Many clients take bone health for granted until they’re presented with a diagnosis of osteoporosis, often following a fracture. Whether your client is nutrient deficient, concerned about bone health, or diagnosed with a metabolic bone disease, adding the right nutrients to a protocol is paramount. In her latest webinar, Dr Danielle Crida discusses: - The importance of bone health - Consequences of low bone mineral density - The most important nutrients for bone health and their synergistic roles - Exercise and lifestyle choices for bone strength - Supplement and dosing recommendations, introducing our new Ca/Mg/D3/K2/Boron product

1. Spotlight on bone health –
optimising nutrient status
Dr Danielle Crida MBChB, Dip Nutr
Nutritionist, Igennus Healthcare Nutrition
1

2. Contents
• Bone health and consequences of low
bone mineral density
• Most important nutrients for bone strength
and their synergistic roles
• Lifestyle choices for bone health
• Igennus’ new Calcium & Magnesium
Marine Mineral Complex – what sets it
apart and who would benefit from it
• Research studies

3. Bones provide structure, protect
organs and anchor muscles.
Bones store minerals and act as a
‘bank’ of calcium and magnesium -
the body is able to make withdrawals
as and when needed to keep the
amount of calcium and magnesium
in circulation at appropriate levels

4. Peak bone mineral mass at
~age 30
Thereafter ~1% loss per
year
Osteoporosis =
Decreased BMD resulting
from an imbalance between
bone deposition and
resorption

5. Osteoporosis
• ‘Porous bone’
• >3 million people in UK
• Initially asymptomatic
• Causes fragility fractures – hip, wrist, vertebrae
– >500,000 annually in UK
• No routine screening
• Diagnosis by bone density scan
• No cure

6. Risk factors for osteoporosis
• A diet low in bone supporting
nutrients, e.g. calcium,
magnesium, Vitamin D and K, and
high in soft drinks, caffeine and
salt.
• Women during and after
menopause
• Men with low testosterone
• Long-term use of high-
dose oral corticosteroids• Other medical conditions – such as diabetes, inflammatory conditions (e.g.
rheumatoid arthritis), hormone-related conditions (e.g. early menopause),
hyperthyroidism or malabsorption problems (e.g. Crohn’s)
• A family history of osteoporosis – particularly history of a hip fracture in a
parent
• Low body mass index (BMI)
• Heavy drinking and smoking

7. Lifestyle choices
• Important nutrients – calcium, magnesium,
vitamins D and K – in food or supplements
• Exercise, esp. weight bearing & resistance
• Avoiding smoking & excessive alcohol
• Avoiding excessive sugar and soft drinks

8. Calcium
Vitamin D
Vitamin K2
Boron &
trace
minerals
Magnesium
Important
nutrients
For bone health

9. Calcium
• 99% stored in skeleton
• Roles in bone structure and growth, dental health,
nerve impulse transmission, muscle contraction,
normal blood clotting, hormone secretion
• Calcium balance regulated by absorption in
intestine, reabsorption in kidney and exchange from
bone
• EU NRV 800mg/d, higher in adolescents and elderly
• Food sources: dairy, bone-in fish, green leafy
vegetables, seeds & nuts, legumes

10. Magnesium
• ~55% stored in bones
Roles in skeletal density & strength and >300
biochemical reactions, including calcium absorption &
metabolism
Magnesium deficiency leads to bone resorption by
osteoclasts
EU NRV 375mg/d
Food sources: wholegrains, green leafy vegetables,

11. Vitamin D
• Promotes absorption and
metabolism of calcium & phosphorus for bone &
dental health, heart & muscle function. Important for
immune health. Directly stimulates osteoblasts.
• UK recommended supplemental intake 10µg /day over
winter months
• Main source: sun exposure (May-September in UK);
• Food sources: oily fish, animal products, mushrooms

12. Vitamin K2
• K1 from leafy greens, for blood clotting
• K2 in animal foods & fermented plant foods
• K2 MK-7 (fermented foods, e.g. natto) for bone, dental,
metabolic & hormonal health; keeps calcium out of blood
vessels and kidneys & ensures deposition in bones and
teeth
• K2 MK-4 (animal foods) involved in gene expression and
hormonal health; K1 and other forms of K2 convert to MK-4
K2 MK-7 = most important form of vitamin K for bone
health

13. Boron
• Increases calcium,
magnesium & vitamin
D3 absorption and
reduces calcium &
magnesium excretion
• Increases half-life and bioavailability of D3 and
sex hormones
• Regulates the gene expression of mineralized
tissue-associated proteins and extracellular
matrix proteins
• Food sources: leafy greens, grains, prunes,

14. Western diet trends
• Calcium – variable
• Low in magnesium especially
adolescents
• Low in vitamin D (20% in UK Vitamin D
deficient)
• Low in vitamin K2If magnesium, D3 and K2 intake is not sufficient,
the body cannot fully utilise dietary sourced
calcium

15. Nutrient synergies: Calcium &
magnesium
Calcium
Mag
• Western diet tends to be
magnesium deficient
• 2:1 calcium:magnesium ratio
considered optimal for bone
health
• Calcium and magnesium
compete for absorption in gut
• Balanced ratio aids in calcium
absorption and conversion of
vitamin D to active form

16. Nutrient synergies: Magnesium & vitamin
D3
Mag
D3
• Vitamin D enhances
magnesium absorption
• Magnesium essential for
absorption and
metabolism of vitamin D to
its active form

17. Nutrient synergies: D3, calcium & K2
K2
Calcium
• D3 increases
calcium absorption
• K2 ensures calcium
is deposited in
bones & teeth

18. Nutrient synergies:
Boron with D3, K2 & magnesium
Boron Calcium
Magnesium D3
• Boron increases
calcium, magnesium &
vitamin D3 absorption
• Reduces calcium &
magnesium excretion
• Increases half-life and
bioavailability of D3

19. Introducing our new supplement
Igennus Calcium & Magnesium Marine Mineral Complex

20. Aquamin® seaweed multi-mineral complex
• Coral-like red algae grown
in Iceland
• Environmentally friendly &
sustainable
• Certified organic
harvesting process
• Porous, honeycomb
structure – digestible &
absorbable
• Calcium, magnesium &
trace minerals
• NutraIngredients 2016 Ingredient of the year – healthy ageing

22. Ingredient: Aquamin® Marine Magnesium
• Irish seawater derived
• Magnesium hydroxide
is highly soluble, with a
high percentage
elemental magnesium

23. Ingredient: Vitamin D3
• Vegan
• Cholecalciferol D3 form
• More bioactive than the
ergocalciferol D2 form of
vitamin D

24. Ingredient: Vitamin K2
• Soy free
• All-trans MK-7
form

26. Who may benefit?
• Support/prevention of
osteoporosis and
osteopenia
• Dental health
• Menopause
• Muscle conditions, e.g.
cramps, fibromyalgia
• Sleep disorders, e.g.
restless leg syndrome,
insomnia
• Vegans & those avoiding
dairy

27. Research studies - Aquamin®
• Supported by ~33
peer reviewed
studies over last 10
years
• Various studies in
bone, joint and
gastrointestinal
conditions

28. Aquamin® in bone health
• Supplementation with Aquamin® resulted
in less deterioration of trabecular bone
than calcium carbonate (Brennan, 2017)

29. Aquamin® in postmenopausal
women
• 300 postmenopausal women – changes
in bone density and bone turnover
markers over 24 months
• Placebo, Aquamin®, and Aquamin® &
short-chain pre-biotic (fructo
oligosaccharide)(Aq+FOS)
• Reduction in bone turnover markers in
women taking Aquamin® and Aq+FOS
• A reduction in bone mineral density loss over the course of
24 months reported in women with osteopaenia at the
outset of the trial who consumed Aquamin ® in combo with
scFOS. (Slevin, 2014)

30. Aquamin ®: Bone strength on a high-fat Western
diet
• Model of bone loss on a
high-fat western diet
(HFWD) over time
• Aquamin®
supplementation
prevented bone loss and
maintained bone
strength, even resulting in
improved bone structure
and function compared to
the control group (fed a
low-fat “healthy” diet)
[Aslam 2010]

31. Aquamin® vs.
standard
calcium
& magnesium
supplements
• Model comparing Aquamin® to calcium
carbonate and magnesium oxide in menopause
• Calcium and magnesium from Aquamin® out-
performed standard calcium and magnesium
sources with respect to bone density
preservation
[Bae 2011]

32. Aquamin® alone and
together with Vitamin D in
bone cell mineralisation
• Osteoblasts cultured in the presence of
Aquamin®: 3-fold increase in mineralisation
compared to controls [O’Gorman, 2012]
• Aquamin® plus Vitamin D increased
mineralisation and ALP more than Aquamin®
alone [Widaa 2014]

33. Algae calcium vs inorganic calcium
carbonate in premenopausal women
• Algae calcium (Aquamin®) showed increased
calcium in urine ~ greater calcium uptake and
improved PTH suppression
[Zenk 2017]

34. BMD in women >40yrs following 3 bone
health plans containing algae calcium
• Previous studies of calcium & vitamin D showed
decreased BMD loss but no increase in BMD
• Women >40yrs with above average compliance
compared to age-related expected BMD loss
• Increase in BMD in all 3 groups by at least 1.3%
after 1 year, proportional to compliance
[Kaats 2011]

35. Aquamin® in joint health:
Osteoarthritis
• ~10% men and 18% of women over 60yrs symptomatic OA
• 80% have limitations in movement
• Progressive joint space narrowing, cartilage breakdown and
osteophyte formation, leading to pain, disability and reduced quality
of life
• No cure; treatment includes NSAIDs (suboptimal) and joint

36. Aquamin® for symptoms of
osteoarthritis
PBO = Placebo
A = Aquamin®
GS = Glucosamine sulphate
G+A = Glucosamine sulphate
+ Aquamin®
[Frestedt, 2008]

37. Aquamin®:
Less NSAID use in
OA
• Moderate-severe osteoarthritis patients
• Daily NSAIDs with gradually reduced dose
• ~3x more in placebo group dropped out due to
increasing pain compared to Aquamin®
• At 50% reduction in NSAIDS, participants using Aquamin
® had improved pain scores, joint range of motion and 6
minute walk test distances compared to placebo group.
[Frestedt 2009]

38. Aquamin®:
Anti-inflammatory
mechanisms
• Production of key pro-inflammatory cytokines,
including TNF- α and IL-1β, are inhibited in the
presence of Aquamin® and an inflammatory
stimulus(LPS) [Ryan 2011]
• Aquamin® regulates the inflammatory response
by modulating nuclear factor kappa B signaling
pathway. [O’Gorman 2012]

39. Aquamin®:
Polyp prevention
study 1
• Aquamin® inhibits polyp formation and
inflammation in the gastrointestinal tract
on a high-fat diet
[Aslam 2010]

40. Aquamin®:
Polyp prevention
study 2
• [Aslam 2012]
• Human studies currently in progress
Standard diet
Colon polyps
High fat Western diet
Colon polyps
No Aquamin® 16/70 (23%) 22/70 (31%)
With Aquamin® 8/70 (11%) 2/70 (3%)

41. Induction of calcium
sensing receptor
(CaSR) in human
colon cancer cells
• Cancer cells that do not express CaSR are highly
malignant
• Calcium, vitamin D and Aquamin® all induced CaSR in
human colon cancer cell lines and inhibited cellular
proliferation in parental and CaSR null cells – Aquamin®
most potent
[Singh 2015]

42. Liver tumors
Standard diet
liver tumors
High-fat Western diet
liver tumors
No Aquamin® 5/50
3/25 male mice
15/50
12/25 male mice
With Aquamin® 1/25 male mice 3/25 male mice
[Aslam 2012]

43. Aquamin® & Aquamin® Mg
and the
gut microbiome
• Increased production of short-chain fatty
acids, e.g. butyrate
• Increased microbial diversity
[Crowley, 2018]

44. Boron in bone and joint health
• Increases half-life and bioavailability of sex hormones
and vitamin D
• Increases calcium and magnesium absorption,
decreases their excretion, and promotes their deposition
into bone
• Reduces inflammatory biomarkers
• Increases antioxidant enzymes
• Promotes production of extracellular matrix proteins
• Adequate intake protects against development of
arthritis, and supplementation significantly decreases
pain and stiffness in osteoarthritis, allowing many to

45. References
• Adluri, R.S., Zhan, L., Bagchi, M. et al. Comparative effects of a novel plant-based calcium supplement with two
common calcium salts on proliferation and mineralization in human osteoblast cells. Mol Cell Biochem 340, 73–80
(2010) doi:10.1007/s11010-010-0402-0
• Aslam MN, Paruchuri T, Bhagavathula N, Varani J. A Mineral-Rich Red Algae Extract Inhibits Polyp Formation and
Inflammation in the Gastrointestinal Tract of Mice on a High-Fat Diet. Integr Cancer Ther (2010) 9:93
• Aslam MN, Bergin I, Naik M, Paruchuri T, Hampton A, Rehman M, Dame MK, Rush H, Varani J. A Multimineral
Natural Product from Red Marine Algae Reduces Colon Polyp Formation in C57BL/6 Mice. Nutrition and
Cancer,(2012) 64 (7): 1020-8
• Aslam MN, Bergin I, Naik M, et al. A multi-mineral natural product inhibits liver tumor formation in C57BL/6 mice.
Biol Trace Elem Res. 2012;147(1-3):267-74.
• Aviello G, Amu S, Saunders SP, Fallon PG. A mineral extract from red algae ameliorates chronic sponta- neous
colitis in IL-10 deficient mice in a mouse strain dependent manner. Phytotherapy research: PTR. 2014;28(2):300-4.
• Aslam MN, Kreider JM, Paruchuri T, et al. A mineral-rich extract from the red marine algae Lithothamnion
calcareum preserves bone structure and function in female mice on a Western-style diet. Calcified tissue
international. 2010;86(4):313-24.
• Aslam MN, Bergin I, Jepsen K, et al. Preservation of bone structure and function by Lithothamnion sp. derived
minerals. Biol Trace Elem Res. 2013;156(1-3):210-20.
• Bae YJ, Bu SY, Kim JY, et al. Magnesium supplementation through seaweed calcium extract rather than synthetic
magnesium oxide improves femur bone mineral density and strength in ovariectomized rats. Biol Trace Elem Res.
2011;144(1-3):992-1002.
• Brennan O, Sweeney J, O’Meara B. et al. A Natural, Calcium-Rich Marine Multi-mineral Complex Preserves Bone
Structure, Composition and Strength in an Ovariectomised Rat Model of Osteoporosis. Calcif Tissue Int 101, 445–
455 (2017) doi:10.1007/s00223-017-0299-7
• Crowley EK, Long-Smith CM, Murphy A, et al. Dietary Supplementation with a Magnesium-Rich Marine Mineral
Blend Enhances the Diversity of Gastrointestinal Microbiota. Mar Drugs. 2018;16(6):216. doi:10.3390/md16060216

46. Frestedt JL, Walsh M, Kuskowski MA, Zenk JL. A natural mineral supplement provides relief from knee
osteoarthritis symptoms: a randomized controlled pilot trial. Nutr J 2008: 7: 9.
Frestedt JL, Kuskowski MA, Zenk JL. 2009, A natural seaweed derived mineral supplement (Aquamin F)
for knee osteoarthritis: a randomised, placebo controlled pilot study. Nutr J 2009. 8: 7–14.
Kaats G et al. A Comparative Effectiveness Study of Bone Density Changes in Women Over 40 Following
Three Bone Health Plans Containing Variations of the Same Novel Plant-sourced Calcium Int. J. Med. Sci.
2011; 8(3):180-191
O'Gorman DM, O'Carroll C, Carmody RJ., 2012, Evidence that marine-derived, multi-mineral, Aquamin,
inhibits the NF-kappa B signaling pathway in vitro. Phytotherapy research 2012;26(4):630-2.
O'Gorman DM, Tierney CM, Brennan O, O'Brien FJ. The marine-derived, multi-mineral formula, Aquamin,
enhances mineralisation of osteoblast cells in vitro. Phytotherapy research 2012;26(3):375-80.
Pizzorno, L. (2015) Nothing boring about Boron. Integrative Medicine 14:4. August 2015
Ryan S, O'Gorman DM, Nolan YM. Evidence that the marine-derived multi-mineral Aquamin has anti-
inflammatory effects on cortical glial-enriched cultures. Phytotherapy research 2011;25(5):765-7
Slevin MM, Allsopp PJ, Magee PJ, et al. Supplementation with calcium and short -chain fructo-
oligosaccharides affects markers of bone turnover but not bone mineral density in postmenopausal
women. J Nutr. 2014;144(3):297-304.
Shea KL, Barry DW, Sherk VD, et al. Calcium supplementation and parathyroid hormone response to
vigorous walking in postmenopausal women. Med Sci Sports Exerc. 2014;46(10):2007-13.
Singh N et al. Induction of Calcium Sensing Receptor in Human Colon Cancer Cells by Calcium, Vitamin D
and Aquamin: Promotion of a More Differentiated, Less Malignant and Indolent Phenotype. Molecular
Carcinogenesis. (2015) 54:543–553
Widaa A et al. The osteogenic potential of the marine-derived multi-mineral formula aquamin is enhanced
by the presence of vitamin D. Phytother Res. 2014 May;28(5):678-84. doi: 10.1002/ptr.5038
Zenk J, Frestedt J & Kuskowski M. Effect of Calcium Derived from Lithothamnion sp. on Markers of
Calcium Metabolism in Premenopausal Women J Med Food 00 (0) 2017, 1–5