Chris Kresser: Certainly, vitamin D and vitamin K2 are crucial here. K2 may be even more important than vitamin D. Very large doses of K2 have been used to treat osteoporosis. Som Japanese studies used up to 45 mg. We don’t know of an upper limit of vitamin K2 at this point. I tend to be a little more conservative just in case we find one later, but certainly, 10 to 15 mg of K2 could be useful here. That’s milligrams not micrograms. Typical doses of K2 are often set at a few hundred micrograms, but I’m talking about 10,000 to 15,000 mcg or 10 to 15 mg. That’s very important for bone health. Then you want to assess calcium intake here. Most people aren’t getting enough calcium. Unfortunately, the serum, urine, and hair testing for calcium is not accurate because most of calcium in our bodies is stored in the bone and the tissue, the hard tissues like the teeth, so it’s very difficult to assess using conventional laboratory methods.
The best way to do it is to get people to track their diet over a three-day period and then use an app such as Chronometer to enter their food intake. I’m talking about very carefully, like weighing what they eat, measuring, and being very specific just for three days. It’s a pain in the butt, but you can do it for a few days. Then Chronometer will spit back a nutrient report, and it’ll tell you how much of each different nutrient that you’re getting. You want to see someone, especially an older woman who is dealing with osteoporosis should be getting over 1,200 mg of calcium a day in the diet. What you’re going to find is that’s going to be very, very difficult to do unless they’re eating bone-in fish like anchovies, sardines, and salmon that have the bones in them. The bones are soft when they’re canned, and they’re easy to eat that way, or dairy products.
There are some good plant sources of calcium, but you have to be aware of antinutrients that inhibit their absorption. Cruciferous vegetables such as broccoli tend to be high in calcium, and they don’t really have a lot antinutrients, so those are good. But spinach and some other dark leafy greens, they’re high in oxalic acid. Even though they contain a lot of calcium on paper, the oxalic acid is going to inhibit that calcium absorption from those plants. As many of you know, I’m actually a proponent of full-fat and fermented dairy products if the person can tolerate them well, and this is one of the reasons. They’re such a great source of bioavailable calcium and also vitamin K2 if it’s grass-fed dairy and vitamin A, which would be beneficial here.
So unless this patient has a specific problem with dairy like they’re insensitive to lactose or casein, then I would say definitely include that along with the supplemental K2. Cod liver oil they could use also for some vitamin D and A, and then the higher dose of K2. Then if she cannot tolerate calcium or dairy products and can’t eat enough bone-in fish to meet that 1,200 mg requirement a day, calcium supplements are not a good idea in most cases. The research has shown that calcium supplements actually have the opposite effect in many cases to dietary calcium.
The one exception is bone meal. Whole bone calcium affects the body in the same way that dietary calcium does. There is a whole bone calcium supplement from Traditional Foods. They’re kind of, I think, a lot of their products based on the kind of Weston Price philosophy, and it’s the only calcium supplement that I would take myself or recommend for family or for my patients. Let’s see if we can—let me give you the exact details here. It’s Traditional Foods Market, traditionalfoods.org is the website, and then it’s called Free Range Pasture Fed Whole Bone Calcium. The whole bone calcium is from, as the name implies, free range pasture-fed animals. I think that’s a great option for calcium supplementation for people who can’t get enough through the diet.
Some weight-bearing act exercise such as strength training is also very important for bone health for women, for everybody, but for particularly women of this age. I think lifting weights like getting her set up with a personal trainer who can address her particular issue since she has osteoporosis and spondyloarthritis. There are some specific considerations, of course, but a skilled personal trainer will know how to work with that. That’s very, very important for restoring normal bone health in addition to everything else we’ve talked about.