20keynutrientsforbonehealthanoverview

byDr.SusanE.Brown,PhD

Dependingonhowwecountthem,thereareatleast20bonebuildingnutrientsthatare essentialforoptimalbonehealthessentialinthatourbodiescannotmanufacturethemon theirown,sowemustgetthemfromourfoodanddrink.Letstakeaquicklookatthem,one byone,soyoucangetabetterideaoftheirroleinbonehealthandhowmuchyoushouldbe getting. Remember,noneofthesenutrientsdotheirworkinisolationyouneedsomeofeachand everyone,sotheycanallworktogethertokeepyourbonesstandingstrongallyourlifelong. Takingatopgrademultivitaminmineralcomplexandessentialfattyacidswillensurethatyour cellshaveadequatelevelsofthesenutrientsreadyathandfromminutetominute,dayafter day,topreventbonelossleadingtoosteoporosis,otherdegenerativediseases,andaccelerated aging. (Clickthroughonindividualnutrientstolearnmore...)

TABLEOF20ESSENTIALBONEBUILDINGNUTRIENTS
Nutrient
AdultRDAorAI Common therapeuticrange forbonehealth (dailyintake) 8001200mg 8001200mg Dietaryconsiderationsconcerningadequacy ofaveragedailyintake Your intake

Keyminerals Calcium (Ca) Phosphorus (P)

10001300mg 1250mg918yrs 700mgadults Typicaldietisinadequate,averaging500 850mg.1 Inadequateintakeisrareexceptinelderly andmalnourished.Excessintakecommon withuseofprocessedfoodsandsoftdrinks ~1500mg/dayinmenand~1025mg/day inwomen.

USDHHS.2004.Bonehealthandosteoporosis:AreportoftheSurgeonGeneral.Chapter1:Apublichealth approachtopromotebonehealth.URL:http://www.surgeongeneral.gov/library/bonehealth/chapter_1.html (accessed05.28.2008). Wright,J.,etal.2003.Dietaryintakesoftenkeynutrientsforpublichealth,UnitedStates:19992000.Adv.Data, (334),14.URL(PDF):http://www.cdc.gov/nchs/data/ad/ad334.pdf(accessed05.28.2008). Morgan,K.,etal.1985.MagnesiumandcalciumdietaryintakesoftheUSpopulation.J.Am.Coll.Nutr.,4(2), 195206.URL(abstract):http://www.ncbi.nlm.nih.gov/pubmed/4019942(accessed05.28.2008).

SusanE.Brown,PhDCenterforBetterBones 605FranklinParkDriveEastSyracuse,NY13057 www.betterbones.com


20Keybonebuildingnutrientsanoverview
Nutrient
AdultRDAorAI Commontherapeutic rangeforbonehealth (dailyintake) 2001000mcg Dietaryconsiderationsconcerning adequacyofaveragedailyintake CommonintakeintheUSis50mcgor lower.2 Your intake

Chromium (Cr)

3035mcg,adult males 2025mcg,adult females Novaluessetto date

Silica (Si)

520mg

Intakesignificantlyhigherinmen(3033 mg/day)thaninwomen(~25mg/day),3yet generallysuboptimal.Silicaisthefirst elementtogoinfoodprocessing. Averageintakeis4663%ofRDA (Pennington,etal.,1986).Marginalzinc deficiencyiscommon,especiallyamong children(Brown,2005). Intakegenerallyinadequate,at1.76mg adolescentgirls;2.05mgadultfemales;and 2.5mgadultmen.4

Zinc (Zn)

11mgadultmales 8mgadult females 2.3mg(AI)adult males 1.8mg(AI)adult females 900mcgadults (0.90mg) NoRDA established 4700mgadults

1230mg

Manganese (Mn)

210mg

Copper (Cu) Boron (B) Potassium (K)

2

13mg 35mg 40006000mg

75%ofdietsfailtocontainRDA.5Average dailyintakeisbelowtheRDA(Brown,2005). Commondailyintakeisonly0.25mg,6to possibleoptimumof3.0mg. Adultintakeaverages2300mgforwomen and3100mgformen.7

Kumpulainen,J.1992.Chromiumcontentoffoodsanddiets.Biol.TraceElem.Res.,32(13),918.URL (abstract):http://www.ncbi.nlm.nih.gov/pubmed/1375091(accessed10.19.2009). 3 Jugdaohsingh,R.,etal.2002.Dietarysiliconandabsorption.Am.J.Clin.Nutr.,75(5),887893.URL: http://www.ajcn.org/cgi/content/full/75/5/887(accessed05.28.2008). 4 FreelandGraves,J.,etal.1988.Metabolicbalanceofmanganeseinyoungmenconsumingdietscontainingfive levelsofdietarymanganese.JNutr.,118(6),764773.URL:http://jn.nutrition.org/cgi/reprint/118/6/764 (accessed05.28.2008). 5 Pennington,J.,etal.1986.Mineralcontentoffoodsandtotaldiets:theSelectedMineralsinFoodsSurvey,1982 to1984.J.Am.Diet.Assoc.,86(7),876891.URL:http://www.ncbi.nlm.nih.gov/pubmed/3722652(accessed 05.28.2008). Klevay,L.1979.Evidenceofdietarycopperandzincdeficiencies.JAMA,241,19171918.URL(abstract): (accessed05.13.2008). 6 Nielsen,F.,etal.1987.Effectofdietaryborononmineral,estrogen,andtestosteronemetabolismin postmenopausalwomen.FASEBJ.,1(5),394397.URL:http://www.fasebj.org/cgi/reprint/1/5/394(accessed 05.13.2008). 7 Hajjar,etal.2001.ImpactofdietonbloodpressureandagerelatedchangesinbloodpressureintheUS population:AnalysisofHNANESIII.Arch.Intern.Med.,161(4),589593.URL:http://archinte.ama assn.org/cgi/content/full/161/4/589(accessed05.28.2008).
SusanE.Brown,PhDCenterforBetterBones 605FranklinParkDriveEastSyracuse,NY13057 www.betterbones.com


20Keybonebuildingnutrientsanoverview
Nutrient
AdultRDAorAI Commontherapeutic rangeforbonehealth (dailyintake) 330mg (supplements) Upto680mg (inmedications) 5000IUorless Dietaryconsiderationsconcerningadequacy ofaveragedailyintake Dailydietaryintakethoughttovaryfrom1 mgtomorethan10mg. Your intake

Strontium

NoRDAestablished

Keyvitamins VitaminA
2997IUadultmales 2331IUadult females 1.31.7mgadult males 1.31.5adult females 400mcgadults (0.4mg) 44%ofUSpopulationhasintakebelowEAR.8

VitaminB6

2550mg

Studiesindicatewidespreadinadequate vitaminB6consumptionamongallsectorsof thepopulation;9>50%ofpopulationconsume <70%RDA. Inadequateintakecommonamongallage groups;althoughimprovingwithfood fortification,1049%ofparticipantsinNHANES surveyhadintakesbelowestimatedaverage requirement(EAR).11Anywherefrom550% ofpopulation(varyingbygeographicregion andethnicity)havegeneticvariantsthat impacttheabilitytooptimallymetabolize folate.12 Upto40%ofUSpopulationhavemarginalB12 status.13Olderpeopleandvegansare especiallyatrisk.14

Folic acid/folate (vitaminB9)

4001000mcg (0.41mg)

VitaminB12

2.4mcgadults

1501000mcg

Moshfegh,A.,etal.2005. Serfontein,W.,etal.1984.VitaminB6revisited.Evidenceofsubclinicaldeficienciesinvarioussegmentsofthe populationandpossibleconsequencesthereof.S.Afr.Med.J.,66(12),437440.URL(abstract): http://www.ncbi.nlm.nih.gov/pubmed/6385307(accessed05.13.2008). 10 Brown,2005. 11 Song,W.,etal.2005.SerumhomocysteineconcentrationofUSadultsassociatedwithfortifiedcereal consumption.J.Am.Coll.Nutr.,24(6),503509.URL:http://www.jacn.org/cgi/content/full/24/6/503(accessed 06.17.2008). 12 Botto,L.,&Yang,Q.2000.5,10Methylenetetrahydrofolatereductasegenevariantsandcongenitalanomalies:A HuGEreview.Am.J.Epidem.,151(6),862.URL:http://www.ajcn.org/cgi/reprint/87/3/734(accessed07.21.2008). 13 McBride,J.2000.B12DeficiencymaybemorewidespreadthanthoughtAugust1,2000Newsfromthe USDAAgriculturalResearchService.URL:http://www.ars.usda.gov/IS/pr/2000/000802.htm(accessed06.17.2008). 14 Brown,2005.
9

SusanE.Brown,PhDCenterforBetterBones 605FranklinParkDriveEastSyracuse,NY13057 www.betterbones.com


20Keybonebuildingnutrientsanoverview
Nutrient
AdultRDAorAI Commontherapeutic rangeforbonehealth (dailyintake) Oral5003000mg (andupwardtobowel tolerance15),as needed. 8002000IUandup, asneeded. Dietaryconsiderationsconcerning adequacyofaveragedailyintake Averagedailyintakeisabout95mgfor womenand107mgformen.BasedonUS surveyofnearly9000people,intakefor 31%ofpopulationisbelowEstimated AverageRequirement(EAR).16 Theoverwhelmingnewsfromnumerous expertsisthatuptoabillionpeople worldwidearedeficient.17Deficiencyis especiallycommonamongtheelderly, darkskinned,andthosewithlittleUV sunlightexposure.Asimple,inexpensive bloodtestfor25(OH)Disthebestwayto determinevitaminDstatusandneed. K1:Averages45150mcg,whichiswell belowtherecommendedAI.18 K2:AverageUSintake912mcg(ifany) Your intake

VitaminC

90mgadultmales 75mgadultfemales

VitaminD

200IUinfancy59yr 400IU5170yr 600IU>70yr

VitaminsK1 andK2

K1: 120mcgadultmales 90mcgadultfemales K2: Norecommendedintake Shouldcompriseminimum of7%totalcalories. Generallynottoexceed 30%caloricintake.

K1: 2501000mcg K2: 45180mcgMK7 (menaquinone7) 2030%oftotal caloriesisperhaps moreideal.

Othernutrients

Fats

AverageAmericanconsumes~33%of his/hercaloriesinfat.Consumptionof essentialfattyacids(EFAs),however,is frequentlyinadequate.19

PDRHealth.[Nodatelisted].VitaminC|Herbalremedies,supplements|PDRHealth.URL: http://www.pdrhealth.com/drugs/altmed/altmed mono.aspx?contentFileName=ame0173.xml&contentName=Vitamin+C&contentId=336(accessed05.13.2008). 16 Moshfegh,A.,etal.2005. 17 Holick,M.2007.VitaminDdeficiency.NewEng.J.Med.,357(3),266281.URL: http://content.nejm.org/cgi/content/full/357/3/266(accessed05.28.2008). Kimlin,M.,etal.2007.LocationandvitaminDsynthesis:Isthehypothesisvalidatedbygeophysicaldata?J. Photochem.Photobiol.,86(3),234249.URL:http://www.ncbi.nlm.nih.gov/pubmed/17142054(accessed 05.20.2008). 18 Booth,S.,&Suttie,J.1998.DietaryintakeandadequacyofvitaminK.JNutr.,128(5),785788.Review.URL: http://jn.nutrition.org/cgi/content/full/128/5/785(accessed05.28.2008). 19 Brown,2005.
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Nutrient
AdultRDAorAI Commontherapeutic rangeforbonehealth (dailyintake) 1.01.5g/kg Dietaryconsiderationsconcerning adequacyofaveragedailyintake Dailyintakecommonlyexceeds100g,but theelderlyandsomewomenoftenhave verydeficientintake.21Higherprotein intakeshouldbebalancedwithhigher RDAlevelpotassiumintakefromfood sources. Your intake

Protein

0.8g/kgperdayadult malesandfemales 125lbperson=45g 175lbperson=63g 56gadultmales 46gadultfemales20

NationalAcademyofSciences.InstituteofMedicine.FoodandNutritionBoard.[Nopublicationdatelisted.] ThroughtheUnitedStatesDepartmentofAgricultureFoodandNutritionInformationCenterwebsite.Dietary ReferenceIntakesforindividuals.PDF:http://www.iom.edu/Object.File/Master/21/372/0.pdf(accessed 05.06.2008). 21 Brown,2005.

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About Dietary Reference Intakes (DRI), Adult Recommended Dietary Allowances (RDA), Adequate Intakes (AI), and Estimated Average Requirements (EAR)

The Dietary Reference Intake (DRI) is a system of nutritional guidelines developed by the Institute of Medicine (IoM) of the US National Academy of Sciences. It was first introduced in 1997 to broaden the existing Recommended Daily Allowances (RDA), which is the system currently still in use in food nutrition labeling.a The DRI includes two sets of values that serve as goals for nutrient intake (from the National Academy of Science). These are the RDA and Adequate Intake (AI). Recommended Dietary Allowances (RDA) represent the daily dietary intake of a nutrient regarded to be sufficient for meeting the requirements of nearly all (97 98%) healthy individuals in each age and gender group.b The RDAs reflect the average daily amount of a nutrient considered adequate to meet the needs of most healthy people. If there is insufficient evidence to determine an RDA, an AI is set. Adult RDA figures from: National Academy of Sciences, Institute of Medicine, Food and Nutrition Board, through the United States Department of Agriculture Food and Nutrition Information Center website. Dietary Reference Intakes for individuals.

Adequate Intake (Al) values are more tentative than RDA, but both may be used as goals for nutrient intake. In addition to the values that serve as goals for nutrient intakes the DRI include a set of values called Tolerable Upper Intake Levels (UL). The UL represent the maximum amount of a nutrient that appears safe for most healthy people to consume on a regular basis. The Estimated Average Requirement (ERA) calculations are the average daily nutrient intake level estimated to meet the requirement of half of the healthy individuals in a particular life stage and gender group. They are established by the Institute of Medicine (IoM).c

Keep in mind that these systems and the nutrient values they represent were established to cover nutritional adequacy for most folks, not for optimizing health! The common therapeutic dose for healthy and strong bones may be higher for most, and significantly higher in special need cases.d
a Wikipedia.org. Dietary Reference Intake. URL: http://en.wikipedia.org/wiki/Dietary_Reference_Intake (accessed 05.06.2008). b Ibid. c Moshfegh, A., et al. 2005. What we eat in America, NHANES 20012002: Usual nutrient intakes from food compared to Dietary Reference Intakes. US Department of Agriculture, Agricultural Research Service. URL: http://www.ars.usda.gov/SP2UserFiles/Place/12355000/pdf/usualintaketables2001-02.pdf (accessed 06.17.2008). d Palacios, C. 2006. The role of nutrients in bone health, from A to Z. Crit. Rev. Food Sci. Nutr., 46 (8), 621 628. URL (abstract): http://www.ncbi.nlm.nih.gov/pubmed/17092827 (accessed 05.13.2008).

SusanE.Brown,PhDCenterforBetterBones 605FranklinParkDriveEastSyracuse,NY13057 www.betterbones.com


20Keybonebuildingnutrientsanoverview Keymineralsforbonehealthcalcium
Ofallthemineralsinthebody,thereismorecalciumthananyother.Itmakesupsomewherearound 2%ofourtotaladultbodyweight,storedmostlyinourbonesandteeth.Boneismadeupofacrystalline mineralcompoundembeddedwithinalivingproteinmatrix.Thiscrystallinemineralcompound,called hydroxyapatite,isformedprincipallyfromcalciumandphosphorus.Itisessentialforhealthybone developmentandbonemaintenance,andgivesourbonesbothstrengthandrigidity. HereintheUnitedStates,about80%ofourcalciumcomesfromdairysources.Butresearchindicates thatdietarycalciumfromsourcessuchasvegetables,fruits,orthesmallbonesoffishsuchascanned salmonoranchovies,maybemuchmorereadilyabsorbedthancalciumfromdairyfoods.22Whilemost Americansthinktheyneedtodrinkmilktogetenoughcalcium,bokchoy,avarietyofChinesecabbage, isoneofthebestcalciumbargainsaroundasfarasabsorbabilityperunitofenergyprovidingaround 1800mgcalciumper100calories!23Anothergoodsourceisbonesthemselves:sincetheinventionof fire,peoplehavebeenboilingupbonesfortherichnutrientstheycontain.(Homemadebrothisnotonly curativeforthecommoncold,itsprophylacticforbonehealth!) Asforcalciumsupplements,itstruethatnotallarecreatedequally.Wehearalotaboutthedifferent formsofsupplementalcalciumandwhichonesarebest.Butthebiggeststorywithcalciumisnotso muchaboutwhichformtouseasitisaboutcalciumabsorptionwhichitselfiscontingentona complexinterplayofhormonesandotherfactors,chiefofwhichisvitaminD.2425 Whileitsinterestingthatcalciumcomesinallthesevariousforms,withoutadequatevitaminDon board(vitaminDsufficiencyiscommonlydefinedasa25(OH)Dbloodlevel26ofatleast3234ng/mL),all thecalciumintheworldwillresultinlittlematerialgainforourbones.27Infact,notedcalcium researcherDr.RobertHeaneyhasfoundthatdifferentindividualscanhaveanearlythreefolddifference intheircalciumabsorptionratesaphenomenonforwhichwecurrentlyhaveonlylimited

Larsen,T.,etal.2000.Wholesmallfishasarichcalciumsource.Br.J.Nutr.,83(2),191196.URL(accessed): http://www.ncbi.nlm.nih.gov/pubmed/10743499(accessed05.06.2008). Hansen,M.,etal.1998.Calciumabsorptionfromsmall,softbonedfish.J.TraceElem.Med.Biol.,12(3),148154. URL(abstract):http://www.ncbi.nlm.nih.gov/pubmed/9857327(accessed05.06.2008). Heaney,R.,&Weaver,C.1990.Calciumabsorptionfromkale.Am.J.Clin.Nutr.,51,656657.URL: http://www.ajcn.org/cgi/reprint/51/4/656(accessed05.06.2008). 23 Weaver,C.,etal.1999.Choicesforachievingadequatedietarycalciumwithavegetariandiet.Am.J.Clin.Nutr., 70(Suppl.),543S548S. 24 Heaney,R.,&Weaver,C.2003.CalciumandvitaminD.Endocrinol.Metab.Clin.N.Am.,32(1),181194,viiviii. URL(abstract):http://www.ncbi.nlm.nih.gov/pubmed/12699298(accessed05.20.2008). 25 Murray,M.,&Pizzorno,J.1998.EncyclopediaofNaturalMedicine,459.Roseville,CA:PrimaPublishing. 26 Brown,S.2008.VitaminDandfracturereduction:Anevaluationoftheexistingresearch.Alt.Med.Rev.,13(1), 2133.URL(PDF):http://www.thorne.com/altmedrev/.fulltext/13/1/21.pdf(accessed05.22.2008). 27 Heaney,R.,&Weaver,C.2003.CalciumandvitaminD.Endocrinol.Metab.Clin.N.Am.,32(1),181194,viiviii. URL(abstract):http://www.ncbi.nlm.nih.gov/pubmed/12699298(accessed05.20.2008). Heaney,R.,etal.2003.Calciumabsorptionvarieswithinthereferencerangeforserum25hydroxyvitaminD.J. Am.Coll.Nutr.,22(2)142146.URL:http://www.jacn.org/cgi/content/full/22/2/142(accessed05.22.2008).
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explanation.28AsidefromhowrepleteourvitaminDstoresare,howwellweabsorbcalciumhasmuch todowiththehealthofourdigestivesystem. Astowhichformsoptimizebothabsorptionandbioavailability,alkalizingcalciumsaltsarethebest calciumcompoundsknowntodate.Theseformsincludecalciumcitrate,calciumcitratemalate,calcium ascorbate,andcalciumcarbonate.Calciumcitrateanditsrelative,calciumcitratemalate(CCM),are sourcesthatdonotrequirehydrochloricacid(HCl)fromthestomachforabsorption,sothecalciumin themisverybioavailabletothebodyandagoodchoiceforpeoplewithlowstomachacid.Calciumin theformofcalciumcitratealsoappearstoplayaprotectiveroleagainsttheformationofkidneystones, anddoesnotappeartointerferewithironabsorptionfromfood.29Calciumcarbonateisoftenfoundnot tobeaswellabsorbedascitrate,30butdoesalkalizewellinthebodyiftakenwithfood.(Calcium absorptionfromallformsisgenerallybetterwhentakenwithameal.) Regardlessofwhatformyourcalciumsupplementationtakes,itshouldalwaysbebalancedwith magnesiumsupplementation.Somebonespecialistsfavormagnesiumcenteredformulationswithequal orslightlymoremagnesiumthancalcium.Asaruleofthumb,Irecommendatleasthalfasmuch magnesiumascalcium(aratioof1partmagnesiumto2partscalcium),andinmostcasesIprefernearly asmuchmagnesiumascalcium.Peoplewithosteoarthritis,inparticular,wanttouseequalamountsof magnesiumandcalcium(1:1). ManyUSexpertsnowsuggestthattheidealdailycalciumintakefromallsources,includingfoodand supplements,wouldbeintherangeof10001200mg.31Formoreonhowboneservesasacalcium reserveforeverydaybodyprocesses,seeourarticleonthenaturalapproachtobonehealth.Seealso ourlistofcalciumrichfoodsforthebestdietarysourcesofthisimportantbonebuildingmineral. Returntotable

Keymineralsforbonehealthphosphorus
Phosphorusisthesecondmostabundantmineralinthebody,makingupafull25%ofallthemineral materialinthebody.Nearlyallthebiochemicalreactionstakingplaceinthebodyinvolvephosphorus, includingregulationofproteinsandenergyproductionthroughtheprocessknownasphosphorylation;
Randall,T.1992.Longitudinalstudypursuesquestionsofcalcium,hormones,andmetabolisminlifeofskeleton. JAMA,268(17),23572358. 29 Sakhaee,K.,etal.2004.Stoneformingriskofcalciumcitratesupplementationinhealthypostmenopausal women.J.Urol.,172(3),958961.URL(abstract):http://www.ncbi.nlm.nih.gov/pubmed/15311008(accessed 05.06.2008). [Noauthorlisted.]1986.Citrateforcalciumnephrolithiasis.Lancet,1(8487),955. Wabner,C.,&Pak,C.1992.Modificationbyfoodofthecalciumabsorbabilityandphysiochemicaleffectsof calciumcitrate.J.Am.Coll.Nutr.,11,548552.URL:(abstract):http://www.ncbi.nlm.nih.gov/pubmed/1452953 (accessed05.06.2008). 30 Heller,H.,etal.2000.Pharmacokineticandpharmacodynamicscomparisonoftwocalciumsupplementsin postmenopausalwomen.J.Clin.Pharmacol.,40(11),12371244.URL(abstract): http://www.ncbi.nlm.nih.gov/pubmed/11075309(accessed05.28.2008). 31 PeckW.,etal.1991.PhysiciansResourceManualonOsteoporosis.Washington,DC:NationalOsteoporosis Foundation.
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hormonesignaling,cellgrowthandrepair;heartcontraction;nerveandmuscleactivity;calcium, glucose,fatandstarchmetabolism;andpHbufferingtomaintainacidalkalinebalanceinthebody. Alsoofspecialinteresttousisthefactthatphosphoruscombineswithcalciumtoformamineralcrystal thatgivesstrengthandstructuretoourbonesandteeth.Ofallthephosphorusinthebody,80%ofitis foundintheteethandbonesintheformofcrystallinebone,hydroxyapatite. Butwhilephosphorusisessentialforbonehealth,toomuchofitisnotagoodthing.Itmustworkin delicatebalancewithcalciuminourbonesandblood.TheaverageAmericandietcontainsmuchmore phosphorusthancalcium(seetable).32Largeamountsarefoundinmeat,softdrinks,andprocessed foods.Insteadofthemoreidealratioofnearlyonepartcalciumtoonepartphosphorus,many Americansconsumetwiceasmuch,ormorephosphorusthancalcium.33Thishighphosphorusto calciumratiocanbedetrimentaltoourbones.34 Returntotable

Keymineralsforbonehealthmagnesium
Overall,magnesiumassuresthestrengthandfirmnessofbonesandmakesteethharder.Since magnesiumparticipatesinanastonishingarrayofbiochemicalreactions,itsnosurprisethatits essentialforhealthybonesandteeth.Mostnotably,adequatemagnesiumisessentialforabsorption andmetabolismofcalcium. Magnesiumalsohasaroletoplay,togetherwiththethyroidandparathyroidglands,insupportingbone health:stimulatingthethyroidsproductionofcalcitonin,whichactsasabonepreservinghormone,and regulatingparathyroidhormone,afunctionofwhichistoregulatebonebreakdowninanumberof ways. Magnesiumisanessentialcofactorin80%ofallcellularenzymes.Itisnecessaryfortheconversionof vitaminDintoitsactiveform,andadeficiencyofmagnesiumcanleadtoasyndromeknownasvitamin Dresistance.35Theenzymerequiredforformingnewcalciumcrystals,alkalinephosphatase,also

FoodandNutritionBoard,InstituteofMedicine.1997.Phosphorus.InDietaryReferenceIntakes:Calcium, Phosphorus,Magnesium,VitaminD,andFluoride,146189.Washington,D.C.:NationalAcademyPress.URL: http://www.nap.edu/books/0309063507/html/index.html(accessed05.20.2008). 33 Moshfegh,A.,etal.2005.WhatweeatinAmerica,NHANES20012002:Usualnutrientintakesfromfood comparedtodietaryreferenceintakes.URL: http://www.ars.usda.gov/SP2UserFiles/Place/12355000/pdf/usualintaketables200102.pdf(accessed05.13.2008). 34 WorthingtonRoberts,B.1981.ContemporaryDevelopmentsinNutrition,240253.St.Louis,MO:MosbyCo. ISBN=0801656273. Linkswiler,H.,etal.1981.Proteininducedhypercalciuria.Fed.Proc.,40(9),24292433.URL: http://www.ncbi.nlm.nih.gov/pubmed/7250387(accessed05.06.2008). 35 Medalle,R.,etal.1976.VitaminDresistanceinmagnesiumdeficiency.Am.J.Clin.Nutr.,29,854858.URL: http://www.ajcn.org/cgi/reprint/29/8/854(accessed05.12.2008).
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requiresmagnesiumforactivation,andiflevelsarelow,abnormalbonecrystalformationcanresult. Evenmildmagnesiumdeficiencyisreportedtobealeadingriskfactorforosteoporosis.36 Aswithcalcium,themajorityofthebodysreservesofmagnesiumareheldinthebone(60%),andthe bonesactasastoragereservoir,transferringmagnesiumintothebloodstreamintimesofneed. Adequatedailyintakeofmagnesiumisimportantthroughoutlifetokeepthemagnesiumthatisstored inthebonesfrombeinglost.Lowmagnesiumintake,aswellaslowbloodandbonemagnesiumlevels, hasbeenwidelyassociatedwithosteoporosisinwomen.37 Itsoftenoverlookedthatmagnesiumandcalciumfunctiontogether,sodeficiencyofonemarkedly affectsthemetabolismoftheother.Infact,increasingcalciumsupplementationwithoutincreasing magnesiumsupplementationcanactuallyincreasemagnesiumloss.Similarly,theuseofcalcium supplementsinthefaceofamagnesiumdeficiencycanleadtocalciumdepositioninthesofttissues, suchasthejoints,whereitcanpromotearthritis,orinthekidney,contributingtokidneystones.38 Therehasbeenconflictingopinionabouttheneedforconcernabouttheadequacyofourmagnesium intake.39Despiteitsrecognizedimportance,mostAmericansconsumelessthantheEstimatedAverage Requirement(EAR)formagnesium.40Infact,asof2001,56%oftheUSpopulationwasnotconsuming theEstimatedAverageRequirementforthismineral.41
Rude,R.,etal.2006.Reductionofdietarymagnesiumbyonly50%intheratdisruptsboneandmineral metabolism.Osteoporos.Int.,17(7),10221032.URL(abstract)http://www.ncbi.nlm.nih.gov/pubmed/16601920 (accessed05.12.2008). Rude,R.,etal.2005.Dietarymagnesiumreductionto25%ofnutrientrequirementdisruptsboneandmineral metabolismintherat.Bone,37(2),211219.URL(abstract):http://www.ncbi.nlm.nih.gov/pubmed/15923157 (accessed05.12.2008). Rude,R.,etal.1999.Magnesiumdeficiencyinducedosteoporosisintherat:Uncouplingofboneformationand boneresorption.Magnes.Res.,14(4),257267.URL:(abstract):http://www.ncbi.nlm.nih.gov/pubmed/10612083 (accessed05.12.2008). Iseri,L.,&French,J.1984.Magnesium:Naturesphysiologiccalciumblocker.Am.HeartJ.,108,188193. 37 Cohen,L,&Kitzes,R.1981.Infraredspectroscopyandmagnesiumcontentofbonemineralinosteoporotic women.IsraelJ.Med.Sci.,17,11231125.URL:http://www.ncbi.nlm.nih.gov/pubmed/7327911(accessed 03.03.2010). Seelig,M.1980.MagnesiumDeficiencyinthePathogenesisofDisease.NewYork:PlenumPress.URL: http://www.mgwater.com/Seelig/MagnesiumDeficiencyinthePathogenesisofDisease/preface.shtml(accessed 05.12.2008). Gaby,A.,&Wright,J.1988.Nutrientsandbonehealth.HealthWorld,2931. Hegsted,D.1967.Mineralintakeandboneloss.Fed.Proceedings,26(6),17471763. 38 Shils,M.1973.Magnesium.InModernNutritioninHealthandDisease,ed.R.Goodhart&M.Shils. Philadelphia:Lea&Febiger.ISBN:0781741335. 39 Pennington,J.1996.Intakesofmineralsfromdietsandfoods:Isthereaneedforconcern?J.Nutr.,126(9 Suppl.),2304S2308S.URL:http://jn.nutrition.org/cgi/reprint/126/9_Suppl/2304S(accessed05.13.2008). 40 Hunt,C.,&Johnson,L.2006.Magnesiumrequirements:Newestimationsformenandwomenbycrosssectional statisticalanalysesofmetabolicmagnesiumbalancedata.Am.J.Clin.Nutr.,84(4),843852.URL: http://www.ajcn.org/cgi/content/full/84/4/843(accessed05.13.2008). Moshfegh,A.,etal.2005.WhatweeatinAmerica,NHANES20012002:Usualnutrientintakesfromfood comparedtodietaryreferenceintakes.URL: http://www.ars.usda.gov/SP2UserFiles/Place/12355000/pdf/usualintaketables200102.pdf(accessed05.13.2008).
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Returntotable

Keymineralsforbonehealthchromium
Chromiumhelpstokeepinsulinactivityinthebodyefficient,42aneffectthatmaybeboneprotectivein acoupleofways: bypromotingtheproductionofcollagenbyourbonebuildingcells(calledosteoblasts);and bymoderatingbonebreakdown(resorption). Thislattereffectwasdemonstratedinastudywherepostmenopausalwomensupplementingwiththe insulinsensitizingnutrientchromiumpicolinatewerefoundtohavelesscalciumandcollagenprotein moleculesintheirurine.43 Athirdboneprotectiveaspectwasidentifiedinasimilarstudy,wherealongwithimprovinginsulin regulationandloweringcalciumexcretion,supplementingwithchromiumpicolinateraisedbloodlevels ofDHEA,ahormonethatmayplayaphysiologicalroleinpreservingbonedensityamong postmenopausalwomen.44 Chromiumabsorptionfromfoodstendstobepoor,andaccordingtoDr.RichardAndersonofthe BeltsvilleHumanNutritionResearchCenterinMaryland,chromiumlevelsinthebloodcanalsobe diminishedbyanumberofstressors:highsugarintake,intenseexercise,pregnancy,breastfeeding, infection,andphysicalinjury.Chromiumlevelsalsotendtodiminishwithage.Theseconcernscanallbe

Food&NutritionBoard,InstituteofMedicine.1997.Dietaryreferenceintakesforcalcium,phosphorus, magnesium,vitaminD,andfluoride.Washington,DC:NationalAcademyPress. 41 Moshfegh,A.,etal.2005.WhatweeatinAmerica,NHANES20012002:Usualnutrientintakesfromfood comparedtodietaryreferenceintakes.URL: http://www.ars.usda.gov/SP2UserFiles/Place/12355000/pdf/usualintaketables200102.pdf(accessed05.13.2008). 42 Martin,J.,etal.2006.Chromiumpicolinatesupplementationattenuatesbodyweightgainandincreasesinsulin sensitivityinsubjectswithtype2diabetes.DiabetesCare,29(8),18261832.URL: http://care.diabetesjournals.org/content/29/8/1826.long(accessed10.20.2009). Frauchiger,M.,etal.2004.Effectsofacutechromiumsupplementationonpostprandialmetabolisminhealthy youngmen.J.Am.Coll.Nutr.,23(4),351357.URL:http://www.jacn.org/cgi/content/full/23/4/351(accessed 10.20.2009). McCarty,M.1995.Anaboliceffectsofinsulinonbonesuggestaroleforchromiumpicolinateinpreservationof bonedensity.Med.Hypotheses,45(3),241246.URL:http://www.ncbi.nlm.nih.gov/pubmed/8569546(accessed 10.20.2009). Evans,G.,etal.1995.Chromiumpicolinatedecreasescalciumexcretionandincreasesdehydroepiandrosterone (DHEA)inpostmenopausalwomen.FASEBJ.,9,A449.[AsquotedinLamson,D.,&Plaza,S.2002.Thesafetyand efficacyofhighdosechromium.Altern.Med.Rev.,7(3),218235.URL(abstract): http://www.ncbi.nlm.nih.gov/pubmed/12126463(accessed10.20.2009).]
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addressedbysupplementingwithamedicalgradeboneformulationcontainingcertainchelatedforms ofchromium,suchaschromiumpolynicotinateorchromiumpicolinate.45 Returntotable

Keymineralsforbonehealthsilica
Silicaisthemostabundantmineralonearth.Wedontfullyunderstanditsfullrangeoffunctionsinthe humanbody,butwedoknowthatsilicacontentishighinthestrongesttissuesofthebody,including thearteries,tendons,ligaments,connectivetissue,collagen,skin,nails,hair,andteeth. AlthoughnoRDAhasbeenestablishedyetforsilica,thismineralclearlymakesadirectcontributionto bonehealth.Bonecollagenisreportedtoincreasewithsilicasupplementation,andthemineralappears tostrengthentheconnectivetissuematrixbycrosslinkingcollagenstrands.Dietarysiliconappearsto increasetherateofmineralization,particularlywhencalciumintakeislow.Aconcentrationofsilicais foundintheareasofactivebonemineralization,andsilicacombineswithcalciuminthebonebuilding cell.Overall,silicaplaysanimportantroleininitiatingthecalcificationprocess,thushelpingusto maintainstrong,flexiblebones.46 PopulationswithhigherintakesofplantbasedfoodshavehighersilicaintakesthandoWestern populations;47andnotsurprisingly,theincidenceofhipfracturesinthesecommunitiesisalsolower.48 Silicaisplentifulinmanyfibrousfoods,butasnutritioneducatorBettyKamenreports,thefiberinfoods (anditssilicacontent)isthefirsttogointheprocessingoffoods.Sinceupto80%ofthefoodwe consumetodayisprocessedcomparedwithamere10%attheturnofthecenturysilica consumptionhasdramaticallydeclinedinjustafewgenerations.49Ofinterestisthatthemajorsourceof

Anderson,R.ChromiuminHealthandDisease.CouncilfortheAdvancementofDiabetesResearchand Education(CADRE)ChromiumSummit.April2003.Boston,Massachusetts. Bae,Y.,etal.2008.Shorttermadministrationofwatersolublesiliconimprovesmineraldensityofthefemur andtibiainovariectomizedrats.Biol.TraceElem.Res.Apr26[Epubaheadofprint].URL(abstract): http://www.ncbi.nlm.nih.gov/pubmed/18438624(accessed05.13.2008). Gaby,A.,&Wright,J.1988. Davies,S.&Stewart,A.1987.NutritionalMedicine:TheDrugfreeGuidetoBetterFamilyHealth.London/Sydney: PanBooks.ISBN=0330288334 Carlisle,E.1975.Siliconwiththeosteoblast,thebondformingcell.Fed.Proc.,34,927. Carlisle,E.1970.Arelationshipbetweensiliconandcalciuminboneformation.Fed.Proc.,29,265. 47 Anderson,J.1999.Plantbaseddietsandbonehealth:nutritionalimplications.Am.J.Clin.Nutr.,70(3)(Suppl,), 539S542S.URL:http://www.ajcn.org/cgi/content/full/70/3/539S(accessed05.28.2008). Chen,F.,etal.1994.EstimatesoftraceelementintakesinChinesefarmers.J.Nutr.,124,196201. Anasuya,A.,etal.1996.Fluorideandsiliconintakeinnormalandendemicfluoroticareas.J.TraceElem.Med. Biol.,10(3),149155.URL(abstract):http://www.ncbi.nlm.nih.gov/pubmed/8905558(accessed05.28.2008). 48 Gullberg,B.,etal.1997.Worldwideprojectionsforhipfracture.Osteoporos.Int.,7,407413.URL(abstract): http://www.ncbi.nlm.nih.gov/pubmed/9425497(accessed05.28.2008). 49 Kamen,B.,etal.1984.Osteoporosis:WhatItIs,HowtoPreventIt,HowtoStopIt,222.NY:PinnacleBooks.ISBN: 1558171711
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silicainAmericanmensdietswasfoundtobebeerandbananas,whileinwomenitwasbananasand stringbeans!50 Returntotable

Keymineralsforbonehealthzinc
Inbonemetabolism,zincisneededtoproducethematrixofcollagenproteinthreadsuponwhichthe boneformingcalciumphosphoruscompoundisdeposited.Itsalsonecessaryfortheproductionof enzymesthatdegradeandrecyclewornoutbitsofboneprotein.Propercalciumabsorptionalso dependsonzinc,andadeficiencypreventsfullabsorptionofcalcium.Itsessentialforbonehealing,and increasedamountsarefoundatthesitesofbonerepair.51Lowlevelsinthebodyhavebeenclosely linkedwithosteoporosis. ItsunfortunatethatinthefaceofdecliningintakeandgrowingdeficienciesofzincintheAmericandiet, authoritieshaveseenfittolowerzincrequirements.Mildbutstillclinicallysignificantzinc deficiencyiswidespreadandfarreachinginitseffects.52The23gramsofzincfoundinthebodyactas acofactorinover200enzymaticreactionsthatareinstrumentalinmaintainingnotjustthehealthof ourbones,butforoptimalsystemwidefunctioning.53 Returntotable

Keymineralsforbonehealthmanganese
Likezincandcopper,manganeseisatraceelementthatcanprofoundlyaffectbonehealth.Yetfora longtimeitwasoneofthemostoverlookednutrients,andtodatenoRDAformanganesehasbeen established.

Jugdaohsingh,R.,etal.2002.Dietarysiliconandabsorption.Am.J.Clin.Nutr.,75(5),887893.URL: http://www.ajcn.org/cgi/content/full/75/5/887(accessed05.28.2008). 51 Kimmel,P.,etal.1992.Zincnutritionalstatusmodulatestheresponseof1,25dihydroxycholecalciferolto calciumdepletioninrats.J.Nutr.,122(7):15761581.URL:http://jn.nutrition.org/cgi/reprint/122/7/1576 (accessed05.13.2008). Teller,E.,etal.1987.Zinc(Z)nutritionalstatusmodulatesthe1,25(OH)2D(125)responsetolowcalcium(LC)diet (D).KidneyInt.,31,358. 52 Hambidge,M.2000.Humanzincdeficiency.J.Nutr.,130(5),1344S1349S.URL: http://jn.nutrition.org/cgi/content/full/130/5/1344S(accessed07.21.2008). 53 Johtatsu,T.,etal.2007.SerumconcentrationsoftraceelementsinpatientswithCrohnsdiseasereceiving enteralnutrition.J.Clin.Biochem.Nutr.,41(3),197201.URL: http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=18299716(accessed 05.13.2008). Hendricks,K.1990.Zincandinflammatoryboweldisease.Nutr.Report,66. Atik,S.1983.Zincandsenileosteoporosis.J.Am.Ger.Soc.,31(12),790791.URL(abstract): http://www.ncbi.nlm.nih.gov/pubmed/6655182(accessed05.13.2008).
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OnereasoncitedforthislackofanRDAinthepastwasthatscientistswerentreallysurewhatpeoples typicalmanganeseintakeswere.54Itappearsmanganeseintakecanvarywidelydependingonbasicfood choices.Forexample,wenowknowthatintakeofmanganeseisgreatlyreducedwhenwholegrainsare replacedinthedietwithfoodsmadefromrefinedflour.55Thisgivesuspausebecausegrainproducts constitutenearly40%ofourdailymanganeseintake.Beverages(particularlytea)contributeabout20%, andvegetableslessthan20%.56Otherdietarypatternscaninhibittheabsorptionofmanganese,suchas gettingtoomuchcalcium,phosphorus,iron,orzinc.57 Inrecentdecadesresearchhasuncoveredthespecialrolemanganeseplaysasacofactorinthe formationofbonecartilageandbonecollagen,aswellasinbonemineralization.58Osteoporoticchanges inbonecanbebroughtaboutbymanganesedeficiency,whichappearstoincreasebonebreakdown whiledecreasingnewbonemineralization.59Bloodlevelsofmanganeseofseverelyosteoporoticwomen werefoundinaBelgianstudytobejustonefourththoseofnonosteoporoticwomentheirsameage. Whatsmore,ofthe25variablesstudied,onlymanganesewassignificantlydifferentbetweenthetwo groups.60Fortunately,manganesedeficiencyisrelativelyeasytoaddressanddietarysourcesare extremelysafe. Returntotable

Keymineralsforbonehealthcopper
Likemanganese,copperisanessentialtracemineralthathasonlyrecentlybeenfoundtoplayan importantroleinbonehealthmaintenance.Thisroleisstillnotfullyunderstood,butwedoknowthat byvirtueofacoppercontainingenzymecalledlysyloxidase,copperaidsintheformationofcollagenfor boneandconnectivetissueandcontributestothemechanicalstrengthofbonecollagenfibrilsthe longthinstrandsofproteinsthatcrosslinktooneanotherinthespacesaroundcells.
Greger,J.1998.Dietarystandardsformanganese:Overlapbetweennutritionalandtoxicologicalstudies.J.Nutr., 128(2),368S371S.URL:http://jn.nutrition.org/cgi/content/full/128/2/368S(accessed05.13.2008). 55 Raloff,J.1986.Reasonsforboninguponmanganese.[Review.]ScienceNews,130,199. Schwartz,R.,etal.1986.ApparentabsorptionandretentionofCa,Cu,Mg,Mn,Znfromadietcontainingbran. Am.J.Clin.Nutr.,43(3),444445.URL:http://www.ajcn.org/cgi/reprint/43/3/444(accessed05.13.2008). 56 Pennington,J.,&Young,B.1991.TotalDietStudynutritionalelements19821989.J.Am.Diet.Assoc.,91(2), 179183.URL(abstract):http://www.ncbi.nlm.nih.gov/pubmed/1991931(accessed05.13.2008). 57 FreelandGraves,J.,etal.1987.Manganeserequirementsofhumans.InNutritionalBioavailabilityof Manganese.ed.C.Keys.Washington,DC:Am.Chem.Soc.ISBN:0841214336. Hallfrisch,J.,etal.1987.Mineralbalancesofmenandwomenconsuminghighfiberdietswithcomplexorsimple carbohydrate.J.Nutr.,117(1),4855.URL:http://jn.nutrition.org/cgi/reprint/117/1/48(accessed05.13.2008). Ricketts,C.,etal.1985.Manganeseandmagnesiumutilizationofhumansasaffectedbylevelandkindofdietary fat.Fed.Proc.,44,1850. 58 Strause,L.,&Saltman,P.1987.Roleofmanganeseinbonemetabolism.InNutritionalBioavailabilityof Manganese.ed.C.Keys.Washington,DC:Am.Chem.Soc.ISBN:0841214336. 59 Slemenda,C.,etal.1990.Predictorsofbonemassinperimenopausalwomen.Aprospectivestudyofclinical datausingphotonabsorptiometry.Ann.Intern.Med.,112(2),96101.URL(abstract): http://www.ncbi.nlm.nih.gov/pubmed/2294827(accessed05.13.2008). 60 Reginster,J.Y.,etal.1988.Traceelementsandpostmenopausalosteoporosis:Apreliminarystudyofdecreased serummanganese.Med.Sci.Res.,16,337338.
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Copperalsohelpsinhibitboneresorptionthroughacopperandzinccontainingantioxidantcalled superoxidedismutase.Thisantioxidantneutralizessuperoxideradicalsproducedbythebone breakdowncellscalledosteoclastsduringboneresorption. Again,aswithmanganese,inadequatecopperlevelshavebeenassociatedwiththedevelopmentof osteoporosis.61Andaswithsomanyotherminerals,copperexcretionfromthebodyisincreasedona diethighinsugar,othersweetenerslikefructose,62andrefinedflour.63Someresearchershave suggestedthatevenlactose(milksugar)couldinterferewithcoppermetabolism,makinghighdairy intakelessthanidealforcopperutilization.64Withourpenchantforsugar,refinedflour,anddairy,its notsurprisingthatcopperisamongthemineralsmostoftendeficientintheAmericandiet.65 Returntotable

Keymineralsforbonehealthboron
Boronisanotherelementonourlistof20keynutrientsthathasbeendiscoveredonlyinrecentyearsto beessentialtobonehealth.Thebodyrequiresboronforpropermetabolismandutilizationofvarious bonebuildingfactors,includingcalcium,magnesium,vitaminD,estrogen,andperhapstestosterone.66 Thoughresultshavebeensomewhatmixedandthemechanismshaveyettobecomeclear,studies overallshowthatboronhasamineralconservingandestrogenenhancingeffect,especiallyamong womenwithlowmagnesiumintake.Leadresearchersnowconsiderboronimportantintheutilization andmetabolismofcalciumandvitaminD,aswellasimportantforoverallhormonalbalance.67
61

Strain,J.1988.Areassessmentofdietandosteoporosispossibleroleforcopper.Med.Hypotheses,27(4), 333338.URL(abstract):http://www.ncbi.nlm.nih.gov/pubmed/3067062(accessed05.13.2008). Strause,L.,etal.1986.Effectsoflongtermdietarymanganeseandcopperdeficiencyonratskeleton.J.Nutr.,116 (1),13541.URL:http://jn.nutrition.org/cgi/reprint/116/1/135(accessed05.13.2008). Raloff,J.1986. 62 Turnlund,J.1999.Copper,inModernNutritioninHealthandDisease,ed.M.E.Shilsetal.,pp.241252. Baltimore:LippincottWilliams&Wilkins. 63 Hallfrisch,J.,etal.1987. 64 Strain,J.1988. 65 Pennington,J.1996. Pennington,J.&Young,B.1991. Pennington,J.,etal.1986.Mineralcontentoffoodandtotaldiet:TheSelectedMineralsinFoodsSurvey,1982to 1984.J.Am.Diet.Assoc.,86(7),876891.URL(abstract):http://www.ncbi.nlm.nih.gov/pubmed/3722652 (accessed05.13.2008). Klevay,L.1979.Evidenceofdietarycopperandzincdeficiencies.JAMA,241,19171918.URL(abstract): (accessed05.13.2008). 66 Samann,S.,etal.1998.Thenutritionalandmetaboliceffectsofboroninhumansandanimals.Biol.TraceElem. Res.,66(13),227235.URL(abstract):http://www.ncbi.nlm.nih.gov/pubmed/10050922(accessed05.13.2008). Nielsen,F.,etal.1987.Effectofdietaryborononmineral,estrogen,andtestosteronemetabolismin postmenopausalwomen.FASEBJ.,1(5),394397.URL:http://www.fasebj.org/cgi/reprint/1/5/394(accessed 05.13.2008). 67 Neilsen,F.1995.PersonalcommunicationwithDr.SusanBrown.
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ThoughRDAsforboronhaveyettobeestablished,weknowthatourancestorsconsumedmuchmore ofthisnutrientthanmostofusdotoday.Excessiveboroninthesupplementalformcanbetoxic,but theresnoneedtorestrictboronfromourfoodsources.Itseasyenoughtoconsumeasmuchas10mg perdaywithadietplentifulinfruits,veggies,andnuts,andthiscouldinpartaccountforalower osteoporosisrateamongvegetarians.Infact,thereareplacesintheworldwherepeopleconsumeas muchasfourtimesthisamount,withoutadverseeffects.68 Returntotable

Keymineralsforbonehealthpotassium
Iliketocallpotassiumthehiddenboneguardian,astheroleitplaysalongwithsodiuminmaintaining criticalfluidbalanceiswidelyknown,butpotassiumsservicetobonehealthislesswellappreciated. Thisguardianshiprolerelatesmainlytotheabilityofcertainalkalinizingpotassiumcompoundsto neutralizethebonedepletingacidsthatareproducedduringeverydaynormalmetabolicprocesses.In maintainingtheacidalkalinebalanceinourbodies,potassiumpreventstoomuchcalciumfrombeing excretedintheurine.69 Dietslowinpotassiumincreaseneturinarycalciumloss,whereasdietshighinpotassiumreduceit.70In fact,dietarypotassiumcanoffsettheexcretionofabsorbedcalciumtosuchanextentthateatingone mediumbakedpotatooronelargebananacanconserveabout60mgofcalcium!71Supplemental potassiumintheformofpotassiumsaltssuchaspotassiumbicarbonateandpotassiumcitratecanalso helpdecreaseurinarylossofcalcium. Thetransitioninourdietinrecentgenerationstoonethatislowerinfruits,vegetables,andlegumes hasresultedinsignificantlydecreasedpotassiumintake.Yetweknowthathigherpotassiumintake, particularlyintheformoffruitsandvegetables,isdirectlyassociatedwithoverallhigherbonemineral densityandlessboneloss72allthemoremotivationforustorenewour510adaypledge!73 (SeemyblogpostonhowtomeasureyourdailypHbalanceandtrackpotentialboneloss,orreadmy fullarticleontestingmarkersofboneresorption.) Returntotable
Gaby,A.1994.PreventingandReversingOsteoporosis:WhatYouCanDoAboutBoneLossALeadingExpert's NaturalApproachtoIncreasingBoneMass,304.Roseville,CA:PrimaPublishing.ISBN:0761500227 69 Sebastian,A.,etal.1994.Improvedmineralbalanceandskeletalmetabolisminpostmenopausalwomentreated withpotassiumbicarbonate.NEJM,130(125),17761781.URL(abstract): http://content.nejm.org/cgi/content/abstract/330/25/1776(accessed06.04.2008). 70 Nieves,J.2005.Osteoporosis:theroleofmicronutrients.Am.J.Clin.Nutr.,81(5),1232S1239S.URL: http://www.ajcn.org/cgi/content/full/81/5/1232S(accessed05.13.2008). 71 Davies,K.,etal.2002.Dietarypotassiumconservescalciumaftermenopause.J.BoneMiner.Res.,17(Suppl.1), S476.AbstractM362. 72 Tucker,K.,etal.2001.Theacidbasehypothesis:DietandboneintheFraminghamOsteoporosisStudy.Eur.J. Nutr.,40(5),231237.URL(abstract):http://www.ncbi.nlm.nih.gov/pubmed/11842948(accessed05.13.2008). 73 Demign,C.,etal.2004.Protectiveeffectsofhighdietarypotassium:Nutritionalandmetabolicaspects.J.Nutr., 134(11),29032906.URL:http://jn.nutrition.org/cgi/content/full/134/11/2903(accessed05.13.2008).
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Keymineralsforbonehealthstrontium
Strontiumisamineralthatnaturallyexistsandispresentinsmallamountsinourfoodandwater. Strontiumhasahighaffinityforboneandisthoughttoplayacriticalroleinbonehealth.Ittendsto migratetothesiteswhereactiveremodelingistakingplaceandpromotesmineralizationofthebones andteeth.Thereareabout320mgofstrontiuminthebody,with99%ofthislocatedinthebonesand teeth.Thetypicaldailydietisthoughttoprovidefromaslittleas1mgtomorethan10mgstrontium. (Thisstablemineralformofstrontiumfoundinfoodandwatershouldnotbeconfusedwiththe radioactiveformofstrontiumthatisproducedbynuclearreactorsorbyexplosionofnuclearweapons.) Intheperiodictableyouwillfindstrontiumbelowcalciumanditbelongstothesamechemicalfamilyas calciumandmagnesium.Infact,becauseofitssimilarities,strontiumiscapableofreplacingasmall proportionofcalciuminthecalcifiedcrystalsofboneandteeth.Asitappears,strontiumaddsstrength tothesetissues,makingthemmoreresistanttobreakdown.Strontiumalsoappearstodrawextra calciumintothebone.74 Dietarystrontiumisconsumedinverysmall,milligramquantitiesandisconsideredanaturaland beneficialbonenutrient.Itisfoundinmostplantfoods,dairyfoods,Brazilnuts,andagain,naturallyin drinkingwater. Veryhighdose(severalhundredmilligramdose)syntheticstrontiumranelate(Protelos)hasbeen developedinEuropeasaprescriptionosteoporosismedicationandisusedforthepurposeofboth haltingbonebreakdownandenhancingnewboneformation.75 Returntotable

KeyvitaminsforbonehealthvitaminA
VitaminAplaysanessentialroleinthedevelopmentofosteoblasts,thebonebuildingcellsthatlay downnewbone.76AdeficiencyinvitaminAalsolimitscalciumabsorptionandmetabolism,which resultsinpoorbonegrowth.77Overall,lowvitaminAlevelsareassociatedwithosteoporosisand increasedriskoffracture.78

Gaby,A.1994. Reginster,J.Y.,etal.2004.Strontiumranelate:Anewparadigminthetreatmentofosteoporosis.ExpertOpin. Investig.Drugs,13(7),857864.Review.URL(abstract): http://www.expertopin.com/doi/abs/10.1517/13543784.13.7.857(accessed05.20.2008). 76 Kawaguchi,J.2006.Generationofosteoblastsandchondrocytesfromembryonicstemcells.MethodsMol.Biol., 330,135148.http://www.ncbi.nlm.nih.gov/pubmed/16846022(accessed05.13.2008). 77 Newton,H.,etal.1985.ThecauseandcorrectionoflowbloodvitaminCconcentrationsintheelderly. 78 Maggio,D.,etal.2006.Lowlevelsofcarotenoidsandretinolininvolutionalosteoporosis.Bone,38(2),244248. URL:(abstract):http://www.ncbi.nlm.nih.gov/pubmed/16188508(accessed03.02.2009).

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Ontheotherhand,thereissomecontroversyastowhetherhighvitaminAintakesareactuallyhelpful, ormoreofahindrancetobonehealth.79SomestudiessuggesthighvitaminAcanbebonedamaging, butthisrelatesonlytotheactiveformsofvitaminA,orretinoids.Thejuryisstilloutonhoworeven ifexcessvitaminAintakeactuallyincreasesriskofosteoporosisandbonefracture.80Butinthe meantime,werecommendlimitingintakeofsupplementalvitaminAthatis,preformedvitaminA,or retinoidformsto5000IUperday.Thisisstillwellbelowtheknowntolerableupperlimit(UL)of preformedvitaminAaround10,000IUperday. WhatdowemeanbypreformedvitaminA?TherearemanyformsofvitaminA,withretinoidsand carotenoidsbeingthetwomaincategories.

Retinoidsnatural,fatsolubleformsofvitaminAthatareavailableforimmediateuseinthe body.Derivedfromanimalsources,retinoidsareasmallerclassthanthecarotenoids,and includeretinol,retinal,andretinoicacid,amongothers. o Subgroup:RetinolalsoreferredtoaspreformedvitaminA,retinolisregardedas themainactiveformforvitaminAinthebody.Itisfoundnaturallyinsomeanimal tissues,suchasliver,whichmakesliveragooddietarysourceofthisvitamin. Carotenoidsalargeclassofnatural,fatsolublepigmentsfoundprincipallyindeeplycolored plantfoods.Carotenoids,sometimesreferredtoasprovitamins,aredietaryprecursorstothe activeformsofvitaminAinthebody.Morethan600carotenoidshavebeenidentifiedtodate.81

RibayaMercado,J.,&Blumberg,J.2007.VitaminA:Isitariskfactorforosteoporosisandbonefracture?Nutr. Rev.,65(10),425438.URL(abstract):http://www.ncbi.nlm.nih.gov/pubmed/17972437(accessed05.22.2008). Macdonald,H.,etal.2004.Nutritionalassociationswithbonelossduringthemenopausaltransition:Evidenceof abeneficialeffectofcalcium,alcohol,andfruitandvegetablenutrientsandofadetrimentaleffectoffattyacids. Am.J.Clin.Nutr.,79,155165. Barker,M.,&Blumsohn,A.2003.IsvitaminAconsumptionariskfactorforosteoporoticfracture?Proc.Nutr. Soc.,62(4),845850.URL(abstract):http://www.ncbi.nlm.nih.gov/pubmed/15018484(accessed05.22.2008). Symanski,E.,&HertzPicciotto,I.1995.Bloodleadlevelsinrelationtomenopause,smoking,andpregnancy history.Am.J.Epidemiol.,141,10471058. Melhus,H.,etal.1998.ExcessivedietaryintakeofvitaminAisassociatedwithreducedbonemineraldensityand increasedriskforhipfracture.Ann.Intern.Med.,129,770778.
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Macdonald,H.,etal.2004. Barker,M.,&Blumsohn,A.2003. Symanski,E.,&HertzPicciotto,I.1995. Melhus,H.,etal.1998. Mercadante,A.Newcarotenoids:Recentprogress.InvitedLecture2.Abstractsofthe12thInternational CarotenoidSymposium,07/1823/1999,Cairns,Australia. Ong,A.,&Tee,E.1992.Naturalsourcesofcarotenoidsfromplantsandoils.Meth.Enzymol.,213,142167.

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o

Subgroup:Betacarotenethemostwellknownplantprecursorsourceofactive vitaminA.OurbodiescanconvertbetacaroteneintoactivevitaminAwhenneeded, storingoreliminatinganyextra.

AfulldescriptionofthehundredsofformsandfunctionsofvitaminAisbeyondthescopeofthisarticle, sohereareafewkeypointstoremember:

MostofthevitaminAinourdietscomesfromplantsintheformofbetacarotene,which,again, isaprecursorthatissafelystoredinourbodyfatandliver,whereitgetsconvertedintoactive vitaminAformsasneeded. Retinol,theprimaryformofactivevitaminA,canbetoxicifconsumedatveryhighlevels. Thankstoaninbuiltmechanismthatshutsoffourbodysconversionofbetacaroteneinto retinolwhenlevelsareadequate,highintakeofbetacaroteneisgenerallynotofconcern. Somerecentresearchhas,however,linkedhighdosebetacarotenesupplementstoincreased riskoflungcanceramongsmokersbuttheoppositeseemstobethecaseamong nonsmokers!82 Thoughtheremaybedifferentthoughtsonwhatconstituteshighdosebetacarotene, amountsover25,000IUaretypicallyconsideredtobeinthehigherrange. Scienceisalwaysevolving,butourBetterBonesproductshavebeenwellformulatedbasedon currentnutritionalresearch,andcontainuseful,nontoxicamountsofbothformsaspartof supplementregimen.

Today,fortheapproximately44%oftheUSpopulationthatunderconsumevitaminAintheirfood, supplementingwithboththeabovedescribedformsofvitaminAisawisemoveforbonehealth. Returntotable

KeyvitaminsforbonehealthvitaminB6(pyroxidine)
VitaminB6isanothernutrientthatplaysanimportantbutindirectroleinbonemetabolism.Herearea fewaspectsoftheworkitdoesforus: B6isnecessaryforhydrochloricacid(HCl)productionbythestomach,andHClinturnis necessaryforcalciumabsorption. B6isnecessaryforadrenalfunctioning.Inturn,severaldozenhormonesareproducedbythe adrenalglands,severalofwhichaidinmaintainingpropermineralbalancewithinthebody.
Tanvetyanon,T.,&Bepler,G.2008.Betacaroteneinmultivitaminsandthepossibleriskoflungcanceramong smokersversusformersmokers:Ametaanalysisandevaluationofnationalbrands.Cancer,113(1),150157.URL (abstract):http://www.ncbi.nlm.nih.gov/pubmed/18429004(accessed02.25.2009). Touvier,M.,etal.2005.Dualassociationofbetacarotenewithriskoftobaccorelatedcancersinacohortof Frenchwomen.J.Natl.CancerInst,97(18),13381344.URL: http://jnci.oxfordjournals.org/cgi/content/full/97/18/1338(accessed02.25.2009).
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B6isafactorinthebreakdownofhomocysteine,whichtendstoincreaseinpostmenopausal women.Homocysteineisametaboliteoftheaminoacidmethionine,whichinterfereswith collagencrosslinkingandleadstodefectivebonematrixandosteoporosis.Italsocontributesto thedevelopmentofheartdisease.B6,alongwithfolicacid,helpspreventbuildupof homocysteineinthebody. Allinall,morethan50enzymesystemsaredirectlydependentonvitaminB6,andmanyothers functionsuboptimallywithoutasufficientamountofthisnutrient.83 B6isalsoanecessarycofactorintheenzymaticcrosslinkingofcollagenstrands,whichincrease thestrengthofconnectivetissue.

StudiesindicatethatinadequatevitaminB6intakeiswidespreadamongallpopulationgroups.Inone study,allofthe21normalAmericanstudentsstudiedoveratwoweekperiodwerefoundtobe functionallydeficientinB6.84 OneofthefactorscontributingtothisproblemistherelativeinstabilityofvitaminB6,whichisdestroyed bylightandheat.Asaresult,muchofitislostinfoodprocessing,storage,andpreparation.Inaddition, higheranimalproteinintakecreatesanincreaseddemandforB6,asdoothercommonB6antagonists suchasyellowdye#5(foodcoloring),oralcontraceptives,andcertainotherdrugsandalcohol.85 Returntotable

KeyvitaminsforbonehealthfolicacidandfolateformsofthewatersolublevitaminB9
FolicacidisanotheroneoftheBvitamins,referredtosometimesasfolate(itsrelatedanionform),or simplyasvitaminB9.Themostnotablerolefolateandfolicacidplayinbonehealthisinthe detoxificationofhomocysteine,anaminoacidlinkedwithinflammationandincreasedfracturerisk. Anywherefrom550%ofanygivenpopulation(varyingbygeographicregionandethnicity)mayhave geneticvariantsthatimpacttheirabilitytooptimallymetabolizefolateand,thus,theirabilitytoprevent homocysteinebuildup,detoxifyadequately,andkeepinflammationatbay.86
Serfontein,W.,etal.1984.VitaminB6revisited.Evidenceofsubclinicaldeficienciesinvarioussegmentsofthe populationandpossibleconsequencesthereof.S.Afr.Med.J.,66(12),437440.URL(abstract): http://www.ncbi.nlm.nih.gov/pubmed/6385307(accessed05.13.2008). 84 Azuma,J.,etal.1976.ApparentdeficiencyofvitaminB6intypicalindividualswhocommonlyserveasnormal controls.Res.Commun.Chem.Pathol.Pharmacol.,14(2),343348.URL(abstract) http://www.ncbi.nlm.nih.gov/pubmed/940965(accessed05.13.2008). 85 Kishi,H.,etal.1977.DeficiencyofvitaminB6inwomentakingcontraceptiveformulations.Res.Commun.Chem. Pathol.Pharmacol.,17(2),283293.URL(abstract):http://www.ncbi.nlm.nih.gov/pubmed/877413(accessed 05.13.2008). Brown,J.1990.TheScienceofHumanNutrition.NY:HarcourtBraceJovanovich.ISBN:015578689X. Azuma,J.,etal.1976. 86 Botto&Yang.2000.
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Homocysteineisacompoundproducedasabyproductofthemetabolismoftheaminoacid methionine.Normally,homocysteinegetsrecycledasanothersubstanceoreliminated,butexcessblood levelscanaccumulateasaresultofgeneticornutritionalfactors.Excesshomocysteinepromotesboth osteoporosisandatherosclerosis.Theproperprocessingofhomocysteinerequiresfolicacid. Researcherssuggestthataroundthetimeofmenopause,womenexperienceareducedcapacityto processhomocysteineappropriately.Itisnotknownwhetherthisisauniversaltraitoronefoundonlyin moredevelopedcountries.Supplementingwithfolicacidhasbeenfoundtoimprovethishomocysteine processingproblem. Deficiencyoffolicacidisanextremelycommonprobleminmanypartsoftheworldwheredietsof refinedfoodspredominate.TheaverageUSintakeisonlyabouthalftheRDA.Womentakingoral contraceptivesorestrogenreplacement,aswellasusersofalcoholandlongtermusersof anticonvulsantmedications,areatspecialriskfordruginducedfolicaciddeficiency. Returntotable ====

KeyvitaminsforbonehealthvitaminB12(cobalamin)
Becauseoftheirroleinthedetoxificationofhomocysteine,vitaminsB6,B12,andfolicacid(B9)haveall beenrecentlyaddedtoourlistofimportantboneprotectivenutrients.87Osteoblasts,thebodysbone buildingcells,requireanadequatesupplyofB12,ortheirabilitytofunctionproperlywillbe compromised.88VitaminB12deficiencyanemiahasbeenassociatedwithosteoporosis,andhavinglow serumlevelsofvitaminB12hasalsobeenassociatedrecentlywithoddsoffrailtyinolderwomen.89 FollowingcarefulanalysisoftheFraminghamOffspringStudyin2000,Tuftsnutritionalepidemiologist KatherineTuckerconcludedthatB12deficiencymaybemorewidespreadthanpreviouslythought,with nearly40%oftheUSpopulationflirtingwithmarginalB12status,accordingtotheUSDAwebsite.90 VitaminB12isnotfoundinplants,butisabundantinanimalprotein.YetvitaminB12deficiencyintheUS maybelargelylinkednotsomuchtoinadequatemeat,poultryandfishintakethefoodsthatsupply themajorityofdietaryB12buttoproblemswithintestinalabsorption.Ofinterestisthatresearchers havefoundintestinalmalabsorptiontobeaproblemamongtheyoungandtheoldalike.Theproblem mayliewithinadequatestomachacid,whichisrequiredtocleavethevitaminfromtheanimalproteins towhichitistightlyboundinfoodsources.Inolderfolks,theproblemswithB12absorptioncouldbedue

Brown,S.2006.Bonenutrition.InScientificEvidenceforMusculoskeletal,Bariatric,andSportsNutrition,ed.I. Kohlstadt,p.458.BocaRaton,FL:CRCPress.ISBN=0849337240 88 Carmel,R.etal.1988.Cobalaminandosteoblastspecificproteins.NEJM,319(2),7075.URL(abstract): http://www.ncbi.nlm.nih.gov/pubmed/3260008(accessed05.13.2008). 89 Matteini,A.,etal.2008.MarkersofBvitamindeficiencyandfrailtyinolderwomen.J.Nutr.HealthAging,12(5): 303308.URL(abstract):http://www.ncbi.nlm.nih.gov/pubmed/18443711(accessed05.06.2008). 90 B12deficiencymaybemorewidespreadthanthought.URL:http://www.ars.usda.gov/IS/pr/2000/000802.htm (accessed06.17.2008).

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toalossofactiveacidsecretingcellsinthestomachasweage.Butinyoungeradults,Tuckerspeculates thattheproblemcouldberesultingfromtheoveruseofantacidtablets.91 B12isalsooneofthefewvitaminsbiosynthesizedbythefriendlyflorainourintestines.92Though productioninthehumanintestinesisnotbelievedtooccurtoanextensivedegree,thereisstillalotfor ustolearnaboutbothB12synthesisandabsorptionprocesses,anditissafetosaythatmaintaining healthygutfloraisonewaytoencourageadequatevitaminB12statusaswellaspromotegoodbone health.Afterall,theB12wegetfromanimalsourcesoriginallyderivesfrombacterialproduction,for instanceintherumenofcows. Evenso,vegetariansarestronglysuggestedtoensureadequateB12intakeahighqualitydaily supplementformulatedtodeliverthemosthighlybioavailableformsofkeybonenutrients,suchas thoseofferedinourBetterBonesprograms,canbeveryhelpful! Returntotable ====

KeyvitaminsforbonehealthvitaminC
VitaminCisinvolvedinagreatvarietyofcomplexandinterrelatedmetabolicprocesses.Herearethree waysinwhichitisessentialforhealthybones. VitaminCassistsintheformationofcollagen.Asdescribedinourarticleonthenatureof healthybones,bonemineralislaiddownoveraproteinmatrixcalledcollagen.Collagenis abundantintheconnectivetissueofcartilageandboneinfact,itmakesupabout30%ofour bones,servingasasupportstructureformineraldepositsandgivingboneitsresilience. Inadditiontoitsroleincollagenformation,vitaminCappearstostimulatethecellsthatbuild bone,enhancecalciumabsorption,andenhancevitaminDseffectonbonemetabolism. AthirdroleforvitaminCandbonesisinthesynthesisandoptimalfunctioningofadrenalsteroid hormones,whichplayavitalroleinbonehealth93especiallyduringperimenopauseand menopause,whenovarianproductionofthesehormonesslows. EventhoughtheRDAsforvitaminCareaveryminimal90mgformenand75mgforwomen,great numbersofAmericansdonotevenconsumethisamount!Manywellqualifiedscientists,includingthe lateNobellaureate,LinusPauling,believerecommendedlevelsareextremelylow,andthatourhealth
McBride,J.2000.AreyouvitaminB12deficient?Ag.Res.Mag.,48(8).URL(PDF): http://www.ars.usda.gov/is/AR/archive/aug00/vita0800.pdf(accessed06.17.2008). 92 Santos,F.,etal.2008.ThecompletecoenzymeB12biosynthesisgeneclusterofLactobacillusreuteriCRL1098. Microbiology,154(Pt1),8193.URL(abstract):http://www.ncbi.nlm.nih.gov/pubmed/18174128(accessed 05.22.2008). 93 Goralczyk,R.,etal.1992.RegulationofsteroidhormonemetabolismrequiresLascorbicacid.Ann.NYAcad. Sci.,669,349351. Freudenheim,J.,etal.1986.
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wouldbegreatlyservedonmanylevelsbyamuchhigherintakeperday.94AttheBetterBonesCenter, patientsareencouragedtostriveforanintakeof20003000mgperdaytorecoverandpreservebone health,andmoreasindividualneedisdetermined. Returntotable

KeyvitaminsforbonehealthvitaminD
Thisamazingvitaminservesasthebodysgreatregulatorofcalciumandphosphorusmetabolismin threemajorways: VitaminDmobilizescalciumandphosphorusforreleasefromboneinthepresenceof parathyroidhormone. VitaminDpromotesintestinalabsorptionofcalciumandphosphate. VitaminDincreaseskidneyabsorptionofcalciumandphosphorusandcarriesthemintothe blood. AdequatevitaminDnutritioniscrucialateverystageofourlives,fromchildhoodtooldage.Butfor decadesboththeprevalenceandimplicationsofvitaminDdeficiencyhavebeengrossly underestimated.95Asimpletestcanquicklytellyouandyourhealthcareproviderwhetheryouhave sufficientstoresofvitaminDdonthesitatetoaskforthisimportanttestyourlifelonghealth dependsonit! Simplywithrespecttobonehealth,thebodycannotproperlyabsorbcalciumwithoutvitaminD,andthe bonesandteethbecomesoftandpoorlymineralized.Inyoungchildren,adeficiencycausespoor mineralizationofthecollagenmatrix,whichresultsingrowthretardationandthebonedeformity conditionknownasrickets.Inadults,vitaminDdeficiencyresultsinatypeofbonesofteningadult rickets,knownasosteomalacia.InadequatelevelsofvitaminDalsodirectlyaffectboneasitcausesa conditionknownassecondaryhyperparathyroidism,whichstimulatesalossofmatrixandminerals,in turnincreasingtheriskofosteoporosisandfractures. RecentlytherehasbeenaveritableexplosionofresearchonvitaminDsbeneficialeffectsthroughout thebody.InadequatelevelsofvitaminDhavenowbeenassociatedwithnumeroustypesofcancer,

Pauling,L.1986.HowtoLiveLongerandFeelBetter.Corvallis,OR:OregonStateUniversityPress.ISBN: 0870710966 95 Holick,M.2006.HighprevalenceofvitaminDinadequacyandimplicationsforhealth.MayoClin.Proc.,81(3), 353373.URL:http://www.ncbi.nlm.nih.gov/pubmed/16529140(accessed05.13.2008). Hanley,D.,&Davison,K.2005.VitaminDinsufficiencyinNorthAmerica.Symposium:VitaminDInsufficiency:A SignificantRiskFactorinChronicDiseasesandPotentialDiseaseSpecificBiomarkersofVitaminDSufficiency.J. Nutr.,135(2),332337.URL:http://jn.nutrition.org/cgi/content/full/135/2/332(accessed05.13.2008). Holick,M.2005.ThevitaminDepidemicanditshealthconsequences.J.Nutr.,135(11),2739S2748S.URL: http://jn.nutrition.org/cgi/content/full/135/11/2739S(accessed05.13.2008).

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cardiovasculardisease,hypertension,stroke,diabetes,multiplesclerosis,rheumatoidarthritis, periodontaldisease,maculardegeneration,mentalillness,propensitytofall,andchronicpain.96 ThenewlyidentifiedlinkbetweenlowvitaminDstatusandcancerhasdrawnparticularattention.A recentstudy,forexample,showedthatwomenwithadequatebloodlevelsofvitaminDatdiagnosishad amuchbetteroutcomeandmuchlessmetastasesoftheirbreastcancerthandidthosewhowere vitaminDdeficientatdiagnosis.97 Also,foryearsithasbeenknownthatosteopenia,osteoporosis,andneedlessfracturesarelinkedwith lowlevelsofvitaminD.Nearlytwodecadesagooneprominentosteoporosisresearcherconcludedthat, ingeneral,themoreadequatethestateofvitaminDnutrition,thelessbonelossamongtheelderly.98 Wenowknowthatwomenofallagescanactuallyhaltboneloss,andevenincreasetheirbonedensity overthecourseoftheyearbyconsumingadequatecalciumandgettingadequateamountsofvitaminD thesunshinevitamin.Thisisespeciallytrueduringthedarkdaysofwinter.99 Mostimportantly,adequatedosevitaminDisnowproventoreducefracturessignificantly.Recently,in fact,threemajorvitaminDresearchersestimatedthat5060%ofallosteoporoticfracturesaredueto insufficientvitaminD.100Andindeed,astheBetterBonesCenterrecentlydocumentedinAlternative MedicineReview,variousclinicaltrialssupportthisamazingfracturereductioncapacityofadequate dosevitaminD.101

Cannell,J.,etal.2008.UsesofvitaminDinclinicalpractice.Alt.Med.Rev.,13(1).URL(PDF): http://www.thorne.com/altmedrev/.fulltext/13/1/6.pdf(accessed06.02.2008). 97 [Noauthorlisted.]2008.Healthday.MedlinePlus:LowlevelsofvitaminDspelltroubleforbreastcancer patients.URL:http://www.nlm.nih.gov/medlineplus/news/fullstory_64701.html(accessed05.28.2008). Grayson,A.2008.ABCNews:LowvitaminDmaymeanworsebreastcancer.Moreaggressivebreastcancerlinked tovitaminDdeficiency.URL: http://abcnews.go.com/Health/OnCallPlusBreastCancerNews/story?id=4866328&page=1(accessed05.28.2008). 98 BischoffFerrari,H.,etal.2007.Calciumintakeandhipfractureriskinmenandwomen:Ametaanalysisof prospectivecohortstudiesandrandomizedcontrolledtrials.Am.J.Clin.Nutr.,86(6),17801790.URL(abstract): http://www.ncbi.nlm.nih.gov/pubmed/18065599(accessed06.17.2008). Steingrimsdottir,L.,etal.2005.Relationshipbetweenserumparathyroidhormonelevels,vitaminDsufficiency, andcalciumintake.JAMA,294(18),23362341.URL:http://jama.amaassn.org/cgi/content/full/294/18/2336 (accessed06.17.2008). DawsonHughes,B.,etal.1997.EffectofcalciumandvitaminDsupplementationonbonedensityinmenand women65yearsofageorolder.NEJM,337(10),670676.URL: http://content.nejm.org/cgi/content/full/337/10/670(accessed06.17.2008). DawsonHughes,B.,etal.1990.Acontrolledtrialoftheeffectofcalciumsupplementationonbonedensityin postmenopausalwomen.NEJM,323(13),878883.URL:http://www.ncbi.nlm.nih.gov/pubmed/2203964 (accessed05.13.2008). 99 DawsonHughes,B.,etal.1990. 100 Grant,W.etal.2005.Comparisonsofestimatedeconomicburdenduetoinsufficientsolarultravioletirradiance fortheUnitedStates.Photochem.Photobiol.,81(6),12761286.URL(abstract): http://www.ncbi.nlm.nih.gov/pubmed/16159309(accessed06.04.2008). 101 Brown,S.2008.VitaminDandfracturereduction:Anevaluationoftheexistingresearch.Alt.Med.Rev.,13(1). URL:(http://www.thorne.com/altmedrev/.fulltext/13/1/21.pdf(accessed06.04.2008).
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AlthoughwerefertovitaminDasavitamin,itisreallyaprehormonewhichistransformedintoa hormoneinthebody.WhileweconsumesmallamountsofvitaminDinourdiet,mostofourvitaminD supplyisproducedbyourbodiesuponexposuretosunlight.Ourwondrouscapacitytoproducevitamin Dinternallyappearstodecreasewithage,however,andelderlypeopleineventheworldssunniest placesareespeciallypronetolowlevelsofinvitaminD. AnotherfascinatingthingaboutvitaminDisthatitdirectlynourishesmuscles.SupplementalvitaminD hasnowbeenrepeatedlyshowntohelpimprovemusclemassandstrengthandthushelpinthe preventionoffalls.102Severalstudieshaveshownarapidreductioninfallsamongtheelderlywith administrationofeven800IUvitaminD.Tworecentclinicaltrials,forexample,showedareductionin fallsof49%and72%withjust800IUsupplementalvitaminD.103Ifforthisreasonalone,itisvitalthat olderpeopleobtainhigheramountsofvitaminDthroughtheirfoodorsupplementation.Butagain, vitaminDseffectsacrossallbodytissuesarefarreachingthroughoutourlives. VitaminDisaverycomplexsubstance,withmanyvariedformsandmyriadbiologicalfunctions,manyof whichwehaveyettoexploreanddescribe.Regardingitspivotalroleinmineralmetabolism,its importanttounderstandthatasahormonevitaminDexistsinbothmoreactiveandlessactivestates.It isconvertedtomoreactivestateswithinthebodyonanasneededbasis.Themostactivemetaboliteof vitaminD,knownas1,25dihydroxyvitaminD,orcalcitriol,isproducedbyourkidneysandinother tissuesfromlessactiveprecursors.ItisthisactivevitaminDhormonethatmediatesthemanybiological effectsofvitaminD,includingcalciumabsorption.Forexample,intheabsenceofactivatedcalcitriol, lessthan10%ofourdietarycalciummaybeabsorbed!104Ourabilitytoabsorbcalciumviatheintestines is,infact,directlyrelatedtoourbloodlevelsofthisactiveformofvitaminD.105Whatsinteresting,as calciumexpertDr.RobertHeaneyhasdemonstrated,isthatintestinalcalciumabsorptionwas65% higherwhenbloodlevelsofvitaminDaveraged34ng/mLwenowknowthislevelapproachesonly
102

Prince,R.,etal.2008.Effectsofergocalciferoladdedtocalciumontheriskoffallsinelderlyhighriskwomen. Arch.Int.Med.,168(1),103108.URLhttp://www.ncbi.nlm.nih.gov/pubmed/18195202(accessed05.13.2008). BischoffFerrari,H.,etal.2006.Effectofcholecalciferolpluscalciumonfallinginambulatoryoldermenand women:A3yearrandomizedcontrolledtrial.URL:http://archinte.amaassn.org/cgi/content/full/166/4/424 (accessed05.13.2008). Flicker,L.,etal.2005.ShouldolderpeopleinresidentialcarereceivevitaminDtopreventfalls?Resultsofa randomizedtrial.J.Am.GeriatricsSoc.,53(11),1881.URL(abstract): http://www.ncbi.nlm.nih.gov/pubmed/16274368(accessed05.13.2008). Freudenheim,J.,etal.1986.Relationshipsbetweenusualnutrientintakeandbonemineralcontentofwomen 3565yearsofage:Longitudinalandcrosssectionalanalysis.Am.J.Clin.Nutr.,44(6),863876.URL: http://www.ajcn.org/cgi/reprint/44/6/863(accessed05.13.2008). 103 Broe,K.,etal.2007.AhigherdoseofvitaminDreducestheriskoffallsinnursinghomeresidents:A randomized,multipledosestudy.J.Am.Geriatr.Soc.,55(2),234239.URL: http://www.medscape.com/viewarticle/553365(accessed06.04.2008). Bischoff,H.,etal.2003.EffectsofvitaminDandcalciumsupplementationonfalls:Arandomizedcontrolledtrial. J.BoneMiner.Res.,18(2),343351.URL:http://www.ncbi.nlm.nih.gov/pubmed/12568412(accessed06.04.2008). 104 NIH.1994.Consensusstatement.Washington,DC:NationalInstituteonAging. 105 Eufemio,M.1990.Advancesinthetherapyofosteoporosis.PartVIII.Ger.Med.Today,9(11),3749. Gallagher,J.,etal.1979.IntestinalcalciumabsorptionandserumvitaminDmetabolitesinnormalsubjectsand osteoporoticpatients.J.Clin.Invest.,64(3),729736.URL:http://www.jci.org/articles/view/109516(accessed 05.13.2008).
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thebarestminimumneededtoensuresystemwidehealth.106(Formoreaboutthis,seemyblogentry onvitaminDandcalcium.) Itsalsoofnotethatatextremelyhighlevels,supplementalvitaminDcanhavetoxiceffects.Formost people,thisisstrictlyatheoreticalconcern,andevidenceoftoxicityinadultsconsumingmorethan 10,000IU/dayisabsentintheliterature.107Nevertheless,itisthistheoreticalriskthatmadesomanyso leeryofvitaminDsupplementationforsolong. EventhoughvitaminDdeficiencyiscommonandvitaminDtoxicityisrare,itisimportanttoget professionalguidanceandtestingbeforesupplementingatlevelsgreaterthan2000IUperday,asthisis thecurrent(albeitoutdated)safeupperlimitsetbyUSFoodandNutritionBoard.108 Todayweknowpreciselywhatlevelsinthebloodareneededforoptimalbonehealth:aminimumof34 mg/mL,butmoreideally,atleast5060mg/mL.Inreality,manypeoplewillneedmorethan2000IU vitaminDdailytoachievethisminimumadequatebloodlevel.Thus,attheCenterforBetterbones,we recommendeveryonehavetheirvitaminDleveltestedusingthe25(OH)Dbloodtest.Testingiseasy, andoneofthemostpowerfultoolsthereistoworkwithtoachievebonehealth.Luckily,weneednot worryaboutgettingtoomuchvitaminDfromourbodysowninternalproduction,sinceourbodysimply stopsproducingvitaminDwhenlevelsareadequate. Foracomprehensiveoverviewofthisexcitingnewresearch,youmayalsowishtovisitthe VitaminDCouncilwebsite,anonprofitorganizationfoundedanddirectedbyDr.JohnCannell. ForfurtherreadingonvitaminD,seealsoourotherarticles: o VitaminD:anoldbonebuildertakesonnewimportance o VitaminD:itsbenefitsaremorethaneverimagined Returntotable

KeyvitaminsforbonehealthvitaminsK1andK2
WhilevitaminKisbestknownforitsroleinbloodclotting,thisnutrientalsoplaysanimportantpartin themaintenanceofhealthybones.NotednutritionauthorityDr.AlanGabyhassuggestedthatvitaminK isasimportanttoboneascalcium.109SoletsfollowDr.Gabysleadanddelvealittledeeperintoitsrole inbonehealth. VitaminKisrequiredforthesynthesisofosteocalcin,theboneproteinmatrixuponwhichcalcium crystallizes.Osteocalcinprovidesthestructureandordertobonetissue;withoutitbonewouldbe
Heaney,R.,etal.2003.Calciumabsorptionvarieswithinthereferencerangeforserum25hydroxyvitaminD.J. Am.Coll.Nutr.,22(2),42146.URL:http://www.jacn.org/cgi/content/full/22/2/142(accessed06.04.2008). 107 Cannell,J.,etal.2008.DiagnosisandtreatmentofvitaminDdeficiency.Review.ExpertOpin.Pharmacother.,9 (1),112.URL(summary):http://www.expertopin.com/doi/abs/10.1517/14656566.9.1.107(accessed05.22.2008). 108 Vieth,R.,etal.2001.EfficacyandsafetyofvitaminDintakeexceedingthelowestobservedadverseeffectlevel. Am.J.Clin.Nutr.,73(2),288294.URL:http://www.ajcn.org/cgi/content/full/73/2/288(accessed06.04.2008). 109 Gaby,A.1994.
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fragileandeasilybroken.VitaminKalsoaidsinthebindingofcalciumtothebonematrix110in essence,itservesasthegluethatbindscalciumontotheskeleton. JustasvitaminKiscentraltoboneformation,soitappearstoplayanimportantroleinfracturehealing. VitaminKlevelsfallduringrecoveryfromfracture,anditappearsthatthisnutrientisactuallydrawn fromtherestofthebodytothesiteoffracturetospeedfracturehealing.111 VitaminKisnotasinglenutrient,butthenamegiventoagroupofvitaminsofsimilarcomposition.The twomaingroupsthatoccurnaturallyarephylloquinone,orK1,whichisfoundinplantbasedfoods, particularlygreenleafyvegetables;andthemenaquinones,orK2,whichareproducedbybacteriain fermentedfoodsandtosomeminorextentinourintestinaltracts.IncombinationwithvitaminDand calcium,bothvitaminsK1andK2increasebonequality.ButvitaminK2ismorebioavailable,longer lasting,andprovidesforgreaterincreaseinbonestrength.112 ThemorewelearnaboutK,themoreweseehowittakesonvariousformsandrolesinthebody.To datemostoftheresearchhasbeendoneonK1.ButanewwaveofresearchisnowfocusingonK2in particularthesubsetofK2knownasmenaquinone7,orMK7.Thisresearchdocumentsthesuperior abilityofMK7overK1toenhancebothboneandhearthealth.113GettingenoughoftheK2formsofthis
Wright,J.1989.TestingforvitaminK1:Anosteoporosisriskfactor,Int.Clin.Nutr.Rev.,9(1),1415. Feldman,E.1988.EssentialsofClinicalNutrition.Philadelphia:F.A.DavisCo.ISBN:0803634315 Tomita,A.1971.PostmenopausalosteoporosisCA47studywithvitaminK2.Clin.Endocrinol.(Jpn.),19,731. 111 Hart,J.,etal.1985.ElectrochemicaldetectionofdepressedcirculatinglevelsofvitaminK1inosteoporosis.J. Clin.Endocrinol.Metab.,60(6),12681269.URL(abstract):http://www.ncbi.nlm.nih.gov/pubmed/3998071 (accessed05.13.2008). 112 Knapen,M.,etal.2007.VitaminK2supplementationimproveshipbonegeometryandbonestrengthindicesin postmenopausalwomen.Osteoporos.Int.,18(78),963972.URL: http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=17287908(accessed 05.14.2008). Braam,L.,etal.2003.VitaminK1supplementationretardsbonelossinpostmenopausalwomenbetween50and 60yearsofage.Calcif.TissueInt.,73(1),2126.URL(abstract): http://www.ncbi.nlm.nih.gov/sites/pubmed/14506950(accessed05.14.2008). 113 Schurgers,L.,etal.2007.VitaminKcontainingdietarysupplements:ComparisonofsyntheticvitaminK1and nattoderivedmenaquinone7.Blood,108(8),32793283.URL(abstract): http://www.ncbi.nlm.nih.gov/pubmed/17158229(accessed05.22.2008). Takemura,H.2006.[Preventionofosteoporosisbyfoodsanddietarysupplements.Kinnotsubuhonegenki:A fermentedsoybean(natto)withreinforcedvitaminK2(menaquinone7)][InJapanese.]Clin.Calcium,16(10),171 172.URL(abstract):http://www.ncbi.nlm.nih.gov/pubmed/17012826(accessed05.22.2008). Yamachuchi,M.,&Ma,Z.2001.Inhibitoryeffectofmenaquinone7(vitaminK2)onosteoclastlikecellformation andosteoclasticboneresorptioninratbonetissuesinvitro.Molecul.Cellul.Biochem.,228(12),3949(9).URL (abstract):http://www.ingentaconnect.com/content/klu/mcbi/2001/00000228/F0020001/00383053(accessed 05.22.2008). Tsukamoto,Y.,etal.2000.Intakeoffermentedsoybean(natto)increasescirculatingvitaminK2(menaquinone7) andgammacarboxylatedosteocalcinconcentrationinnormalindividuals.J.BoneMiner.Metab.18(4),216222. URL(abstract):http://www.ncbi.nlm.nih.gov/pubmed/10874601(accessed05.22.2008). Yamaguchi,M.,etal.1998.EffectofvitaminK2(menaquinone7)infermentedsoybean(natto)onbonelossin ovariectomizedrats.J.BoneMin.Metab.,17(1),2329.URL(abstract): http://www.springerlink.com/content/xgyn1c0mkl6frhen/(accessed05.22.2008).
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vitaminhasbeenfoundtobeespeciallyimportantforhealthybonesinpatientsbeingtreatedwithoral anticoagulants,suchaswarfarin(Coumadin).114(ReadmoreaboutvitaminKresearchattheBetter BonesFoundation.) AsidefromgettingKthroughdietarysources,vitaminKcanalsobeproducedinthebodybycertain beneficialintestinalbacteria.Bycompromisingthisprocess,longtermuseofantibioticscanleadto vitaminKdeficiency.115Asidefromoralantibioticandanticoagulantuse,culpritsinvitaminKinadequacy includethefreezingoffoods,mineraloillaxatives,rancidandhydrogenatedfats,radiation,impairedfat absorption,sulfadrugs,andcertainliverdiseases. Tolearnmore,readmyarticleonvitaminKtheoverlookedbonebuilderandheartprotector. Returntotable

Otherkeynutrientforbonehealthessentialfattyacids(EFAs)
Conventionalwisdomtellsusweshouldcutthefatinourdiet,andindeed,toomuchofthewrongkinds offatcanbedetrimentaltobonehealthbydecreasingcalciumabsorption.Onaverage,weAmericans consumemorethanonethirdofourcaloriesasfat. Butwhatwearejustbeginningtoappreciateisthatourbodiesrequiremoreofcertainfats,justasthey requirecertainvitaminsandminerals,proteins,fiber,andwater.Thesefatsarecalledessentialfatty acidsbecausetheyarenotproducedbythebodyandmustbeconsumedinthedietorby supplementation.Thesefattyacidsareessentialfornervefunctioning,hormoneproduction,forthe maintenanceandfunctioningofthebrain,andforeverydayenergyproduction. Fattyacidsalsoplaymultiplerolesinbonestructure,function,anddevelopment.Fatsarerequiredfor propercalciummetabolism,andtheyareessentialcomponentsofallmembranes,includingthoseof cartilageandbone. AsexplainedbyessentialfattyacidresearcherDr.DavidHorrobin,EFAsincreasecalciumabsorption fromthegut,inpartbyenhancingtheeffectsofvitaminD.Theyalsoregulateandreduceurinary excretionofcalcium,possiblybyreducingproductionofproinflammatorymoleculescalled prostaglandins.Infact,theroleomega3fattyacidsplayincounteringinflammationisarguablytheir mostbonecriticalmission.

Cranenburg,E.,etal.2007.VitaminK:Thecoagulationvitaminthatbecameomnipotent.Thrombos. Haemostasis,98(1),120125.URL(PDF): http://www.schattauer.de/index.php?id=1268&pii=th07070120&no_cache=1(accessed06.17.2008). 115 Krasinski,S.,etal.1985.TheprevalenceofvitaminKdeficiencyinchronicgastrointestinaldisorders.Am.J.Clin. Nutr.,41,7075.URL:http://www.ajcn.org/cgi/reprint/41/3/639(accessed05.13.2008).

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EFAshavealsobeenfoundtoincreasecalciumdepositioninbone,whichisnotsurprisingsincebone calcificationmusttakeplaceinthepresenceofatypeoffatknownasphospholipids.Finally,essential fattyacidsappeartoimprovebonestrength,possiblybyfomentingcollagensynthesis.116 Returntotable

Otherkeynutrientsinbonehealthprotein
Whenitcomestobonenutrition,thesituationwithproteinissomewhatofaparadoxsimilartothat withfats.Whilesomeproteinisessential,toomuchisdetrimental.Proteinisbeneficialforintestinal absorptionofcalcium,andproteinisamajorbuildingblockforbone.117Byweight,roughlyonethirdto onehalfofourboneislivingorganicproteinmatrix!Proteinmalnutritiondebilitatesbone,andcanbea significantproblemamongtheelderlyinWesterncountries. Yetoverconsumptionofdietaryprotein(thinkAtkinsdiet)again,ifnotadequatelybalancedwith alkalizingcompoundsofmineralslikecalcium,magnesium,potassiumcanlikewiseleadtoboneloss. Inthiscasethelossresultsfromanincreasedacidloadwhichourbodiesmustbufferdailybydrawing calciumandotheralkalizingmineralcompoundsfromthebones. Whileadequateproteinintakeiscertainlynecessary,theaveragepersonintheUSconsumesfartoo muchproteinintheformofmeatanddairyproducts.Notthateitherofthesefoodstuffsarebadperse wejustneedtoremembertobalancethemwithplentyofalkalizingfruitsandvegetables,including somehighcarb,butnutrientdenseveggieslikesweetpotatoesandcarrots.Thisexcessanimalprotein intakeleadstoastateknownaschroniclowgrademetabolicacidosis(CLGMA),whichactuallywashes calciumoutofthebody. Formoreinformationonchroniclowgrademetabolicacidosis,seemyarticleonacidalkalinebalance. Returntotable

Kruger,M.,&Horrobin,D.1997.Calciummetabolism,osteoporosis,andessentialfattyacids:Areview.Prog. LipidRes.,36(23),131151.URL:http://www.ncbi.nlm.nih.gov/pubmed/9624425(accessed05.13.2008). 117 DawsonHughes,B.,&Harris,S.2002.Calciumintakeinfluencestheassociationofproteinintakewithratesof bonelossinelderlymenandwomen.Am.J.Clin.Nutr.,75(4),773779.URL: http://www.ajcn.org/cgi/content/full/75/4/773(accessed05.22.2008).

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