Are you scratching your head over what to do about a low bone density diagnosis? You aren’t alone.
According to the National Osteoporosis Foundation, 54 million Americans “have low bone density or osteoporosis.” And of the millions with osteoporosis, 80% are women. So combatting low bone density is a cause that should be near and dear to all of our hearts.
Bones are living parts of the body and are nourished or damaged both by what you put into your body and by what you don’t. Bones have often been compared to a bank or credit union— you get out what you put in, and if you’re not careful with your “deposits,” you’ll pay more in “added fees” down the road.
Ideally, making nutrient deposits to your “bone bank” when you’re young will save you in the long run. But if you fail to make enough deposits within the first 25 to 30 years of life, low bone density can be much more difficult to correct later.
A number of factors contribute to bone loss and lead to low bone density and osteoporosis. Hormones, exercise, nutrition, fat intake, and gut health all play a role in deciding the fate of your bones.
Taking Low Bone Density Seriously
If you think that you do not need to worry about bone loss until menopause, we have some bad news. If you are gluten sensitive or have celiac disease your bones may not be as strong as they should be at an alarmingly young age. One fundamental problem lies in this single statistic: less than 10% of girls & young women between the ages of 9 and 17 are meeting the daily recommended requirement for calcium intake.
You read that correctly… less than 10%. That statistic alone should alarm you for the following reasons:
1. Approximately 40 to 45% of those diagnosed with celiac disease have osteopenia (which is low bone density).
3. If you got brainwashed by the low-fat, no-fat craze and have continued to think this was a wise way to eat, there’s a good chance that avoiding fat has prevented your digestive system from absorbing the key fat soluble vitamins that support your bones.
4. If you’ve got any sort of gut issues (which is probably why you’re here), your small intestine may be struggling to absorb those key bone-building nutrients that your body needs.
5. Those calcium and vitamin D supplements are probably not enough to fix the problem due to too many problems previously mentioned.
For these reasons (and more that are not listed),
it’s time for you to put the health of your bones at the forefront, before time (and age) limit your options.
Determining Bone Density – What You Need to Know
One of the biggest mistakes that people make is assuming that their blood concentrations of calcium are enough to indicate the status of their bones. The calcium test is usually included in the battery of blood tests you have annually, but it provides virtually no insight as to bone health.
The reason is that about 99% of your calcium is stored in your teeth and bones. If you’re not consuming enough dietary calcium, your body leeches calcium from its stores to maintain adequate levels of calcium in the blood. This is why only testing the blood can’t paint the whole picture.
Kim Millman, MD, shared during the Women’s Gluten-Free Health Summit that too many women end up in a state of low bone density because the correct markers and tests aren’t being evaluated. She cautioned that “anyone who is gluten sensitive needs a Dexa Scan for a bone health baseline since calcium levels in blood work aren’t reliable” indicators of bone density.
What’s a DEXA Scan?
DEXA (or DXA) stands for “dual energy X-ray absorptiometry” and measures the full density of bones to effectively discover any risks of bone loss and as well as to identify current bone mass. The denser your bones, the better. The more porous are your bones, the lower is your bone density.
If you’ve got celiac (or even gluten sensitivity), requesting a DEXA scan is a good idea, especially after age 30. Age 30 is an important mile marker for bone health because this is the age at which bone density begins to naturally decline. For post-menopausal women, checking the status of your bones is key since the rate of osteoporosis is much higher in this segment of the population.
DEXA scan results are always listed as T-scores. The following information is quoted directly from the National Osteoporosis Foundation:
- -1.0 or above is normal bone density. Examples are 0.9, 0, and -0.9.
- between -1.0 and -2.5 means you have low bone density or osteopenia. Examples are T-scores of -1.1, -1.6, and -2.4.
- -2.5 or below is a diagnosis of osteoporosis. Examples are T-scores of -2.6, -3.3, and -3.9.
The lower a person’s T-score, the lower the bone density. A T-score of -1.0 is lower than a T-score of 0.5 and a T-score of -3.5 is lower than a T-score of -3.0.
Just be aware that if you are under the age of 65, your insurance may not cover this test. Check around because prices at different facilities can vary from $125 to over $300. (source)
Key Nutrients You Need in Your Diet for Healthy Bones
To be clear, if you need to be gluten-free due to gluten sensitivity or celiac disease, then being 100% gluten-free is important. Even though a gluten-free diet will not reverse low bone density, it’s a great place to start. As you may have already realized, correcting damage done by gluten typically requires a multi-pronged approach.
However, we cannot forget about other micronutrients that are vital to the health of your bones. While micronutrient deficiencies are rampant and can have very devastating effects on your body according to Dr. Terry Wahls, it is possible and important to get the following micronutrients from your diet whenever possible.
It’s been shown that untreated celiac disease can cause vitamin B12 deficiency due to damage to the intestinal tract, but numerous other health conditions can also cause gut irritation and malabsorption. What’s alarming is that low levels of B12 have been connected to low bone density in men and women aged 30-87.
Make sure to get B12 through dietary sources like meat, eggs, dairy, shellfish, and fortified non-dairy and vegan “meat” products, or if levels are very low, talk with a doctor about a safe course of supplementation. Sublingual tablets or injections may be a better option for those with serious gut problems or those who are taking medication for stomach acid control due to GERD or heartburn. It’s a simple thing that can ward off porous weak bones in the future.
Calcium, Vitamin D, & Magnesium
Calcium, vitamin D, and magnesium are all vital important nutrients for bones. While it’s best to obtain these mainly from food, some restricted diets and health conditions can be deficient in these nutrient. It’s becoming more widely accepted to take these three micronutrients together in supplement form to maximize absorption.
Magnesium can sometimes play second fiddle to calcium and vitamin D, but it’s extremely important in the development and support of strong bones. While men generally require more magnesium than women, the recommended daily values vary from birth to later years. The National Institute of Health has a great breakdown of these values here.
All forms of calcium supplements are not equal. According to Harvard Medical School, “…the calcium in most supplements is either in the form of calcium carbonate or calcium citrate. Research shows that they are absorbed equally well with meals, but calcium carbonate is harder to digest than calcium citrate. People are usually advised to take calcium carbonate with or soon after a meal. Calcium citrate can be taken at any time.”
Still on the topic of calcium, some emerging studies claim that the calcium in milk isn’t the best source because milk may have the potential to cause a more acidic environment in the body and actually cause the body to suck nutrients from the bones to balance itself. But there are numerous other studies that claim the opposite. Overall, it seems the medical jury is (yet again) still undecided.
based on stages of life and other risk factors. The best way to make sure you’re getting these nutrients (including magnesium) is through a balanced diet. Check out some of the best dietary sources (this is not a full listing, just some rich sources):
Calcium: Dairy, but if you can’t tolerate dairy, pairing the following foods with vitamin D and magnesium sources is best: seafood, legumes, dark leafy greens (such as collard greens), almonds, sesame seeds and non-dairy fortified beverages.
Fatty fish (such as salmon or cod), some organ meats, fortified products such as dairy and non-dairy beverages and “cheeses” (not naturally occurring, but still high), and mushrooms.
Magnesium: Nuts (especially almonds), seeds, gluten-free whole grains like brown rice, and dark leafy greens.
This can be a controversial topic, but the medical field generally states that if sun exposure is limited to the daily recommended amount, it is not dangerous. Ten to 20 minutes a day in the sun is all that you probably need, depending on the shade of your skin and geographic location.
One good thing about allowing your body to naturally produce vitamin D from sun exposure is that there’s no risk of toxicity. While supplementing with extra oral vitamin D over the long term could cause toxicity since it is a fat soluble vitamin, there are mechanisms in place to shut down the production once you’ve hit a certain amount.
Vitamin K (specifically K2) is necessary for your bones to utilize calcium. Increased vitamin K levels are correlate with increased bone density. This is why there are calcium supplements that contain both vitamins D and K, since both are necessary to build healthy, strong bones.
Good sources of vitamin K are dark leafy greens, broccoli, brussels sprouts, an assortment of fermented foods, eggs, meats, and organ meats such as liver.
Gut Problems Can Cause Deficiency of Key Nutrients
Knowing how to get your micronutrients from food and oral supplements is extremely useful, assuming your digestive system is in healthy, working order. For many of us, that’s simply not the case. With celiac or Crohn’s disease, damage to the small intestine can make it a serious challenge to absorb nutrients properly, which can lead to deficiency. Those who have issues with fat malabsorption (and even those who have had their gall bladder removed) must be particularly keen to get those important bone-building fat-soluble vitamins (D & K).
The bottom line here is that you must get to the bottom of your gut imbalance and find a way to optimize your digestion and absorption. If that’s not possible, then you need to work with a practitioner who can help you solve your unique problem so that you can get the nutrients you need to keep your bones strong.
The Problem with Vegan Diets & Bone Health
A vegan diet does not create bone density problems if it is balanced and adequately fortified, but the risk increases if the vegan diet is unbalanced and does not provide the daily recommended level of nutrients. As with gluten-free products, just because a label says “vegan” does not automatically mean it supports the complete health of your body.
It has been found that vegans can face a higher risk of osteoporosis and fractures than those who consume a lacto-ovo vegetarian diet or a diet that includes meat. The reason is that plant-based diets typically have trouble providing the key nutrients for bones (namely vitamin B12 and D, and sometimes extra calcium) that can reverse low bone density.
Resistance & Weight-bearing Exercise
When it comes to keeping strong bones, exercise is key. Adding specific types of exercise can help existing bone mass stay strong and can reinforce bone mass even when it has already been affected by osteoporosis. Weight-bearing, resistance, and flexibility exercises (such as yoga) can contribute to developing stronger bones.
Somewhat surprisingly, bicycling does not help you build and maintain strong bones. In fact, studies have found that professional road cyclists tend to have lower bone density perhaps in part because cycling isn’t a weight bearing exercise. If road cycling is your thing (or your significant other’s), consider adding on some running to your fitness routine (running on a trail or soft ground is better than hard pavement in order to minimize further damage to bones and joints).
Of course, be sure to check with your doctor before beginning an exercise regimen.
If you have one or more autoimmune diseases and have been treated with steroids, osteoporosis should be on your radar. High doses of corticosteroids taken over a long period of time can leave you with low bone density since each long term dose increases your risk of developing bone loss.
Speak with your doctor about your dietary and micronutrient supplement options that can help protect your bones.