Dr. Vliet’s Health Tip: Beyond Calcium: Critical Factors for Strong Bones

Estradiol is needed for proper gastric pH for calcium to be absorbed from the stomach and then deposited into bones.  When estradiol is too low, calcium can’t be used to build bone so calcium deposits build up in soft tissues like breast, eyes, kidneys, and arteries.  I describe this in more detail in my book, Screaming to Be Heard: Hormone Connections Women Suspect and Doctors Still Ignore. Men and women reach peak bone density in their mid-3os, and from then on, there is a gradual (or more rapid) decline in bone depending on many aspects of our health—hormone balance, diet, other medicines, stress, etc.  So what minerals and other factors ARE overlooked and needed for strong bones?  I’ll discuss that in today’s health tip.

But first, what are the most important objective measures to check?
As part of my laboratory analysis for all my patients, I check additional vitamin and mineral levels most doctors ignore—N-telopeptide (NTx), 25 OH vitamin D, magnesium (serum and red blood cell), zinc, selenium, and other critical minerals, not just calcium included on a comprehensive metabolic panel.  I also always include the gold standard serum tests of estradiol, testosterone, DHEA-S and unconjugated DHEA –the critical hormones for building strong, healthy bone.  Older men and women get a baseline DEXA bone density (BMD test of hip and spine bone density, to give a reliable marker of debilitating fracture risk.   This comprehensive analysis of my patients then gives me a clear picture of bone health and future fracture risk, so that we can work together to develop a robust plan to help them rebuild strong healthy bone.

Most of the patients I see have been found to heave unrecognized deficiencies in vitamin D stores, zinc, magnesium and other minerals, even though more than 90%of my patients have normal serum calcium levels. This is not so unusual, since parathyroid hormone regulates blood calcium levels within a narrow range at almost any cost, which includes robbing calcium from our skeleton when intake is not adequate or when absorption is impaired by low gastric pH, taking anti-acid meds, or proton-pump inhibitors and other medications that interfere with calcium absorption.

Balanced serum calcium is crucial to so many critical functions in the body—muscle contraction, including the heart muscle, nerve signal transmission, blood clotting, blood vessel constriction and relaxation, and normal enzyme function—that parathyroid hormone is the master regulator to maintain calcium homeostasis, including as I said above, stealing calcium from our bones to keep calcium in the bloodstream within the critical range.  This loss of calcium from the bones can lead to decreased bone density,  increased bone fragility, and increased risk for osteoporosis.

It may surprise you that I generally do not recommend calcium supplementation as the primary mineral for reducing risk of osteoporosis, or the main source of calcium intake.  The best option is to get adequate calcium (600-800 mg a day) from food sources: dairy products (especially full fat yogurt, Kefir, or cottage cheese), canned salmon with bones, and to a lesser extent nuts and seeds.  For those sensitive to lactose (milk sugar), the fermented dairy products like yogurt and Kefir don’t seem to be a problem.  I generally don’t recommend calcium from plant sources is not as well absorbed due to phytates and fiber blocking absorption. Calcium in foods is absorbed more efficiently because it is consumed with other nutrients like protein and other minerals which aid calcium uptake. It also helps spread your calcium doses throughout the day with each meal to align better with your body’s absorption capacity rather than one large supplemental dose.

Calcium supplements have also been associated with higher risks of cardiovascular plaque and gastrointestinal issues like constipation, bloating, and gas. Excessive calcium supplementation can also disrupt mineral balance by interfering with the absorption of other minerals like iron, zinc and magnesium.  This problem typically doesn’t occur with calcium from food sources, since calcium is present in balanced amounts and does not impede the other minerals absorption.

The bottom line is that calcium from food provides steady absorption throughout the day and avoids the sudden high blood calcium spikes seen with supplementation.

There are a number of overlooked vitamins and minerals that are crucial for strong bones and affect calcium from your diet being absorbed and deposited into bones where you need it!   Here are the critical ones I have in my recommended Bone Health Formula:

• TruOptiD3+K2™
• TruMagnesium™
• TruZinc™
• TruMultiV or TruMultiV with Iron to provide the proper levels of supplemental selenium and manganese and other trace minerals.

Let’s look at each one of these:

Vitamin D3 and K2 (TruOptiD3+K2™)–key players. Vitamin D3 and vitamin K2 interact with calcium metabolism in a complementary manner. Vitamin D3 promotes intestinal absorption of calcium, increasing calcium levels in the bloodstream.  Vitamin K2 then helps to direct this absorbed calcium from the bloodstream into the bones and teeth by activating a calcium binding protein called osteocalcin that supports bone mineralization.  Vitamin K2 also simultaneously activates matrix GLA protein, which prevents calcium deposition into the soft tissues such as arteries, reducing the risk of breast, eye, kidney, and vascular calcification and related cardiovascular diseases. Vitamin K2 is needed for Vitamin D3 to work properly in regulating calcium absorption.  Without the K2, and only taking vitamin D3, calcium  may accumulate in arteries and soft tissues potentially increasing risks of arterial calcification, heart disease and kidney stones.

That is why I recommend taking vitamin D3 and K2 together in a balanced formula to help maintain calcium absorption and deposition into bone preferentially, and avoiding excess calcium deposits into soft tissues that creates other health risks.

TruOptiD3+K2™ Summary of Clinical Applications
• Supports Bone Health by Promoting Carboxylation of Bone Proteins*
• Supports Cardiovascular Health by Affecting Arterial Calcium Deposits*
• Supports Healthy Blood Clotting*

Since few of us actually get out in the sun without sunscreen enough to have adequate vitamin D from sunlight, TruOptiD3+K2™ provides the dosage I find commonly needed for most people: 5000 IU Vitamin D3 with 90 mcg of K2.

TruOpti D3+K2™ provides vitamin D3  as cholecalciferol, the identical form in which vitamin D is derived in the body from cholesterol and synthesized by sunlight on the skin. TruOpti D3+K2™ also features K2 as menaquinone-7 (MK-7), the highly bioavailable and bioactive form of K2. This is an important distinction.  Vitamin K supplements can be found in three forms: synthetic K1; MK-4, which is structurally like K1; and natural, long-chain MK-7.  Current research shows that the need for menaquinones is higher than were previously thought.

TruOpti D3+K2™ provides MK-7 as Vitamk7™, a naturally derived and solvent-free vitamin K2 that has been obtained through a patent-granted biofermentation process of Bacillus subtilis natto cultures. In addition, improved MK-7 bioavailability increases extrahepatic tissue utilization of vitamin K. Schurgers et al conducted human studies to compare the in vivo properties of orally administered K1 and MK-7. The results supported better bioavailability and utilization of MK-7 as did other animal and human studies that demonstrated a significant beneficial effect of MK-7 supplementation on bone health.  It is challenging to get adequate K2 from dietary sources, which is the reason I recommend supplementation.

A Few Important Notes about K2:

1. There is not an optimal dosing time for taking vitamin D3 and K2.  It is just important to take them together with a meal that contains fat, since both are fat soluble vitamins, and absorption is enhanced by dietary fat. The most crucial factor is consistency rather than specific time of day.
2. Caution if  you are taking the anticoagulant (blood thinner) warfarin (Brand name: Coumadin): Vitamin K2 can reduce the anticoagulant effect and lower warfarin efficacy, potentially increasing the risk of clotting.  Check with your physician before starting K2 supplements. Those taking vitamin K supplements that are on warfarin need to take vitamin K2 on a consistent basis to avoid sudden fluctuations in blood clotting control and need to be monitored by their physician to measure the INR (International Normalized Ratio), a blood test to check warfarin effectiveness.

Magnesium influences bone mineralization and formation by stimulating osteoblasts proliferation and activity as well as increasing alkaline phosphatase activity, an enzyme important in bone mineralization. Magnesium further helps regulate calcium and phosphorus balance.  Low magnesium also impairs parathyroid hormone (PTH) secretion and can lead to decreased calcium absorption and bone loss. Magnesium deficiency also promotes inflammation which can exacerbate bone loss.

Excess calcium and low magnesium intake also increases the risk of blood clots, which is already markedly increased in people who had the COVID shots.  This is another critical reason among many to be sure that you are taking magnesium supplements each day.  Most American diets are seriously deficient in magnesium.

Selenium is an essential trace mineral that is important in DNA synthesis, reproduction, protecting cells from oxidative damage from free radicals, and is a powerful antioxidant helpful in reducing inflammation.  Selenium Inhibits excessive bone resorption by suppressing osteoclast activity, stimulates mitochondrial function and biogenesis of bone cells, and is essential for the synthesis of selenoproteins, which have antioxidant functions that help maintain redox balance in bones cells which reduces oxidative stress and inflammation that can otherwise damage bone tissue and accelerate bone loss. Selenium is naturally present in foods like Brazil nuts, fish, meat, eggs and grains. Selenium is only needed in small amounts! Higher levels are toxic.  Do not exceed 400 mcg per day.

Manganese is also an essential trace mineral that plays a crucial role in bone health and bone metabolism. Manganese stimulates osteoblast proliferation and differentiation, supporting the formation of new bone. Manganese acts as a cofactor for several enzymes involved in bone formation. It influences bone mineralization by promoting collagen formation and deposition, the primary organic component of bone, and modulates bone remodeling by regulating the activities of osteoblasts and osteoclasts. Deficiency of manganese leads to impaired bone growth, decreased bone mineral density, and skeletal abnormalities. Manganese works synergistically with other minerals such as calcium, zinc, and copper to support bone mineral density and reduce bone loss, especially in older adults and postmenopausal women. Excessive manganese exposure may have adverse effects on mitochondrial function in bone cells, potentially negatively impacting bone health.  The good news is that both are usually found in most multivitamins in the proper dose and balance to the other minerals in the formulation to avoid taking too much.

As always, we urge you to avoid supplements without checking knowledgeable sources to evaluate your medical situation, proper lab tests to verify what is needed, and to make sure to avoid adverse interactions with prescription medicines and other supplements you take.

I encourage you to consider our other natural medicines with our top quality, cGMP-compliant professional formulas for TruImmune™Boost, TruNAC™, TruImmunoglobulin,™ TruC with BioFlav™ (Vitamin C with complete Bioflavonoids), Tru BioD3™, TruZinc™, TruMitochondrial ™Boost and TruProBiotic™ Daily to replenish critical bifidobacteria depleted by COVID shots, viral illnesses, and antibiotic therapy.

All Truth for Health Foundation Formulas Meet or Exceed cGMP Quality Standards, the highest quality standard for supplements sold in the USA.
For more information, references from studies are listed in the Product Data Sheets for each product, available on our website.  Under medical practice regulations, we are unable to answer individual medical questions or make specific individual supplement recommendations for people who are not established patients of Dr. Vliet’s independent medical practice.

To Your good health and improving resilience!
Elizabeth Lee Vliet, MD

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