While we’re on the topic of perimenopause –and will we ever get off it btw because quite frankly there’s so much that needs to be said?!– I need to bang the drum some more about bone health & our role in that. During our recent all-things-peri-education-event I said, this is the time when our bones adopt the ‘brace position’. You know the one before the plane crashes?🛬 Unless. Unless we use it instead as the ultimate window of opportunity to preserve the existing BMD – better yet, even build on this, which, of course, only resistance training can claim.
So let me guess what comes to mind supplement wise for preservation of BMD?
Vitamin D? K2? and Calcium?
Most of us are well past the point of believing that it’s just about taking enough of these 3. Neither the evidence nor our own clinical experience supports that. Bone metabolism & its heath is far more multifaceted and, in particular, nutritionally complex than this. So while I left the crude Calcium concept (you know, it’s the major mineral component so load ’em up) for dead a long time ago, I use Calcium almost always during perimenopause for two reasons. Firstly, most women’s intake is grossly inadequate – and I am talking here with respect to the most well-supported recommendation for daily intake and optimal bones of 800mg, not the ridiculous RDI (this is something we discuss – all RDIs and how to rationalise these in light of levels of evidence in the Nutrient Prescribers’ Program – so if you want refs just ask). The second reason to prescribe Calcium is to put pause on any increase in PTH & therefore STOP! its pilfering in its tracks. Like right here right now in this moment.
PTH is an acute responder to any dip in Calcium
…Within seconds it surges
Within minutes the GIT becomes ‘leaky’ to increase Calcium’s paracellular uptake
Within 1-3hrs the bones have been tapped
PTH peaks first thing in the morning partly in response to an endogenous circadian rhythm but also because, quite simply, we’ve been fasting and no new Calcium has come into the system. So what if we extend our overnight fasting? The PTH gets higher and stays up for longer, resulting in more negative impact on the bones. And SO many women have embraced TRE or at least extended overnight fasting – for good reasons, right? But are you assessing the impact this is having on one of the most modifiable risk factors for osteoporosis? I am and I’ve just had this conversation again with yet another woman. We had sequential PTH measures one at 7.20am (PTH 4.7 pmol/L), one at 8.30am (PTH 5.3 pmol/L) – both are too high for optimal BMD preservation. But the real issue is she doesn’t actually eat her breakfast usually until about 10! This translates to a very long period of exposure not only to high PTH but peak cortisol concentrations to boot. She was taking enough Calcium (and doing everything else right) but I had to tweak the timing of her first dose… and then we had to try and reconcile this with her TRE.
For a patient like this with that tendency for the PTH to push up too high – the 1st dose of Calcium must be within 2hrs of waking
Compared with other supplements it’s an easy one to take (not a gastric irritant like some) & with just 50-100ml of whatever milk or substitute you prefer is an easy ask before hitting the gym or the pavement or the desk! Alternatively, of course, if someone is not adhering extended overnight fasting, you just bring breakfast forward & ensure it’s a calcium rich choice. This is what I mean when I say science drives the most successful prescribing…not the bad most basic of nutritional science that SCREAMS, ”Deliver Ca to those bones like a concrete-mixer. Just pour it in!”
Nope.
The exceptional science that reveals the real nuance of how nutrients work and how then to employ them to achieve the very best results.
And if now you’re rushing to reach for Calcium but have questions about best form and dose, duration and combinations…and are hungry to experience the same level of confidence prescribing all the other nutrients to boot…well might I suggest 🤓
The Nutrient Prescribers’ Program offers you a complete revolution in the way you practice
Dynamically delivered across 11 modules which will answer just about every question you’ve ever had (What form? When? How much? How often? For how long? What with?) And all the others you haven’t thought about yet!
Or want to understand the parathyroid better as well as be across some other common things missed or ‘mistaken’ as menopause? Yes? Then check out this episode
Image by Erdei Gréta via Unsplash