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29 Mar

8 Primal Rules for Building Better Bones

Bones FinalStrip away the skin, fascia, muscles, organs, blood vessels of a human and you’re left with the bones: the foundation providing passive structural support. Many people accept that we can affect and even control the health of the rest of our tissues. Muscles? Just lift. Cardiovascular system? Do some cardio and lose weight. Teeth? Stop sugar. But bones just wear down the older you get. Everyone knows it. And sometimes bones just break. There’s nothing you can to prevent it and nothing you can do to improve your healing except wait and hope. If you want stronger bones, you’ll need some pharmacological assistance provided by a white coat-clad adult wielding a prescription pad.

But bones aren’t inert. They are living metabolic tissue. And though we can’t tell them what to do directly, they grow—or diminish—in response to the signals we send. What kind of signals should we be sending?

1. Lift hard and move quickly

Bones respond to intensity. Forceful impacts, heavy weights, high mechanical loading—these are a few of your osteoblasts’ favorite things. They are unmistakable signals that trigger your bones to begin fortifying themselves.

In one study, researchers attached activity monitors to the hips of adolescent boys and girls. As they went about their week, the monitors tracked their exposure to forceful impacts. People whose hips experienced impacts of 4.2 Gs (activities like 10 minute mile runs or 15 inch box jumps qualify) or greater had the sturdiest hips. Next, they attached monitors to a group of women over 60 and ran them through an aerobics class consisting of brisk walking and box stepping. None of the older women experienced an impact over 2.1 Gs, yet they still saw bone density benefits.

Old bones respond to the same training signals. For instance, older endurance runners have lower bone density than age-matched sprinters, and senior athletes who engage in high-impact activity have higher bone density.

But older adults don’t have to join CrossFit to start seeing benefits to their bone density. Another study found that premenopausal women aged 35-50 who hopped in place 20 to 40 times a day (broken up into two sets of 10 or 20 with 30 seconds of rest in between hops) for 16 weeks experienced improvements to their hip bone density; those hopping 40 times a day saw bigger improvements. That’s very doable. And if you’re a postmenopausal woman (at greater risk for osteoporosis than premenopausal), you can throw on a weight vest when you do your hops.

The very best type of training for all ages is a combination of “impact training” and resistance exercise.

With regards to changes in bone density, exercise is site specific. Only the bones you subject to stress will respond.

2. Animal protein is safe and good to eat, so chow down

Go to any online vegan community and you’ll hear that animal protein leaches calcium from our bones. To support this assertion, they’ll cite studies showing that increased meat intakes lead to increased urinary output of calcium. So, is that steak you ate yesterday making you piss out desiccated femur?

No. Increased protein intake actually increases calcium absorption, and researchers who’ve looked into the situation closely conclude that, as bone health is linked to lean muscle mass, activity levels, and physical strength, the average protein intake is inadequate for optimal bone health especially among the elderly. If anything, “more concern should be focused on increasing fruit and vegetable intake rather than reducing protein sources.” Meanwhile, older men with the lowest protein intakes tend to have the greatest bone loss.

The reverse is true. Animal protein protects and strengthens bones and you should make sure to eat enough of it if you’re interested in preserving and/or building bone health.

3. Dairy helps, so give it a chance if you can

Dairy gets a bad rap. It’s “acidic.” It “leaches calcium” from your bones. You “can’t absorb” the calcium it does contain.

Nonsense.

Dairy actually isn’t acidic, nor does it leach calcium from the bones. And dairy-bound calcium is perfectly absorbable by humans. Most serious researchers recommend that older people at risk for osteoporosis consume more dairy, not less. In fact, people who can’t consume dairy because of an allergy have lower bone mineral density. Upon desensitization therapy and resumption of dairy consumption, bone mineral density recovers.

For optimal results, eat dairy that contains additional bone-friendly nutrients, like gouda cheese (with vitamin K2) or yogurt/kefir (which seem to induce more favorable changes to bone metabolism than unfermented dairy).

4. Maintain good sleep hygiene

Yeah, yeah. Sleep’s important, Sisson. We get it. But allow me to display just how high quality sleep—or the lack thereof, rather—affects bone health.

  • In older folks, self-reported sleep duration is inversely associated with osteoporosis. Less sleep leads to greater bone loss. More sleep protects against it.
  • Melatonin, the hormone that induces sleepiness at night, plays a huge role in bone metabolism. For instance, removing a rat’s pineal gland (which produces melatonin) significantly lowers their bone mineral density.
  • Obstructive sleep apnea, a disorder characterized by frequent cessations of breathing during sleep and an overall lower quality of sleep, is independently associated with low bone mineral density.
  • Too much or too little sleep are both linked to osteoporosis, with daily sleep durations of 7-8 hours, 9-10 hours, and 10 hours all showing a relationship to low bone mineral density.

We can’t know if this is a causal association, of course. Osteoporosis and one’s sleep needs may have a common determinant. But given the role melatonin plays in bone metabolism, optimizing sleep and circadian rhythm is a good idea. Either way, lack or excess of sleep is probably an indication that bone health may be compromised.

5. Drink mineral water

Historically, all water was mineral water. Whether it came from mountain springs or local wells, water came imbued with magnesium, calcium, and other trace minerals. But water loaded with minerals like calcium and magnesium is hard water; it’s bad for lathering soap, it leaves mineral films on dishes and pans, it can gunk up plumbing, and it has a distinct taste (which means “tastes bad” to many people). Thus, most tap water is softened and most bottled water is glorified tap water, filtered to remove “impurities” (which include minerals). And some people, fearing fluoride and other nebulous elements, drink distilled or reverse-osmosis filtered waters containing essentially no minerals at all. This leads to lower bone-friendly mineral intakes and a host of health issues (PDF).

Meanwhile, areas with high mineral content tap water tend to have lower rates of many degenerative diseases, including osteoporosis (PDF). Calcium in mineral water is highly bioavailable, equivalent to the calcium in milk. Magnesium, too. Both minerals are extremely important for bone health and mineral water is an effective, delicious way to obtain more of them. You don’t even have to change your behavior much. You’re already drinking water; it’s a fundamental requirement for biological organisms. Just drink a different kind of water. I suggest Gerolsteiner, a German brand loaded with calcium and magnesium that comes in glass bottles.

A mineral water habit can get expensive, though. Consider making your own.

6. Get enough of these specific nutrients and foods

Melatonin: Getting plenty of full natural light when you wake and throughout the day, avoiding blue light in the evening, and getting to sleep at a normal, consistent time promote healthy melatonin production, but supplemental melatonin has also been shown to improve bone metabolism and health and even counteract osteopenia. Are the people who benefit most from supplementation doing everything they can to optimize circadian health? Probably not. Does melatonin work? Yes. Just make sure to take it when you’d normally make it—an hour before bedtime.

Cod liver oil: If you want to supplement vitamin A, stick to cod liver oil, which has the correct pre-formed retinol form and enough vitamin D to balance your intake. Isolated vitamin A supplementation without concomitant vitamin D tends to perform poorly, while high retinol levels achieved via cod liver oil do not contribute to poor bone health.

Blackstrap molasses: For a triple whammy of bone supporting nutrients, have a tablespoon of blackstrap molasses. Just one will give you 180 mg of calcium, at least 48 mg of magnesium (and I’ve seen brands that give almost 100 mg per tablespoon), and about 20% of your daily copper needs.

Gelatin or collagen: People don’t often realize that collagen makes up a significant portion of the bone matrix. Without collagen present, bone would be overly hard and likely brittle (PDF). Collagen provides elasticity, not enough that you could make the Fantastic Four but enough that your tibia doesn’t shatter at the slightest provocation. I prefer gelatin over collagen hydrolysate because you can use the former to make fantastic sauces, curries, and gravies, but either one provides the basic collagenous building blocks that we use to make bone. Eating enough gelatin can also offset the inflammatory load caused by excessive amounts of methionine, the amino acid found abundantly in muscle meat.

Vitamin D, vitamin A, and vitamin K2: The Third Triumvirate, these three synergistically promote healthy bone metabolism. Both vitamin D and vitamin K2 have been shown to improve osteoporosis, and people often say that vitamin A is bad for bone health, but they actually promote better bones when obtained together. For vitamin D, get sun exposure or supplement to reach a blood level between 30-50 ng/dL. For vitamin A, eat liver once a week or take the aforementioned cod liver oil (which is also a source of vitamin D). For vitamin K2, eat natto, gouda, and goose liver.

Leafy greens: Greens like kale and spinach contains important minerals (calcium and magnesium) and polyphenols for bone health and inflammation.

Small bony fish: Bone-in fish like sardines provide the important pro-bone trio of animal protein, anti-inflammatory omega-3s, and bioavailable calcium.

Also, check the list of pro-bone nutrients, vitamins, and supplements listed in the recent Dear Mark post. Those that increase the healing of broken bones will also fortify otherwise healthy ones.

7. Avoid chronic inflammation

There’s strong evidence (both mechanistic and observational) that inflammation and bone health are linked.

Finally, resolution of inflammation has been shown to restore the lost osteoblast activity, so be sure to address any aspects of your diet and lifestyle that increase net inflammation.

8. Eat lots of produce

Amid all the hullabaloo regarding the relationships of animal protein, dairy, and other “controversial” foods with osteoporosis, everyone can agree that fruit and vegetable consumption has a positive connection to bone health. Study after study shows that greater intakes of fruit and vegetable (and potassium and magnesium which are markers for produce intake) predict better bone health.

There was even a controlled trial from earlier this year that found a diet consisting of vegetation known to have specific bone-friendly micronutrients and compounds—bok choy, red lettuce, Chinese cabbage, citrus fruits, parsley, sage, rosemary, and thyme—improved bone metabolism biomarkers compared to a control diet and an intervention diet full of regular old vegetation (PDF).

It’s a good idea to focus on phytonutrient-rich produce. Think colorful fruits and vegetables, like purple potatoes, cabbage, and carrots and berries of all kinds. even extra virgin olive oil contains a polyphenol with bone-promoting effects.

Sound like a lot to take in? For the big takeaways, the interventions that provide the most benefit, the things you can tell your mom (or yourself) to start doing and expect actual results without getting bogged down in the details, try the following:

  1. Lift heavy things twice a week. “Heavy” is relative (it just has to be heavy for you, not for Internet lifting board denizens). Even “things” is relative (it could be your own bodyweight, which isn’t an external thing in the normal sense of the word). But “lift” is unequivocal.
  2. Expose your body to strong but manageable impacts. Sprinting will do it. Olympic lifting, box jumps, jump squats, playing sports will do it. But so will simply hopping in place, if that’s what you can manage.
  3. Perform but don’t rely on low-impact exercise. Biking, swimming, and brisk walking are great ways to stay active and get in shape, but they don’t exert enough impact to stimulate bone strengthening.
  4. Obtain enough calcium (600-1000 mg), magnesium (400 mg), and trace minerals. A liter of Gerolsteiner would get you on your way. High quality full-fat dairy and leafy greens round out the rest.
  5. Obtain enough vitamin D, vitamin A, and vitamin K2. Get regular sun exposure or take a vitamin D3 supplement (vitamin D). Eat liver once a week or supplement with cod liver oil (vitamin A). Eat natto and gouda regularly (vitamin K2). To be sure, take a vitamin K2 supplement, since not everyone can stomach natto and I wouldn’t trust my K2 intake entirely to gouda.
  6. Eat a variety of colorful fruits, vegetables, spices, and herbs. These provide important minerals, vitamins, phytonutrients, and antioxidant compounds that can reduce inflammation and improve bone health.
  7. Avoid chronic inflammation.
  8. If poor bone health is present, look into some of the supplements listed.

The longer you wait to enact these changes, the more interventions you’ll have to introduce. It’s easier to keep what you have than get back what you’ve lost.

What about you, folks? How do you address bone health? Since going Primal, has your bone density improved (if you’ve checked)?

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You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. Question: would purified water do in place of mineral water? The stuff I drink has calcium, potassium, and magnesium in it, but no carbonation–easy on the tummy. I go through about a gallon of this stuff daily with cooking, tea drinking, and just plain ol’ water drinking.

    Wenchypoo wrote on March 29th, 2016
  2. High vitamin butter oil is a nice supplement for vitamin k2.

    barry wrote on March 29th, 2016
    • Just googled “butter oil”. I’d never heard of it. Very cool, thanks!

      Becky D wrote on March 29th, 2016
      • When I first heard of “ghee” a few years ago I had to look it up and my reaction was, “oh, butter oil!”

        Frans wrote on April 16th, 2016
  3. Well, it looks like I’m eating right. Now I just have to start hopping. That actually sounds like fun!

    Elizabeth wrote on March 29th, 2016
    • Jump rope?!

      HopelessDreamer wrote on March 30th, 2016
  4. This is helpful and timely advice! I’ll be implementing a few of the suggestions myself, and recommending these to my older friends and family members who are facing declining bone health.

    Jessica wrote on March 29th, 2016
  5. Thanks, Mark! Very helpful.

    Harry Mossman wrote on March 29th, 2016
  6. Sleep hygiene? Is that like…changing my covers daily?

    M wrote on March 29th, 2016
  7. Pre-primal my bone health was bad and deteriorating. I was told my osteopenia was getting worse at age 52, several months before going primal. About 5 months after going primal I was told it had deteriorated to osteoporosis. My CW doctor wanted to put me on bisphosphonates (actually she wanted to do that a year earlier), but I refused and chose to go the paleo/primal diet and exercise route, supplement with Vitamin D, magnesium, Primal omegas and probiotics. A year of that stopped the bone loss progression. At that point I went to a functional medicine doctor who suggested adding bioidentical hormone therapy and I also added ARx training. At my last bone density test about 1 year ago, my bone density had increased by 6%. I have another test scheduled in a couple of weeks, and my doctor is pretty confident that I will be happy with the outcome.

    Paleo4life wrote on March 29th, 2016
  8. Just wanted to say that I greatly appreciate the defense of animal protein and dairy! My ancestors were polish and I THRIVE off of dairy and natural animal fats and proteins. It’s very annoying when people try to apply their own lactose intolerance to humans in general.

    Thanks for an interesting read.

    Mitchell wrote on March 29th, 2016
  9. Mark, this was an excellent article, and a timely one for me personally, too. My activity has declined steeply this past year or so due to some changes in my life that have made it more challenging to get outdoors. I used to walk all over the small town we lived in, Benicia, CA. In fact, some people thought I was a bit strange. I walked about five miles a day, 4 to 5 days a week without even thinking about it as for a while, we only had one car. I even did my Christmas shopping this way one year. Also, I want to comment on the Gerolsteiner water: I believe it helped me through some upper GI issues. Even though I stopped drinking it for now, $$$$, it seems to have made a lasting impact on my digestive health. One day I’ll take a serious look at replicating it at home. Being postmenopausal, 56, I need to take this info to heart. It’s interesting, too, that you mention Gouda. I have difficulty with fermented dairy because, partly, the acidity. Gouda is one of the least acidic cheeses. Thanks again for these reminders- stuff I knew but haven’t been doing.

    Laura Routh wrote on March 29th, 2016
    • Have you looked at ionic magnesium? I found it had similar effects on me as the mineral water without as much cost.

      Becky D wrote on March 29th, 2016
  10. Mineral water is great but, yes, a bit costly. We’ve been taking ionic magnesium to balance out the filtered water. It’s more bio-available than tablets and has been fantastic. Helped with stress, tension, ease of movement, and better rest to name a just a couple.
    We found it through Dr. Carolyn Dean’s book “The Magnesium Miracle” which really has everything you could ever want to know about magnesium and then some, haha.

    I wish it was easier to make mineral water, I’d drink it a lot more often if I could. Apollinaris mineral water also has a good magnesium:calcium ratio and I’ve found it everywhere from Whole Foods to Big Lots.

    Becky D wrote on March 29th, 2016
  11. Mark, I hope you didn’t find those skeletons in your closet!

    Thanks for the great suggestions. Now I’m gonna ‘hop to it’.

    Noconago wrote on March 29th, 2016
  12. could not find any gerolsteiner mineral water here in the netherlands BUT had to drop off my aunty in dusseldorf last weekend which is a bit longer then a one hour drive just cross the german border and found a big supermarket near the airport… and what do you know… 1.5 liter bottles of gerolsteiner for just 89 eurocents… i can home with 24 bottles hahaha

    funny thing is that i go to dusseldorf a couple of times a year so i am a happy camper :)

    ender kulan wrote on March 29th, 2016
  13. And don’t forget your bone broth for lots of minerals. Mark has an article on ‘Cooking with Bones” http://www.marksdailyapple.com/cooking-with-bones/#axzz44KwFI8Kl

    Maureen wrote on March 29th, 2016
  14. Anyone have recommendations for minimalist shoes/boots for work as landscaper/waterfeature construction? Stealtoe not necessary, thanks. Thanks for another good articule!!

    Paul wrote on March 29th, 2016
    • Look at the Vibram fivefinger range, they’ve hugely increased their range in recent years, I wear nothing else now.

      Kelda wrote on March 31st, 2016
      • Thanks, but I need something with harder sole for literally jumping on shovel when digging big holes! I have a couple pair of vibrams and do like them for workouts and walking around. Also love Lems shoes. I guess I am looking for minimalist work boot-very hard to find!

        Paul wrote on March 31st, 2016
        • Hi Paul, two of my sons have Merrell Bare Access shoes (Vibram sole) and they have a zero drop but quite a sturdy sole considering that they are essentially a ‘barefoot’ shoe. In fact, reviewers complain that there is less ground-feel than they would like. I’m not sure if they would be strong enough for you but they are a world away from my Merrell Pace Gloves, which are a lot more minimal. I think there is a Gore-Tex version in men’s. Best wishes.

          Caroline wrote on April 2nd, 2016
  15. I’ve been using computers very little lately (my library account is deactivated and I assume I’ll need ID to rectify that, unless my six month ban was extended after getting ornery with the arrogant rent-a-cop six months ago who banned me for no good reason, in which case I’d rather just sneak in and use the stupid 15min limit guest computers than have them look up my account info and kick me out again).
    Might head out before reading much more but the mineral water link reminded me that lately I’ve occasionally been buying pure vitamin C powder. It’s “King of Spice” brand or that’s part of their label. I get it at a Bulk Barn in 100g bottles for $6. I mix it into water and other drinks and it tastes like lemon.

    Animanarchy wrote on March 29th, 2016
  16. Dammit, Mark — every time you recommend Gerolsteiner, Trader Joe’s has a shortage. Stop it!

    Margaret wrote on March 29th, 2016
    • Our Trader Joe’s seems to have a shortage of everything – recommended or not. We can’t count on anything we need being available anymore. It’s becoming very annoying You’d have thought they’d have figured it out by now — just saying—

      PrimalGrandma wrote on March 29th, 2016
  17. Thanks for this info Mark, I will “bone up” on this material as I am having foot surgery in a few weeks. :)

    HealthyHombre wrote on March 29th, 2016
  18. Regarding melatonin, less is often more. Start with a minimal dosage, such as one-half to one mg. Experiment to find your personal sweet spot. For me it’s about 1-1/2 mg. Too much can cause an unpleasant jittery feeling for some people.

    Shary wrote on March 30th, 2016
  19. The better bones blog at the women’s health network says a study claims eating 6 prunes a day helps build bones. 2 after every meal?

    I started hopping a couple of years ago but then got distracted and forgot to keep it up. That seems to be my MO about most exercise. Actually, I find jump roping is a little more interesting than hopping,

    Maybe I should conjure up some adult game that involves hopping or just incorporate it into my mode of transportation.

    Sharon wrote on March 30th, 2016
    • I would think jumping rope is the definition of ” hopping”! I just started doing jump rope sprints, so I hope that will count as ” hopping”! (It’s fun, too.)

      HopelessDreamer wrote on March 30th, 2016
  20. Great article. I was diagnosed with osteopenia in my hip about 6 months ago (I’m 49). About 1 year ago, I started exercising (Pilates, mainly on machines).

    I bought a Bellicon rebounder after my diagnosis and love it. I was able to get it reimbursed under my Flex Spending Account due to medical necessity because I was diagnosed with chondromalacia patella about 2 years ago. That means any hopping/ high impact is out.

    In the beginning of Feb I joined the YMCA and have started out with weight machines and have gotten serious with cardio (in terms of getting the suggested 150-200 minutes a week). With all this, my rebounding has decreased but I feel confident that the exercise I’m doing suffices. I was glad to read about the lesser impact that helped women over 60 because high impact just isn’t do-able. In fact, once osteoporosis sets in, high impact can be risky.

    I’ve started taking Life Extension’s Bone Restore.

    Is my diet primal? Well… I lean that way mentally and have started incorporating more ideas into my diet, but I’m still very far from perfect!

    I’m hoping for better news for my next appointment.

    One Q about blackstrap molasses – do people just take it straight from the spoon, or mixed in with something?

    Julia wrote on April 2nd, 2016

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