“The Calcium Paradox” – the bone/artery connection

How are your bones?

Maybe your doctor says you have osteoporosis or osteopenia. Osteopenia is when your bones are weaker than normal but not so far gone that they break easily, the mark of osteoporosis. Sometimes you get diagnosed by a bone density test ordered by your doctor. Sometimes we find out we have osteoporosis when we break a bone.

Maybe the doctor says you need to get more calcium. That seems to make sense because the primary mineral in bone is calcium. And we think taking that supplement or drinking more milk will get some more calcium in those weak bones and all will be good. Maybe not.

Do you need more calcium?

Americans drink more milk than any other country in the world and have the highest level of osteoporosis. So something else is amiss. The problem isn’t necessarily the absence of calcium but that the calcium just isn’t staying where it belongs – in your bones and teeth.

Think about teeth for a minute. Children whose jaws are too small for their permanent teeth have crooked teeth and the ever popular “braces.” Their little systems haven’t kept calcium in the jaw where it belongs, “uncontrolled and inappropriate calcification.” Teeth prone to decay are missing calcium.

So where does the calcium go?

So where does the calcium go when it isn’t staying in your bones or teeth?

It is floating around in your blood looking for a home. That “home” might be soft tissue like joints, in the kidneys (think kidney stones), or worse yet the walls of your arteries and veins (think cardiovascular disease). So the important question becomes: how do we get the calcium to go to and stay where it belongs?

Just bear in mind that a nutrient in your food isn’t just fired with a canon to some special spot in your body. Food has to be first broken down into nutrient parts in your stomach/intestines and shipped out via the blood into the body. Then all the nutrients interact with each other and eventually arrive in multiple places meeting some important need.

In other words, every essential vitamin, mineral, etc is required for health. Any nutrient that doesn’t arrive where it belongs (and that will be many places) will eventually have consequences. We are examining only one such consequence.

Nutrients involved in calcium deposition

Vitamin A, D3, and K2 are the three key nutritional elements involved in calcium deposition. Vitamin A and D3 cause cells to produce proteins to which minerals and water-soluble vitamins “bind.” Calcium is a mineral. However, if the proteins are not “activated” ain’t no binding going on. Activation requires vitamin K2.

Maybe you think vitamin K is just one thing but it’s not.

Vitamin K1 is abundantly available in green leafy vegetables and works to keep blood thin enough to avoid inappropriate clotting. Those taking a “blood thinner” like Coumadin are trying to avoid clotting. K2 has a different job in activating vitamins A and D3.

Of course, as said above, vitamins A, D3, and K2 actually have multiple very critical jobs in the body but managing calcium is the subject of this article.

Vitamin A is required for proteins that break down old damaged bone and Vitamin D3 does the same for laying down new bone in its place. This is called bone “remodeling” and it happens if K2 is around to properly activate the calcium binding process.

What does this have to do with cardiovascular disease?

So what does this have to do with cardiovascular disease, the hottest health topic around these days? Well, look at it this way.

One of the latest tests is a CAC test, a CT scan that looks for buildup of calcified plaque in the arteries that supply blood to the heart. That is the source of blockage. That is calcium misplaced. So if you are still wondering where else calcium might be going, now you know. Cardiovascular disease is still the #1 cause of death. You do want to avoid it.

Therefore, along with the calcium in your food, it is equally (and maybe more) important for you to get Vitamins A, D3, and K2. But from where?

Where do you get Vitamins A, D3, and K2?

Note first that these three are all fat soluble vitamins. That means you find them in fat. That said:

  1. The best sources of vitamin A are meat (especially liver) and meat products like eggs and cheese. A thing called beta carotene in intensely colored plants can be partially converted into vitamin A. But some people (including me) have a genetic variation that limits conversion of beta carotene to vitamin A. I eat meat.
  2. D3 is actually available in fish and fish oil but, for most of us, is ideally created in our skin with regular, albeit minimal exposure to the sun. After all in the (really) old days Eskimos had lots of fish but not much exposure to sun. Conversely the folks in the middle of Central America had lots of sun but not much in the way of fish.
  3. Vitamin K2 is produced by bacteria found in fermented foods and produced in animal products as long as the animals eat green, chlorophyll containing foods. In other words, they graze. A human diet that consists of nutrient poor, ultra-processed food and animals raised on corn can easily be K2 deficient.

If you are in dietary trouble on any one of these three, you are predisposed for misplaced calcium (as well as lots of other problems). In the early stages diet change alone may be enough to sidestep the problem. Otherwise consider adding supplementation to your diet change.

According to naturopathic doctor Kate Rheaume-Bleue, author of Vitamin K2 and the Calcium Paradox, the recommended daily allowances (RDA) for A and D3 are adequate. K2 can be from 120 to 140 micrograms and even more is not toxic.

More to know about vitamin K2.

Vitamin K2 actually arrives in food and is broken down into several forms. For the purposes of this discussion, the MK4 and MK7 are the most important. Eaten in food as opposed to supplementation highlights the difference.

MK4 recycles in the body when it arrives via food so a ton is really not required. But if taken as a supplement you have to arrange for a larger supply to keep it available all the time. MK7 doesn’t recycle but it lasts a long time. So a supplement can be taken less often.

Bottom line is, according to Dr. Rheaume-Bleue, an MK7 pill only needs to be taken daily (or even less) but three MK4 pills will be required daily. That could get expensive and tax your memory. I can’t imagine trying to remember to take a pill three times per day.

One more thing

There is a basic nutrient requirement that hasn’t been covered here.

Magnesium is perhaps the most basic mineral used by the body, used everywhere for essentially everything that has to happen. If magnesium is inadequate, nothing else is going to work as well as it should.

If you don’t eat a variety of whole plant foods, perhaps depending mostly on ultra-processed commercial food, you are likely magnesium deficient.

This link takes you to a relatively easy magnesium reference provided by Chris Masterjohn, PHD, an expert in nutritional science.

What about osteoporosis drugs?

And no, taking an osteoporosis drug like Fosomax or Boniva is not a substitute for the right nutrients or even supplements.

If you are using any of those drugs your dentist should want to test to assure that your body is actually building bone. There is an uncommon but extremely detrimental condition associated with those drugs marked by deterioration of the jaw bone.

Your dentist may not be willing to pull a tooth or perform any other procedure that might expose your jaw bone if you are using or have recently used these drugs. I have a friend who went down this road without such a warning and the result was not pleasant. But it is rare.

How much more do you want to know?

I do highly recommend Kate Rheaume-Bleue’s book listed above. She packages information that would require a lot of research and time to collect on your own. And if you think you need to be convinced, the book will undoubtedly do it for you.

On the other hand, I do remind one last time that this is a diet thing. The simplest overall guidelines for nutritious food choices are in my book, It’s All about the Food. It is far better to avoid osteoporosis, cardiovascular disease, and kidney stones than it is to treat them.


Pat Smith is the author of “It’s All about the Food,” a book that guides nutritious food choices as the way to avoid illness and maintain a healthy weight. Proceeds from her book benefit the Montgomery County Food Pantry. Her website is http://www.allaboutthefood.org/ She can be contacted at patsmith2@live.com, 501-605-3902. Her Facebook page is www.facebook.com/patsmithbooks.