“I think a rational therapy for osteoporosis would include thyroid, Vitamin A, bright light, and either pregnenolone or a mixture of progesterone and DHEA, with a diet rich in protein and all the salts: calcium, magnesium, sodium, and potassium.” -Ray Peat Ph.D.
You either are, or should be, scared of developing weak bones as you age. You do not want to be in a situation where your hip bone breaks as a result of you simply getting out of a car. This is an especially important topic for women as women are at least 4x more likely than men to develop osteoporosis.
This will, unfortunately, be one of my more controversial pieces as some of what I describe here goes against the current mainstream opinions about what causes and helps with osteoporosis, particularly about the role of estrogen in osteoporosis.
Cortisol, PTH and prolactin are bone-shredding hormones, so to speak. Having high levels of any of those hormones for prolonged periods of time can drastically increase one’s risk of osteoporosis. DHEA, progesterone, thyroid hormone and pregnenolone are bone-protective hormones. Vitamin A, vitamin E, vitamin D, Vitamin K2, glycine, calcium, magnesium and sodium are all very important bone-protective nutrients.
“Although I believe that a vitamin A supplement will offer considerable protection against osteoporosis (and also against ageing of the skin), it is important to remember that excessive vitamin A inhibits the thyroid, and that there is less risk of toxicity when vitamin E is supplemented too”. -Ray Peat Ph.D.
When it comes to parathyroid hormone (“PTH”) it is important to consume enough calcium and magnesium, along with having a sufficient vitamin D level in order to keep PTH from getting too high. It also helps to consume enough vitamin K2. In addition to having enough calcium, it’s also important to have enough calcium in relation to phosphorus. The calcium-to-phosphorus ratio is very important, and it is difficult to have a good ratio as so many foods are rich in phosphorus. For example, beans, meat and fish are all high in phosphorus but low in calcium. Having enough calcium is crucial as if you do not consume enough calcium in the diet, your body will respond by increasing hormones that mobilize calcium from your bones, PTH is one of these hormones. Over time, this will greatly weaken the bones and can lead to osteoporosis.
Vitamin D helps in many ways, in part by working with calcium to keep PTH from getting too high. You want vitamin D to be at least 40-50 ng/mL (these are the units they use in America, other countries such as Canada and Australia use different units) in order to keep PTH from getting too high. A low vitamin D can result in a high PTH, thus it is important to get more vitamin D if PTH is elevated on a blood test. When supplementing vitamin D I think the best supplements are ones that are in a base of olive oil. The dose varies and depends largely on how much you need to increase your vitamin D level after discovering a low level on a blood test. The typical range of vitamin D supplementation is 1,000-10,000 IU daily.
Magnesium is also important for keeping PTH down, and other minerals are likely also important such as boron. With the increase in calcium consumption, increasing vitamin K2 consumption is a good idea as these nutrients work in tandem. Vitamin K2 seems to be very protective of the bones in general. Vitamin K2 is high in goose liver, butter from grass-fed cows, certain cheeses and some other foods, however, if someone has osteoporosis they should consider supplementing vitamin K2.
“Vitamin K2 stimulates the formation of two important bone proteins, osteocalcin and osteonectin”
There is a debate about whether vitamin K2 as MK-4 or MK-7 is the better form. Many supplements contain both MK-4 and MK-7 so this debate can be considered relatively moot. Having said that, Ray Peat, Georgi Dinkov and
have spoken about using the MK-4 form of vitamin K2.
Prolactin is also a hormone that can weaken bones, and a lot of the discussion above on PTH is also relevant to keeping prolactin down. In addition to all that has been discussed already, it is crucial to keep estrogen from being elevated as excess estrogen will increase prolactin. Elevated serotonin also increases prolactin and many prolactin-lowering medications work by antagonizing serotonin. This is an especially important consideration for those who are thinking of getting on an SSRI. High prolactin on a blood test can be a classic sign of excess estrogen in the body, for men or women. A1 dairy (as opposed to A2 dairy from A2 cows or goats/sheep etc.) and gluten can also increase prolactin levels.
Having said that, milk and dairy can be very important foods for protecting against osteoporosis: “A protein deficiency is a clear cause of osteoporosis, and bone density corresponds to the amount of protein consumed. Milk protein, especially, protects against osteoporosis, independently of milk’s other important nutrients.” -Ray Peat, Ph.D.
There are other nutrients that are helpful for keeping prolactin down, some of these nutrients are zinc, vitamin B6 and vitamin E. Eating enough of these nutrients is a great idea, and as such having oysters or red meat such as lamb or beef is important as those are the best zinc sources from food. Vitamin B6 and vitamin E are in a wide variety of foods, and some may benefit from extra supplementation, especially if prolactin is very high (such as above 11 ng/mL for men or 13 ng/mL for women).
“Around the age of 50, when bone loss is increasing, progesterone and thyroid are likely to be deficient, and cortisol and prolactin are likely to be increased. Prolactin contributes directly to bone loss, and is likely to be one of the factors that contributes to decreased progesterone production.”
-Ray Peat Ph.D.
Estrogen is a major cause of increased prolactin, thus having high levels of unopposed estrogen is clearly a situation that would be harmful for those with osteoporosis. Progesterone, which is very low after menopause, is one of the main endogenous hormones in women that protects against excessive estrogen. Keep in mind, estrogen can be produced in almost every cell in the body and we can easily create estrogen from aromatisable hormones such as DHEA and testosterone via the aromatase enzyme. Therefore, progesterone can be very helpful for osteoporosis because of its protective effects against estrogen and prolactin, among other things.
“A former editor of Yearbook of Endocrinology had reviewed a series of studies showing that excess prolactin can cause osteoporosis. Then, he presented a group of studies showing how estrogen promotes the secretion of prolactin and can cause hyperprolactinemia. In that review, he wryly wondered how something that increases something that causes osteoporosis could prevent osteoporosis.”
“Between the ages of 20 and 40, there is a very considerable increase in the blood level of estrogen in women. However, bone loss begins around the age of 23, and progresses through the years when estrogen levels are rising. Osteoarthritis, which involves degeneration of the bones around joints, is strongly associated with high levels of estrogen, and can be produced in animals with estrogen treatment.”
“Estrogen is the cause of a variety of tissue atrophies, including the suppression of bone formation.”
-Ray Peat, Ph.D.
In addition to that, progesterone seems to be very bone-protective via many mechanisms.
“Their attention to the bone-protective effect of progesterone has been noticeably less than their mad campaign to sell estrogen, despite the evidence that progesterone can promote bone rebuilding, rather than just slowing its loss.”
“I began referring to progesterone as the "anticatabolic" hormone that should be used to prevent stress-induced atrophy of skin, bones, brain, etc.”
“It is reasonable to think that progesterone should protect against bone loss, and that it is a progesterone deficiency after menopause which is a major factor in the development of osteoporosis.
-Ray Peat, Ph.D.
The use of estrogen, as Ray Peat very aptly puts it, is “worse than dubious”:
“I have doubted that it was rational to use estrogen to prevent osteoporosis, especially when it is known to be carcinogenic and when the ratio of estrogen to androgens and progesterone increases after menopause. Now that several publications have appeared clearly showing that estrogen increases prolactin, that prolactin increases with aging, and that prolactin contributes to osteoporosis, the postmenopausal use of estrogen is worse than dubious.”
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*None of this is medical advice. I am not a medical professional, always talk to your doctor*
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