It’s the 14th of July, a big holiday here in France. There’s fireworks, the parade down the Champs-Élysées, and La Marseillaise has been stuck in my head for a good six hours at this point.
Safe to say, it’s been hard to get today’s newsletter out with my usual timeliness.
And today’s isn’t about iron. A reader wrote me recently asking about calcium. She’s been told that she needs more of it. Unfortunately, there is so much information out there and it’s confusing, with a whole lot of moving parts. Covering all of that ground will take a few weeks, so let’s get started.
Eat more calcium. Add protein. Take vitamin D. Drop dairy for inflammation. Lift weights. Ask about hormones. Consider medication. That’s a lot.
And come on, you’re likely in the trenches of daily life, career, family, social life, and everything else. Drop in health issues and deciphering the related research, keeping the feelings of overwhelm at bay can be another full-time job.
So I’ve done that research for you today. I looked into the scientific literature to see what I could find in the way of evidence. And this is the result. I’ve ranked how best to focus on rebuilding or maintaining bone density based on what we know so far.
Here’s what caught my eye this week:
🔎 The "cortisol cocktail" is all over your feed this month: the logic — each ingredient (OJ, coconut water, salt, sometimes magnesium) nudges cortisol, so the drink must lower it — isn't crazy, but the drink itself has never been tested. And the component studies are in stressed or deficient groups at set doses (not daily juice).
🔎 The tiredness, brain fog and low mood women keep calling "burnout": iron deficiency + thyroid as the miss behind "burnout."
🧴 SPRIND opened a €40M "continuous hormone monitoring" challenge: Clue founder Ida Tin funding a continuous-hormone wearable at pre-product R&D stage.
Just sharing here what's new this week. No affiliates, no sponsorships, no freebies. A mention here isn't a recommendation.
For your bones, it’s (nearly) impossible to do everything, all at once. So here’s the ranked list.
Two matter most for almost everyone: strength-and-impact exercise, and dealing with the estrogen drop of menopause.
Everything else depends on a few facts about you.
Start with yourself
Your plan depends on where you are and a handful of numbers, so it’s most helpful if you have this information first.
Where you are in menopause. Before menopause, you're building peak bone mass, the most bone you'll ever have. In perimenopause or after, falling estrogen becomes the main driver of bone loss and the goal shifts to preventing fractures.
Your bone-density scan (DXA) T-score. This is the number that defines osteoporosis and sets how aggressive to be.
Your vitamin D blood level. Below 20 ng/mL is a real shortfall, and where you work on getting back to sufficiency.
Your calcium from food. Count calcium-rich servings: a cup of milk or yogurt, a piece of hard cheese, fortified plant milk or juice, or canned fish with bones each count as one. Aim for about three a day to reach the ~1,200 mg target, or try the free IOF Calcium Calculator.
Your protein. Know how much you eat in a day. For older women, you want to be getting roughly 1.0 to 1.2 grams per kilo, daily.
Whether you already do strength and impact exercise. Real resistance and impact work, not just walking.
Hidden causes. Celiac disease, thyroid and parathyroid problems, and certain medications can diminish bone density. These will need to be addressed first before even considering the items listed below.
Your priorities, strongest lever first
This is the order for most people. But knowing your specifics above can help you to make the adjustments that best address your specific needs.
Strength and impact exercise. Lifting weights, jumping, jogging builds bone where non-exercisers lose it and reduces the falls that break bones, which vitamin D doesn't. This is a top priority if you're not already doing real resistance and impact work.
Deal with the estrogen drop. Hormone therapy cuts hip fractures by about a third. Move it to the top of the list if you're within ~10 years of menopause.
Bring each nutrient up to enough, then stop.
Vitamin D low? Fix it first, since it controls calcium absorption. Below 20 ng/mL is a real shortfall. It won’t help more beyond that.
Calcium short? Try to close the gap with food first. Guidelines say to use supplements only when you can't reach the target from your diet, and in trials it was fortified dairy, not pills, that actually raised bone density.
Protein low? The simplest fix is a protein source at every meal. Eggs or dairy at breakfast, then fish, meat, beans, or tofu. But this only really helps if your calcium is adequate.
Already at target? No need to add more. Studies show that beyond the recommended thresholds, no extra bone is rebuilt, and extra calcium pills didn't lower hip fractures.
Medication. For a T-score −2.5 or lower, or a low-trauma fracture, medication does more than any nutrient. If you fall into this category, medication actually jumps to the top of the list and it’s worth discussing with your doctor. Diet becomes support only in this case.
What the research says about "anti-inflammatory eating"
The evidence here is thin.
Everything linking an "anti-inflammatory diet" to bone comes from observational studies that score diet questionnaires for inflammation and compare them to bone density or fractures. No trial has actually tested an anti-inflammatory diet for bone.
In those studies, its link to bone density is very small. The link to fractures shows up in weaker designs, but not in the stronger ones that follow women over years, and one study of ~93,000 women even found the opposite.
So there's no solid evidence it helps your bones, and it’s never been properly tested. There’s also no strong evidence that it hurts.
It’s worth noting that dairy — as a calcium-rich food — is an efficient calcium source, so cutting it as part of an anti-inflammatory diet would also mean cutting a great source of calcium and protein.
📋 Write down the four numbers that set your bone plan, and ask for them at your next check-up. A DXA scan for your T-score, vitamin D blood level, a thyroid and calcium check, and a celiac test if you have gut symptoms.
🩸 If you already have a vitamin D result, treat anything under 20 ng/mL as a shortfall to fix before anything else. Fix it even if the lab calls it "normal." Below 20 is deficiency, and it sets how much calcium you absorb.
🥛 This week, count your calcium-rich servings on a normal day. Milk, yogurt, hard cheese, fortified plant milk or juice, and canned fish with bones each count as one.
🏋🏻 Put two strength-and-impact sessions on your calendar each week. Lift something heavy for you, plus a few hops or jumps if your joints and doctor allow. Bone rebuilds slowly, so this is for the long term.
⏳ If you're within ~10 years of your last period, put hormone therapy on the agenda at your next doctor’s visit. In that window, it's the single biggest lever against fractures, and the benefit fades the longer you wait.
How valuable was today's issue for you?
