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OSTEOPOROSIS
- Natural help for
bone loss
by Lynn Hinderliter CN, LDN
How huge our parents appeared to us when we were
children, yet when we are grown, they seem so much smaller . It is not
just that we have grown, very likely they are smaller now.
This is because with age the body's frame can
shrink as we lose cartilage, the padding between the bones of the spine. For
some people this process remains within acceptable bounds, but for others it can
become a major heath hazard as not only is the cartilage affected, but the bones
themselves become brittle and start to erode . This bone loss happens to men as
well as women, but is more common and a greater health risk in women.
It is never too soon to start
ensuring the health of your bones: adequate steps taken during
adolescence and before the child-bearing years translate to protection
later!
Bone loss in women usually starts imperceptibly
around the age of 30, increasing rapidly with the onset of menopause, then
slowing down again about 5 years after the "change" to the earlier
rate. The point is that the better the foundation of bone laid down in youth,
the further you have to decline in age to be in trouble. As with so many health
problems, prevention is so much easier than cure.
Risks are higher for some women than for others,
and the following factors are extremely relevant:
Hormonal Balance is crucial to healthy bones. In Dr.
John Lee's book, Natural Progesterone, The Multiple Roles of a
Remarkable Hormone, he points out that if estrogen were the only hormone
involved in the accelerated bone loss of the menopausal years, then there would
be no bone loss when hormonal levels of estrogen are high, as is the case
certainly after age 30 and even into the later childbearing years.
The fact that the rate of bone loss accelerates
when estrogen levels fall suggests a partial involvement, but the hormone that
is lower during both these times in a woman's life is progesterone.
The evidence we have at the moment suggests that estrogen's role in bone loss is
limited to increased bone resorption in its absence.
In other words, when levels of estrogen
are low, it can no longer inhibit the rate at which bone is broken down:
but we have no real evidence of receptor sites for estrogen in the
bone building process.
On the other hand, there is evidence that such
sites do exist for progesterone. In fact, Dr. Lee's studies show that untreated
post menopausal women will lose bone mass, that estrogen supplementation will
maintain bone mass, but that supplementing with natural progesterone will
increase bone mass, effectively reversing the osteoporotic process.
Remember, all hormones have cholesterol as a
base, and the hormone-like vitamin D is also dependent on cholesterol.
Regulation of cholesterol and LDL is dependent on the presence of the correct
fatty acids. Because of the hormone connection to bone health, I urge you to balance
your essential fatty acid intake to make sure you are getting a healthy ratio of
Omega 3 to Omega 6. Think fish 3 times a week, or a supplemental
source of Fish Liver Oil.
Researchers measured bone
density at several skeletal locations
in 130 anorexic women in their mid 20s. 92% had substantial bone loss in at least one site: 38%
had bone loss severe enough to qualify as osteoporosis. "Bone
mineral density did not differ by history of estrogen use at any
site," the study authors reported.
While estrogen use was not related to bone
density, several other factors were:
Weight
Age at first period
Amount of time
that had elapsed since women had their last menstrual period
were all associated with bone density.
Interestingly, this study found that calcium and vitamin D
supplements did not improve bone density in these women either. I would be
interested to see a study investigating the connection between low
stomach enzyme levels and anorexia: lack of hydrochloric acid is
one cause of zinc deficiency, which has been linked to eating disorders. HCL
is necessary for the absorption of both calcium and zinc.
Annals of Internal Medicine November 21, 2000; 133:
790-794
Step 2
Proper diet. For women, this
involves careful balancing of nutrients, heavy on the green leafy vegetables
(such as kale, spinach, broccoli, cabbage), and low on animal fats. The Nurses'
Health Study looked at this question of diet, and Dr. Diane Feshkanish, M.D. of
Harvard Medical School found that the 20% of women who consumed less than 109
mcgs. of Vit. K (found primarily in your green leafies) had a
43% higher risk of hip fracture.
There are numerous studies that show bone mass in
vegetarians is much denser than that of meat-eaters when they reach their
fifties, and the reason appears to be that high animal protein promotes the
excretion of calcium. The main dietary enemies of proper calcium balance are
sugar, caffeine and alcohol, all of which cause calcium to be lost from the
body, and drinking carbonated pops, where the excess of phosphoric acid is
thought to interfere with calcium uptake. I theorize it also causes an acid body
pH, which affects calcium balances.
Osteoporosis is intimately affected by your pH. Counteracting
Acidic Diet Reduces Markers of Bone Loss in Older Adults http://www.medpagetoday.com/PrimaryCare/DietNutrition/12006
I also recommend that women limit their
dairy intake (unless they have access to raw milk products), except for
yoghurt and kefir (see RESOURCES at bottom) and
replace some dairy with soy products. As previously stated, studies are
suggesting that soy promotes proper hormonal balance, essential for
bone-building, and it is a fact that countries where dairy consumption is high
tend to have higher levels of osteoporosis. Interestingly, tea (even
caffeinated) is associated with higher bone density. This is probably because
tea contains many positive elements, flavonoids such as catechins, and now
research has discovered that an amino acid in Green Tea, called
L-Theanine, counteracts the effects of caffeine giving the drinker the
benefits of both relaxation and stimulation!
A caveat here: if you cannot handle
dairy, and/or are lactose intolerant, be very careful to supplement with
enough calcium. See RESOURCES at
bottom for a study connecting dairy intolerance with osteoporosis.
Another reason diet is important is that calcium
is very sensitive to acid conditions, and relies on a combination of the proper
acid environment in the stomach - i.e. enough hydrochloric acid -
and a more or less neutral pH in the blood for absorption. A
diet high in veggies will take care of the latter part of this equation, but
those of us who have digestive problems had better be SURE they are due to too
MUCH acid before taking antacids! A 2008 study found that using proton pump
ionhibtors for over 7 years DOUBLERD the risk of osteoporosis. Regular and
habitual long term use of antacids is directly connected to poor calcium
absorption. Unfortunately,
so may chocolate!! (http://www.vitasearch.com/get-clp-summary/37199)
It is much more common as we age
to have too little acid in our stomach which can mimic the same symptoms
of discomfort: addressing the situation with antacids, however, will
mean adversely affecting calcium status. See below, step 3, for
more information on that.
High homocysteine levels are now suspect in osteoporosis,
which is not a surprise, given the connection between pH, methylation and
homocysteine.
The study's authors state:
"An increased homocysteine level appears to be a strong and
independent risk factor for osteoporotic fractures in older men and
women," while recommending that this risk be confirmed in
other large population studies. "Proof of a causal relationship
between increased homocysteine levels and bone disease could be
established by intervention studies aimed at lowering the serum
homocysteine level. Whereas randomized, controlled trials have shown
that folic acid–based vitamin supplements can effectively reduce
homocysteine levels and reduce the rate of coronary restenosis,
additional studies are needed to assess whether the use of such
therapy will reduce the risk of fracture."
Step 3
Exercise of almost any kind: including
walking, swimming, yoga, jogging, but most effective is working out with light
hand weights. One of our foremost holistic doctors has suggested, only
half in jest, that we levy a tax on video games, television programs and other
couch potato type occupations that keep our young people inactive, and set it
aside in a fund for all the hips that will be fractured in the year 2030!
As little as 1
hour of exercise 3 times a week has been shown
to help reverse bone loss. Even just brisk walking.
The importance of exercise is
high-lighted by a 2002 study at the University of Connecticut (Ilich-Ernst, et
al) that showed pretty conclusively a direct connection between lean body mass (LBM)
and bone mineral density (BMD):
Results: The
results showed significant reduction of both total body BMD and lean body mass (LBM)
of 13% and 12%, respectively, with age. LBM was the strongest determinant of BMD
in various skeletal sites in the entire cohort and groups. Ca was positively
associated with BMD of various regions of hip in the entire cohort and in the
youngest and oldest subjects (r ranging from 0.32-0.56, P < .05, in
simple regression), but not in perimenopausal and early postmenopausal women.
Past activity (sports and recreation) was positively associated with BMD in
total body, spine, hip, and forearm (r ranging from 0.26-0.37, P <
.05). Various modes of present walking were positively associated with BMD in
regions of femur and forearm. Conclusions: These results reveal the importance of lean tissue
acting independently on bone at different skeletal sites in women across age
groups as well as the positive effects on BMD of Ca in the youngest and oldest
women and life-long engagement in physical activity in older women.
Step 4
Supplementing: this is a complex
subject , certainly not as simple as just taking Tums, made from calcium
carbonate, an inefficiently absorbed form of calcium to start with, and one that
ironically requires the stomach acid it is designed to suppress to be
absorbed at all!
In fact, Max Motyka, who holds an MS in Pharmacy,
wrote in an article in October 1999 that clinicians are reporting a rise in a
problem called Milk-Alkali Syndrome. Sufferers present with irritability,
nausea, headache, vertigo, weariness, hypercalcemia, metabolic alkalosis and
renal failure. All of the cases were attributable to the use of a popular
calcium carbonate antacid formula as a calcium supplement.
Unfortunately, too, whatever calcium is absorbed
from Tums , when combined with the highly alkaline carbonate, greatly increases
the risk of kidney stones.
This is what I suggest you look for in a calcium
supplement, together with some of the reasons:
Calcium in an absorbable form,
such as citrate, or there are studies suggesting MCHA calcium, from actual
(organic bovine) bone is also a very positive choice for absorbable
supplementation.
If you have an acidic pH, consider adding Coral
Calcium as part of your calcium supplementation.
I aim for between 500 and 1500 mg depending on
the individual’s dietary level of calcium.
A recent NIH study makes it clear that starting in childhood,
reserves need to be built up and that this early approach to bone building pays
off in later life. Yet the figures are far from encouraging:
Daily calcium intakes of 800 mg for children aged three to
eight years and 1,300 mg for children and adolescents aged nine to 17 years
are suggested by the Institute of Medicine. Only about 25% of boys and 10%
of girls aged nine to 17 years meet these recommendations.
Daily calcium intake for older adults should be maintained
at 1,000 to 1,500 mg, yet only about 50%-60% of this population meets this
recommendation.
Magnesium - at least 50% of the
calcium level, perhaps more. Many people (women in particular) are seriously
deficient. Boron - a trace mineral that has an estrogenic effect on calcium
absorption.
L-Lysine - important in calcium
absorption and connective tissue strength.
Vitamin D - Essential for
calcium uptake. Look for D3, calciferol, and consider doses of up to 2000 i.u.
Vitamin K - essential for bone
formation, and found chiefly in green leafy vegetables. A Japanese food called Natto
is an excellent source of Vitamin K.
Silicon/Silica - difficult to
find enough in the diet, and a nutrient found in high concentrations anywhere
bone is being built.
Additionally, the process of bone
adsorption and formation is at all times dynamic. Osteoporosis occurs
when the rate of bone breakdown by osteoclasts outpaces the rate of bone
building by osteoblasts. A 1993 study done in Paris by Dr. Marie dealt
with Silicon supplementation in estrogen deficient
rats. The ovaries were removed surgically, and true bone loss was
observed both as loss of bone volume, and an increase in osteoclasts as
compared to controls. One finding was that Silicon supplementation
significantly reduced the rate of bone loss, from 48% in unsupplemented
rats to 34% in those receiving Silicon. (Animal
model for osteoporosis Hott et al, 53, 174 1993.)
Melatonin -interesting new
research is linking age-related Melatonin deficiencies to osteoporosis. For
some, this might be a helpful addition, but I recommend
measuring
the level of the hormone through a saliva test before supplementing
.
It is also really important to take your calcium
in divided doses throughout the day, with some being taken last thing at night.
Measurements of uptake show 29% efficiency for 500 mg taken once a day, versus
40% efficiency for 500 mg divided into three daily doses with an all time low of
14% uptake for 2000 mg taken in one dose!
Strontium - here
is an expert opinion
(http://www.vrp.com/art/1193.asp?c=1152106334968&k=/vrpsearch.asp&m=/includes/vrp.css&p=no&s=0). Strontium is demonstrably present in bone
when it is actively building.
Study showing low
levels of Vitamin D in all hip fractures
Recently, some extremely encouraging research has
been done on a supplement called Ipriflavone, which shows
promise for restoring bone mass: it was first discovered back in the 1930s, but
has recently been reintroduced along with new evidence of its benefits. This
substance, which is found naturally in Alfalfa and Bee Propolis,
has been shown not only to prevent bone loss ( even in patients with Paget's
disease and thyroid problems) but to either maintain, or improve, bone density
in post-menopausal women. The interesting thing about Ipriflavone is that it
achieves this by exerting an estrogen-like influence on the body, but absolutely
without affecting hormonal levels at all: in other words, it appears to carry
with it none of the risks of Hormone Replacement Therapy, even for women
susceptible to estrogen-induced forms of cancer. (Source:
Osteoporosis Int (1997) 7: 119-125)
One Italian study (Moscarini - Gynecol
Endocrinol 8:203-207, 1989) of 90 women aged 53 to 65 found that
Ipriflavone and Calcium supplementation increased bone mineral density
by 2% after 6 months, and 5.8% after 12, with the added bonus of a
significant decrease in pain - 45% at 6 months, and 62% at 12. While
this was not a placebo controlled study, subsequent better designed
studies have confirmed these results.
Recent research at the Universities of Purdue and
Indiana has turned up a connection between bone health and Vitamin E.
Working with chickens, Drs. Watkins and Seifert found that supplementing the
birds' feed with natural D-Alpha Tocopherol along with the naturally
occurring companion mixed tocopherols not only resulted in leg bones
that grew longer, stronger and denser, but also inhibited the effects of free
radicals on existing bone, shielding the bone-forming cells (osteoclasts) and
allowing them to continue with their job of producing new bone. This has
definite implications for osteoporosis, say the two doctors. Let me point out
here that I have been saying for many years how inferior the activity of
synthetic Vitamin E is to the natural: now comes a study in the American Journal
of Clinical Nutrition that unequivocally show the rate of absorption of
synthetic is far less than that of natural, perhaps as little as one half as
much.
On another interesting note, studies in Sweden
suggest that women ingesting more than 1.5 mg of Vitamin A daily
had almost twice the risk of hip fractures. Some experts have data that suggests
making sure you are getting enough vitamin D mitigates
this risk.
What this translates to is that if a woman is
drinking 5 glasses of milk per day, or the equivalent in other dairy foods and
foods high in Vitamin A, she should make sure she is not taking a multivitamin
with Vitamin A. Even 5000 i.u. is enough in combination with a diet high
in A to increase risk for bone density loss. Beta carotene is NOT a villain
here, since it is only converted to Vitamin A if the body needs it.
Ongoing research continues to
emphasize the importance of Vitamin D:
I feel that once again reaction has gone overboard on the
strength of inconclusive evidence, and I worry about the harm being
done to bone health by recommendations that we avoid the sun entirely:
as you all know, sunlight synthesizes Vitamin D in the body.
When you consider that D is not
only essential for the absorption of calcium, but also protects
against falls by improving the ability of the cell to contract,
thereby improving muscle strength: well, as you age you are not
only going to fall, but you'll be sure to break a bone as well! See
the research at
http://www.healthandage.com/Home/gm=0!gc=1!gid2=2881
A study by Dr. Schurch (with WHO in Geneva) has
demonstrated that protein plays an important role in proper bone growth:
his double blind, randomized study showed that not only did it slow bone loss
and help heal existing fractures, but it also supported immune function. (Ann
Intern Med1998 / 128 (10) / 801-809.)
Confirmation of this information comes from an
Australian study published in the Am. Journal of Clinical Nutrition (vol
81, no 6, pp1423-1428) in 2005: results showed a
positive correlation between protein intake and both heel and hip bone mineral
density, even after adjusting for age, body mass index, and other nutrients.
Levels of protein below 66gms per day were problematic, over 87 gms protective.
This would seem to give double validity for the
regular daily use of soy or whey protein shakes, particularly for women
who not only are at greater risk for bone loss and consequent fractures, but who
also benefit in other ways from the beneficial phytoestrogens in soy. I have
used a shake made from soy protein for breakfast for nearly 20 years now, and
every day it appears I find out a new reason why!
See RESOURCES at bottom for the connection between protein and Osteoporosis. This is part of the pH
Factor, without which calcium
cannot be absorbed. As is so often the case, balance is the key.
It seems to me conclusive that a
combination of Ipriflavone and natural Progesterone,
along with soy and possibly other phytoestrogenic herbs, and the
necessary vitamins and minerals, would be an effective approach both to
combating existing osteoporosis and to preventing its occurrence in the
first place for women who wish to avoid the possible risks of hormone
replacement therapy.
Now let's look at other factors, all of which are
well within our own control. I proved this last week when my dog (all 140 lbs of
him) barreled into me (all 63 years of me) when I was running, and knocked me
down two flights of concrete steps. I landed on my arm, and thought I had broken
it - an X-ray showed that I had only bruised it badly. Now, if I can just
control my dog as well as I control my bones ...
I feel it important that women should
know there is a possibility of an adverse effect on bone production by
synthetic thyroid hormone therapy: a reduction
in thyroid hormone is a fairly common occurrence in women over 60, and
a new study in the Journal Am. Board Fam. Pract.
13(6):403-407, 2000 shows a potential risk in older nursing home
residents because of the inappropriate use of thyroid hormone therapy.
" It is clear from several studies that excessive or suppressive
doses of thyroid hormone result in a decrease in bone density. It is
less certain, but an increasing body of evidence suggests that even
therapeutic doses of thyroid hormone contribute to decreased bone
density. Kung and Pun, in their study of 26 premenopausal women
receiving physiologic doses of levothyroxine compared with age-matched
control women, found that femoral bone density was between 5% and 15%
less in the women on thyroid hormone therapy. The mean duration of
hormone therapy in these patients was 7.5 years, and the mean dose of
thyroid hormone was 106 µg."
This same study showed that it was possible
to discontinue the use of the thyroid hormone in half of the
residents, because it had either been prescribed
inappropriately originally, or the thyroid imbalance had corrected
itself in the meantime.
To recap: we
can keep our bones strong through a combination of exercise, diet,
supplementation, and hormonal balance. The sooner in life we start, the better:
but it's never too late to start building stronger bones!
Topic:
Hyperhomocysteinemia
May Increase the Risk of Osteoporosis
http://www.vitasearch.com/get-clp-summary/36999
Keywords:
OSTEOPOROSIS, BONE HEALTH, BONE DENSITY
- Homocysteine, Hyperhomocysteinemia, B Vitamins
Reference:
"The role of hyperhomocysteinemia as well
as folate, vitamin B(6) and B(12) deficiencies in osteoporosis -
a systematic review," Herrmann M, Peter Schmidt J, et al,
Clin Chem Lab Med, 2007; 45(12): 1621-32. (Address: ANZAC
Research Institute, University of Sydney, Sydney NSW, Australia
and Department of Clinical Chemistry and Laboratory Medicine,
University Hospital of Saarland, Homburg/Saar, Germany).
Summary:
In this article, recent epidemiological studies,
randomized clinical trials, and experimental studies examining
the possible link between hyperhomocysteinemia and osteoporosis
are reviewed. Results of epidemiological and randomized clinical
trials suggest that hyperhomocysteinemia increases fracture
risk. However, no clear relationship has been found between
hyperhomocysteinemia and bone mineral density. Results of animal
studies suggest that bone resorption is stimulated and bone
quality is diminished in hyperhomocysteinemic animals. Results
of cell culture studies suggest that bone resorption is
stimulated in the presence of hyperhomocysteinemia, demonstrated
by the stimulation of osteoclasts but not osteoblasts in the
presence of Hcy. Furthermore, hyperhomocysteinemia appears to
disturb collagen cross linking, adversely affecting the
extracellular bone matrix. The authors conclude their review by
stating that, "...Existing data suggest that HHCY (and
possibly B-vitamin deficiencies) adversely affects bone quality
by stimulation of bone resorption and disturbance of collagen
cross linking."
Keywords: bone
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