! However, it’s important you engage in weight bearing exercises such as weight training, walking, jogging, climbing stairs and dancing to improve bone density (15). Bicycling and swimming are not weight bearing.
In this interesting study of prehistoric bones out of Penn State University researchers compared the bones of hunter-gatherers from 7000 years ago to those of farmers in the same geographic area over 6000 years later. After taking into account dietary differences and changes in body size, the researchers concluded that physical activity was the greatest factor accountable for about 20% more bone mass found in the “mobile foragers” compared to the “sedentary agriculturalists.” (16)
Anything that contributes to systemic inflammation such as stress, lack of sleep and leaky gut can influence osteoporosis.(17) If you refer back to the list of conditions associated with osteoporosis, you can see that all of them have inflammatory roots.
The Paleo diet eliminates foods known to cause inflammation such as excess alcohol, refined food products, excess sugar, grains, gluten and legumes and excess omega-6 fatty acids found largely in seed oils. Anti-inflammatory omega-3 fatty acids found in grass-fed meat, pastured eggs, and fatty fish such as salmon, tuna, mackerel, and sardines may reduce the activity of cells that breakdown bone and resorb minerals such as calcium and magnesium. (16)
Poor sleep habits and inadequate stress management, further increase inflammation. There are many simple ways you can start to improve the quality and quantity of your sleep as soon as tonight! To hack your stress response, check out this great post.
Changing hormone levels as we age and hormonal disorders affect bone health. (17) If you suspect you have hormone issues that you need help addressing, find a knowledgeable health care provider to work with. You can look for a functional medicine specialist in your area at www.primaldocs.com or www.paleophysiciansnetwork.com.
Microbiome and Gut Health
It would be remiss to exclude a mention of the emerging evidence surrounding the influence of our gut microbes on chronic disease. In this post, Chris Kresser addresses how our microbiota may affect our bones and osteoporosis.
Paleo is Your Best Bet for Bone Health
The Paleo diet and lifestyle can improve your nutritional status, reduce inflammation and lower your risk of developing chronic diseases of modern civilization including osteoporosis. Here’s to strong bones for life! In summary:
- Eat a high quality Paleo diet full of a variety of pastured meats, wild fish, healthy fats and colorful produce including leafy greens rich in bone building nutrients and bioavailable calcium.
- Eat nose to tail they way our ancestors did by including organs such as mineral rich liver in your diet.
- Eat bone broth regularly to get plenty of collagen.
- Get outdoors and soak up some sunshine as often as possible.
- Perform weight bearing exercises regularly.
- Don’t smoke and don’t drink too much alcohol.
- If you suspect you have hormonal issues that need addressing, and/or you think supplementation would benefit your nutrient status, a knowledgeable healthcare provider can help.
- Take steps to ease stress and promote sleep.
- Make sure you are getting enough probiotics in your diet or from supplements to support healthy gut microbes.
- If you are taking medications associated with bone loss, as your health improves, reevaluate your need for them with your doctor.
- If you’re not past your 30s, you have the advantage that your body still favors bone formation over resorption. Take advantage of that!
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