Try This: Optimize Your Bone Health and Live Longer

Hi ,Do you want to hear something wild and crazy about how bone health plays into our longevity?If you break a hip after the age of 60, your risk of death increases by a whopping 180 percent within a year (1). One-hundred eighty percent!This statistic left me gobsmacked when I first heard it. And it got me thinking: we spend so much time talking about metabolic health, which is no doubt super important for overall health and longevity (it even influences our bone mineral density!).However, I do think bone health deserves its own spotlight, too, and taking steps toward preserving our bone mass is something we definitely need to be paying attention to as we age…  So when I saw that Peter Attia released an Ask Me Anything episode on all things bone health, I couldn’t wait to listen to it and share my biggest takeaways with you. Today, we’re talking about the role our bones play in our overall health and longevity, who is most at risk for fractures, and what is driving this global epidemic we’re facing of weak and brittle bones. And for this week’s protocol, I’m sharing Dr. Peter Attia’s key nutrients and lifestyle strategies for strong, healthy bones and what you can do to start strengthening your bones before it's too late!By the way, you can get access to Dr. Attia’s AMA episodes through his private membership community, which is one of my go-to places for staying up to date on the latest research in nutrition, health, and fitness!All right, are you ready? Let’s jump in!Our Bones Do More Than You Think Most of us think of our bones as the framework that holds us together and keeps our organs in the right places, and that’s true—but they do so much more than that. Our bones account for 99 percent of our body’s total calcium stores. The remaining 1 percent circulates in our bloodstream and is used for blood clotting, muscle contractions, cell-to-cell communication, neuron firing, and more. Calcium is so essential that we have mechanisms in place to maintain optimal levels in the blood—our bodies are just smart like that!If our calcium levels drop too low, parathyroid hormone (PTH) is released and tells our bones to secrete calcium from storage to bring our levels back up. Tapping into our bones’ calcium supply helps prevent shortages in the blood, so our neurons, cells, and muscles can continue to function properly. 

Did you know that four out of five people in the U.S. have poor cardiovascular health? Crazy, right? And the worse part is, most people have no idea until something happens or they’re given a diagnosis by their doctor. But the truth is, there’s a lot we can do to take care of our heart health, and it’s never too late! I love companies like InsideTracker that make it easy to proactively measure markers that directly influence our cardiovascular and overall health.With InsideTracker's Ultimate Plan, you can measure HbA1c, glucose, triglycerides, and total cholesterol. They even test biomarkers like vitamin D and magnesium that aren't included on standard lab tests but directly impact our heart health.I’m such a big fan of Inside Tracker is because they're all about preventative health and personalization. Their team will create a nutrition, exercise, and lifestyle plan just for you based on your lab results, DNA, and personal preferences. This Labor Day, InsideTracker is offering my Try This community $155 off their Ultimate Plan. But you have to act fast! This offer is only available until 9/5!

Just click this link and use the code DHRU155OFF at checkout.

The Price of Tapping into our Bones’ Calcium StoresIf we aren’t replacing the calcium that’s extracted from our bones and getting enough of the other nutrients essential for bone re-mineralization (i.e., vitamin D, vitamin K2, and magnesium), they start to get weak and porous, which leads to osteopenia and osteoporosis—the loss of 10 percent and 25 percent bone mineral density, respectively. Over time, this makes us more susceptible to fractures, which is why, according to the CDC, the loss of bone mineral density is the leading cause of injury-related deaths in adults over the age of 65 (2). Middle-aged and elderly adults are most at risk for osteoporosis, a condition that an estimated 200 million people suffer from worldwide—and women are at a greater risk than men. Why Are Women More Susceptible to Weak Bones Than Men?According to the International Osteoporosis Foundation, one in three women and one in five men over the age of 50 are predicted to experience a fracture in their lifetime (3). Similar to cardiometabolic disease risk (which we discussed in a previous newsletter), middle-aged women are getting shafted again regarding long-term health outcomes. But why?Because the hormone estrogen is intimately involved in the process of laying down new bone, this puts women in their pre-, peri-, and postmenopausal years at a higher risk for fracture, since estrogen production is significantly blunted after their reproductive years. Research shows that women can lose up to 7 percent of the bone mineral density in their hip and 10 percent in their spine within five years of the onset of menopause (4). By the time a woman turns 65, her rate of bone loss slows down and is similar to men (about 2 percent per year). So, besides age and menopause…What Else Contributes to Poor Bone Health?Calcium, vitamin D and magnesium deficiencies are super common today, which is problematic because we need sufficient levels of all of these to have strong, healthy bones.Another huge contributor to poor bone health is a lack of strength training. Putting physical, weight-bearing stress on our muscles sends signals to our bone cells to lay down more tissue to be prepared to lift the force of that weight again in the future. This is a hormetic effect that results in greater bone mineral density and muscle mass, which is also super critical for protecting our bones from a fall (something we’ll talk more about more in next week’s newsletter!)Certain medications have been linked to bone loss too. Long-term use of corticosteroids inhibits the absorption of calcium in the gut and has been linked to the development and progression of osteoporosis (5). There is also a potential link between proton pump inhibitors and the risk of fracture, although more research is needed (6).  All right, now that we know what weakens our bones, what can we do to strengthen them?Try This:

1. Incorporate weekly strength-training exercises. Research says that 30–60 minutes of the 150 minutes of recommended exercise per week should focus on strength-training exercises. Just 5–10 minutes of strength training daily can lower your risk of all-cause mortality by nearly 20 percent (7). Think lifting weights, climbing stairs, squatting with weights, resistance bands, yoga, hiking, or walking uphill. Walking, jogging, and biking on a flat road doesn’t count. The goal is to have some sort of weight or resistance that you're pushing up against. Note: If you have been diagnosed with osteopenia or osteoporosis, you’re going to want to avoid exercises that increase the risk of fracture. Work with your doctor to figure out a bone-strengthening exercise plan that’s right for you.

2. Optimize your intake of these nutrients for strong bones. Whole foods should always come first when it comes to optimal nutrition, but certain nutrients are harder to get from your diet than others and will require supplementation. In this section of my protocol, I’m giving you the minimum RDAs for adults and how to achieve them using a combination of food and supplements. 

• Calcium RDA: 1,000mg per day, or 1,200mg for women who are in or around their menopausal years.Calcium-rich foods:

  • Dairy (only if you can tolerate it!): just make sure you’re purchasing high-quality organic, grass-fed dairy products if you can. 

    • Parmesan cheese: 315mg in an ounce

    • Milk: 300mg in a cup

    • Plain yogurt: 250mg in a cup   Personally, I don’t do well with cow’s milk (it triggers acne and digestion problems), but I can tolerate goat and sheep’s milk. I’m a big fan of goat kefir, which provides 300mg of calcium per cup, about 30 percent of my RDA—not bad!

  • Sardines (with the bones): 325mg of calcium in a three-ounce can.

  • Leafy green vegetables: some sources are better than others, depending on their level of oxalates—an antinutrient that binds to calcium and inhibits its absorption. In a recent conversation with my dear friend, Chris Kresser, he said that spinach has a 5 percent calcium absorption rate and that you would need to eat 16 cups to get the same amount as an eight-ounce glass of milk. Try to focus on the more bioavailable sources instead.An important note about calcium supplementation:  We know that calcium is key to bone health, but what about calcium supplementation? This is one area where strong caution is advised by many Functional Medicine doctors due to its association with an increased risk of artery calcification, plaque buildup, heart attack, and stroke. My friend Chris Kresser has written an in-depth article on this topic. He says that calcium supplements are not only unsafe, but also ineffective for increasing bone mineral density—and may actually increase the risk of fracture! I recommend reading Chris’s article to learn more about the potentially harmful effects of calcium supplementation.Based on the evidence, taking a food-first approach is definitely your best and safest bet for reaching the calcium RDA.

• Vitamin D3 and K2: these two work together, so it's important that we’re getting both. Vitamin D3 increases the absorption of calcium in the intestines, and vitamin K2 makes sure it's being deposited in the right place (your bones) and keeps it from being deposited in the wrong place (your arteries). 

  • Vitamin D3 RDA: 800–1,200 IU (at minimum!)

    • Optimize your vitamin D levels! Getting sunlight on your skin for at least 15 minutes a day without sunscreen is the best way to optimize your vitamin D levels. If you’re susceptible to burning or don’t have access to the sun year-round, it's important to take a vitamin D3 supplement.   It is typically safe to supplement with 5,000 IU of D3 per day to correct deficiencies, but everyone’s ability to metabolize and absorb vitamin D is different. Ask your doctor to check your vitamin D levels and adjust your dosage as necessary.   You can get vitamin D from salmon, mushrooms, and pastured egg yolks; however, these do not contain enough vitamin D to take the place of sunlight.

  • Vitamin K RDA : 90–120mcg

    • Food sources of vitamin K2. Animal foods and fermented foods are the most bioavailable sources of vitamin K2. Natto, a traditional Japanese dish of fermented soybeans, contains the most vitamin K2 of any other food at 150mcg per tablespoon. Muenster, Camembert, and Gouda cheeses contain 50mcg, 34mcg, and 32mcg, respectively, in a two-ounce serving. Pastured egg yolks, grass-fed butter, and kefir are other good sources.

  • Vitamin D3/K2 Supplement: Designs for Health Vitamin D Supreme. This supplement contains a therapeutic dose of vitamin D3 and K2 in the appropriate ratios to optimize your levels and correct deficiencies.

• Magnesium: People with a higher intake of magnesium have a higher bone mineral density, but it is virtually impossible to meet the minimum RDA from food alone. A combination of food and supplementation is your best bet for meeting the minimum RDA of 300–500mg. Some food sources of magnesium include:

  • 1-oz of pumpkin seeds: 150mg

  • 1-oz of almonds: 80mg

  • 1 medium avocado: 60mg However, plant-based sources of magnesium are bound to antinutrients that inhibit its absorption by up to 50 percent, which is why supplementation is critical when it comes to meeting the RDA for magnesium.

  • Magnesium Supplement:BiOptimizers Magnesium Breakthrough. This is my favorite magnesium supplement because it contains seven different forms of the mineral and is extremely well rounded.

• Ask your doctor for a DEXA scan. DEXA is the test that’s used for measuring bone mineral density. Anyone 65 and older can request a DEXA scan. Women may want to ask for one sooner, especially if they had early-onset menopause.   Most insurance companies will cover a DEXA scan if you meet any one or more of the risk factors for it (you have a family history of osteoporosis, drink alcohol regularly, are underweight, are a smoker, have a chronic disease, or have broken a bone recently) (8).This blog can help you determine your risk to know when to ask your doctor for a DEXA scan. After you get a DEXA scan, this guide from the NIH may be a useful resource for helping you interpret your results.

Final Thoughts There is no silver bullet for optimizing our bone health. We need to focus on everything from resistance training to eating a diet rich in calcium, magnesium, and vitamin K2 and getting our preventative screenings to make sure our bones are strong and protected, so we don’t have to worry about the impact of a fall.Strong bones = strong body, strong health, and the ability to enjoy all the good things in life for as long as we possibly can!Here’s to your bone health,Dhru PurohitReferences1. PMID: 280938242. https://www.cdc.gov/falls/data/fall-deaths.html3. PMID: 282934534. PMID: 181604675. PMID: 265090496. PMID: 310603197. PMID: 352282018. PMID: 24766381