What do my patients have in common?

They are diagnosed with certain illness, and may be taking prescriptions to treat that illness but also which have reduced their ability to make bone. If you are not a patient and still reading, you may know someone who has bone and muscle loss - share this with them and sign up for more great information to go directly to your inbox.

Today I give the bad news first and move quickly from there to the good news and what can be done here and now to start the reversal of muscle and, more importantly, bone loss.

You will gain:

· an understanding of the bad news: what the causes and risk factors are

· the good news: nutrients and lifestyle habits you can build into your life, starting today.

The Bad News:

Fact: Osteoporosis is a very big health problem that becomes a lifestyle problem.

In North America, bone density loss in the form of Osteopenia and then Osteoporosis is the number one common disease in women and the number 2 common disease in men behind Congestive Obstructive Pulmonary Disease[1]. It is very common in men and women over age 65, yet it is not actively discussed with health care providers as the leading cause of chronic pain, reduced mobility, isolation, and overall loss if quality of life. Its impossible to live a normal life with osteoporosis due to fear of falling, chronic pain, immobility and isolation. We need to move our perception of osteoporosis to that of a preventable disease. Below are some causes and risk factors that influence development of this chronic disease.

Causes: Loss of bone and muscle mass can be from genetic and lifestyle factors:

  1. poor dietary protein intake in middle age

  2. excessive smoking and alcohol intake

  3. a sedentary lifestyle in childhood, adolescence, and early adulthood combined with

  4. poor dietary intake of Vitamin K, Calcium, and Vitamin D rich foods

  5. medications that reduce stomach acid, long term corticosteroid use, hormone blockade therapy such as those used in treatment of hormone related cancer (prostate, breast, ovarian, etc), anti-depressants, sedatives, and anti anxiety drugs.

Fracture Risk factors include:

  1. progressive loss in height,

  2. low body weight,

  3. parental history of fracture

  4. a history of falls causing a mild trauma bone fracture.

More information about Fracture Risk assessment is available here and requires your bone mineral density measure and additional factors to assess risk.

Gravity will always win when we fall. If you already have either osteopenia or osteoporosis, the bones with less calcium and more load-bearing responsibility will fracture first. These are usually vertebrae, hip and wrist bones.

Ok that’s the bad news. Below we move onto what you can do to reduce your risk of fracture as you age. No matter what your age is today, you can start the process of building bone.

Solution: Preventing bone and muscle loss starts early in life (i.e. infancy and childhood) with movement and nutrition habits that encourage production of bone and muscle for a couple decades or more. Then in our 30’s, while staying active and eating well to maintain muscle mass, adding nutrients in clinically supported doses specific to bone health for long term maintenance.

Our Bodies Were Made to Move:

Movement to reduce risk of falling by maintenance of muscle and bone tissue.

The more bone density one has, the harder it is to cause a fracture in a fall. Likewise, the more muscle mass one has, the better the odds are of having good balance and strength to stay upright even if something causes us a misstep.

Only you can build bone.

If you don’t have time exercise and/or are allergic to the word, consider this an investment in your body. Perhaps thinking of exercise as “movement for my body”, or “strengthening and lengthening” instead, it may start to change your perception. You can also think of it as an equation if you are inclined:

Strength + Flexibility = Bone Density

Think on this concept. Find something that changes your perception of exercise so that you can confidently start with just one thing that moves your body in a way that promotes bone density. You can add another when you are ready and confident it can be maintained. The key is to keep doing this one thing until you have it down, usually in 30-90 days. In case you enjoy tracking what you do, consider using fitness apps to support your goal. I recommend MyFitnessPal often but look around and see what fits your needs.

Exercise Defined:

Exercise consists of aerobic and anaerobic activity, strength-training, flexibility and balance. These ALL add up to achieve the goal. The best method to keeping your bone and muscle mass is to build an exercise routine that includes all of the above at a level you can maintain for your life.

If bone density is your singular goal based on your risk factors and genetics, the following is key: Doing balance and flexibility work like floor/mat Pilates, Yoga and Tai Chi has shown to prevent falls as we age[2] because it improves balance and strength. Falling is the number one cause of hip fracture[3] for anyone over age 65 due to a loss of strength and sense of balance. Aerobic fitness is not quite as important when it comes to balance. Here are two 5-minute Yoga and Pilates apps I often recommend but check the reviews to be sure this is for you. Starting with 5 minutes makes it manageable builds your confidence to do more as you get better at balance.

A word of caution:

Too much exercise in women can cause hormone changes that result in bone loss [4]. This means that you don’t lose your menstrual cycle via excessive exercise and poor calorie intake to cause low body weight/extreme weight loss. When this happens, neither bone nor muscle is made until the menstrual cycle starts again.

Your Nutrient and Food Choices Matter


The building block needed to build muscle is protein from animal sources BUT with the caveat of limiting red meat to once every 2 weeks. All animal protein (chicken, eggs, cheese, fish, turkey, etc) must be free range and grass-fed or wild caught. Vegetarian sources of protein are encouraged (lentils, legumes, tofu).

Does this sound familiar? If yes, it is because this encourages one to follow the same dietary intake as that found in the Mediterranean diet. The evidence is in favor of this diet and the ability of the body to improve bone density.[5] In addition to that, the Mediterranean diet has a host of other benefits for gut and heart health over the long term.

2. Vitamin D, Calcium and Vitamin K2: The triumvirate in producing bone tissue and maintaining it. Bone is 95% type 1 collagen, which becomes calcified and controls the process of building bone, and hydroxyapatite crystals found between and around the collagen and becomes bone tissue. This allows bone to withstand pressure and stress without breaking. Below you will learn how these three nutrients control this process.

  • Vitamin D3 as cholecalciferol is the active form needed to absorb the calcium from food and supplements, and build bone, (Vitamin D2 is the inactive form and does not do this).

How much?

Deficiencies of Vitamin D cause bone loss. First get a baseline blood test to determine if you are deficient. With these results - less than 50 nmol/l is considered deficient in my practice, and anyone with osteoporosis should maintain blood levels at the 70-80nmol/l range in blood results[6]. Re-assess blood levels every 6 months to ensure you are at the right range above 70nmol/l. Testing is available via your PCP and via www.directlabs.com.

  • Calcium

The type and dose of calcium are important.

I recommend calcium citrate, using a dose that includes all reported dietary recall sources of dietary calcium. There is theoretical concern that too much calcium carbonate contributes to cardiovascular disease. Calcium citrate does not need to be taken with food and is well absorbed.

  • Vitamin K2

There are plant based sources called phylloquinones of Vitamin K (K1) and there are the menaquinone (MK) types of Vitamin K (MK2-MK14). Menaquinones are also found in fermented food (highest in natto) and in animal products but are primarily made from the gut microbiome - another bonus to having good large intestine probiotic diversity. Supplements usually do not have the right form of Vitamin K from menaquiones to build bone for that reason.

How Vitamin K2 works:

Vitamin K2 deficiency can reduce bone mineralization – it disrupts this cascade of reactions in making bone. First Vitamin D makes a protein called osteocalcin and then that protein uses Calcium and Vitamin K2 to make bone through maturation of hydroxyapatite. Hydroxyapatite is the crystal that surrounds the Type 1 collagen to make health bone tissue.

Type and Dose:

You need 45mcg of Vitamin K2 from MK4 per day for the best effect. But it’s not that easy. Do you remember why? Think back to your gut. Since this is made in the large intestine via the good bacteria we have there, that means your gut bacteria will to make MK4 when you eat a whole foods diet rich in soluble and insoluble fiber. (HINT: Think Mediterranean…).

If you don’t have a diverse gut microbiome, chances are you are deficient in Vitamin K. Below are a few things you can start doing:

· Get a stool analysis test can determine if you lack the right microbiome.

·If you don’t have a diverse gut microbiome, chances are you are deficient in Vitamin K2.

· Introduce fiber into your diet.

· Take a full spectrum probiotic capsule to introduce the right bacteria. This also means balancing out the bad bacteria associated with MK4 Vitamin K2 deficiency such as the families Enterococcus, Paraprevotella, and Clostridia and increasing the good bacteria that promote MK4 Vitamin K2 levels such as Firmicutes, Lachnospiaceae and Ruminococcaceae [7].

While osteoporosis may be prevalent among all people as they age, it is a condition which can be prevented entirely.

References: [1] Lippuner K, Golder M, Greier R (2005) Epidemiology and direct medical costs of osteoporotic fractures in men and women in Switzerland. Osteoporos Int 16 Suppl 2:S8. [2] Chan K, Qin L, Lau M, et al. (2004) A randomized, prospective study of the effects of Tai Chi Chun exercise on bone mineral density in postmenopausal women. Arch Phys Med Rehabil 85:717. [3] Tinetti ME (2003) Clinical practice. Preventing falls in elderly persons. N Engl J Med 348:42. [4] Warren MP (1999) Health issues for women athletes: exercise-induced amenorrhea. J Clin Endocrinol Metab 84:1892. [5] Jesús Pérez-Rey,† Raúl Roncero-Martín,† Sergio Rico-Martín, et al Nutrients. 2019 Mar 5;11(3). pii: E555. [6] Dawson-Hughes B, Heaney RP, Holick MF, et al. (2005) Estimates of optimal vitamin D status. Osteoporos Int 16:713-716 [7] Kohei Wagatsuma,1,† Satoshi Yamada,2,† Misora Ao,3 et al. (2019) Diversity of Gut Microbiota Affecting Serum Level of Undercarboxylated Osteocalcin in Patients with Crohn’s Disease. Nutrients. July; 11(7): 1541.

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