By Dr. Linda J. Dobberstein, DC, Board Certified in Clinical Nutrition
Calcium is the most abundant, essential mineral in the human body. The body contains on average two to three pounds of calcium with 99 percent found in the bones and teeth. The other one percent supports critical metabolic functions for blood vessel relaxation and contraction, muscle function, cellular signaling, and hormonal secretion. The amount of calcium found in the blood or in a standard serum calcium test is very tightly regulated. This amount does not generally change with dietary intake. When the body needs calcium for these metabolic functions, it takes from the bones.
Bone Health Requires Several Nutrients
Bones are in a constant state of turnover throughout life. Certain cells, called osteoclasts, break down old bone. Other cells, called osteoblasts, build new bone. It’s a complex process, but it is what keeps our bones strong, dense, and flexible, with tensile strength, i.e. the ability to withstand forces without breaking at any age.
Several nutrients are needed for this.At the top of the list is calcium. Several other major players are needed for building bone, maintaining quality structure and to help make calcium work. These include magnesium, vitamins B, C, D, K1, and K2, boron, manganese, zinc, strontium, glucosamine, and hyaluronic acid. Calories, protein, fat, and carbohydrate intake also influence calcium absorption and fracture risk in bone health.
The Journal of Academic Nutritional Dietetics reviewed this matter, clearly stating bone health and fracture risk reduction is much more than calcium and vitamin D intake as bone health relies on the teamwork of the nutrients mentioned above. In addition, factors related to blood sugar, leptin, and thyroid also determine the quality of bone structure.
Calcium Absorption and Bone Strength Depends on Gut Health
Calcium absorption and bone health depends on the gut. Regulation of calcium absorption in stomach and intestinal physiology and how it coordinates bone health is extraordinarily complex. It’s not a simple quick step of taking calcium and it’s automatically distributed to the bones. There are many series of complex steps from the stomach, small and large intestine with numerous receptors, channels, and transport proteins that determine calcium absorption and effectiveness.
A recent review article from the American Physiological Society fully describes and sheds enormous insight into the intricacies and complexity of gut physiology with stomach acid, nutrient transport and the consequential impact on bone strength and durability. Their concluding statement in this massive review article was, “A disruption in any one of these mechanisms by disease, genetic polymorphism (mutations), or pharmaceutical drugs can easily lead to changes in bone health.”
One significant factor described in this physiology review article is the health of the stomach. The stomach secretes hydrochloric acid, but is involved with hormones like parathyroid hormone (PTH), gastrin, pancreastatin, and others. When stomach acid is suppressed, calcium and these hormones that are involved with the regulation of calcium in the digestive tract are disrupted. Insufficient stomach acid and derailed hormones lead to impaired bone mineralization, i.e. the calcium does not get absorbed and bone health suffers.
Elderly individuals often experience significant or complete loss of stomach acid production. In addition, many individuals in this age category take acid-blocking medications because of poor digestion. Acid blocking meds compromise this entire process of calcium absorption. As noted above, this stomach acid is at the crux of a series of events starting with the intake of calcium into the digestive tract to the end point of bone structure. If stomach acid is not present in adequate amounts, it changes the entire progression of bone health.
Other Factors that Interfere with Calcium
There are several other factors that interfere with calcium absorption, eventually compromising bone health. High salt intake, diets high in phosphorous (soda pop, especially colas, and processed foods), high oxalate acid and phytic acid foods (spinach, chard, berries, chocolate, green and black tea, beans, seeds, nuts and soy isolates), insoluble fiber like wheat bran, along with alcohol, caffeine, smoking, stress, and lack of exercise interfere with calcium absorption.
In addition, medications like steroids (inhalers, prednisone, Solul Medrol, etc), mineral oil, laxatives, and thyroid medications interfere with the absorption of calcium. Even taking more than 500 mg of calcium at a time can interfere with how much the body absorbs. The body absorbs calcium best at rates of 500 mg or less per dose. Those individuals who take 1,000 mg of calcium once per day may be unable to absorb the full amount which will further conflict with desired therapeutic benefit.
Probiotics and Prebiotics Play Fundamental Role in Bone Health
Emerging research shows that healthy gut flora plays a fundamental role in bone mass and the natural turnover of bone cells. This is in addition to healthy stomach acid. Understanding this process for bone health and rate turnover of bone cells with nutritional status is on the frontier of bone health. Research from earlier this year identified that the gut bacteria regulate bone mass and bone cell turnover. It showed that unhealthy gut bacteria or changes in the gut flora balance caused immune cells to disrupt the remodeling process of bone cells. Thus, when immune cell inflammation occurred from unhealthy gut bacteria, bone loss occurred. As a result, the risk for osteoporosis and fractures increased.
Bone mass density benefits from beneficial bacteria such as Bifidobacterium and Lactobacillus. In a recent animal study, it was shown that the internal architecture of femur (thigh) bone improved with Bifido bacteria in animals in menopause states. The presence of healthy Bifido bacteria in the gut was shown to support serum osteocalcin, osteoblasts and other bone formation factors, while reducing breakdown of bone. Prebiotics like FOS have also been shown to assist with mineral absorption, bone mineral content, and bone structure.
Genetic Mutations
Genetic polymorphisms or dysfunction with calcium transport and vitamin D receptor sites play major roles in bone health and resultant fracture risk. Methylation genetic defects and high homocysteine levels are other factors that lead to compromised bone metabolism. Defective vitamin D and calcium transport from genetic changes will affect how resilient and healthy bone status is. This information on gut health with stomach acid, gut flora, and genetics certainly paints a different picture on calcium and bone health.
Other Global Factors Interfering with Healthy Physiology
Digestive problems with imbalanced gut bacteria, altered absorption, reduced stomach acid, common medications, insoluble fiber, teas, etc., and changes in genetics all impact calcium function and bone health. Increasing worldwide problems with celiac disease and gluten intolerance, Roundup and glyphosate, and H. pylori overgrowth changes gut flora and physiology. The obvious conclusion becomes bone health is much more than just how much calcium to take.
Nutritional Support for Bones
Knowing that bone health depends on multiple factors is the first step towards understanding bone health and not succumbing to incomplete, twisted information. The second step is to ensure gut health with beneficial bacteria and prebiotics (FOS) and proper digestive support with stomach acid and pancreatic enzyme support. This helps ensure proper cross-talk that occurs with our gut bacteria, immune system, hormones, minerals, and inflammation. This is the crux of healthy physiology to get the nutrients to the bones. Next, make sure that calcium and other minerals and co-factors like the magnesium, vitamins K1, and K2, D, fish oils, hyaluronic acid and trace minerals are present. Follow The Leptin Diet to support healthy leptin hormone and blood sugar function as this supports gut bacteria cross-talk with the bones and immune system.
Use It or Lose It Principle
Wolff’s law on bone health which is akin to “use it or lose it” says we must use our body to maintain bone density and health. When muscles pull on the bones to which they are attached, the bones become stronger and denser. You can support this law by strength training, isometrics, and just being active in many forms.
Calcium Quality Matters
Quality of nutritional supplements, especially with the nutrient form and how it is balanced with other cofactor nutrients is immensely important. The microcrystalline hydroxyapatite (MCHC) form of calcium provides superior support in bone health.
A 2015 review study that evaluated several years’ worth of data on MCHC showed superiority over other forms of calcium in postmenopausal women. The study also revealed that MCHC improved pain symptoms and help fractures heal in those with bone loss. The authors conclued, “The hydroxyapatite complex is significantly more effective than calcium carbonate”.
Bones rely on calcium, many team players and an army of activity within the gut flora, hormones, and immune cells to maintain its integrity and function.
