Osteopenia, low carb & calcium

[Alexandra100]

I recently had a big shock when I was diagnosed with osteopenia. Osteopenia is to osteoporosis as pre-diabetes is to diabetes ie the situation is already serious and something needs to be done! My scoliosis (S-shaped side to side curve of the spine) has taken a big turn for the worse, with frequent pain, especially when standing and walking. Is my weakened spine crumbling / collapsing? I do wonder.
Of course I researched diet. Adequate calcium intake is defined as 1200mg for women over 70. However, too much dietary calcium may end up blocking arteries! The best sources of calcium by far are dairy and fish bones (as in tinned sardines and salmon). To get 1200mg of calcium from plant sources would require consuming quite unrealistic amounts of eg spinach. To make that worse, spinach is suspected of impairing absorption of calcium. For those of us who have given up milk, only cheese is left, and for those of us who need to eat low calorie as well as low carb IMO the only solution is calcium tablets. Since I am very under-weight, eating lots of cheese (especially hard British cheese such as Cheddar, the highest in calcium) is calorie-wise not a problem, though upping my cheese intake will likely not help my LDL.
For calcium absorption, vitamin D is needed. Collagen (gelatin) is also said to be very important for strong bones. I have bought a tub of high quality powdered collagen (at huge expense) and am consuming 1 heaped T daily.
I read that we can't absorb more than 500mg calcium at one time, so I am keeping a spreadsheet and programming 2 meals with 500mg and a snack in between with 200mg. I have some good quality calcium tablets for a backup any time I don't meet my target by diet.
Are 1200mg of calcium really necessary for a woman over 70? I have no idea.
I do urge anyone, especially if you are eating low carb and avoiding milk, at least to check out your calcium intake.
I'd love to hear from anyone with osteopenia or osteoporosis.

 

[Dr Snoddy]

Hi Alexandra. I broke my wrist, developed chronic regional pain syndrome, was diagnosed with osteoporosis and then Type 2 Diabetes all within 8 months. It was not a good time but fortunately I have a science and nutrition background. I did increase my uptake of hard cheese quite happily. I was given tablets that contained both calcium carbonate and Vit D3 but they did give me horrendous constipation. So ditched the tablets, purchased D3/K2 spray from BetterYou and decided to rely on dietary sources of calcium. I was also prescribed alendronate which I have up after 3 years as I was concerned about possible long term effects.
One of the best dietary sources of calcium is actually tofu at 510mg Ca per 100g although fried whitebait is better at 860mg Ca per 100g along with other fish with bones in and hard cheeses are also incredibly good. However, I very much doubt that I get anywhere near 1200mg per day as recommended. The good news is that for the past 6 years my hip joints have been in the normal range for a healthy 30 year old woman which I very definitely am well beyond. They were previously osteopenic. My spine has moved out of the osteoporosis range and is now oestopenic instead. so to some extent I have been able to improve my bone health. I also walk a lot on hard surfaces.
So a nutritional drug-free approach has worked for me so far. I also put the diabetes into remission in the same time frame.
If you decide that you do need more calcium I would suggest getting one of the forms that is more bioavailable like calcium citrate. I tried to get this on the NHS but was refused as it is more expensive. Calcium carbonate as a supplement is all but useless unless you are severely calcium deficient.

 

[AndBreathe]

I recently had a big shock when I was diagnosed with osteopenia. Osteopenia is to osteoporosis as pre-diabetes is to diabetes ie the situation is already serious and something needs to be done! My scoliosis (S-shaped side to side curve of the spine) has taken a big turn for the worse, with frequent pain, especially when standing and walking. Is my weakened spine crumbling / collapsing? I do wonder.
Of course I researched diet. Adequate calcium intake is defined as 1200mg for women over 70. However, too much dietary calcium may end up blocking arteries! The best sources of calcium by far are dairy and fish bones (as in tinned sardines and salmon). To get 1200mg of calcium from plant sources would require consuming quite unrealistic amounts of eg spinach. To make that worse, spinach is suspected of impairing absorption of calcium. For those of us who have given up milk, only cheese is left, and for those of us who need to eat low calorie as well as low carb IMO the only solution is calcium tablets. Since I am very under-weight, eating lots of cheese (especially hard British cheese such as Cheddar, the highest in calcium) is calorie-wise not a problem, though upping my cheese intake will likely not help my LDL.
For calcium absorption, vitamin D is needed. Collagen (gelatin) is also said to be very important for strong bones. I have bought a tub of high quality powdered collagen (at huge expense) and am consuming 1 heaped T daily.
I read that we can't absorb more than 500mg calcium at one time, so I am keeping a spreadsheet and programming 2 meals with 500mg and a snack in between with 200mg. I have some good quality calcium tablets for a backup any time I don't meet my target by diet.
Are 1200mg of calcium really necessary for a woman over 70? I have no idea.
I do urge anyone, especially if you are eating low carb and avoiding milk, at least to check out your calcium intake.
I'd love to hear from anyone with osteopenia or osteoporosis.

Mid 2019 I was prescribed Liothyronine, in addition to Levothyroxine to treat my hypothyroidism. Thereafter I was referred to the Metabolic Bone Clinic for a DEXA scan by my Endo, to check bone health.

The outcome of that scan was a brief diagnosis of osteoporosis. I say brief, because it was promptly re-assessed to be osteopenia in one hip, but otherwise fairly decent bone health - in the joint scanned.

I always have consumed dairy products, including milk so continued with that, and I ensure I take decent levels of weight bearing exercise.

At the time, I was offered treatment with Alendronic Acid, but reading the available information, I elected to wait and watch for some time. Alendronic Acid isn't a particularly pleasant drug, and whilst it can help with bone health - mainly be slowing any deterioration, it can also cause brittle bones and other seemingly counter productive side effects. I will be rescanned in 2024 (Yes, I have the appointment already!), or sooner, if I exhibit any symptoms, or experience a pathological fracture.

Alexandra, do you have the breakdown of your results from your DEXA scan? Those can be helpful to your thought process.

Finally, when I questioned the probable and potential root causes for my sub-optimal bone health, medical opinion was most likely my hypothyroidism, which had proven tricky to treat effectively, or my period of anorexia earlier in life, when I was effectively under-nourished. There was no mention of low carb as a potential suspect, and my Endo is very clear about my LC and gluten-free lifestyle.

I am still quite a slight person, but I do ensure I don't lose any weight.

 

[Alexandra100]

So a nutritional drug-free approach has worked for me so far. I also put the diabetes into remission in the same time frame.
If you decide that you do need more calcium I would suggest getting one of the forms that is more bioavailable like calcium citrate.

@Dr Snoddy, thanks very much for the encouragement. Your success is admirable. I hope to follow your example. I don't at all like the sound of the drugs on offer, so it will be diet and exercise for me. Thank heaven for Cheddar cheese.
I already bought calcium citrate. I am keeping it in reserve to take at the end of any day where I see I am not going to hit the 1200mg target. I do have my doubts whether such a high calcium intake is necessary or even desirable, but I don't know of any way to find out for sure.

 

[Alexandra100]

I do urge anyone, especially if you are eating low carb and avoiding milk, at least to check out your calcium intake.

To clarify, I have never heard of a low carb diet's leading to bone weakness. However, if one is avoiding milk and restricting yoghurt in one's low carb diet (as I do) AND restricting cheese intake in order to keep calories down, AND one is a woman over 70, it may be hard to get recommended levels of calcium in one's diet. Whether those recommendations are correct is another matter entirely.

 

[Dr Snoddy]

Also, just remembered that a DEXA scan measures bone density which does not necessarily equate to bone strength.

 

[Dr Snoddy]

Calcium supplementation
Calcium supplementation is no longer routinely recommended to improve bone health because it lacks fracture reduction efficacy and potentially increases cardiovascular events.4

A dietary calcium intake of 500 mg/day (2–3 servings of calcium-rich foods such as dairy products [milk, yoghurt, cheese], calcium-fortified products [fortified soy and rice milks, fortified cereals and fortified orange juice], tofu, calcium-rich vegetables, tinned sardines/salmon [including the bones] or calcium-rich nuts and fruits) is sufficient for an adult.

You may find this interesting. It is the official guidance for the treatment of osteoporosis in New Zealand.

 

[AndBreathe]

To clarify, I have never heard of a low carb diet's leading to bone weakness. However, if one is avoiding milk and restricting yoghurt in one's low carb diet (as I do) AND restricting cheese intake in order to keep calories down, AND one is a woman over 70, it may be hard to get recommended levels of calcium in one's diet. Whether those recommendations are correct is another matter entirely.

Alexandra, how are your vitamin D levels? It is important they remain at a good point, which in my view is right a the top of the "normal" range, or a little higher. If you are taking Vitamin D, it should be D3, with K2 for increased bio-availability.

Which medical team are caring for you relating to your bone health?

 

[Alexandra100]

Alexandra, how are your vitamin D levels? It is important they remain at a good point, which in my view is right a the top of the "normal" range, or a little higher. If you are taking Vitamin D, it should be D3, with K2 for increased bio-availability.

Which medical team are caring for you relating to your bone health?

@AndBreathe, I have not had my vitamin D levels tested recently, but I am taking the highest daily dose that is considered safe, and because I have digestive problems which may well impair absorption I use a spray. I have recently begun taking K2 separately - the MK7 form. Thanks for asking.

As for being cared for by a medical team, that would be my GP, but as I don't like the sound of Fossamax, I will have to try and address this by diet and exercise.

 

[Alexandra100]

You may find this interesting. It is the official guidance for the treatment of osteoporosis in New Zealand.

@Dr Snoddy, yes its very interesting that in New Zealand 500mg calcium is considered sufficient, whereas here, "The National Osteoporosis Foundation recommends that women aged 50 or younger and men 70 or younger should get 1,000 milligrams (mg) of calcium per day. Men and women older than that should get 1,200 mg daily."
The NHS says one can take up to 1500mg calcium daily without risk. I take issue with some of the target amounts for various vitamins and minerals they set, and yet go on to say these can be had from a normal diet. IMO its either lower the targets or accept that supplementation is often/usually/ necessary to meet them.

 

[Alexandra100]

Also, just remembered that a DEXA scan measures bone density which does not necessarily equate to bone strength.

@Dr Snoddy, yes, I recently learned about this from a video by Dr Ken Berry. I would certainly not adopt him as my guru, but he has influenced me to start taking collagen every day precisely in order to improve my bone strength. I have not yet adopted his strategy of eating egg shells in order to ingest a high (and free) dose of calcium!

 

[Alexandra100]

One of the best dietary sources of calcium is actually tofu

@Dr Snoddy I used to eat tofu every day, until I read 2 large population studies of Japanese couples eating tofu every day or even several times daily. They had a raised tendency to developing Alzheimer's. It has been suggested that tofu is OK for the young, but not for older people (like me). I don't know the truth, but IMO its not worth the risk. I believe the fermented form of soy, Natto, is thought to be OK. Last time I tried it, I found it disgusting, but perhaps I should try again.

 

[NicoleC1971]

I remember Cadbury advertising their chocolate as beneficial because of its milk content!
Logically though if Japan is a country where they don't consume much dairy why is it that they have a low incidence of osteoporosis? I don't think this issue is to do with low calcium intake.
Possibly that is the tofu and or the K2 in foods like natto (I think). I take my d3 wih k2 but the latter can be found in Swiss cheese, sauerkraut and Korean Kymchee (no idea if that is how it is spelt but that's my phonic version).
For anyone below mid 30s doing some impact exercises can help and unless you have very fragile bones, so can using a vibration plate (originally designed to strengthen the bones of astronauts after gravity had softened them).
Into your later years doing exercise to strengthen muscles should also help support joints and the skeleton such that you are less prone to falls. Ditto balance work.

 

[AndBreathe]

@AndBreathe, I have not had my vitamin D levels tested recently, but I am taking the highest daily dose that is considered safe, and because I have digestive problems which may well impair absorption I use a spray. I have recently begun taking K2 separately - the MK7 form. Thanks for asking.

As for being cared for by a medical team, that would be my GP, but as I don't like the sound of Fossamax, I will have to try and address this by diet and exercise.

I have to agree bisphosphates can be quite unpleasant if the individual gets unlucky on their impacts. I was prescribed alendronic acid (bisphosphate) before I had had the chance to research it. I took one dose then agreed with the Endo I'd go solo. The consultant from the Metabolic Health clinic was fine about it too.

 

[aard]

@Dr Snoddy, yes, I recently learned about this from a video by Dr Ken Berry. I would certainly not adopt him as my guru, but he has influenced me to start taking collagen every day precisely in order to improve my bone strength. I have not yet adopted his strategy of eating egg shells in order to ingest a high (and free) dose of calcium!

yeah some of what Ken Berry makes sense, but he definitely has some weird contradictory views on some things especially when it comes to vegetables and fruit. He will often recommend some things saying man has evolved over thousands of years to eat them but then will dismiss things like eating/drinking wheat and milk as not natural; despite humans consuming them for ten thousands years.