Part 4 of an ongoing series
Part 3 ended on movement: how loading builds bone, and why muscle strength is the difference-maker. This post turns to the other half of that story, bone nutrition: what actually feeds the system, and where common advice gets it wrong.
Published findings carry a number in brackets that matches the reference list at the end. Everything else comes from what I see in practice.
Beyond Calcium: How Bone Nutrition Has Shifted
For decades, bone nutrition advice fit in one word: calcium. Bone is mostly mineral, so the logic seemed airtight. Take more of it, add a supplement, drink the milk.
The research has moved on. Calcium is the raw material, but it doesn’t decide where it ends up. Vitamin D3 governs how much calcium the gut absorbs. Vitamin K2 activates the proteins, osteocalcin and matrix Gla protein, that help direct calcium into bone and keep it out of soft tissue like the arteries.[1] Reviews of calcium supplements taken on their own have shown limited fracture benefit, along with open questions about heart and kidney stone risk.[2]
In my practice, we moved away from heavy calcium supplementation a long time ago. Our approach is food-first calcium, with supplements reserved for a documented shortfall.
Vitamin K2 is fat-soluble, so absorbing it depends on healthy digestion, including bile from the liver and enzymes from the pancreas.[1] That detail comes back later in this post.
Vitamin D: The Supplement and the Sun Are Not the Same Thing
Time outdoors does more than any capsule. Sun on the skin makes vitamin D, and daylight through the eyes sets the body clock that runs your sleep, which we covered in the circadian rhythm post. Living with nature as often as possible gets you both.
For bone, I find a D3 supplement is often necessary, especially for people who are deficient. I just don’t think of it as a replacement for time outside.
Food as Part of the Inflammation Equation
Part 2 described a competition. When the body runs a chronic inflammatory cascade, bone gets pulled into buffering duty, and its own maintenance loses out. The biology behind that is well established. When the body carries a heavier acid load, bone is one of the buffers it draws on, and acid directly switches on the cells that break bone down while slowing the cells that build it.[3] Chronic inflammation pushes in the same direction through its own chemical signals.[4]
Vitamin D3 and K2 work on the supply side of bone. What you eat every day works on the demand side, because it either feeds that inflammatory load or helps settle it.
“Anti-inflammatory diet” describes any way of eating built around lowering inflammatory load. Fiber is one lever, because it shapes which bacteria thrive in the gut.[5] Food quality is another: whole foods over highly processed carbohydrates, sugars, and saturated fats.[5]
Diet quality shows up in bone. In pooled studies, people eating the most inflammatory diets had lower bone density and more fractures than people eating the least inflammatory diets.[6] Of the diet patterns studied, the Mediterranean pattern (vegetables, fruit, legumes, fish, olive oil) shows the most positive effect on bone, and closer adherence to it is linked to about a 21% lower risk of hip fracture.[5] These are associations from observational research, but they point the same way the biology does.
Mediterranean and Paleo-style eating share the same core: whole foods and minimal refined or processed food. Both are built to keep inflammation low. Mediterranean has the deeper research record.
Paleo is a good example of eating with inflammation in mind. It removes grains, dairy, and refined foods in one move, which strips out many common triggers at once. That is especially useful for athletes, since heavy training raises both protein needs and inflammatory load. The point is the principle underneath: find what feeds the inflammation and take it away.
Dairy, Food Sensitivity, and Getting Calcium Elsewhere
About two-thirds of adults worldwide stop making enough of the enzyme that digests milk sugar.[7] In those people, lactose passes undigested into the colon, where it draws in water and is fermented by bacteria. The result is the gas, bloating, and loose stools many people accept as normal.[7]
Whether that ongoing disruption feeds body-wide inflammation hasn’t been settled in human studies. In my practice, most patients simply do better off dairy.
When a patient needs to know which foods are driving a reaction, I order food sensitivity testing through a CLIA-certified lab. I use the results to build a strict but safe elimination plan. Foods come out for a defined period, and I replace the nutrients they supplied on purpose, calcium in particular when dairy is removed. Then each food goes back in one at a time. The test gives me a starting list, and the patient’s own response to reintroduction confirms it. Over years of practice, I’ve seen this approach produce consistent results.
Going dairy-free is fine for bone as long as the calcium is replaced on purpose. For my patients eating this way, calcium comes through the rest of the pattern: leafy greens, canned fish with the bones, nuts and seeds. The exception is a patient who is also vegetarian. With meat and fish off the table too, I point them to dark green leafy vegetables as their main calcium source, favoring greens like kale and bok choy, which give up their calcium more easily than spinach does.
Protein: Eating It Is Only Half the Job
Protein is the raw material for muscle, but it only builds muscle when the muscle is asked to work. In older adults, extra protein improved muscle mass and grip strength when it was paired with resistance training.[8] And as Part 3 laid out, muscle is one of the best partners bone has, because working muscle is what loads the skeleton.
Eating enough protein doesn’t help much if digestion can’t do its part. When someone isn’t breaking protein down well, the amino acids that rebuild muscle and support bone never fully arrive. The same goes for K2, which needs healthy fat digestion to be absorbed. I look at digestion alongside intake.
Put Out the Fire Before You Build
This is the same order as Part 3. There, posture and stability came before loading. Here, calming inflammation comes before building.
Many digestive problems end in inflammation. When the gut isn’t breaking food down or absorbing it well, the result is more inflammatory load on the whole body, which is the same load Part 2 showed pulling bone away from its own maintenance.
You can’t build while the fire is still burning. Adding protein, calcium, D3, and K2 to a body that is digesting poorly and running chronically inflamed means those inputs get wasted or fight a losing battle. So I clear the inflammation first, then build on top of it.
Clearing the fire usually combines a few tools, chosen by what is driving the problem in that patient. The diet changes above do the heavy lifting on inflammation. Immune support is another tool.
Amino acids aimed at the gut lining are another, and they are showing real promise. Glutamine is the best example. In a randomized, placebo-controlled trial published in the journal Gut, people whose gut lining had become leaky after a gut infection took glutamine for eight weeks. Their gut barrier returned to normal, and about 80% saw major symptom relief, compared with about 6% on placebo.[9] That is one study in one group of patients, so I use glutamine as a targeted tool.
Spore-based probiotics, often including Bacillus subtilis, are where I usually start for gut and immune support. These spores survive stomach acid and become active in the small intestine within hours.[10] Human studies show they work while they’re present, which is why they’re taken daily. In human trials, specific strains have eased bloating and gas[11] and shown immune-modulating effects.[12] I use specific, strain-verified products, because quality varies widely across this category.
Why This Belongs in a Chiropractic Series
The nervous system needs every pillar working well: posture, nutrition, clarity, and sleep. When one is off, it becomes a distraction. The body has to spend resources on that problem, which pulls it away from building and pushes it into stress. That is why nutrition belongs in a chiropractic series. It is one of the inputs the nervous system needs in order to hold the structural work. A body that is inflamed and digesting poorly has a harder time holding posture, responding to loading, and keeping the disc fed through its endplate.
In my practice, the pillars of care (posture, nutrition, clarity, and sleep) are introduced as they become relevant, and as early as I can. Nutrition does not wait until a patient asks. Even the casual patient who comes in for one complaint will hear about it, because it supports everything else we are building.
Where We’re Headed
Part 5 picks up the hormonal drivers behind bone loss, including thyroid, vitamin D, sex hormones, and parathyroid hormone more broadly, and how they tie back to the brain-and-bone connection from Part 1. As always, no rush.
Dr. Anish Bajaj, DC, is the founder of Well Rooted Health (Westfield, NJ) and Well Rooted Chiropractic (NYC), a peer-reviewed researcher, and a 25-year practitioner focused on the intersection of posture, nutrition, cognition, and sleep.
References
- Fan X, Rudel R, Berger M, et al. General nutritional principles. In: Yamada’s Textbook of Gastroenterology. 7th ed. 2022.
- Reid IR. Calcium supplementation: efficacy and safety. Current Osteoporosis Reports. 2025.
- Bushinsky DA, Krieger NS. Effects of acid on bone. Kidney International. 2022.
- Rauner M, Bozec A. Mechanisms of osteoclast activation in inflammatory bone loss in rheumatoid arthritis. Nature Reviews Rheumatology. 2026.
- Rizzoli R, Biver E, Brennan-Speranza TC. Nutritional intake and bone health. Lancet Diabetes & Endocrinology. 2021.
- Fang Y, Zhu J, Fan J, et al. Dietary inflammatory index in relation to bone mineral density, osteoporosis risk and fracture risk: a systematic review and meta-analysis. Osteoporosis International. 2021.
- Micic D, Rao VL, Rubin DT. Clinical approach to lactose intolerance. JAMA. 2019.
- Kirwan RP, Mazidi M, Rodríguez García C, et al. Protein interventions augment the effect of resistance exercise on appendicular lean mass and handgrip strength in older adults: a systematic review and meta-analysis of randomized controlled trials. American Journal of Clinical Nutrition. 2022.
- Zhou Q, Verne ML, Fields JZ, et al. Randomised placebo-controlled trial of dietary glutamine supplements for postinfectious irritable bowel syndrome. Gut. 2019.
- Colom J, Freitas D, Simon A, et al. Acute physiological effects following Bacillus subtilis DE111 oral ingestion: a randomised, double blinded, placebo-controlled study. Beneficial Microbes. 2023;14(1):31-44.
- Garvey SM, Mah E, Blonquist TM, Kaden VN, Spears JL. The probiotic Bacillus subtilis BS50 decreases gastrointestinal symptoms in healthy adults: a randomized, double-blind, placebo-controlled trial. Gut Microbes. 2022.
- Lefevre M, Racedo SM, Ripert G, et al. Probiotic strain Bacillus subtilis CU1 stimulates immune system of elderly during common infectious disease period: a randomized, double-blind placebo-controlled study. Immunity & Ageing. 2015;12:24.
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