Osteoporosis: Maintain Strong Bones
Protect Against Weakening Bones
“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.”
There is a lot that can go into the discussion on elevated cortisol, but what is clear is that this hormone can be very detrimental to bone health. In fact, DHEA, which is a strong endogenous cortisol antagonist, is able to protect the bones, likely in large part due to its anti-cortisol effects. When it comes to supplementing with DHEA, it’s probably best to stick with 5-15mg at most in a day, and it can help when you take it alongside pregnenolone. Pregnenolone has been shown, by itself, to be very bone-protective. Part of this may be via pregnenolone’s conversion to DHEA, but it seems that pregnenolone itself is very bone protective either way, regardless of its conversion to DHEA. Furthermore, pregnenolone can decrease ACTH secretion, which will lessen cortisol, thus protecting the bones. For those who do not know, these three hormones are over the counter in many countries and I have links to some products at the end of the article.
One common cause of elevated cortisol and decreased levels of the protective steroid hormones (pregnenolone, DHEA, progesterone) is low thyroid function, low metabolism or general hypothyroidism. If active thyroid hormone levels are adequate then the body does not need to compensate for low thyroid hormones with increased stress hormones such as cortisol. So, increasing the thyroid hormone levels in the body should allow the body to produce far less cortisol. Thyroid hormone will also allow cholesterol to be converted into the protective steroid hormones, which will be extremely protective of the bones. Thyroid hormone itself seems to be very useful for strengthening the bones and preventing osteoporosis.
“Thyroid and progesterone, unlike estrogen, stimulate bone-building and are associated with a decreased risk of cancer. It seems sensible to use thyroid and progesterone for their general anti-degenerative effects, protecting the bones, joints, brain, immune system, heart, blood vessels, breasts, etc.”
“T3, the active form of thyroid hormone, does contribute to bone formation.”
“Chronic hypothyroidism causes osteopenia, and in this connection, it is significant that women (as a result of estrogen's effects on the thyroid) are much more likely than men to be hypothyroid, and that, relative to men, women in general are "osteopenic," that is, they have more delicate skeletons than men do.”
Increasing the production and retention of CO2 and decreasing the production of lactate/lactic acid is also very important when it comes to bone health. The best way to normalize CO2 levels is by optimizing cellular respiration, i.e. “utilizing glucose well”. I won’t go into detail about how to utilize glucose well here as I have already written an article on the topic that I’ve linked.
It’s important to avoid the consumption of too many polyunsaturated fats for many reasons, including protecting the bones. This means it’s crucial to curb eating out as it is nigh impossible to avoid polyunsaturated fats (canola oil, sunflower oil etc.) when eating at a restaurant. Instead, oils like coconut oil are preferable, and in fact, Ray Peat once opined that coconut oil may be able to help protect against osteoporosis.
“The increased use of the unsaturated oils has coincided with the increase of osteoporosis.”
-Ray Peat, Ph.D.
Some final quick thoughts are that excessive nitric oxide also seems to be harmful to the bones so avoiding NO boosters like nitrates is reasonable. Glycine seems to be helpful for the bones and this amino acid is high in gelatin, collagen, and gelatinous meats such as flank steak, lamb shank, beef cheek and so on. Glycine can also be supplemented as a powder, it is sweet to the taste (glycine comes from the Greek word for sweet) and it dissolves in water very well. A reasonable dose of glycine if supplemented is 3-15g a day. PPI drugs, often used for acid reflux, contribute to osteoporosis.
Ray Peat has also explained how X-rays can be very harmful to bone health in many of his articles and newsletters. Also, he has mentioned how Aspirin seems to be able to be useful for osteoporosis:
“Aspirin inhibits the formation of TNF, and aspirin has been found to retard bone loss in the case of osteoporosis”
Summary list of helpful tips for Osteoporosis:
Pregnenolone, DHEA and progesterone supplementation (product links with discount code DEAN at the end of the article)
Consume enough Vitamin A, K2, glycine, calcium, and magnesium
(many of these nutrients can be supplemented in addition to getting them from food, such as supplementing vitamin K2)
Consider supplementing vitamin D, especially if a blood test indicates low levels or high PTH
Eat enough protein
Consider supplementing vitamin B6 or vitamin E if prolactin is elevated
Correct hypothyroidism (best to avoid T4 monotherapy such as thyroxine treatment, this is a large topic and is out of the scope of this article)
Increasing CO2 production and retention via improving one’s ability to oxidize glucose (vitamin B1 and magnesium are some helpful supplements for this)
Aspirin can be helpful
Be wary of estrogen usage.
Some haidut.me blog posts on osteoporosis:
Blocking estrogen (and/or taking DHEA) prevents menopausal obesity, diabetes, osteoporosis, etc
Pregnenolone (P5) – a new osteoporosis drug
Aspirin – a new osteoporosis drug
Osteoporosis is caused by mitochondrial dysfunction, driven by nitric oxide (NO)
Low vitamin D and HIGH (not low) PTH predict bone deterioration
*None of this is medical advice. I am not a medical professional, always talk to your doctor*
If you enjoyed this article, please consider checking out the other articles I’ve written. Also, please feel free to subscribe (it is free to do so) and share the articles with others. Thank you!
BTW: I am a frequent guest on the podcast “Stuff Your Doctor Should Know”.
Discount code DEAN works at:
Ona’s Naturals (progesterone oil, topical progesterone and pregnenolone creams)
LifeBlud (Magnesium products, Taurine, Theanine, B vitamins, Methylene Blue)
Health Natura (oral pregnenolone, Methylene Blue)
Thank you for this article, Constantine! Do you have any links for DHEA, by any chance? Thanks!
Bone loss begins around age 23? Can you elaborate? Where does this fact come from?