- This post is designed to be informative, it should never be taken as a replacement for personalised advice.
Bone density is one of those areas of health where standard medicine offers a well established treatment plan. However the understanding of how bone mineralisation, preservation and remodelling actually occurs has advanced significantly since this approach was established, leaving it lacking when we start to pick it apart.
I was diagnosed with osteoporosis (the advanced form of disease associated with low bone density) at the age of 25 after a failure in my oestrogen production due to oral contraceptive use and high stress levels. I was offered the standard approach of calcium carbonate and Vitamin D3 supplements alongside biphosphonate medication (alendronic acid is a common example of this) but my knowledge of how the skeletal system actually functions led me to decline and develop the approach I have used with my clients ever since. At the age of 33, when it was expected that my bone density would have continued to decline, I was officially reclassified as having lowered bone density for my age, but no longer being osteoporotic.
This programme is applicable for both men and women, whatever the cause of their lowered bone density. Because what we are aiming to do is not just limit the impact of a loss of bone mineralisation on quality of life, health and wellbeing, we are instead looking to activate the biological processes that help us to produce new bone, reinforce existing bone tissue, and prevent any further losses occurring in future.
How Bone Remodelling Works + The Limitations Of Standard Medications
Bone building and breakdown is occurring all the time. It is controlled by the relative activity of two sets of cells; your osteoblasts (builders) and osteoclasts (demolishers). When we are young their activity is relatively evenly matched meaning we cycle through bone in a happy equilibrium. Our peak bone mass (the highest density we will ever have) is actually achieved in our teenage years, and from then on we are looking at controlling the rate of losses by keeping those two teams of cells well matched in terms of their activity.
The impact of standard biphosphonate medication on this is just to freeze us in time.
They are bone mass preservers, they do not encourage bone growth, bone mineralisation or bone remodelling. So when they are prescribed they are simply looking at the existing bone and keeping that there, this does not decrease the risk of fractures, falls or bone breakdown. Over time that bone will actually become progressively more brittle and those risks will rise, leading to a loss of mobility, more fear around falling, and often secondary issues such as joint pain and degradation (osteoarthritis for example).
Elements That Impact Bone Loss & Renewal
Many who receive an osteopenia or osteoporosis diagnosis will feel they have no choice but to opt for the above, however what I want to start to show is how much impact we can have through our dietary and lifestyle choices on our bone health. Awareness of these things can also of course offer opportunity to prevent any concerns related to bone health ever arising.
- Oestrogen & Testosterone: These hormones encourage osteoblast activity to build new bone, whilst suppressing osteoclast bone resorption. This helps to maintain our bone density through the majority of our adult lives. Low hormone levels will see bone building slow whilst breakdown continues at the same rate or even increases. Where hormone levels have fallen, either naturally following menopause, or prematurely due to ovarian failure, high intensity exercise, hysterectomy, oophorectomy or amenhorrea, we just need to be more diligent in countering this with the other elements that will encourage osteoblast activity.
- Vitamin D: Plays a couple of key roles. It is crucial for calcium absorption, which is a key mineral we use to build bone. But it also has a inhibitory impact on parathyroid hormone (PTH). Increased PTH will cause more bone to be broken down to get access to the minerals inside, so when someone has low Vitamin D they not only don't absorb calcium from their diet properly, they will also break down their existing bone mass faster.
- Stress: Increased physical or emotional stress causes us to produce more of the hormone cortisol, and cortisol blocks osteoblast activity. Cortisol also suppresses the function of other hormones including oestrogen, testosterone and thyroid hormones which then further push us into the increased bone breakdown : decreased bone building risk area. Other systemic impacts of stress can include alterations in immune function and decreased digestive efficacy which will limit our ability to uptake and utilise the key nutrients we need to build bone too.
- Inflammatory state: Similar to stress, an imbalance in our body that swings us towards being more pro rather than anti-inflammatory will always be detrimental to bone health. This is most often due to poor diet, or poor dietary balance. A lack of diversity of fresh produce, an increased reliance on simple carbohydrates or stimulants like caffeine, low intake of omega 3 rich foods (mackerel, sardines, anchovies, salmon, herring, trout) compared to a higher intake of omega 6 foods (nuts, seeds, intensively reared red meat, vegetable and sunflower oil) and consumption of ultra processed ingredients will all cumulatively drain from bone building resources.
- Overall nutrient status: Bone is a vitamin, mineral and protein hungry body tissue! If our diet is lacking in protein, in addition to elements such as zinc, iron, magnesium, calcium, vitamin A, C, D, K2 and B vitamins there just won't be adequate building blocks for us to make bone out of. And in some instances our body may actually look at existing bone as a source to top up circulating levels to fill in the gap.
- Exercise: Is a critical element to support bone density as if used appropriately it is a key driver to force bones to renew and repair. Anything that places burden on the skeleton will trigger osteoblast activity, and this is why weight training becomes ever more important as we age. Endurance cardio activity (for example running, spinning and endurance cycling) will be interpreted by the body as a form of stress, driving up cortisol levels which we know is counterproductive to skeletal renewal. This doesn't mean that you cannot include these but they must be evenly matched, or outshone, by a dedication to resistance training in order to maintain bone density.
The Main Event
As a quick proviso, this is designed as a therapeutic programme, it requires effort and the level of adherence required in order to create positive change will be dependant on a few key factors including:
- Age: the older we are the harder we have to work
- Hormone levels: low hormone levels again will work against us so we would need to be even more aware of limiting other drains on mineral status
- Current bone health state: the lower the density as a baseline in combination with the above will dictate how much you can expect to improve. I had very low hormones and very low density so even though I was young I had to work hard.
The focus is on decreasing inflammation and adding in as many nutrients as possible. Organic dairy is a great source of nutrients but it is not integral, I am personally allergic so relied on organic soy, small fish bones and tahini as my calcium sources.
Key dietary inclusions:
- Electrolyte drops in 2l of filtered water daily (use NATURAL20 for a discount on the Elete drops)
- 100g grass fed & finished calve’s/lamb/chicken liver 3-5 times a month (I use Swaledale Butchers, NATNOURISH will give you 10% off all orders)
- 1-2 tablespoons roasted bone marrow 3-4 times a week (used as a replacement for butter. Roast the bones and then whip the marrow until butter like)
- 100g unsmoked fresh or tinned salmon, mackerel, sardines or anchovies 3-4 times a week (if using tinned try to choose those with soft bones you can eat)
- Seaweed 3-4 times a week (provides iodine)
- Tahini 1 tablespoon a day (provides calcium)
- 100-150g organic grass fed dairy products or organic non-GMO soy milk, tofu or tempeh 4-5 times a week (provides calcium)
- 2-3 organic eggs daily (if you can bake the shells then grind to a powder then add a teaspoon into a cup of soup, stews, sauces etc for extra minerals as often as possible)
- 1 portion seasonal fruit within meals 3-4 times a week. No dried fruit.
Key dietary elements to limit/avoid:
- Alcohol and caffeine: Both of these waste calcium by increasing the amount we lose in our urine. They also disrupt sleep and increase the stress response which again interferes with mineral metabolism. I personally removed both totally for almost 5 years, I would have an alcoholic drink on occasion if I fancied but to me it didn’t make sense to work so hard in other areas to have these then draining from that.
- Fizzy drinks: Both classic and diet versions are huge mineral wasting factors in addition to negatively impacting gut bacteria and blood sugar regulation (which then creates a pro-inflammatory state in the body as a whole).
- Simple sugars: All artificial sweets, added sugars and refined white carbohydrates if eaten by themselves will cause negative impacts on the skeleton. Try to choose naturally sweet fruits and vegetables, spices like cinnamon and ginger, and higher fibre carbohydrates like brown rice and pasta, consuming these after a protein source such as yoghurt, meat, fish or eggs.
This is all targeted to getting the skeleton to naturally want to renew itself. We all have preferences and capabilities when it comes to physical activity, I have included exactly what I did but when building your own programme you need to include an element for each of the below.
- Bouncing or jumping: on the spot, with a rope, on a mini trampoline. If you struggle with joint issues or have an injury concentrate
- Weight and resistance training: you start where it suits you, if this is just using your bodyweight to gain confidence that's great. Then add light dumbbells or wrist/ankle weights and gradually build up over time.
- Regular reminders to renew over the day: we want to avoid long gaps when the body can turn off so instead include 2-3 small 10-15 minute triggering activities each day. This could be squats or lunges waiting for the kettle to boil, carrying your shopping in from the car, laundry up the stairs, gardening or popping on wrist/ankle weights or a weighted vest when you go out for a walk.
The Regime I Followed
I was weak, littered with injuries and lacked confidence in the gym when I began so I chose reformer Pilates as a combined strength, resistance and stability form of bone building exercise. It formed a solid foundation for all of the other forms of activity I then progressively included and is something I continue to adore doing now a decade later.
When I reached the point of being injury free I transferred to a gym based setting and have use the Primebody strength training programmes for the last 6-7 years to guide my training. NATURAL15 gives a 15% discount on all of the male/female plans.
I have also always swam and included restorative yoga as my meditative mobility forms of activity.
For ankle and wrist weights I use options like this.
And for weighted vests I use this kind. The training versions which have chest/back plates are great for workouts but not comfortable to walk in.
If you have an injury or any joint issues be mindful of these before adding in weights.
- Stage 1: Reformer pilates x 3-4/week, skipping rope 5-10 minutes x 3-4/week, walking with 0.5kg wrist or ankle weights 20-30 mins x 2-3/week.
- Stage 2: Reformer pilates 2-3/week, bodyweight + light dumbbell gym workouts x2/week, skipping rope as above, walking with wrist or ankle weights x2/week week + x1 with a 5kg weighted vest.
- Stage 3: Reformer pilates 1-2/week, Primebody strength workouts x3/week, walking with 1kg wrist/ankle weights x2/week + x2 with a 8kg weighted vest.
- Now: Primebody strength workouts x3-4/week, reformer pilates whenever I fancy, 1kg wrist weights or 8kg weighted vest when I walk the dog most days.
Will never replace dietary foundations, however when looking to remedy an issue we need to top up certain nutrients above the level that any diet could provide. Calcium carbonate supplements have been proven to be wholly ineffective for bone density improvements, they continue to be prescribed because they are cheap.
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