Every four years, the world comes together to celebrate the Olympic games. Olympic sports are broadly classified as either team- or individually-based. Soccer and volleyball, for example, are team sports, whereas boxing and tennis are more individual.
With individual sports, coaches, trainers, and physical therapists play supporting roles to the individual who gets the spotlight. With team sports, winning usually requires strong team dynamics and success stories are almost always collaborative efforts.
Nutrition is the same way. We often focus on certain key nutrients without understanding the importance of nutrient interactions, ratios, and synergies.
Calcium is an excellent example.
Most of us grew up being constantly reminded to drink more milk, ostensibly to obtain enough calcium. Certainly we require dietary calcium, but for optimal health, we need to view calcium holistically, as one player working in concert with many other key nutrients.
Meet the Team
Calcium is essential for strong, healthy bones and teeth. It also plays vital roles in hormone regulation, muscle function, and proper heart and blood vessel function. When calcium and associated nutrient levels are properly balanced, bone strength is optimized while fracture risk is minimized.
However, when calcium is out-of-balance with the other essential nutrients more than just our bones suffer. The risk of arterial calcification and resultant cardiovascular disease increases. So which key nutrients support calcium balance?
Insufficient vitamin D inhibits calcium absorption within the intestines.1 This means even if you consume adequate calcium, you might not absorb enough if your vitamin D levels are below normal. Vitamin D status is so important that, according to the authors of a major review for the American Society for Bone and Mineral Research, vitamin D is a better predictor of bone mineral density than calcium.2 This is especially relevant considering that 42% of US adults are vitamin D deficient, with deficiency rates being even higher among blacks (82%) and Hispanics (69%).3
Magnesium is another essential mineral with respect to calcium. Roughly half of US adults have low magnesium, which is associated with type-2 diabetes, metabolic syndrome, hypertension, atherosclerotic vascular disease, sudden cardiac death, osteoporosis, migraine headaches, asthma, and colon cancer.4 One of the most powerful predictors of all-cause mortality and cardiovascular events is vascular calcification – the accumulation of calcium within the arteries, which is associated with atherosclerosis.5,6,7 Various factors promote vascular calcification, including low magnesium levels.8,9 The optimum ratio of calcium to magnesium is around 2:1. Focusing on calcium without considering magnesium is problematic.10
Vitamin K works synergistically with other fat-soluble vitamins, like D and A, to maintain serum calcium concentrations and for bone tissue maintenance. Vitamin K (in its various forms) appears to play significant roles in reducing both arterial calcification and bone fracture risk.11,12,13 Optimal ratios of calcium to vitamins K1 and K2 have not been established, but these K vitamins play such a critical role on “team calcium,” that vitamin K supplementation may be an important health strategy.14,15
It has been established that protein consumption promotes increased urinary calcium excretion. Knowing this, some researchers have suggested that lower protein diets are optimal for calcium balance and general bone health. They have gone as far to say that vegetable protein is better than animal protein.
Such conclusions, however, ignore the evidence linking low protein consumption to decreased calcium absorption.16 The RDA for protein is 0.8 grams per kg bodyweight, but optimal levels for calcium homeostasis range from 1.0 to 1.5 grams.17 This means that calcium absorption becomes more efficient as protein consumption increases. As summarized in an American Journal of Clinical Nutrition review, “concerns about dietary protein increasing urinary calcium appear to be offset by increases in absorption. Likewise, concerns about the impact of protein on acid production appear to be minor compared with the alkalinizing effects of fruits and vegetables.”18
A Paleo diet promotes this balance of healthy protein consumption along with plenty of fruit and vegetables to optimize calcium absorption.
Potassium/sodium – A Key Ratio in Acid Load
Net acid-alkaline load is an important component of health. Evidence suggests that ancestral diets were net-alkaline, thereby contributing to our ancestors’ strong bones.19,20 In other words, although they ate animal protein (net acid), they ate proportionally more vegetables, fruits, and other net-alkaline foods.
A further benefit of increased vegetable consumption is higher potassium to sodium ratios. The Institute of Medicine’s recommended ratio is 2.0, which is on par with ancestral diets, but roughly 10 times higher than ratios observed in contemporary diets.21,22 With respect to calcium, this is significant because higher potassium to sodium ratios may help the body conserve calcium more effectively.23
Conclusion: Team Tactics with a Paleo Diet
Calcium is much more of a “team sport” than an isolated nutrient. Which is why simply drinking a glass of milk or taking a calcium supplement may have disappointing results.
Getting “enough” calcium necessitates concurrently getting enough vitamin D, magnesium, vitamin K, protein, potassium, and more. This may sound complicated, but the Paleo diet is the ideal template for consuming these nutrients in their proper ratios. In some cases, supplementation of vitamins D and K may be prudent. For an in-depth look at achieving and maintaining calcium balance, check out Marc Bubb’s part 2 in this series covering how to maximize your calcium balance on a Paleo Diet.
PROMOTING CALCIUM BALANCE HEALTH ON A PALEO DIET (EASIER THAN YOU THINK) By Dr. Marc Bubbs ND, CISSN, CSCS
COCONUT MILK: A DAIRY ALTERNATIVE By Nell Stephenson