Dr Gavin Levy | Contributors - Nourish plant-based living

15th September 2022

Words by Dr Gavin Levy

Category: Health | Features

Strong bones are important for all ages. While bone health is critical for healthy ageing, it’s the bones you bank today that can protect you from osteoporosis later.

Bones play an essential role in the human body – they support movement, protect our vital organs, and store essential nutrients.

Bone is living tissue and undergoes continuous change throughout our lives via a biological process called remodelling, where older bone tissue is removed and new bone tissue is formed. This protects our bones from stress failure and is essential in maintaining normal blood calcium levels, important for many critical functions in our body, including healthy heart and nerve function. Remodelling is regulated by many factors: our diet, physical activity, hormones, and medications.

YOUR BONE BANK ACCOUNT

When it comes to bone health, we often associate it with ageing, although we should be paying attention to our bones much earlier than this. The more bone mass we ‘bank’ in our younger years, the better protected we are from osteoporosis and fractures later in life.

Puberty is often correlated with growing taller, but what isn’t as obvious is the rapid increase in bone mass, reaching its maximum when we are around 25 to 30 years of age. By the time we are in our forties and fifties, we slowly begin to lose bone mass as a normal part of ageing. We can, however, take steps to optimise bone health at any age to avoid osteopenia or osteoporosis later in life.

Osteoporosis is a condition that results in loss of bone strength, making bones more fragile and prone to fractures. Osteopenia, often referred to as ‘pre-osteoporosis’, is where bone mass is abnormally low, but not to the same extent as osteoporosis.

For women, the drop in oestrogen levels that occurs around menopause upsets the balance of bone remodelling, resulting in increased bone loss. An initial rapid decrease is often experienced, which tends to slow over time. For men, the rapid bone loss phase tends to be delayed, typically commencing in their mid to late sixties. For most of us, bone loss can be significantly slowed through proper nutrition and regular exercise.

“For most of us, bone loss can be significantly slowed through proper nutrition and regular exercise.”

THE BEST NUTRITION FOR STRONG BONES

Let’s get one thing out of the way first. ‘Milk builds strong bones’ is a reductionist way of approaching this important part of human health. Bone health is much more complex than consuming adequate calcium.

First, achieving and maintaining excellent bone health is multifactorial: it is a combination of excellent nutrition, regular physical activity, sunlight exposure, and avoiding factors that can be detrimental to bone health where possible. Second, more than adequate dietary calcium levels can be achieved by adopting a diverse wholefood, plant-based diet that excludes dairy. And third, from a purely nutritional perspective, while calcium forms a critical dietary contribution to bone health, there are many other dietary factors that work to either optimise or hinder bone health.

If you already eat a diverse diet rich in whole plant foods while minimising processed foods, you are well on the way to achieving and maintaining bone health. Let’s explore some important nutritional requirements for healthy bones.

CALCIUM

It is well known that calcium is an important nutrient for healthy bones, and over 98 percent of our body’s calcium is held within our bones. Here’s the catch with that pervasive milk marketing: while dairy products contain calcium, they also regularly contain growth factors, lactose sugar, occasional contaminants, and often a significant amount of fat and cholesterol, making them an unfavourable choice for obtaining this nutrient.

As a general rule, the most healthful calcium sources are green leafy vegetables and legumes. Broccoli, Brussels sprouts, kale, and other greens are loaded with highly absorbable calcium and a host of other healthful properties. Exceptions are spinach and chard, which contain a large amount of calcium but hold on to it tenaciously, making it difficult to absorb. You will also find plenty of calcium in legumes, including chickpeas, beans, and lentils. Soy products like tofu and soy milk are available fortified with calcium (look out for at least 100 mg of added calcium per 100 ml). These also contain phytoestrogens, or plant compounds, that have a similar structure to oestrogen and help to reduce excessive bone breakdown.

Healthy vegan sources of calcium – beans, tofu, greens, oranges, etc

“As a general rule, the most healthful calcium sources are green leafy vegetables and legumes.”

VITAMIN D

The importance of vitamin D for bone health is evident through the range of bone conditions that can be experienced when intake is inadequate, in particular rickets and osteomalacia. While vitamin D is often considered a dietary requirement, it is primarily obtained from sunlight, and only small quantities actually come from our food. Vitamin D is crucial in promoting calcium absorption into the bloodstream from the gastrointestinal tract. The best and most efficient way for us to obtain vitamin D is through sunlight exposure. If you can’t obtain adequate sun exposure, then a supplement is recommended.

VITAMIN C

Vitamin C is important for the formation of collagen, with type 1 collagen being a major component of bone. Our body cannot produce or store vitamin C. Therefore, it is essential to consume in our diet regularly and in sufficient amounts. It’s true, the humble orange is a great source, but so are plenty of other fruits and vegetables: sweet potato, capsicum, kiwifruit, tomato … the list goes on!

VITAMIN K

Several studies have found low vitamin K intake to be associated with low bone mass and increased risk of fractures. Good sources of vitamin K include dark green leafy vegetables such as spinach and kale.

Just one cup of raw spinach will provide more than the recommended daily intake. Other sources include Brussels sprouts, broccoli, cauliflower, and blueberries.

MAGNESIUM

Approximately 60 percent of this essential mineral is found in bone. Low magnesium intake is associated with a lower bone mass.

Beans and greens are magnesium rich, while other great sources are wholegrains, nuts and seeds, bananas, and even dark chocolate (80 percent cocoa or more). Stick to a high-quality vegan variety and remember, don’t go crazy, it comes with other additives we are best to minimise.

ZINC, COPPER, MANGANESE, AND PHOSPHORUS

Zinc, copper, and manganese have been shown to play an important role in bone health, while phosphorus is necessary to support increases in bone mass, and is predominantly stored with calcium in bones. All of these can be found in abundance in a variety of plant foods: wholegrains, legumes, nuts, seeds, fruits, and vegetables.

THE BONE THIEVES

So we now know eating a variety of whole plant foods is important for supporting strong bones. But there are also factors that can diminish bone health. These are often referred to as the ‘bone thieves’. Here’s what you might want to avoid or limit where possible.

Alcohol: Excessive alcohol consumption is a well-recognised risk factor for decreased bone mass and osteoporosis. Simply put, it has a toxic effect on our bone-forming cells.

Medications: Corticosteroids suppress bone formation, while certain antiseizure medications are associated with vitamin D deficiency, also negatively affecting bone health. It’s important to remember that medication is frequently necessary. In situations where chronic usage is unavoidable, a proper assessment of bone health should be conducted and bisphosphonate treatment may be considered.

Smoking: There are many reasons to take heed of this message, and maintaining healthy bones is one of them. Smoking creates an imbalance in bone turnover, contributing to lower bone mass and an increased risk of osteoporosis.

Sugar-sweetened beverages and caffeine: Soft drinks are high in phosphates that tend to inhibit calcium absorption, and sugar-sweetened beverages (especially cola drinks) are associated with increased risk of fractures. Also be aware that caffeinated beverages such as coffee are associated with accelerated bone loss.

“Combine optimal nutrition with regular physical activity and sunlight exposure to maximise your bone mass”

MOVE IT OR LOSE IT

Physical activity is vital to bone health for all age groups. Weight-bearing activities, such as jogging or jumping, in combination with resistance training is recommended. These activities place our bones under mechanical strain, resulting in an increase in bone formation while suppressing bone breakdown. As we age, we are likely to sustain good bone health or experience a slower decline in bone mass if we maintain an exercise regime.

Bone health is a complex, lifelong process. A diverse wholefood, plant-based diet puts you on the right track for maintaining healthy bones. Combine optimal nutrition with regular physical activity and sunlight exposure to maximise your bone mass and minimise your risk of developing osteoporosis. Remember, it is never too late, no matter what life stage you are in – you can always improve your bone health with these strategies.