If there is one overwhelming theme in osteoporosis management, it’s that people will do literally anything to avoid taking medications for bone loss.
In past, popular conversations on bone health like Calcium Doesn’t Work, I’ve stressed that, for most folks, a bone disease diagnosis normally happens at a point where lifestyle modifications will do little in the way of rebuilding bone.
It’s important to hear, so you might want to read that sentence again.
Not that diet, supplements, and weight-bearing exercise aren’t crucial. It’s just that we often are being dishonest by promoting those things OVER medications.
It’s not one OR the other, it’s both.
A good calcium supplement will certainly slow or pause further bone loss. Weight-bearing exercise is important for your bones AND the muscles around the bones that support your balance and gait.
There are a number of bone-healthy foods we can include in our diet. Unfortunately, there are a number of foods that can further contribute to bone loss that we must avoid.
Today we focus on do’s and don’ts of bone health nutrition.
Foods that Make Our Bones Healthy
Fish and Other Proteins
Most articles start with the easy one, calcium. Not me, as I am intentionally disruptive to the norm.
I believe protein is the most important nutrient for bone health because our bones are protein! Specifically, collagen fibers are crafted from the amino acids we get from eating a protein-rich diet.
These fibers are then hardened by the calcium hydroxyapatite compound.
For a guide on proteins (and protein supplements), check out our article Protein Powders: Whey-ing The Pros & Cons.
The long and short of it is, shoot for at least 1 gram per kg of body weight each day. You calculate kg of weight by moving to any other country in the world and use the metric system there, or divide lbs by 2.2.
Important note: protein can be a catch 22. Excess protein consumption can lead to more excretion, or removal, of calcium. This number is WAY higher than even our upper limit that we recommend of 1.4 grams per kg of body weight. Considering most folks struggle to get in the 1 gram per kg range, this shouldn’t be an issue for most people.
Some protein-rich fish will also contain Vitamin D, but as we’ve discussed before, it’s best to supplement Vitamin D. We need to achieve optimal levels (50-75 nmol/L) for skeletal benefits AND for COVID and beyond.
Eat these protein-rich foods for healthy bones:
- Canned sardines, salmon, tuna, mackerel
- Protein-rich foods like chicken, pork, and many plant-based sources (but don’t skip the last section of this blog!)
Of course, calcium is the big mamma jamma of bone nutrition.
Here are some common sources of calcium:
We know that foods rich in dairy will also be calcium-rich, and that’s awesome. Some of us are plant-o-sauruses, and therefore need to rely more on greens than dairy
It should be noted that some calcium sources may be rich in oxalates, like spinach, beet greens, certain beans, and rhubarb. Oxalates reduce calcium absorption (and may contribute to kidney stones). These foods are healthy, but shouldn’t be counted towards your calcium goals.
Yes, even though I included spinach in the diagram above!
The reality is this: despite dietary calcium goals being achievable (1,000-1,200 mg daily for adults), most folks ingest way less. Sounds just like protein, right?
In my experience, most people take in about 400mg of calcium, meaning supplementation should be limited to 6-800mg daily.
Remember, commercial dairy alternatives often are posers. They use poorly absorbed forms of calcium, like calcium carbonate, to give consumers the perception of being true dairy alternatives. In reality, they’re more accurately described as ‘water alternatives’ and should be minimized, if not avoided.
Eat these calcium-rich foods for healthy bones:
- Collard greens, kale, Chinese cabbage
- Dandelion greens, mustard greens, broccoli
Other Bone Healthy Foods
Magnesium: Magnesium is an important mineral for bone health (and otherwise) that most of us are “oh so close” to hitting our daily requirements (usually in the 3-400mg range).
Eat spinach, tomato products, sweet potatoes, collard greens, raisins, and pumpkin seeds for healthy sources of magnesium.
Vitamin C: Vitamin C has important roles in bone health, typically via collagen formation. If you’ve read any of my stuff, you know I think the Vitamin C Worship has to stop. We must EAT Vitamin C and put down the gross supplements.
Eat peppers, oranges and other citrus, apples, broccoli, berries and cherries, Brussels sprouts (like momma said), and pineapples for Vitamin C.
Potassium: It’s really, really hard to supplement enough potassium every day, seeing as we need about 4000mg and supplements are limited to 100mg. It’s much more fun to eat potassium-rich foods like the ones I’m recommending here.
Eat sweet potatoes, papaya, oranges, bananas, prunes and raisins, and tomato products for potassium-rich foods.
Vitamin K: We have a pretty detailed Guide to Vitamin K where we stress to not be so quick to jump on the Vitamin K supplementation bandwagon. Vitamin K deficiency leads to weak bones, and it only requires about 100mcg to have ample Vitamin K to have normal bone health. Extra Vitamin K (like 1000x what we use as supplements) does little for bone health as a medication in Japan. So, eat the food!
Eat dark, leafy greens like kale, collards, spinach, and even Brussels sprouts.
Foods that Make Our Bones Less Healthy
There are a number of foods that will actually make calcium loss a thing, which will make bones weaker and defeat any ‘sick gainz’ your healthy diet or supplements would normally give you.
Excessive booze intake will accelerate bone loss. Limit yourself to 3 drinks per day. Which is normally a lot but it’s also COVID and 12 o’clock somewhere…
Excessive caffeine from soda, coffee, and tea will decrease calcium absorption, so stick to less than 3 total of caffeine-based beverages. This is important for hydration as well.
It seems I’m basically saying that you shouldn’t have Rum & Cokes, since you can’t have alcohol, caffeine, or soda.
There’s a big myth around soda and bone health that should be addressed: carbonation does NOT contribute to bone loss.
It’s mostly the caffeine that’s the problem, but also phosphorus. Phosphorus is an important nutrient for bone health, and it’s found in animal products, beans, and nuts.
As we know right now, excessive phosphorus can contribute to bone loss, but experts aren’t in agreement about it. Do we get too much? Is there this huge role in bone health we’re missing?
My answer is simple: reduce the amount of soda to less than 1 per day, on average, if you have to have it at all. Eat lots of calcium-rich foods to make up for any potential harm that excess phosphorus can cause.
Phytates are compounds found in healthy foods that some refer to as “anti-nutrients.” They block the absorption of important minerals like calcium.
Foods that contain phytate are other bone-healthy foods like beans, potatoes, wheat bran, and grains.
The thing is, phytates aren’t entirely bad, nor are they really a problem.
Most foods are processed or prepared in a way that drastically reduces phytate levels, making them a non-issue. They recommend soaking your beans and rice for 24 hours, for example.
Phytates themselves can have antioxidant and anti-inflammatory effects in the body.
If we eat lots of raw beans and grains, phytates will be a problem. You should be aware of this and plan your diet accordingly.
Excess salt consumption, normally from salt added to packaged and processed foods, is a problem for us.
Besides the cardiovascular detriment, salt will also cause calcium loss. Most recommendations state to eliminate added salt and keep total intake to less than 2,300mg daily.
Keep Your Balance and Keep Your Bones Strong
One of the themes that I hope you picked up in these nutritional recommendations is essentially the same boring advice you’ve heard over and over: everything in moderation.
Some foods can be harmful only when consumed in excess. Some foods can be troublesome, so balance is required.
Excessive protein, caffeine, phosphorus, salt, phytic acid, and fortified calcium can all contribute to health problems, including weaker bones.
But, consuming these things responsibly in a healthy, balanced diet, will help ensure we are making the best decisions for our bone health.
“In these troubling times,” it’s hard to not binge eat M&Ms or day-drink to help with our anxiety from doom-scrolling Twitter and Facebook.
Disengage if you can. Your bones will thank you.
Just trying to keep it real…
Neal Smoller, PharmD
Owner, Pharmacist, Big Mouth