Osteoporosis And Bone Health - Why The Optimal Intake Of Vitamin D and K Is More Important Than Calcium Supplementation
Posted Jan 07 2009 3:16pm
An estimated 10 million Americans - 8 million women and 2 million men - have osteoporosis (porous bones). Another 34 million have low bone mass, placing them at increased risk for osteoporosis. (1) Osteoporosis and Osteopenia (low bone density)*, is related to many factors beyond calcium need and optimization. Magnesium, Zinc, Copper, manganese, boron and many more mineral cofactors, are important in healthy bone formation. Besides minerals, vitamin D, K, folic acid, vitamin B6, B12, phosphorus, and vitamin C are all shown to have a vital role in bone health. You need the complete spectrum of mineral supplementation to benefit from nutritional therapy. Certainly, the type of calcium, or for that matter, the “types” of supportive minerals can make a difference in absorption and healthy bone metabolism. I recommend a “true chelated” mineral product that is produced by Albion Labs. The minerals from Albion are chelated (bound to amino acids) that allows for superior assimilation in the digestive tract. However, calcium is far from the “answer” to bone loss as women and men age. Studies have indicated that higher amounts of calcium for the prevention of osteoporosis may not actually reduce risk. In countries where average daily calcium intake is low, bone fracture rates are low in comparison to those in the U.S and other western societies who consume high-calcium diets. (2) In fact, more important than your intake of calcium, is the optimal intake of vitamin D and K from supplemental sources. Vitamin D
Vitamin D plays an important role in optimal health. Low vitamin D status is associated with several chronic diseases including insulin resistance, cardiovascular disease, autoimmune disease, Alzheimer’s disease, Osteoporosis and many others. The value of vitamin D in healthy bones is understood by most. However, what is not well known is that the levels recommended by most resources for this vital nutrient-200 to 600 I.U.s, are woefully inadequate, both for bone health and the health of your heart and brain. For this article we will stick to the relationship of vitamin D to bone health and the fact that many individuals are not getting enough.
Vitamin D is vital to bone metabolism. Without vit. D, you cannot utilize the calcium you ingest. Vitamin D (D3) facilitates the absorption of the calcium from the small intestine and stimulates the production of osteocalcin, an important bone protein (see vit K section-Part 2)*, by bone cells. Recent research in vitamin D levels in people indicates that an optimum daily intake of 1,000 to 2,000 IUs of vitamin D may be the ideal level of supplementation to shoot for-especially above 40 degrees latitude in the U.S. (north of San Francisco, Denver, Indianapolis, and Philadelphia), and during the winter where sun exposure is minimal if any. (3) However, recent evidence also indicates that living in a sunny climate is no guarantee of vitamin D sufficiency. The majority of residents of southern Arizona where sun exposure is high were found to be deficient in vitamin D (25(OH)D). (4) This finding coupled with fact that the late winter average of 25-hydroxyvitamin D (25(OH)D) in the US is about 15-18 ng/ml, indicates that the assessment for need of vitamin D and supplementation in higher doses than currently recommended, is necessary to bring most individuals to vitamin D sufficiency. One study of healthy adult men, determined that between 3,000 to 5,000 IUs of vitamin D3 intake during winter months was necessary to maintain blood levels achieved during the previous fall months. (5) And recently, the US-based Council for Responsible Nutrition (CRN) upon review of numerous clinical trials, recommended that the tolerable upper intake level for oral vitamin D3 should be increased five-fold from the current 2,000 IUs/day to 10,000 IUs/day. (6) What is the right dose for you? The only way to ascertain the ideal dose of vitamin D is to check your blood levels. Optimum Serum Vitamin D Levels
A review published in the July 2006 issue of the American Journal of Clinical Nutrition, concluded that “the most advantageous serum concentrations of 25-OHD (25-hydroxyvitamin D), * the vitamin D marker that reflects biological activity, begins at 75 nmol/L (30 ng/mL), and the best range being from 90 to 100 nmol/L (36–40 ng/mL)”. (7) The authors of the review concluded that these concentrations could not be reached with the currently recommended daily intakes of 200 IU vitamin D for younger adults and 600 IU vitamin D for older adults, and that at least 1000 IU of vitamin D3 (cholecalciferol) /day was necessary to bring 50% of the population up to optimal levels. The study analyzed optimal vitamin D levels in relation to not only bone mass density*, but fracture rate, risk of falling, oral health, and colorectal cancer as well. Other studies over the past few years convey similar recommendations not only for bone health, but also for the prevention of certain cancers, cardiovascular disease, and other degenerative health conditions mentioned above.
25-hydroxyvitamin D is the main circulating form of the vitamin D. Testing your blood levels for 25-hydroxyvitamin D (25(OH)D), is one of my most recommended health assessments-not only for bone health, but for the prevention of many chronic disease now linked to vitamin D deficiency.** Vitamin D3 (cholecalciferol) is the preferred form for supplementation. It is the same vitamin D produced in the body from sun exposure. Liberal use of sunscreen lotion will severely inhibit vitamin D production in the body’s primary manufacturing site, the skin. 10-15 min whole-body exposure to peak summer sun will generate and release up to 20,000 IU vitamin D-3 into the circulation (8), which brings into perspective the notion of supplementing with higher levels of vitamin D than currently recommended. 2,000, 5,000 IUs or even 10,000 Ius of vitamin D3 therapy for deficiency states hardly seems to be excessive in light of what the body will produce when maximally exposed to the sun. However, vitamin D supplementation at higher levels should only be taken under the supervision of a qualified practitioner who can monitor your blood levels and adjust the best therapeutic or maintenance dose for you. Individuals with hyperparathyroidism should not take vitamin D without consulting a physician, and there is research that indicates that vitamin D supplementation is contraindicated in people with sarcoidosis.
** Two vitamin D tests, 1,25(OH)D and 25(OH)D (25-hydroxyvitamin D) are used to assess vitamin D status in the body and for related health conditions. Of the two, 25(OH)D is accepted to be the best indicator of overall vitamin D status in the body.
1. Osteoporosis facts. National Osteoporosis Foundation.
2. Fractures, calcium, and the modern diet. Hegsted DM. Am J Clin Nutr. 2001 Nov;74(5):571-3.
3. Current Recommended Vitamin D Intake May Not Be Optimal Laurie Barclay, MDâ¨CME Author: Désirée Lie, MD, MSEd Am J Clin Nutr. 2006;84:18-28
4. Vitamin D insufficiency in southern Arizona Elizabeth T Jacobs, David S Alberts, Janet A Foote, Sylvan B Green, Bruce W Hollis, Zerui Yu and María Elena Martínez. American Journal of Clinical Nutrition, Vol. 87, No. 3, 608-613, March 2008
5. Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Heaney RP, Davies KM, Chen TC, Holick MF, Barger-Lux MJ. Am J Clin Nutr. 2003 Sep;78(3):496-7.
6. Risk assessment for vitamin D J.N. Hathcock, A. Shao, R. Vieth, R. Heaney American Journal of Clinical Nutrition. January 2007, Volume85, Pages 6-18
7. Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Heike A Bischoff-Ferrari, Edward Giovannucci, Walter C Willett, Thomas Dietrich and Bess Dawson-Hughes Am J Clin Nutr. 2006 Jul;84(1):18-28.
8. Circulating 25-Hydroxyvitamin D Levels Indicative of Vitamin D Sufficiency: Implications for Establishing a New Effective Dietary Intake Recommendation for Vitamin D Bruce W. Hollis The American Society for Nutritional Sciences J. Nutr. 135:317-322, February 2005