If you believe that bones are made of calcium, you have subscribed to The Calcium Lie[14]. You're not alone. Most consumers and, surprisingly, most doctors, believe that bones are made of calcium. 

19 Important Nutrients

In this article, we show you that it takes at least 18 other nutrients to build strong bones in addition to calcium (Ca):

1. Boron (B)

   • Without enough of it, the body cannot efficiently use Ca, Mg, and Vitamin D to make strong bone

2. Copper (Cu)

   • Necessary for collagen formation and bone mineralization

3. Fluoride (F)

   • Helps harden the minerals in bones and teeth

4. Magnesium (Mg)

   • Without it, vitamin D can't move calcium into bone.  Also, as Dr. Oz says, it’s important to take Ca and Mg together since calcium alone can cause constipation, whereas magnesium will prevent this side effect.[9]

5. Manganese (Mn)

   • Necessary for both collagen formation and bone mineralization

6. Phosphorus (P)

   • For strong bones, calcium must combine with phosphorus

7. Potassium (K)

   • Body needs potassium to maintain proper pH levels in body fluids, and optimize sodium to potassium ratio which also affects bone mass[1,13].

8. Silica (Si)

   • Necessary for crystallization of calcium[6]

9. Zinc (Zn)

   • Helps build the collagen framework for bone

10. Vitamin A

    • Bone-building osteoblasts cannot develop properly without it

11. Vitamin C

    • Necessary for the formation of bone collagen

12. Vitamin B6

    • Without enough of it, bones are weak

13. Vitamin B12

    • Osteoblasts cannot build bone without it

14. Vitamin D

    • Necessary for incorporation of Ca and phosporus into bone.

    • If you opt for oral vitamin D, you need to also consume in your food or take supplemental vitamin K2[13].

      • Because when you take vitamin D, your body creates more vitamin K2-dependent proteins—the proteins that help move the calcium around in your body. But you need vitamin K2 to activate those proteins. If they're not activated, the calcium in your body will not be properly distributed and can lead to weaker bones and hardened arteries.

15. Vitamin K

    • Vitamin K2, also called menaquinone, is made by the bacteria that line your gastrointestinal tract.

    • Crucial to incorporation of mineral crystals into the collagen matrix. 

16. Folic Acid

    • Helps prevent bone demineralization

17. Essential fatty acids

    • Necessary for a healthy collagen matrix and for normal bone mineralization

18. Protein

    • A modest amount of protein is a key component of bone's collagen matrix.

These 18 nutrients are not only necessary for strong bones but also must be consumed in the proper proportions. For example, without enough vitamin A, bones cannot develop normally. But too much increases fracture risk.  If you wonder how to get enough of these nutrients, [1] suggests eating enough fruits, vegetables, nuts, and legumes every day. These plant foods contain all the nutrients essential for strong bones, except vitamin B12 which you can obtain it from supplements, fortified cereals, milk, cheese, eggs, salmon, sardines, or beef. However, you don't need much vitamin B12. One or two servings of animal foods per month is sufficient. 

Conventional Wisdom

Different from conventional wisdom, consuming large amounts of milk, dairy foods, or calcium supplements daily doesn't prevent fractures (read [11] for possible health risks of calcium supplements).  Based on researches published in 1985, 1992, 2000, and 2006, it shows that countries that consume the most milk, dairy foods, and calcium supplements suffer the most bone fractures[1,11]. In addition, there are total 86 scientific studies surveyed by [1] to answer this question:

• Do milk, dairy foods, and calcium supplements, by themselves or combined, reduce the risk of fractures?

The survey shows that:

• 24 studies showing they do

• 15 studies showing inconclusive results

• 47 studies showing that milk and dairy foods do not reduce risk of fractures.

As early as 1968, an article in The Lancet [2] suggested that the conventional wisdom was not the answer—but that something else was. Low-acid eating.

Low-Acid Eating

Today many researchers consider low-acid eating and daily exercise[1,3,23] the best, most cost-effective way to strengthen bone and reduce fractures. Blood is slightly alkaline. Its normal pH varies from 7.35 to 7.45. If the blood's pH falls below 7.35 or rises above 7.45, the body cannot function properly. As a result, the body's expends considerable energy to regulate the blood's pH within its normal range. When the blood's pH falls below normal, the body must restore it immediately. It does this by pulling calcium compounds from bone into the blood to neutralize excess acids.

What makes the blood acidic? Predominantly protein. As the amount of protein in the diet increases, so does the amount of calcium excreted in urine. This is scientifically well established. In addition to pulling calcium out of blood, the kidneys process excess amino acids into ammonia, which is acidic and toxic to the central nervous systems. The liver quickly converts ammonia into urea, also acidic, and incorporates it into urine, increasing urinary acidity.

Some foods acidify the urine considerably more than others. Compared with fruits and vegetables, animal foods—red meats, poultry, fish, eggs, and dairy items—introduce much more acid into urine and, therefore, into blood, causing greater loss of calcium compounds from bone. Note that grains, breads, and pastas also acidify the urine and blood, but less than most animal foods.

Here is a list  of foods that leave behind acids (acid-forming), those that are buffers (that will balance either side), and those that leave bases (alkalizing) once they are metabolized [4]: 

Acid-Forming Foods (Reduce)

•  Alcohol

•  Sugar (including drinking soda)

•  Oils

•  Flour

•  Fish

•  Poultry

•  Meat

•  Eggs

 Buffers (Moderate)

•  Yogurt

•  Milk

•  Cheese

•  Tofu (if made with calcium carbonate)

 Alkalizing Foods (increase)

•  Juices (moderate)

•  Fruits

•  Green vegetables

•  Green beans

•  Potatoes (because they contain solanine, an alkaloid)

•  Seaweeds (sea vegetables)

•  Soy sauce (moderate)

•  Miso (moderate)

•  Salt (moderate)

  • Try Himalaya Salt

Our goal is to eat from both the acid-forming and the alkalizing groups.  The body demands balance.  Eating too high a proportion of acid-forming foods will draw minerals out of the  teeth and bones, whereas eating a high proportion of alkalizing foods often tends to create cravings for sweets or carbohydrates, as many vegetarians will attest to, in order to bring in some counterbalancing acid-forming foods. 

Conclusions

Dr. Anthony Sebastian led the research team at UCSF that published the 2000 survey of worldwide fracture rates. His team concluded:

"The high incidence of hip fracture in industrialized countries is caused by the cumulative effects on bone of the body's chronic high net acid load. This high net acid load, in turn, is the result of disproportionate consumption of animal (acid) foods relative to vegetable (alkaline) foods. Otherwise healthy individuals who eat net acid-producing diets are in a chronic state of low-grade metabolic acidosis [acidic blood and urine]. The body adapts through dissolution of bone. Over decades, the magnitude of a daily positive acid balance [that is, chronically acidic blood and urine] may be sufficient to induce osteoporosis. Moderation of animal food consumption and an increased ratio of vegetable-to-animal food consumption may confer a fracture-protective effect."

Best Foods For Strong Bones—Recommendations from Doctors

Dr. Annemarie Colbin recommends the following best foods for strong bones[4]:

1. Vegetables, especially leafy greens, and also roots and stalks (for the iron and calcium, and for vitamins K and C, which together with protein, help deposit the collagen matrix)

2. Protein in modest amount, such as animal foods, beans, and soy foods (for the collagen matrix)

3. Stock (for the minerals)

4. Whole grains (for the magnesium)

5. Foods rich in trace minerals, such as seaweeds, nuts, and seeds

6. Edible bones (for the calcium and other minerals)

7. Healthy fats (for the fat-soluble vitamins needed for the bones, such as vitamins K and D)

Dr. Chu (朱文骏) recommends the following natural foods[8]:

1. Cloud Ear Fungus or Black Fungus (黑木耳)

2. Seaweeds (see [12] for its consumption recommendation)

3. Pueraria Root (葛根)

4. Vegetables such as broccoli, cabbage and beans

Dr. Mercola recommends the following foods to prevent bone loss[13]:

1. Fennel

   • The fennel appeared to work by reducing osteoclast differentiation and function, thereby slightly decreasing bone turnover markers and offering a protective effect on the bones.[15]

2. Specially Fermented Vegetables (for Vitamin K2)

   • Certain fermented foods such as natto,[20] or vegetables fermented using a starter culture of vitamin K2-producing bacteria. 

   • However, most yogurts have almost no vitamin K2

3. Certain cheeses such as Brie and Gouda

   • These two are particularly high in K2, containing about 75 mcg per ounce.

4. Vegetables

   • Good sources of silica are cucumbers, bell peppers, tomatoes, and a number of herbs including horsetail, nettles, oat straw, and alfalfa. 

Reference(s)

1. Building Bone Vitablity by Amy Joy Lanou, Ph.D. and Michael Castleman.

2. Diet and osteoporosis by Wachman A and Bernstein DS. Lancet. 1968 May 4;1(7549):958-9.

3. The Best Exercises for Healthy Bones

4. The Whole-Food Guide to Strong Bones by Annemarie Colbin, Ph.D.

5. Acid-Alkaline Balance (Travel and Health)

6. Silica and Your Body

7. Drinking Milk— It's Pros and Cons

8. 60岁以上国人 半数有关节痛(Singapore)

9. Dr. Oz’s 3 Key Supplements

10. Too Much Thyroid Hormone Increases Risk for Bone Fractures (Annals of Internal Medicine)

11. 6 Health Risks of Calcium Supplements

12. How Much Daily Iodine Intake Is Enough?

13. Specially Fermented Vegetables and Fennel are More Effective Than Calcium to Prevent Bone Loss

14. The Calcium Lie by Dr. Robert Thompson

15. Potent inhibitory effect of Foeniculum vulgare Miller extract on osteoclast differentiation and ovariectomy-induced bone loss.

16. Check out "Normal Calcium Metabolism" in this article.

17. Dr. Bahram H. Arjmandi discusses how dried plums (prunes) may increase bone density

    • In the context of adequate Ca and Vitamin D, dried plums may reverse osteoporosis.

18. The Little-Known Vitamin Essential to Your Health

19. Nutritional Aspects of Osteoporosis

20. Japanese fermented soybean food as the major determinant of the large geographic difference in circulating levels of vitamin K2: possible implications for hip-fracture risk.

21. Obesity and Type 2 Diabetes Harm Bone Health

22. 10 Things Your Doctor Won’t Tell You About Your Bones

23. Strength Training Promotes Bone Health In Men (Video)

24. Vitamin K Nutrition, Metabolism, and Requirements: Current Concepts and Future Research

25. Vitamin K Deficiency Is Associated with Incident Knee Osteoarthritis

26. Osteoporosis prevention and nutrition

    • In addition to dairy, fruit and vegetable intake has emerged as an important modifiable protective factor for bone health. Several nutrients, including magnesium, potassium, vitamin C, vitamin K, several B vitamins, and carotenoids, have been shown to be more important than previously realized. 

27. Nationwide data on municipal drinking water and hip fracture: could calcium and magnesium be protective? A NOREPOS study

28. 13 Strange and Interesting Facts About Your Bones (Infographic)

29. Cooking With Beans & Legume (Dr Andrew Weil)

30. Osteoporosis (Dr Michael Greger)

31. The Risks and Benefits of Calcium Supplements (Dr Michael Greger)

32. How Do Your Bones Change Over Time?

33. For healthy bones: Got prunes? Onions? Salmon? Walnuts?