4 skeletons playing musical instruments

Image of four skeletons playing musical instruments by Jacques Gamelin (1779) courtesy of Wellcome Images, a website operated by Wellcome Trust, a global charitable foundation based in the United Kingdom


Part 1 was last month, in which we covered bone health in general, and the pros and cons of calcium.  Now: on to everything else!


Calcium, without magnesium, is a problem.  We know that insufficient magnesium impairs bone formation, especially in adolescence.  We also see that higher magnesium is linked to better bone density and better markers of bone turnover.  Magnesium is needed to activate vitamin D, too.

Meanwhile, low magnesium levels are implicated in diabetes, high blood pressure, heart disease, asthma, migraines, kidney stones, muscle cramps, anxiety, even colon cancer.

There’s almost nothing in the body magnesium doesn’t touch, directly or indirectly.

And yet most Americans are deficient in the crucial mineral.  In 2005-2006, for example, more than half of us fell below the recommended daily allowance of 400 mg – itself considered low by many experts. 

We can blame our magnesium deficiency first of all on declining dietary intake.  Consider the foods richest in magnesium: whole grains, beans, nuts, leafy greens, seaweeds, some mineral waters, and some fruits (okay: and chocolate[1]).  Our ancestors used to eat like this every day.  Today, we’re lucky if we see a single whole grain on our plates all day.

We can also blame our low magnesium on the amount of calcium we get.  Calcium displaces magnesium in the body, and uses it up.  So the more calcium we get, the more magnesium we need.  (Two other things that deplete magnesium?  Caffeine and alcohol).

Generally, we want to look for a ratio of magnesium to calcium around 1:2 or even 1:1.  Depending, of course, on absorption and other factors.  Better-absorbing forms of magnesium include magnesium citrate and generic chelates.  Some of the best-absorbing forms include magnesium glycinate and magnesium taurate.  Poorer-absorbing forms such as magnesium oxide are acceptable, but run a higher risk of creating loose stools.

Vitamin D:

This so-called “sunshine vitamin” isn’t actually a vitamin at all.  Why not?  By definition, the body cannot manufacture vitamins; they need to be obtained through the diet.  But the body can make vitamin D, whenever our skin is exposed to direct sunlight.

Mostly this is relevant because our vitamin D levels fluctuate seasonally.  We tend to run low in winter (very low in New England).  Meanwhile, we tend to do fine in summer.  Unless our summers are sunless, too, like they are for some office dwellers, committed users of SPF-40, and nursing home residents.  We also see lower levels in dark-skinned people, whose skin tone acts as a sort of built-in sunblock.

About 20 years ago, nobody talked about vitamin D beyond preventing rickets.  A decade later, new and evolving research had somehow transformed this nutrient into the end-all-be-all bone nutrient of our time.

Today, we can see that the truth falls somewhere in between.  Adequate vitamin D is absolutely crucial for bone health.  But there may not be additional bone benefit going much higher[2].

So my suggestion is to get adequate!  For most of us, that’s going to involve somewhere between 2,000 and 5,000 iu daily in the winter months.  Or whatever a blood test points you to.    Vitamin D absorbs better with fatty food.  Vitamin D3 is better than vitamin D2.

Vitamin K:

K is for koagulation – at least in the original German it was.  But there’s a lot more going on here than simple blood clotting.  Vitamin K is also the quintessential calcium management nutrient.

It helps get calcium to the right places, and keep it out of the wrong ones.  In the bones, vitamin K activates both osteoblasts (building up bone), and osteoclasts (breaking down bone).  The net result is not only greater bone density, but also greater bone quality, as old, brittle bone is slowly replaced by fresh, vibrant bone.

The research on vitamin K is quite good.  Close to two dozen positive human clinical trials already.  And when the right doses of the right forms are used (see below), we see consistent improvements in bone density, and other markers of bone health.  In one study, vitamin K was compared directly to Fosamax™.  The Fosamax™ put up better numbers in bone density (i.e. lab results), but the K demonstrated greater reductions in fracture (i.e. real world results).  In another study, K or placebo was used for two years by 120 osteoporotic patients.  Vitamin K reduced the risk of spine fracture by more than half.  Meanwhile, the placebo group saw a 3.3% decrease in lumbar bone density, vs. only a 0.5% decrease in the K2 group.

Plus vitamin K reduces the risk of heart disease, and protects the brain from aging.  Simply put, vitamin K is my single favorite nutrient for the bones.   Simple enough?

Now, bear with me while I make it a little more complicated.  There are two kinds of vitamin K: K1 and K2.  K1 is alright, for clotting at least.  But if you’re looking to help your bones, you’re really going to want the K2.

Unfortunately, there are also different kinds of K2, each of which has its own number and multisyllabic name.  The two primary ones are MK-4 and MK-7.  Long story short, MK-4 has more research behind it – and better research results.  In fact, the studies I cited earlier all used MK-4.  Almost all of the impressive trials do.  And MK-4 is also more versatile.[3]  Meanwhile, MK-7 may not do as much, but it appears to do what it does at a lower (read: less expensive) dose, and lasts longer in the body.[4]

For me, if money were no object and I really needed the help, I’d reach for the MK-4 without hesitation.  A standard dose is 45 mg a day.  That will set you back about $50 a month.

If you want to opt for the MK-7, a standard dose is in the ballpark of 100-200 mcg a day, although it generally doesn’t hurt to go higher.  What I really like to recommend, though, if you’re not going “full MK-4” is a brand-name product from the Life Extension company.  It’s a combo of low-dose MK-4, high-dose MK-7, and a standard dose of plain K1.  It runs $10 a month.  Or the very-easy-to-take liquid vitamin D + K drops from Carlson Labs.

Very few food sources approach the doses of K2 you can get with supplements.  Except for a Japanese fermented food called natto; an “acquired taste,” to put it politely.  Liver, aged cheeses, and grass-fed eggs are all small but entirely insignificant sources as well.

Finally, we should talk about vitamin K vs. Coumadin™, a common drug which prevents clotting by interfering with vitamin K’s role in the process.  Unfortunately, this doesn’t just block clotting, but everything vitamin K does.  Not surprisingly, there is now research which suggests that anticoagulants may decrease bone density, and increase risk of fracture.

Often, we’re instructed to keep vitamin K low when we’re on these drugs.  However, this is not necessary.  What’s necessary is to keep vitamin K consistent – and then to calibrate your Coumadin™ to that consistent level.  In fact, we see better Coumadin™ control when people supplement with vitamin K: when you start with moderate baseline levels of a nutrient, dietary fluctuations are less severe.  This isn’t something to do-it-yourself at home.  You need to work with your doctor or clinic.  But you can do it.


No other nutrient puts up such impressive numbers in terms of bone density improvements, in just a matter of months.

In fact, the increases in bone density were sometimes so dramatic in the scientific literature, they actually worried scientists.  The thinking went like this: if we see a 14.4% increase in lumbar spine bone mineral density in three years (which we saw in one study, published in the New England Journal of Medicine in 2004), what’s going to happen after 10 or 20 years?  Will we start growing bony plates, like a stegosaurus? (Spoiler alert: we won’t).

On the flip side, other researchers were concerned that the increases in bone density created by strontium were “false.”  Normally, we care about bone density because it reflects the amount of calcium in the bones, which in turn correlates with bone strength.  But strontium goes into the bones, too, where it spikes bone density readings independent of calcium.  Yes, the numbers were going up.  But did they mean anything?

All of those concerns were finally laid to rest with a study published in 2012 in the journal Osteoporosis International, which tracked 237 people on a clinical dose of strontium for 10 years. The increases in bone density and decreases in fracture risk both tended to peak by year five, and were maintained at a steady level during years 6-10. All told, there was a 36% relative reduction in fracture risk.  Other studies have included more people, and have had even more impressive results.  But I like to point at this one, since it went the full decade.

A standard dose of strontium is 680 mg a day.  Strontium should be taken a few hours apart from calcium.  It doesn’t need to be, but it absorbs better if it is.

Unfortunately, a recent report out of the U.K. has highlighted potentially safety concerns.  Aggregating data from a number of clinical trials, we see that strontium supplements are linked with a 0.6% increased risk of nonfatal heart attacks, in people who are already at higher risk of a heart attack due to uncontrolled high blood pressure and/or cholesterol.  There was no increase in heart attack risk in people who didn’t already have these risk factors in play.  And there was no increase in risk of fatal heart attacks in any group.

Having said that, heart attacks are heart attacks, and they scare me regardless.  While it’s obvious the benefits of strontium outweigh the risks – at least for anyone with declining bone density, and a healthy cardiovascular system – I always prefer to try something that has the possibility of side benefits before I reach for something with the potential of negative side effects.

What else?

I’m a big believer in seaweeds, in low to moderate doses, to support bone health.  I think the trace minerals they provide are valuable.  I can find no research to confirm that, though.

There’s a supplement called MBP (Milk Basic Protein), out of Japan, which so far has looked promising over six human clinical trials.  Having said that, the trials were all very small and sponsored by the company that makes it.  And they usually looked at markers one or two steps removed from clinical outcomes.  I’m cautiously optimistic about this one.

Silica: This is another one I’m cautiously optimistic about.  We know it can strengthen and increase the growth rate of nails and hair.  We know it can slightly reduce the depth of fine wrinkles.  And again, there’s some preliminary, small-scale research suggesting a bone benefit…  I like to reach for this one when I’m talking with someone who has soft, breakable fingernails; thinning hair with split ends.


[Note from Debra:  Nicknamed the knit-bone remedy, the homeopathic remedy symphytum is said to stimulate osteoblasts, the bone building cells, too.  Dr. Vikas Sharma, homeopath, says, “… Symphytum increases the activity of new bone forming cells (osteoblasts)…. It is also recommended for pain in old fractures.”]

[1] Chocolate is among our richest sources of magnesium.  But unless you’re eating very dark chocolate, you’re not getting very much actual chocolate.  And meanwhile, you are getting a fair amount of sugar, fat, etc.

[2] At least, that’s in terms of bone health… Early evidence suggests significant benefit protecting the aging brain and cardiovascular system, reducing cancer risk, mitigating seasonal affective disorder (wintertime depression) & preventing infections.  Consider even higher doses for autoimmunity.

[3] MK-4 is by far the preferred form of K2 in the brain, as well as to cross the placenta.  To read more about K2 in the brain, check out https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4580041/.  Some very preliminary research on K2 and cancer prevention has also involved MK-4.

[4] …although it has been theorized that MK-7may lasts longer simply because fewer tissues take it up…?