Bone Woman Wellbeing
with Kerri Alexander

Bone is living tissue and is constantly being broken down and rebuilt in a process known as bone remodelling. There are two processes involved in bone remodelling. Osteoblasts are involved in the process of building bone by forming collagen matrixes which are later calcified while osteoclasts break bone down and cause minerals to be reabsorbed into the blood stream.

Oestrogen is essential for bone health because it promotes the activity of osteoblasts, the cells that are responsible for producing new bone. As oestrogen levels begin to decline during late perimenopause and menopause, osteoblasts are unable to produce as much bone as before while osteoclasts continue to breakdown bone at the same rate resulting in more bone resorption than formation. In addition, dropping oestrogen levels result in the loss of lean muscle mass which further contributes to a decline in bone density.

Women are at greater risk of osteoporosis due to increased bone loss during the menopausal transition. Bone loss at the spine begins about 18 months before the last menstrual period and there is rapid acceleration in the first 5 years following menopause.
The average woman loses up to 10 per cent of her bone mass in the first five years after menopause. During this time loss in the trabecular bone of the spine is 5% annually and hip bone loss is 5 – 7% annually, after which women lose bone at 1% annually in line with men.

For the duration of the menopausal transition and for the 5 – 10 years following menopause calcium, magnesium, vitamin D and cofactor supplementation should be put in place to ensure bone health into the eldering years. The inner part of the bone consists of various minerals with calcium being the primary mineral followed closely in importance by magnesium. Other nutrients involved in bone structure and remodelling include the B complex vitamins, vitamins A, C, D, E and K as well as boron, potassium, phosphorus, copper, manganese, silica and zinc.

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Calcium & Magnesium
Calcium is essential for the formation of strong bones and teeth, in improving and maintaining bone mineral density, for reducing irritability and nervousness and in balancing the pH balance of the blood. Magnesium is as important as calcium for maintaining bone health and is an essential cofactor for calcium absorption from food and supplements, for calcium retention in the bones and to increase bone mineral density.

For maintaining strong and healthy bones through the perimenopausal years and into menopause it is a must that calcium supplements are paired with magnesium in a 2:1 ratio as both minerals are required for bone health.
 

~ Calcium @ 1200mg /day with 600mg magnesium/day for perimenopausal women and/or women under 50yrs. Calcium @ 1500 – 2000mg/day with 800 – 1000mg magnesium/day for post-menopausal women and/or women over 50yrs depending on individual need and family history.

          *It is preferable to take calcium supplements with meals and at divided doses of about 500mg
          or more 1 – 2 times per day. Taking calcium at night with food will also give you the added benefit of improving your sleep.

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Vitamin D
Vitamin D is required for normal growth and development of bones and teeth, is essential for the absorption and utilisation of calcium and phosphorus, protects against muscle weakness and plays a central role in immunity. Vitamin D is present in some foods but is inactive and must be converted by the liver and kidneys to become available to the body. Vitamin D is synthesised in the skin and eyes when exposed to ultraviolet light which is present in full spectrum natural light. Regular exposure to sunlight will ensure adequate levels of vitamin D however due to working indoors, longer working hours and the highly efficient Cancer Council’s Sun Smart message of Slip, Slop, Slap and COVID lockdowns many women are deficient in vitamin D.

~ Vitamin D @ 800 – 1000iu/day depending on individual blood results along with 5 – 10 minutes of safe sun exposure daily.

         * Safe sun exposure to ensure adequate vitamin D levels is considered to be 5 – 10 minutes of unprotected exposure to 15% of the body outside the hours of 10am – 3pm during the summer months and 15 – 30 minutes during the winter months. Darker skinned people require longer sun exposure times to activate vitamin D in the skin and eyes.

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Vitamin K
Vitamin K is required for healthy blood clotting, bone and connective tissue metabolism, the integrity of blood vessel walls, hormone function as well as brain and nerve function. Vitamin K is essential for bone formation and repair as it is an essential cofactor in the formation of various Gla proteins. These proteins are responsible for binding calcium in the body, including in bone and blood vessels. Osteocalcin, a vitamin K dependant Gla protein, is secreted by osteoclasts which are responsible for binding calcium to into hydroxyapatite crystals in the bone so promoting bone mineralisation.

Vitamin K also inhibits the process of bone resorption, which is the breakdown of the bone matrix, by regulating bone cell and enzyme production. Additionally, Vitamin K is required as a cofactor with calcium, magnesium and vitamin D in
bone maintenance and has a regulatory effect on calcium metabolism throughout the body. Research demonstrates that a lower intake of vitamin K can lead to higher risk of bone fractures. When combined with calcium, supplementation of vitamin K can help to maintain osteocalcin levels, bone density and reduce the risk of bone fractures.

There are two forms of vitamin K available in food - phylloquinone and menaquinone. Phylloquinone is found in plants and some microalgae with high amounts found in cruciferous vegetables such as broccoli, cabbage, Brussels sprouts, cabbage, cauliflower, asparagus, kale as well as other dark green leafy vegetables including spinach, salad greens and watercress and microalgae such as chlorella and spirulina. Small amounts of menaquinone can be found in animal products such as meats, mature cheese, butter, egg yolks and soybeans as well as fermented foods including miso, tempeh and natto.

~ Vitamin K @ 180mcg/day depending on individual blood results and alongside calcium and vitamin D.

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Other Nutrients and Foods

Boron has a modest impact on bone health but is still required as it assists calcium absorption

and may also have an oestrogen-like effect. It is most needed when magnesium, potassium and

vitamin D deficiency is present. Potassiumis important for maintenance of bone health and is

often lacking in modern diets as most of this mineral comes from fresh fruit and vegetables. It

plays a role increasing bone matrix and reducing loss of calcium through the urine due to a

highly acidic diet.

Phosphorus is essential for cellular energy and the health of bones and teeth. Intake is easily exceeded in modern diets due to high meat and carbonated drink intake. These factors in combination with low calcium intake can result in increased loss of calcium from the bones. Phytoestrogen foods especially those from soy such as tofu, tempeh, natto and miso have been found to stimulate bone formation and protect against bone mineral loss. Studies have found that 40 – 60mg of isoflavones from either soy, red clover or 100g tofu daily had positive effects on bone mineral density.

Essential fatty acids especially those from deep sea omega-rich fish such as salmon, trout, tuna, herring, sardines and mackerel or from plant sources such as evening primrose oil, borage oil, hemp seeds and chia seeds have been shown to protect against bone loss and resorption.

Vitamins B6, B9, B12, A, C and E are essential for protection and maintenance of collagen, and women with osteoporosis have been found to have low levels of these nutrients. Other minerals such as zinc, manganese, copper, silicon and strontium are also involved in collagen synthesis and bone mineralisation.

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Eat a Mediterranean style wholefood diet high in fresh fruit and vegetables, whole grains, legumes, some dairy foods, fish and small amounts of red meat in order to get a wide range of nutrients for ongoing bone and cardiovascular health.

✓ Take the juice of a 1⁄2 - 1⁄4 lemon with hot water and a small amount of raw organic honey daily to improve liver function and to support hydrochloric acid levels in the stomach.
✓ Include fermented probiotic foods to improve digestion and balance bowel flora such as traditionally fermented vegetables such as sauerkraut, kimchi or lacto-fermented vegetables, dairy based fermented foods such as kefir, yogurt, cultured butter or other fermented foods such as kombucha, miso, tempeh and natto.
✓ Add foods that boost digestive enzymes and improve nutrient absorption such as rocket, endive, witlof, radicchio, pineapple, paw paw, kiwi fruit or Swedish bitters.
✓ Eat more Brassica foods such as broccoli, cauliflower, cabbage, Brussels sprouts, asparagus, turnips, kohlrabi, swedes, radishes, horseradish, daikon, kale, bok choy, choy sum, gai lan, wombok, rainbow chard, watercress and rocket to improve liver function and support detoxification pathways.
✓ Remember to soak all grains and legumes for 3 – 4 hours before cooking to improve digestibility and absorption of nutrients.
✓ Include calcium rich foods such as organic grass-fed full fat dairy products such as cheese, milk, butter, cream, buttermilk and yoghurt, dark green leafy vegetables, salmon and sardines with bones, seafood and sea vegetables, sesame seeds and tahini.
✓ Include magnesium rich foods such as nuts and seeds – almonds, brazil nuts, cashews, hazelnuts, pine nuts - organic grass-fed full fat dairy products, fish, green leafy vegetables, all legumes, meat, seafood, spinach and wholegrains.
✓ Include vitamin D rich foods such as cod liver oil, organic grass-fed full fat dairy products, eggs and oily saltwater fish such as mackerel, herring, kipper, salmon, sardines and tuna as well as chanterelle and shiitake mushrooms.
✓ Include vitamin K rich foods such as leafy green vegetables including broccoli, cabbage, Brussels sprouts, cabbage, asparagus, kale, spinach, lettuce, cucumber as well as animal products such as meats, cheese and egg yolks as well as fermented foods including miso, tempeh and natto.

Add foods high in phytoestrogens such as soy beans, soy milk, tofu, tempeh, natto and miso to stimulate bone formation and reduce bone loss.
✓ Include foods high in essential fatty acids such as avocados, chia seeds, evening primrose oil, flaxseeds, hemp seeds and oil, linseeds, oily deep sea fish such as salmon, trout, tuna, herring, sardines and mackerel, olive oil, seaweeds, spirulina and walnuts for adequate protein and to protect against bone resorption.

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Herbal Medicines for Bone Health

Herbal medicines that have high levels of minerals such as calcium, magnesium, iron,

silica and boron, or phytonutrients such as isoflavones, can be used to support and

nourish bone health. Add them to the foods that you prepare, your herbal tea

blends or your morning smoothie to boost your overall dietary intake.

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Black cohosh (Actaea racemosa)

Black cohosh is a useful herb that can be employed for supporting hormonal

disturbances throughout the menstrual years and beyond. The oestrogen

modulating effects reduce perimenopausal and menopausal symptoms such

as premenstrual syndrome, menstrual migraines, hot flushes, poor sleep

quality, irritability, anxiety and depression. The anti-inflammatory and
antirheumatic actions also make Black cohosh a valuable herb for menopausal bone health by improving bone deposition, preventing osteoporotic bone loss and reducing arthritic or muscular aches and pain. Best to be used under the care of a herbalist or naturopath.

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Gotu kola (Centella asiatica)

Gotu kola is another herb with many varied uses in herbal medicine ranging from central nervous system and cardiovascular support through to wound healing. Gotu kola is widely revered for its ability to support connective tissue regeneration through increasing blood flow and collagen deposition and reducing fibrotic adhesions. In combination with other herbs that support bone health, this is a valuable herb in the treatment of osteopenia, osteoarthritis, connective tissue weakness, tendonitis, ligament damage, chronic skin conditions and scarring.

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Horsetail (Equisetum arvense)

Horsetail is another herb that is rich in vitamins and minerals, most notably silica, potassium and manganese. Silica is vital for bone health as it forms connections between collagen and structural proteins within the bone matrix. The combination of minerals in Horsetail help to support bone deposition, reduce bone loss and improve the integrity of connective tissue throughout the body.

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Nettle leaf (Urtica dioica)

Although typically regarded as a weed, Stinging Nettle leaves boast a rich profile of vitamins and minerals including calcium, magnesium, iron and vitamin K making it a beautiful plant ally for bone health throughout the menopausal transition. Nettle also has anti-inflammatory, antirheumatic, nutritive and kidney tonic effects so supporting conditions of the joints such as arthritis, gout and osteoporosis. As outlined below Nettle makes a great long infusion that can be drunk throughout the day.

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Turmeric (Curcuma longa)

Turmeric is one of our most well-known herbal medicines for joint health. It has potent antioxidant, anti-inflammatory and cardiotonic effects amongst others. This herb is a powerful ally for arthritic pain and inflammation as experienced in osteoarthritis, rheumatoid arthritis, fibromyalgia, lower back pain and osteoporosis. It is also one of the easiest herbs to incorporate into the diet where it can be included in curries, soups, slow cooked meals or drunk as Golden Milk each day. The combination of turmeric with pepper and a fat source, such as coconut cream or full-fat organic dairy milk, supports and potentiates the absorption of curcumin, one of the main medicinal constituents of turmeric.

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Wild yam (Dioscorea villosa)

Wild Yam is a versatile herbal medicine with a wide range of uses and is particularly valuable during the perimenopausal and menopausal transition. Wild yam has phytoestrogenic compounds which help to stimulate bone formation and support bone retention along with attenuating other perimenopausal and menopausal symptoms such as premenstrual syndrome, menstrual pain, vaginal dryness, hot flushes, osteoporosis and low libido. It is also an anti-inflammatory and antirheumatic herb and so works to reduce joint pain and muscle or uterine tension, pain or cramping.

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Exercise & Lifestyle for Bone Health

~ Although exercise has the most beneficial effect on bone during the menstruating years when oestrogen is available exercise related increases in bone mineral density can be seen at any time of life and should not be underestimated.
~ Keeping active and engaging in regular exercise beginning early in perimenopause produces the best outcomes for bone, cardiovascular and mental health with positive ongoing effects being shown long after menopause.
~ Regular weight bearing exercise in combination with resistance training and a diet high in essential nutrients is the best combination for preventing loss of bone mass and improving co-ordination, muscle mass and balance.
~ Weight bearing exercise such as walking, hiking, jogging, stair climbing, tennis, gardening or dancing will maintain flexibility, balance and muscle mass, prevent bone loss and manage weight during perimenopause and menopause.
~ Walking has been shown to be best for the neck, hips and leg bones as it encourages deposition of calcium in these areas of the body.
~ Yoga can improve bone density score if done regularly however more benefit comes from improved balance, flexibility and in pain management and social interaction.

~ Tai chi is excellent for osteoporosis and has been found to improve bone density scores, protect against fractures, improve balance, coordination and muscle strength and reduce stress.
~ Weight lifting and balance training provide the best protection against falls and hip fractures by improving co-ordination, reducing muscle weakness and improving muscle mass around the joints.
~ If osteoporosis is severe or significantly advanced then only regular weight bearing exercise is recommended as high impact exercise may pose too much risk of fall or fracture.

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For the safest and most effective herbal management of health in menopause, please work closely with a naturopath or herbalist who can create highly personalised herbal medicines formulated for your specific symptoms and condition.

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© Kerri Alexander -Naturopath & Herbalist

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