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RHR: Q&A on Osteoporosis: Risk Factors and Lifestyle Considerations

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Osteoporosis affects approximately 50% of people over the age of 50 or 60, making prevention and treatment an important topic for people of all ages. In this episode of Revolution Health Radio, I provide a deep dive into some of the most important factors affecting bone health, reveal the critical nutrients that are necessary to maintain a strong body, and answer a number of questions patients and listeners have asked about what to eat and how to live in order to prevent osteoporosis and limit some of its negative effects. This episode contains Chris’s tips for decreasing your risk of osteoporosis, even without access to lab testing or a Functional Medicine doctor. 

In this episode, we discuss:

  • Dietary considerations for osteoporosis, including the importance of nutrients like calcium, vitamins A, D, and K2, magnesium, collagen, and more
  • Underlying causes of osteoporosis such as gluten intolerance and inflammation
  • The controversial connection between consuming dairy products and osteoporosis
  • The acid/alkaline balance in the body
  • Lifestyle factors that are not talked about enough, like exercise, sleep, and stress

Show notes:

RHR – Osteoporosis

Intro:

Hey, everybody, Chris Kresser here. Welcome to another episode of Revolution Health Radio. This week, I am doing a solo episode on osteoporosis. I can’t believe I’ve never done a full show on osteoporosis in 11 years of podcasting. I’ve covered it briefly in the context of other topics, or maybe as a Q&A grab bag type of thing, but I’ve never done a full show. So I’m going to fix that issue here. It’s a really important topic. Osteoporosis affects 50 percent of people over I think 50 or 60 years old. And so [it’s] definitely something to be aware of and have on your radar as [you] age.

We’re going to cover some basics on bone remodeling and osteoporosis; we’re going to talk about dietary considerations, including calcium, vitamins A, D, and K2, [and] magnesium. We’re going to talk about gluten intolerance and how that can contribute. [We’ll] talk about inflammation, both acute and chronic inflammation, and the impact that can have on osteoporosis risk. We’re going to talk about dairy products and what role they should play in the diet. There’s a lot of controversy about dairy and osteoporosis. We’re going to address that a little bit. We’ll talk about collagen, which is a very important nutrient when it comes to bone health. We’ll talk about acid alkaline balance and whether that’s something you need to consider or be aware of in any way. And then [we’ll discuss] exercise, sleep, and stress, which are all crucial factors but often completely left out of the conversation.

I think you’re going to get a lot out of this [episode]. And these are some excellent fundamental steps to take both to prevent osteoporosis and even reverse it if it’s already starting to develop. I hope you enjoy the show. Let’s dive in.

What Is Osteoporosis?

Chris Kresser: All right, so let’s dive into this topic of osteoporosis. It’s hard for me to believe that I haven’t done a full show on this topic in the 11 years that I’ve been podcasting. But I searched all of the previous episodes, and I’ve definitely covered it as a part of other episodes, but I’ve never done a full episode exclusively dedicated to osteoporosis, which is definitely something that I want to correct today, because bone disorders are a scarily common issue. About one in two women and up to one in four men age 50 or older will break a bone due to osteoporosis. And it’s not just about breaking the bone, because, as I’m sure many of you know, fractures are one of the most serious things that can happen to us as we age, particularly [for] people who are, let’s say, 70 years old. There’s a saying in medicine, “Break your hip, die of pneumonia,” because what can happen with a serious fracture is the patient becomes immobilized and bedridden. And then, fluid can pool in the lungs, in the hospital, and they can develop pneumonia, and then they can die from that.

So this is one of the many reasons why keeping our bones healthy as we age is super important. It’s one of the things that impacts longevity more than just about anything else. Studies have shown that fractures can significantly increase the risk of early death for older adults, even doubling or tripling [the] risk of death in that age group. So it’s a really important issue to be aware of, and if you see osteoporosis or earlier osteopenia starting to develop, it makes a lot of sense to address [it], and, of course, we want to do everything we can to prevent it from developing in the first place.

How Do Our Bones Work?

Before we jump into the pathological processes of osteopenia, osteomalacia, and osteoporosis, we should talk a little bit about bones and the bone remodeling process, which is the normal function of bone and how things should be working with bone. As children’s bones grow, the remodeling process is what allows those bones to get longer and change shape and fit the needs of the body as it develops. And when new forces and stresses are applied to bone, remodeling is used to add new bone tissue to the area where it’s needed based on these new movements and stresses and then, strengthen the bones and help them to be able to support the infrastructure of the body, if you will, as we grow. Another major function of bone is it’s the biggest storage organ for calcium, which is kept in a really tight homeostatic range in our blood, so that it can provide support for nerve signaling, blood clotting, muscle contractions, and many other functions that calcium helps with. When our blood levels of calcium drop, cells called osteoclasts break down bone tissue and release that calcium in the blood. And then, conversely, when calcium is elevated, as long as the body’s healthy, it will use those osteoblasts to return that calcium to the bone reservoir. So it’s a very dynamic process. It’s constantly in flux depending on the changing conditions, and, if everything is working well, then the bones are healthy and retain their density and structure.

Issues Affecting Bone Health

When things don’t work well, one circumstance is just getting older. In that situation, that bone remodeling process becomes less efficient, and osteopenia or osteoporosis can develop. So when that happens, it means the bones become more porous and, thus, a little more brittle. And this is typically diagnosed using a bone mineral density scan with a [dual-energy X-ray absorptiometry] machine. And typically, it’s more common in women than men, typically starts to show up in the 50s, although it can start earlier. I’ve seen it in the late 30s and 40s. And, of course, for some, it never happens at all. So it just depends on a number of different factors, both genetic and environmental, some of which we’ll cover here.

Osteomalacia is a little bit different. It’s a softening of the bones due to vitamin D deficiency. And it is another cause along with osteopenia and osteoporosis of bone fractures. But this one has a much more direct, traceable cause with vitamin D deficiency. One other thing to be aware of is one of the reasons that women are at significantly higher risk of osteopenia and osteoporosis is due to the role that estrogen plays in maintaining bone mass. And estrogen, of course, declines with age, particularly when a woman enters menopause and estrogen levels go down, [and] then that supportive role that estrogen was playing in bone mass decreases. So we’re not going to talk a lot about estrogen and estrogen metabolism and regulation in this show. But that is something that you should definitely be aware of. And there are hormonal considerations when it comes to osteoporosis.

I’m going to focus on a lot of the other considerations in this show, because they’re more broadly applicable. But if you try a lot of the things that I talk about in this show, and you’re not getting good results, then one further step to take would be consulting with a Functional Medicine practitioner [who] understands hormones and hormone balance, particularly in menopausal women, and making sure that’s all working as it should be. Because that can definitely be an important factor.

Nutrients Affecting Osteoporosis and Bone Health

Let’s start by talking a little bit about calcium. That always comes up in discussions of bone health, and it is an important nutrient. As I mentioned, one of the main functions [of bone] is a storage reservoir for calcium. And this should always be at the top of the list when you’re thinking about bone health. However, I would say that sometimes too much focus is put here at the expense of other important factors. And calcium supplementation is problematic as we’ll discuss a little bit, and is often done poorly and in a way that actually not only doesn’t improve bone health, but may even increase the risk of fractures. So let’s just start with what you should be doing in terms of calcium, then we’ll talk a little bit about supplementation and some of the considerations there if you’re not getting enough calcium through diet. So even the ideal range for calcium is somewhat controversial. Conventional sources recommend anywhere from 1,000 to 1,300 milligrams daily for adults with women who are pregnant or nursing or trying to conceive, and also women above 55, 60 years of age at the higher end of that range, 1,300 milligrams, and younger women and men being at around 1,000 milligram part of the range.

Some sources, though, suggest that [you] really only need about 600 to 800 milligrams of calcium, as long as you’re getting adequate amounts of other synergistic nutrients like vitamin[s] K2, A, and D. So it’s a little bit unclear. I tend to probably fall more in the latter camp because I think nutrient synergy is a really important concept, and it’s not unusual in the case of many other nutrients that if you get enough of all of the synergistic nutrients, the amount that you need of the one target nutrient drops. I think that’s a pretty well-established concept in biology, biochemistry, and when it applies to the human body and nutrient status. And then there are others who argue that the bioavailability of calcium from different foods will affect how much calcium you actually need to eat in order to [meet] the full calcium needs daily. And I’m definitely one of those people. Because we know that bioavailability can vary dramatically. For example, some animal sources of calcium like fish bones and dairy products are highly bioavailable. Also, cruciferous vegetables like broccoli tend to be very bioavailable, but calcium as it occurs in dark leafy greens like collard greens and spinach is not very bioavailable because of the phytic acid that’s in those foods.

Phytic acid is a compound that inhibits calcium absorption and it’s found in relatively high amounts in dark leafy greens like collards and spinach. So, if you look at a chart with highest food sources of calcium, foods like sesame seeds, that’s actually number one in terms of serving size, sardines with bones is number two, yogurt is number three, then collard greens and spinach are number four and five. But of those top five, sesame seeds, collard greens and spinach are going to be much more poorly absorbed than the calcium from sardines with bones and yogurt. So even though on paper they appear in that top five list, you’re going to be able to absorb the calcium in dairy and sardine bones much more readily than you will with those other foods. Broccoli is down around number 15 just below kale and cabbage and chard, but it would actually probably be higher than kale and cabbage and chard for the reasons that I just mentioned. So just keep that in mind when you’re looking at lists that document the amount of calcium in foods. Almost none of those lists consider bioavailability as a factor. And it’s really important to do that.

So if vitamins D, A and K2 play a synergistic role with calcium and I’m going to come back to those in a moment. But as I was saying before, if you need to make sure that you’re getting enough of those nutrients as well. If you are, I think targeting for let’s say a menopausal woman targeting a range of 800 milligrams of calcium a day, while making sure that you get enough of those other synergistic nutrients is probably a good target. And you can do that without eating dairy, it’s just, it’s harder. But if you’re eating like bone-in fish, like canned fish, like sardines with bone, the bones are soft, you can easily eat them. Canned sockeye salmon with bones is a great source that’s like number seven or eight on the list. So if you’re eating, if you eat a few of those a week, and then you’re eating plenty of greens and cruciferous vegetables, sesame seeds, things like that, then you should be able to meet your daily calcium need fairly easily. If you are able to tolerate dairy like yogurt and kefir, and cheese that will make it even easier because it’s highly bioavailable source of calcium and it’s also at the top of the list in terms of the amount of calcium in foods there. Several of the top 10 foods are dairy foods. That’s easier for sure.

So let’s talk a little bit about calcium supplementation. So if you look at your calcium intake, use kind of any of the many online tools available for measuring your daily intake of calcium, and you determine that you’re below that range, which is not unusual, then you have start thinking about calcium supplements. So calcium supplements are among the most commonly sold supplements. Calcium is in almost all the multivitamins and then there are lots of calcium supplements that are sold, particularly to older adults. However, the research on the impact of these calcium supplements is pretty disappointing, to say the least. So for example, 2012 analysis found that consuming calcium in the form of supplements provided no benefit for hip or lumbar vertebral bone mineral density in older adults. A 2007 study published in American Journal of Clinical Nutrition found that calcium supplements don’t reduce fracture rates in postmenopausal women, and may actually even increase the rate of hip fractures. So this is what I was talking about before.

Beyond that, calcium supplementation has been shown to have some pretty disturbing risks associated with it. So a 2012 study of 24,000 men and women aged 35 to 64, published in BMJ found that those who use calcium supplements had 100 and almost 140 percent greater risk of heart attack during the 11-year study period. While intake of food calcium did not increase the risk. So I’m going to come back to that. It’s a really important point. A meta analysis of studies involving more than 12,000 people also published in the BMJ found that calcium supplementation increased the risk of heart attack by 31 percent, stroke by 20 percent, and death from all causes by 9 percent. Then there was another analysis involving 12,000 men published in JAMA Internal Medicine, which found that intakes of over 1000 milligrams a day of supplemental calcium were associated with 20 percent increase in the risk of death from cardiovascular disease. So that’s just for heart disease risk. There’s also cancer, kidney stones, and other health risks associated with excess calcium intake. And I wrote an article about this, we’ll put a link to it in the show notes. And if you just search for Chris Kresser, calcium supplements, it’ll pop right up. There’s a lot more data there and I highly recommend reading that if you’re interested in this topic.

So just now, I mentioned that in one of these studies, actually, in many of these studies, they see a distinct difference between the impact of supplemental calcium and food calcium. So in other words, eating more calcium from food does not have the same impact, and is not associated with the same risks as increasing your calcium from supplements. Why would that be? Well, one theory is that when you take supplemental calcium, you’re taking it in a kind of unnatural way, where you’re taking a large bolus of calcium that is absorbed rapidly into the bloodstream. And then the body doesn’t really know what to do with that calcium. And it ends up getting into the soft tissues, like the arteries, or the heart, where it does not belong, or the kidneys, and it causes those problems like increasing cardiovascular disease and increasing kidney stones. Whereas when you eat calcium in food, it’s bound with the food and it’s absorbed much more slowly, and that’s the typical way that we ate calcium historically as human beings. And so the body knows how to process that and deal with that, and the calcium ends up in the bones, and the hard tissues where it belongs.

Now, another factor that determines where calcium ends up is if you have adequate levels of K2 and D because those regulate calcium metabolism. And so that could be another kind of risk factor if you’re taking typical calcium supplements, and you’re low in K2, make sure that calcium gets into the bones and teeth and the hard tissues where it belongs and stays out of the soft tissues where it doesn’t belong. So if you have low K2 it’s even more likely that you might be harmed by calcium supplementation. So what to do about all this? Well, the only form of calcium that I feel really confident in that doesn’t cause this problem is whole bone meal. So this is calcium that is basically, you’re taking bone meal and bone, of course, has calcium. I said before, that’s one of its major functions is being the reservoir of calcium. So if you take a bone meal complex, they will not only contain calcium, but it will also contain other good things that are found in bone like collagen, growth factors, trace minerals and other elements that we need. And that’s actually the way that humans probably got most of our calcium for the vast majority of our evolutionary history.

Connections Between Dairy Consumption and Osteoporosis

Because, we only started consuming dairy products regularly maybe 11,000 years ago, and even then only in some parts of the world. Still many parts of the world, most people don’t consume dairy products, but they still get enough calcium. So they can get that in a Paleolithic diet from gnawing on bones and actually eating some bones. Later on eating bones with fish in them, fermenting the fish, and the bones, making the bone soft. And then, of course, through some of the vegetables, greens, seeds, cruciferous vegetables, etc, probably more recently. So, whole bone meal is the best form of calcium supplement to take. Unfortunately, it’s not pleasant for most people. It’s a grit as you can imagine. It’s kind of a gritty texture and not as easy to take as typical calcium supplements that you might buy at the local drugstore or something like that. But I think it’s worth it because it’s a much safer form of calcium to supplement with. There are a few different brands out there now that offer bones from free range and pasture fed animals. And so, I don’t necessarily have a particular brand that I recommend, but I would search for free range bone meal complex from free range, pasture fed animals, ideally.

Vitamins and Minerals that Affect Bone Health

Okay, so that’s calcium. And I want to move on to talk a little bit about vitamins A, D, and K, which are fat soluble vitamins that play a synergistic role with calcium and help with calcium metabolism. I don’t want to spend too much time on this because there’s a lot more I want to cover. But in short, like I said, K2 regulates calcium metabolism, helps it get into the hard tissues, where it belongs, and stay out of the soft tissues where it doesn’t belong. And K2, I’ve written a bunch of that on this. So if you just search for Chris Kresser and K2, you can get some basic info on how to get it into your diet. It’s found in dark meat chicken, goose liver, which I bet all of you are eating on a regular basis. It’s in fermented foods like natto, again, not a very commonly eaten food, but it’s also in hard cheeses. It’s in like fermented foods like sauerkraut and kefir. So a little tricky to get through the diet. These days, certain vitamin D supplements, you can get combo of vitamin D, K2 supplements. NOW has a good supplement that has vitamin D and K2 in it. And there’s also a great book by Dr. Kate Rheaume-Bleue, Vitamin K2 and the Calcium Paradox, which we’ll try to link to in the show notes if you want to get a little bit more information about the relationship between K2 and calcium.

Vitamin D also plays a role in calcium metabolism. And this is of course, a nutrient that is often low in many people. So making sure you’re maintaining normal vitamin D levels. I recommend the range now, this is during the COVID pandemic I’m recording this about 18, 20 months in. So I think it’s really important to maintain a vitamin D, a 25 D level in the range of maybe 40 to 60 or even 50 to 60 nanograms per milliliter in the time of this pandemic, and 40 to 60 would be a pretty good range to shoot for in general. And then finally vitamin A, it doesn’t play as much of a role in calcium metabolism as vitamins D and K2, but it does play a role. And so getting enough vitamin A from liver, organ meats, cod liver oil, things like egg yolks, pasteurized butter etc. can be good sources of vitamin A.

Okay, so let’s move on to magnesium. Another critical nutrient for bone health, but not often talked about in the conventional world at least in that context. Magnesium is one of the key minerals that makes up the structure of the bone matrix and it can be pulled out of the bones if blood magnesium levels drop. And magnesium levels are typically low. It’s one of the nutrients that is most commonly shows up as low when we do nutrient testing on patients. And I can’t remember the exact percentage of Americans that are low in magnesium, but it’s the majority, it’s definitely over 50 percent. And then, magnesium deficiency, not surprisingly, given what I just said, is a known risk factor for osteoporosis. So, I recommend a range of magnesium of around 800 milligrams a day, and that can come from food and supplements. So a lot of people do need to supplement with magnesium and somewhere between 200 to 400 milligrams per day of supplementation is often a good idea in order to maintain normal magnesium levels.

So the best forms of magnesium to supplement with are glycinate and malate which are generally better tolerated and better absorbed than like citrate or oxide, and don’t tend to cause as many digestive side effects. So that’s typically the best way to supplement with magnesium. There are lots of different brands out there that offer glycinate and malate. Another thing to consider with osteoporosis and again, something that’s not typically thought of in the conventional approach to it is inflammation. So there are several different inflammatory cytokines that have been implicated in the development of osteoporosis and chronic inflammation is believed to be a major risk factor for the disease. So it’s beyond the scope of this podcast to go into every potential cause of inflammation, but just keep that in mind and certainly eating an anti-inflammatory whole foods diet and then identifying and addressing any signs of chronic inflammation like a gut infection or SIBO or heavy metal toxicity or something like that is really important to reducing the risk of osteoporosis or even trying to reverse it if it’s already present. So this is definitely consistent with the more functional, holistic whole system approach to, I’ve just got to pause here. All right back here. Okay, sorry I had to take a little break there. I’ll start over with inflammation. I’ll just kind of back up a little bit and start over here, so.

The Connection Between Inflammation, Gluten Intolerance, and Osteoporosis

So inflammation has a lot of causes and it’s beyond the scope of this show to go talk about every single one of them, but it’s just something to be aware of. If you’re dealing with osteoporosis you definitely of course want to be on an anti-inflammatory diet because diet is one of the biggest sources of inflammation. Nutrient dense whole foods, anti-inflammatory diet, eating plenty of EPA and DHA, which are the long chain omega three fats which are anti-inflammatory, reducing your intake of industrial seed oils that are high in omega six and tend to be inflammatory. Reducing your consumption of flour and sugar. But then also identifying other potential sources of inflammation like undetected gut infection or SIBO, or heavy metal toxicity, other toxins, etc. So that’s really important. Gluten is another issue that can potentially contribute to osteoporosis. So I just mentioned that inflammation is a significant risk factor. And if someone is gluten intolerant and is not aware of that, and they’re eating gluten containing foods on a regular basis, then that’s going to basically cause a persistent state of low grade chronic inflammation, which could increase the risk of osteoporosis.

And some of the lines of evidence that support this are the observation that a decrease in bone density is one of the first symptoms of celiac disease even in otherwise asymptomatic patients. That’s been documented in the literature. And the good news, on the other hand, is that those who have reduced bone mineral density from previously undiagnosed and untreated celiac disease, can significantly improve their bone strength followed by a gluten free diet. A couple of studies have shown that to be true. So if you are gluten intolerant, and you learn that and you take it out of your diet, then the bone density can actually improve just from that single change. So really important factor to consider. Dairy products. So another very controversial topic, I’ve written a separate article on dairy products and osteoporosis. So again, we’ll put in the show notes, or you can just search for Chris Kresser, dairy osteoporosis. And there’s a lot of myth busting in that article. Because this is actually one area where I agree with the conventional nutrition paradigm, because the conventional nutrition paradigm has, at least, mostly been very supportive of dairy products as a way of preventing and improving osteoporosis. Whereas in the integrative medicine world, I think there’s been more of a bias against dairy products as being inflammatory, which they certainly can be for some people who are intolerant of the proteins or the sugar, but they aren’t necessarily inflammatory for people who are not intolerant. And they have a lot of beneficial nutrients, calcium being one of the main, highly bioavailable calcium, and they can really be a helpful addition to the diet in certain cases.

So dairy products, as I mentioned before, are very rich sources of calcium. They’re bioavailable. And while you don’t need them necessarily to get adequate calcium, and vitamin D to build healthy bones, certainly, it’s easier if you tolerate full fat kefir, yogurt and some hard cheeses, you can generally, even people who are lactose sensitive can tolerate some amount of those more full fat and more fermented dairy because they’re much lower in lactose. But they still contain good amounts of calcium, and other beneficial nutrients. So just including some yogurt or kefir daily and some hard cheese is a really good way of boosting calcium intake if you don’t have any issue with dairy products.

How Collagen Affects Bone Health

Next is collagen. So collagen, about 25 to 30 percent of the dry weight of bone is made of collagen protein. And the strength of our bones is highly dependent on the quality of the collagen matrix and especially the cross-linking of collagen. So it makes sense that supporting collagen formation is a really important component of keeping bones strong as we age. In order to do that, you have to have the amino acids glycine, proline and lysine along with adequate amounts of vitamin C that’s needed for the hydroxylation of those amino acids in the production of collagen. The body can produce some of its own glycine, proline and lysine from dietary protein. There’s some evidence that that doesn’t happen very well and it’s really much better to get them from foods in the diet. So that means eating lots of bones, joints, tendons and skin from other animals. This is one of the reasons why I’ve been such an advocate of bone broth for many, many years. Consuming gelatin, so this is like eating the odd bits of the animal, nose to tail eating pattern that our ancestors would have done. And they didn’t know the science behind it, but this is certainly one of the ways that they benefited from doing that. Instead of just eating like very lean steak or lean ground beef, consuming some of these other parts of the animal or even just fattier, more gelatinous cuts of meat like brisket, chuck roast, oxtail, shanks, etc will help increase your gelatin consumption. And then getting plenty of vitamin C from fresh fruits and vegetables to help ensure proper collagen formation. That’s all really important and can contribute to bone health.

Understanding Acid-Alkaline Balance in the Body

Some of you are probably wondering about acid-alkaline balance, and particularly in relation to dietary protein in things like dairy products and the effect on bone health. There’s a kind of common critique of the Paleo Diet, which is that it causes acidification of the body because it’s so high in animal protein and that leads to bone demineralization. But that’s just simply incorrect. I wrote a series on the acid-alkaline myth. And there’s two articles, again, we’ll try to link to that in the show notes or just search for Chris Kresser acid-alkaline myth. And I just deconstruct that entire argument using a lot of studies and research showing that that argument is fundamentally flawed on many levels. Then, of course, we also have observational studies that have not found a correlation between dietary acid load and bone mineral density. And in fact, animal protein, which is the most acid forming food of all, has been associated with better bone health in numerous observational studies. So it’s just an argument that doesn’t really carry any legitimate weight at least according to the scientific literature and it shouldn’t be a concern. If you’re consuming animal proteins and wanting to strengthen your bones, then animal protein and dairy products will be very helpful.

Lifestyle Factors that Can Affect Osteoporosis

Exercise is critical, and particularly weight-bearing exercise. That’s what’s most important for improving bone density. And, strength training, in particular with relatively heavy weights is important. Obviously, you don’t want to start there if you haven’t been doing any strength training at all. And it’s not necessary, you don’t necessarily ever have to get to really heavy weights. But the stress that weight-bearing exercise puts on the bones really stimulates the remodeling process that we talked about in the beginning of this show. And just doing moderate weight-lifting exercises a few times a week, for example, has been shown to significantly increased bone density, particularly in postmenopausal women. One of the things I tell my patients, both men and women, but especially women who are in their 40s and 50s, is like lifting weights is really one of the best things you can do to promote your longevity, not just because of the kind of overall pleiotropic benefits of exercise, but like I said, this weight-bearing exercise in particular, strengthens our bones. It also, of course, strengthens our muscle and increases muscle mass. And I think maintaining adequate muscle mass and adequate bone density are really two of the most important things we can do to expand our health span as we age. So really critical for bone density and health, and something that I see a lot of people omit from from their physical activity regimen.

You won’t be surprised to hear me say that sleep is critical for bone health. Melatonin affects the actions of osteoblasts and osteoclasts and interacts with other hormones like estrogen to augment bone remodeling. And it also functions as a really potent antioxidant which protects bone cells from oxidative stress and inflammation. And the best way to keep melatonin production functioning optimally is to entrain your circadian rhythms to the appropriate 24-hour cycle, which means limiting your exposure to artificial light at night, getting some exposure to bright sunlight during the day, committing to eight hours, 7 to 8 hours at least of quality sleep in a cool dark room. All of that will help boost melatonin production. And so following good sleep hygiene methods and doing everything I just said will, I mean sleep helps us so many different things but particularly in relation to bone health it’s critical.

Stress is another factor that almost always gets ignored in the conventional paradigm. But stress can have a big impact on bone health. We know that long-term use of corticosteroid medications, which affect cortisol levels, cause bone loss and can lead to osteoporosis. So depressing cortisol really, really low does that. On the flip side, really high cortisol persistently can have similar effects on bone density. Cortisol indirectly acts on bone by blocking calcium absorption and that decreases bone cell growth. And so some studies have shown that even a short bout of high cortisol can cause a decrease in bone mass and that prolonged high cortisol can lead to decreases in bone density. So another important consideration, lots of different options for managing stress and cortisol levels, including meditation, mindfulness, deep breathing, yoga, social support. There are lots of new, PEMF, infrared sauna, things like that can help. But just having a regular stress management practice is essential.

I’m probably preaching to the choir here. I don’t know if it’s necessary to mention this, but I should at least, tobacco, smoking cigarettes and excess alcohol consumption, are definitely linked to reduced bone density. So if you’re smoking or drinking a lot, then addressing those two things would be right at the top of the list along with everything else that we’ve covered in the show so far.

So those are kind of my fundamental recommendations for osteoporosis that anyone can do without any lab testing or access to a functional medicine provider. I think those are all an excellent starting place and I would try this and do this for a period of time. And then if you’re not getting results, then you can move on to the next steps, which get a little bit more complicated. It might involve working with a practitioner and getting some testing. I mentioned earlier, estrogen is really critical for women, particularly women in menopause or perimenopause. So taking a closer look at that would be good. And then supplementing with a higher dose of K2 is something that you could consider even without seeing a practitioner. The typical range, that supplement range that’s recommended is in the microgram quantity, like 100 to 300 micrograms a day. But in some of the Japanese osteoporosis studies, they use doses as high as 30 to 40 milligrams, and they use those for an extended period of time with no ill effects. Vitamin K2 seems to be one of the nutrients that doesn’t have an upper limit that we know of yet, there doesn’t seem to be a known toxicity range. So I’m quite comfortable recommending doses up to 10, 20 milligrams per day for my patients of vitamin K2, who are already dealing with osteoporosis, to help redirect calcium into the bone and help remineralize the bone.

There are a bunch of other things that a functional medicine practitioner might start to look at including underlying causes of inflammation, which I mentioned before that, things like gut infections, heavy metals and other toxins. And, just doing a deeper dive into some of the underlying factors that can drive osteoporosis.

Okay, so I hope that was really helpful. And please do keep sending in your questions to ChrisKresser.com/podcastquestion and I will talk to you next time.

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