Episode 77: Eat Your Way to Strong Bones

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Welcome to Supplementing Health, a podcast presented by Advanced Orthomolecular Research. We are all about applying evidence based and effective dietary lifestyle and natural health product strategies for your optimal health. In each episode, we will feature very engaging clinicians and experts from the world of functional and naturopathic medicine to help achieve our mission to empower people to lead their best lives naturally.

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[01:11] Cassy Price: Thanks for tuning into Supplementing Health. Building and maintaining bone mineral density through nutrition is an important consideration at all ages. Today I am joined by Carrie Bonfitto, board certified nutrition consultant, cooking instructor, and speaker to discuss some of the foods we should be incorporating into our diet at all ages to support bone development and maintenance. Welcome Carrie, thanks for joining me today.

[01:34] Carrie Bonfitto: Thanks for having me.

[01:35] Cassy Price: So, bone density changes over time and up until our late twenties our bones are constantly growing however after that point we may start to experience more bone loss than we do growth. At what stage of life would you recommend that people start consciously eating to support their bone health?

[01:56] Carrie Bonfitto: Right, people often think that bone loss happens when we get old, but it is really a slow process and it can depend on different risk factors that you might have for bone density loss but actually I think that people of all ages should be considering bone health. We know that people who have higher peak bone mass when they reach that twenty-year goal that you mentioned have a lower risk of osteoporosis, which means that we need to be feeding our kids to support bone health from day one. However, that being said it is really important especially for women to start supporting our bones during menopause which is a process that can take ten years. It usually starts around our forties and people don’t realise that what is happening is that our estrogen is dropping, and estrogen actually helps with calcium absorption and this hormone starts to dip during this stage of life so that means that we need to be consuming more calcium in order to maintain our levels. Men’s estrogen levels also decline as they go, so they need to be taking in calcium as well.

[03:12] Cassy Price: Does testosterone also have a similar effect as well or is it just for estrogen levels?

[03:20] Carrie Bonfitto: Testosterone will start to decline but it is the estrogen that is the most important hormone for calcium absorption.

[03:29] Cassy Price: Okay. So, beyond calcium what other nutrients are really important to maintaining that bone mineral density?

[03:38] Carrie Bonfitto: We know we need Vitamin B3 which really helps calcium to absorb as well. Magnesium is a super important cofactor for calcium. Calcium and magnesium work together in the body. We need Silica. Silica along with magnesium helps to turn calcium into a form that the bones can actually use. That is really important. Vitamin K2 can also be really important because it helps to guide calcium into the bones and the teeth and remove calcium deposits form our arteries. You might have heard of calcification of the arteries and that is when calcium is building up.

[04:27] Cassy Price: So, if someone doesn’t consume dairy which is a common source of calcium, what are some other foods that they can incorporate to get that calcium level?

[04:44] Carrie Bonfitto: There is actually quite a few foods. Many of the plant-based milk actually boast having 50% more calcium than regular milk. You can also try if you are not able to tolerate cows’ milk, you can try sheep’s milk cheeses and yoghurt can often be more tolerated but if you are completely plant-based then sesame seeds are really high in calcium and tahini, which is ground up sesame seeds, is a great way to add calcium to your diet, from using it as sauces or as dips or dressing. I even have a really nice recipe for gluten free bread that used tahini as a binder.

[05:38] Cassy Price: Oh, wow. So, for some of those other nutrients like Vitamin K2 are they often in dietary sources with calcium or do you have to get different items together to get that full mineral profile that we are looking for?

[05:55] Carrie Bonfitto: Well K2 is definitely in some cheeses. It is in brie. It is also in gouda. Those are two cheeses that are super high in K2. If you are getting grass fed products, then there is K2 in those products so grass-fed meat like grass-fed ground beef or grass-fed butter or grass-fed cheeses of any variety will have more K2. You can also get a little bit of K2 from egg yolks and fermented foods like fermented sauerkraut has a lot of K2.

[06:37] Cassy Price: So, then are there dietary changes between the way we should be feeding our bones as they are still growing, so childhood through to early adulthood, verses when we start to have that more deterioration after our twenties?

[06:57] Carrie Bonfitto: So, it is really in the amount of calcium that we need. We still need all of the cofactors, we need the magnesium the K2, the silica, we even need boron and things like collagen, which I didn’t mention before, and vitamin D throughout our lives. What happens is that you need the most in childhood and when you reach that age of twenty you can taper off the calcium a little bit until your forties and your fifties and it starts creeping up as we age even more.

[07:42] Cassy Price: So, are there foods then that are detrimental to bone density? I know alcohol can leach those minerals out of our bones. So, are there other foods or things to avoid that have those detrimental effects?

[08:00] Carrie Bonfitto: Yes, absolutely. You mentioned alcohol, that can be a big one. Also, too much caffeine so things like soda that has a lot of caffeine, coffee and tea, can also leach calcium. Also, if you are having too much meat that meat has phosphorus in it and we need the Phosphorus for our bones but when we have too much it throws things out of balance. It is a delicate balance with meat products.

[08:36] Cassy Price: So, what are some of your favourite bones supporting foods to incorporate in your diet?

[08:44] Carrie Bonfitto: One of them is kind of unusual is flaxseeds because I love flaxseeds for the plant estrogen. This helps to support estrogen so we don’t have as much of a dip and we can absorb the calcium. I also like salmon and tuna and eggs and mushrooms for the vitamin D that they can provide. We need collagen. Bones are made up of collagen as well so something like bone broth can be really important because it is hard to get collagen in other food sources. Then the calcium that we talked about the grass-fed milk and the dairy products. Leafy greens, so things like wood chard can be really important. I love those sesame seeds. I love wheat grass, even if you can get your hands on a good source of wheat grass it is a good source of calcium. For magnesium I like pumpkin seeds. I like cacao which is chocolate so if you can find chocolate that is 70% cacao and higher, so it is more chocolate than sugar, that is really great source of magnesium. Yeah, there is magnesium in other things too like figs or avocados.

[10:15] Cassy Price: So, do these complementary nutrients play a role in different stages of bone regeneration because of course all of our organs are constantly refreshing and growing and changing. So, are there different stages in that cycle that each of these nutrients play a bigger role in?

[10:36] Carrie Bonfitto: When you are looking at what is happening, are we feeding a fracture or are we trying to restore blood flow to a broken bone because they had a fall or maybe we are just looking at remineralisation of bone. When we are talking about remineralisation, I think that is what we have been talking about the most with all of these nutrients so just really getting those nutrients into the bone so that we are not excreting them because it is a process of how the water in our bodies and depending on the other nutrients in there depends on whether the calcium is going to stay in the bones or it going to be excreted. So, really, we are talking about remineralisation for the most part.

[11:37] Cassy Price: How does dehydration affect that process or does it?

[11:43] Carrie Bonfitto: So, it is definitely important to stay hydrated. That keeps in our minerals in better balance. It obviously helps with toxins. It can lower inflammation. We want to stay hydrated right because I said we were going to be excreting these through our urine but if we don’t and we are dehydrated things that can happen is that this calcium that we are having can build up into kidney stones. A lot of people who are underhydrated will experience this calcium not going into their bones because they didn’t have the cofactors to put it there but they also didn’t have the water to flush it out so that becomes little stones that are developing in our kidneys.

[12:44] Cassy Price: Interesting. So, for people with a hectic schedule who are more prone to eating in a grab and go style which if we are being honest is a very large portion of the population. What are some of your tips to help them make healthier food choices and support that bone health even when you’re on the go?

[13:09] Carrie Bonfitto: If you have just a few minutes to make a vegetable and protein rich smoothie in the morning, it takes only a minute to throw some frozen cauliflower and some berries and some yoghurt in a blender and take that with you on your commute, that is a really great start. If that is even too much for you just look for restaurants around you that are Mediterranean. So, somewhere that you can get some nice hummus which has got that tahini, those sesame seeds that are high in calcium, that is one of the ingredients of the hummus. Tabouleh salad which is parsley which is really high in calcium which is great. Those Greek salads that have a little bit of feta cheese and tzatziki sauce which is made with yogurt and herbs and may even have leafy greens in the forms of stuffed grape leaves. So, those types of restaurants can be really great. If you don’t have those types of restaurants near you almost everybody in the country can pop into their local grocery store, grab a rotisserie chicken and a tub of hummus and a bagged salad and a little bit of yoghurt to balance out those nutrients that we need.

[14:36] Cassy Price: Awesome. So, if people aren’t getting the nutrients that they need, do you ever recommend supplements? If you do, do you prefer formulations where it is a multi-style or individual ones?

[14:53] Carrie Bonfitto:  I do like multi-style supplements for people who can’t get the food. There is a lot of great ones out there that have magnesium, calcium, vitamin D together. There are even some that go further and put boron and zinc and even a little bit of plant estrogens in there. So, those can be really easy for people to consume because it is usually more than one capsule, usually two capsules twice a day type of thing, that seems to be easier than opening four or five bottles.

[15:38] Cassy Price: How important is protein to bone building? I know we talked a little bit about collagen and often collagen is thought of alongside protein because it comes from meat sources and things like that. So, is protein fairly important to bone health and maintenance as well?

[15:56] Carrie Bonfitto: It is really important because we were talking about Phosphorus which is really only coming from protein sources so meat, dairy, legumes, nuts are all really good sources of phosphorus. We need this as a component in that bone structure. We have to be making sure we are getting some sort of protein. It doesn’t have to be meat-based but it has to be a significant amount. It is something that we have to be watching for.

[16:34] Cassy Price: Awesome. So, for dietary conditions such as leaky gut, Crohn’s, colitis, things like that can be very affected by diet, can they have a far-reaching effect on bone health as well?

[16:52] Carrie Bonfitto: Yes. So, those conditions that you mentioned are really digestive issues, a lot of them. So, if you are not digesting your food properly you can’t extract nutrients from it. There is a saying in the nutrition world: ‘you aren’t what you eat, you are what you absorb.’ That goes for food and supplements. If we are not digesting all of these great things that we are talking about it is not going to be benefiting us, no matter what we are eating. That needs to be fixed first. I use a lot of therapeutic diets to address those conditions, things like autoimmune protocols, low FODMAP diets, other types of elimination diets that can be very healing first so that we can then absorb the nutrients from the supplements. When we are then replacing the supplements, it is really important that I work with people on therapeutic doses of the supplements because you have been so depleted you need to be taking larger amounts than the recommended daily allowance of these in order to rebuild. It is very individualised doing that.

[18:16] Cassy Price: Of course. That totally makes sense. Beyond digestive conditions, are there other health conditions that are commonly linked with bone mineral density loss or bone health issues?

[18:33] Carrie Bonfitto: So, one of the conditions especially is anorexia or people that are underweight. So, if you are underweighting this is usually a sign that you are not getting all of the nutrients and minerals that you need. That is something that is a big red flag.

[18:53] Cassy Price: That makes sense as well. So, if someone has come to you and they have received an osteoporosis diagnosis or they have some other kind of bone issue, what are some of the dietary recommendations that you have for someone who has already progressed so far down the bone loss path?

[19:14] Carrie Bonfitto: So, definitely if they already have that diagnosis, it is really important that we are looking at the foods that they are eating. If they can tolerate lactose, then I would try to get them to drink one full cup of grass-fed milk every day. Drink one to two cups of bone broth and in that bone broth adding a tablespoon of apple cider vinegar to fortify the digestion, also adding ground flaxseed into that bone broth, that can be a nice soupy kind of comforting food to have. Making sure that you are getting enough protein with lentil soups and adding calcium rich greens to that so spinach cooked in that. Making sure that they are cooking their greens. A lot of people are eating spinach like crazy raw; they might be throwing it raw into a smoothie or having spinach salads but there are compounds in the spinach that make it hard to digest the calcium and absorb the calcium. We want to make sure that if you have that diagnosis that you are cooking your leafy greens and you are not eating them raw. So, making sure beet greens are being cooked, spinach is being cooked. Lettuces are usually okay. I would also switch them to grass-fed meat and making sure that they are eating whole eggs with the yolk. Making sure they are getting fish because these are all vitamin D foods, eggs, fish. Then adding some sauerkraut for that vitamin K. Possibly a prune or two. I guess we don’t call them prunes anymore, we call them dried plums, because they are one of the top boron foods and boron is really important to help us absorb that calcium.    

[21:22] Cassy Price: So, if someone is on a vegan diet a lot of the foods that you just mentioned like the grass-fed meats and the dairy, and the fish aren’t available to them. Are there additional fruits, veggies, nuts, and seeds that you would suggest to fill that gap?

[21:43] Carrie Bonfitto: Definitely. Vegans can do the legumes; those lentils and all types of nuts are going to be important. Seeds. Pumpkin seeds. Sesame seeds. Different types of flaxseeds and those greens need to be in the diet. So, cooked greens. Collared greens. Cooked beet greens. Cooked spinach. Just make sure that you are doing those fortified plant-based milks that have extra calcium in them. Vitamin D can be trickier if you are completely vegan because you can’t really do the eggs or the fish so I would definitely recommend supplementing if you are vegan. We can get some vitamin D from the sun, but it can be really difficult and if you are darker skinned it is even more difficult for you to absorb vitamin D from sunlight. So, that as a supplement I think is a must if you are vegan. There is also a lot of emerging evidence that inadequate B vitamins, like B12 that we know we can only get from animal sources, inadequate B vitamins we are finding in people who have hip fractures, so we want to make sure that you are supplementing with B12. Probably a good Iron supplement because Iron is one the minerals that helps us produce collagen. Vitamin C also helps us to produce collagen so those are important supplements.

[23:30] Cassy Price: On a similar note, are there common medications that people should be aware depletes our vitamins? I know birth control is a common one that can deplete vitamins or blood pressure medicines. Are there things like that that people should be aware of might be interfering with that absorption?

[23:54] Carrie Bonfitto: Yes. There is definitely medication like you were mentioning that we need to make sure we are absorbing from. You mentioned the birth control. That really lowers the absorption of the B vitamin. I think even more importantly is that people don’t realise that the calcium blocks medication absorption. So, if you are supplementing with calcium, magnesium, if you are taking medication like your thyroid medication that you have to get into your system, even if you are on an antibiotic and you take that antibiotic, the calcium in that milk is going to block the absorption of that medication into your body. It is really important to sperate having the medication with having those mineral supplements. I often will tell clients that you need to make sure that you are taking your minerals and your calcium and your magnesium at night for the best absorption so that when you are taking those medications that you are supposed to be taking first thing in the morning when you wake up that you are actually getting that medication into your system.

[25:20] Cassy Price: Interesting, I never thought of it from that angle.

[25:25] Carrie Bonfitto: Yes. Especially that there are so many people on thyroid medication, and they are taking calcium and thyroid medication together and it is basically negating the thyroid medication. Other food will do that as well. So, wheat bran, if you look at wheat bran so something like shredded wheat cereal which is 100% wheat bran and you have a nice cup of milk on top of that, the wheat bran is going to block the absorption of the calcium so you can’t count that calcium from that cup of milk in your daily milligrams of calcium because your body is not absorbing it because you ate it with wheat bran.

[26:13] Cassy Price: Interesting. So, through your company Two Hearts you offer cooking classes. Are they available for anyone and do they have tailored focuses in your lessons for people which different dietary goals at all?

[26:29] Carrie Bonfitto: They are available for anyone. I do private lessons which people who have specific health conditions that we really need to dial in, things like renal disease or Celiac disease or obesity or certain autoimmune conditions like lupus or Hashimoto’s. I offer group classes that are generally gluten free because we are focusing on whole foods. Usually most of the gluten grains are best consumed when they are processed and when they are ground. They are gluten free, and they are low dairy because a lot of people do have issues with dairy as you mentioned. A lot of the classes are online, so they are available to anybody. I have some classes that are cooking based but also classes that are nutrition based like understanding weight loss or aimed at longevity and you can check all of my classes on my website at twoheartsnutrition.com. I love to do these group classes with people. I learn so much every time I do one.

[27:43] Cassy Price: That is fantastic. So, if people wanted to work with you on a one-to-one basis, would your website be the best place to go as well?

[27:52] Carrie Bonfitto: Yes. You can actually schedule a free fifteen-minute consultation with me where I just go over how I work and we talk about what is going on with you and see if food is the best way to improve your symptoms.

[28:11] Cassy Price: Awesome. So, that again was twoheartsnutrition.com for our listeners. Thank you so much for joining me today. I really appreciate you taking the time to chat with me and I hope there was a lot of really great information in there for all of the listeners that they can take away and utilise in their day-to-day life.

[28:38] Carrie Bonfitto:  It was great talking with you as well. Thank you.    

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Thank you for listening to Supplementing Health. For more information about our guests, past shows, and future topics, please visit AOR.ca/podcasts or AOR.us/podcasts. Do you have a topic you want us to cover? We invite you to engage with us on social media to request a future topic or email us at marketing@aor.ca. We hope you tune in again next week to learn more about supplementing your health.

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