The Gut "Connections to Health & Disease"

Health & Wellness: Bone Health

In order to have proper bone health, it takes a lot of focus and a lot of nutrients. Bone health is not only an important aspect when it comes to our structure but to our overall health in general. Our bones make and house bone marrow. Bone marrow is where every single blood cell in the body gets created. Without proper bone health, we see dysfunction in our blood, tissues, and other organ systems.

As we age, our bone health starts to decline. This often leads to osteoporosis. A complex disease that is characterized by decreased bone mass, deterioration of bone tissue, and an increased risk for fractures. Studies have shown that if you have one hip fracture, that is an 80% mortality rate. Studies using families and twins have shown a strong genetic contribution to osteoporosis and 60-70% of the variability in bone mineral mass can be accounted for by genetic variations as well as variations in diet and other environmental factors. The study Osteoporosis Prevention and Management: Nonpharmacologic and Lifestyle Options is a research article showing lifestyle medications that can decrease the risk of fracture.

Our genes have been associated with:

• calcium homeostasis
• hormonal dysfunctional
• osteoblast and osteoclast development and regulation
• cartilage matrix metabolism
• lipoprotein metabolism

Lifestyle and nutrition have a large impact on these genes as osteoblasts are driven out of control with sleep deprivation, stress, poor nutrition, too much caffeine (this will drive calcium into the urine, where it is not able to be used by the body), a lack of exercise, too much exercise, and inflammation.

Genes

VDR Fok1 

The peak bone mass we have is genetically determined. VDR stands for Vitamin D Receptor gene and it accounts for 70% of the entire genetic influence on bone density. VDR also contributes to calcium homeostasis, bone cell growth, and differentiation, as well as intestinal calcium absorption. The wild type, TT, has a high impact. The Heterozygote, TC, has a low impact and the homozygote CC has no impact.

We have seen that the T allele does not absorb calcium as well as the C allele. Those who have the TT allele are more likely to have higher bone turnover and increased bone loss. These have both been associated with osteoporosis in the lumbar spine.

For those who have the T allele, it is important that they intake calcium and vitamin D. This will help their body get more of the nutrients it needs to slow down bone loss. Additionally, caffeine should be limited to 300mg a day (about 2 cups of coffee). Finally, our bones do best when they are strong. One of the best ways to encourage healthy bone growth is to practice load-bearing exercises. For more information, please see GeneCards, The Human Gene Database.

VDR Bsm1 

This is another vitamin D receptor gene that has varying impacts depending on the genotype. The wild type GG, has no impact. The heterozygote AG has a low impact and the homozygote AA has a high impact. For these genotypes, the A allele has been associated with reduced bone mass measurement in a dose-dependent matter and shows a predisposition to osteoporosis. When the calcium intake an individual has is low, the risk increases.

It is highly important to obtain calcium through dietary components as well as in supplemental form if you have the A allele. Individuals who do not have high dietary calcium have a lower phosphorus re-absorption which results in a higher risk of a hip fracture. Caffeine should also be limited for women who have the A allele. Exercise should be included as a regular routine. For more information, please see GeneCards, The Human Gene Database.

VDR Taq1

Another vitamin D receptor is VDR Taq1. The wild type, CC has a high impact. The heterozygote CT has a low impact and the homozygote TT has no impact. It has been linked that those who have a C allele have higher bone turnover and increased bone loss. This peaks when calcium intake is low. For those who have a C allele, it is best to reduce caffeine, increase load-bearing exercise as part of a normal routine, and ensure they are getting enough vitamin D and calcium. For more information, please see GeneCards, The Human Gene Database.

COL1A1 

Bones need protein in order to be made. Type 1 collagen is the major protein found in bone. Type 1 collagen is formed by two other collagen chains (alpha-1 and alpha-2). Individuals who have the wild GG genotype show no impact. The heterozygote GT shows a moderate impact and the homozygote TT shows a high impact.

It has been reported that the T allele has the ability to influence the ratio of collagen alpha chains produced by the bone cells. This can lead to abnormal mineralization of bone and overall reduced bone strength. Women who have the T allele need to be especially cautious as they have a significant chance of developing bone loss at the spine.

Individuals should follow the same precautions as above. Incorporating a load-bearing exercise routine and decreasing caffeine while increasing calcium is beneficial. For more information, please see GeneCards, The Human Gene Database. 

Test Pairing

The best place to start for personalized medicine and making these recommendations is to first understand what genotype an individual possesses and their specific risk factor. This is done with a DNA Health test by DNA Life. A sample report is shown below.

Once we have the genes figured out, we pair this test with a micronutrient test from SpectraCell. This test measures the functional level and capability of the micronutrients that are present in the white blood cells. The white blood cells is where metabolism takes place. This test measures the micronutrients that we need for proper growth, producing enzymes, hormones, development, and overall good health. Additionally, one of the micronutrients it measures for is vitamin D. A sample of the test is shown below:

If available, these two tests can be paired with a DXA test in order to assess bone mineral density. This test can diagnose osteoporosis before a broken bone occurs.

Remember that bones are dynamic tissues and they can be turned around. In order to do this, we need to ensure that bone health is a priority. Exercise is one of the first things people stop when they feel stressed or overwhelmed. However, the tug and pull on bones during resistance training is what signals the bones to deposit nutrients and break down in a healthy matter to rebuild stronger. Resistance training should be practiced at least three times a week for proper health. In addition to resistance training, increasing foods that contain calcium is a great way to increase your bone strength and provide your body with essential nutrients. Some foods that contain high calcium include cheese, yogurt, milk, sardines, and dark leafy greens like spinach, scale, turnips. Additionally, adding in foods that contain high vitamin D has also shown to be beneficial. These foods include fatty fish like tuna, mackerel, and salmon, cheese, and egg yolks.

Assessing your genes is the first step in truly personalized medicine. With this information, we are able to detect your vulnerabilities and test pair accordingly. From here, we have the ability to make changes to your lifestyle to better help your genes express in a positive manner and decrease your risk of overall disease. A great place to start is in the kitchen. You can create a quick breakfast with fruits, dark leafy greens, and yogurt to increase calcium and feed your body the nutrients it needs. -Kenna Vaughn, Senior Health Coach

References:

Christianson MS, Shen W. Osteoporosis prevention and management: nonpharmacologic and lifestyle options. Clin Obstet Gynecol. 2013;56(4):703-710. doi:10.1097/GRF.0b013e3182a9d15a

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