OSTEOPOROSIS
by Michael Klaper
www.vegsource.com/klaper/
Dear Dr. Klaper,
What are your thoughts on osteoporosis? What is it and
what can we do to prevent it? Can it be reversed and bone strength
improved?
-- J.K.
Dear J.K.:
Good - and timely - questions. Everyone has an image of
her in their mind - the little, old woman, bent over with a C-shaped
spine. She is the embodiment of a process that does to the skeleton what
Alzheimer�s disease does to the brain. In osteoporosis, for which she has
become the symbol, the bones become so weakened and crumbly they have the
tensile strength of styrofoam. Daily body movements and the relentless
force of gravity have compressed the vertebral bones of her spine,
collapsing them, and bending her permanently forward. Most of her skeleton
is equally as fragile. A cough, a hug, or a minor fall, can snap a rib, an
arm, a thigh - and a fractured hip in one�s seventies or eighties can be a
death sentence.
The specter of the elderly woman with the collapsing
spine described above is a common one, but far from complete picture. The
young, lean, female long-distance runner or a 60-year old apparently
healthy male would not seem to be candidates for osteoporosis � yet they
too can be victims. In industrialized nations, osteoporosis is a
devastating, but silent, epidemic. One out of four Americans will suffer
an osteoporosis-related fracture during their lifetime - at least 1.2
million fractures in the U.S. resulting in medical and social costs of at
least 6.1 billion dollars every year.
If you believe the many advertisements, osteoporosis
results from not swallowing enough calcium in our daily diets. Yet,
medical studies2 show that merely consuming more dairy products or calcium
tablets is not sufficient to prevent nor reverse this devastating disease.
So, let�s consider some of the underlying causes of osteoporosis, as well
as strategies for preserving and even strengthening our bones.
To understand osteoporosis, we must first realize that
our bones are alive. Rather than dead, chalky rods that support us as we
walk, sit, and stand, our bones are living tissue, with a rich blood
supply and a high level of metabolic activity. Bones are constantly being
built up by busy cells called �osteoblasts,� as well as being dismantled
and re-shaped by the bone-dissolving cells called "osteoclasts." The
balance of bone build-up versus bone break-down determines the strength of
our skeletons. When bone dissolution and breakdown exceeds the rate of
bone construction, our skeleton becomes weakened and susceptible to
fracture - the disease of osteoporosis.
Diagnosing Osteoporosis
The loss of calcium from the bones is painless.
Osteoporosis gives no warning symptoms until it is detected on a test or,
worse, announces itself with a painful fracture. If a person has the risk
factors for osteoporosis - Caucasian race, sedentary lifestyle, cigarette
smoking, etc. - she or he should consider having her bone density
measured. Contrary to popular belief, an x-ray is not effective in
diagnosing early osteoporosis. By the time decreased bone density can be
diagnosed on an x-ray film, the osteoporotic process is already far
advanced. Long before reaching this point, anyone suspected of developing
osteoporosis should have their skeletal density assessed with a
non-invasive test called bone densitometry. This painless examination uses
a light ray to measure the density of the bones, usually at the wrist and
lower spine. Any family doctor can order this test.
Osteoporosis is not an inevitable part of growing older.
Nature would not supply us with a heart and blood vessel system made to
function for over 100 years, while giving us bones destined to fall apart
at age 60! Bones are supposed to last as long as all the rest of our
organs, at least to the hundred year mark - and beyond. Rather than being
a normal part of aging, osteoporosis is a disease state � characterized by
excessive loss of calcium from the bones with eventual dissolution of the
bone structure. This is an important concept. Osteoporosis is not so much
a disease of deficient calcium intake, but rather excessive calcium loss
from the bones. Where is the calcium going? It's going out through the
kidneys into the urine - and down the toilet!
�Calcium Thieves�
Why does this happen? In our daily lives, we encounter a
number of "calcium thieves" that can rob our bones of this vital mineral.
Interestingly, with one exception, all the �calcium thieves� have
something in common - they are things that we put in our mouths. We will
examine them in a moment, but first we must consider the one "thief" that
we do not ingest - in fact, the one that we do not have to do anything to
invite to weaken our skeleton. Actually, this rascal is the number one
cause of calcium flowing from the bones of modern women and men - simply
the lack of physically using our bones, especially against the force of
gravity.
Like muscle, nerve, and all the other tissues of the
body, the more we use our bones, the stronger they become and the better
they function. Every step you take sends pulses of electrical energy up
and down the lengths of your leg bones. These pulsating currents of
bio-electricity help to keep the calcium atoms firmly anchored in the
substance of the skeleton. Thus, every movement of our body - especially
movements against resistance such as gravity, elastic exercise bands, etc.
- helps to keep the bones calcified, healthy, and fracture-resistant.
Unfortunately, today most of us do very little manual
labor - machines carry our loads, and even carry most of us everywhere -
so we are free to sit for most of our day. This is a very effective way to
let the calcium drain out of our bones. As we look around the globe, we
see that in countries where people spend their entire long lives
physically active, their bones stay strong. In these nations, the disease
of osteoporosis is rare.
A dramatic demonstration of the opposite situation is
seen in the astronauts, who spend relatively few days in gravity-free
environments, and yet who suffer severe loss of calcium from their bones.
Fortunately, the calcium is restored to the skeleton in a relatively short
time when the astronaut is back in a normal-gravity environment. This is
an important, and hopeful, clue for the rest of us - evidence that the
osteoporotic process can be reversed.
To keep your bones healthy and to prevent osteoporosis,
the most important thing you can do is to stay as physically active as you
can throughout your life. Since calcium is always being laid down in the
skeleton, it is never to late to begin to strengthen the bones. Medical
studies by Dr. Aloia and others have shown that, even in elderly people,
osteoporotic bones can be made stronger by gentle but steady exercise,
like walking up stairs or squeezing rubber balls.3 Such is the power of
using our muscles - it actually helps pull calcium into the bones and keep
it there, keeping our skeleton strong.
Any exercise that places a mild, repeated stress on the
bones, causes the bones to become thicker, stronger, and more calcified.
Never miss a chance to walk up stairs or to carry packages. Never stop
walking - try to take a brisk, 30 to 60-minute walk at least every other
day - and more frequently is even better.
Although exercises against gravity are especially potent
in helping bones stay strong, muscle contraction of any kind will help
generate electrical currents that help pull calcium into the bones.
Elastic, stretchable bands that can be used in resistance training, even
while a person is sitting, are also excellent tools to provide muscular
exercise that will help keep bones strong.
Now that we understand that our ever-more-sedentary desk
jobs and lifestyles are the chief cause of the osteoporosis epidemic that
is ravaging virtually all industrialized societies, we�ll look at the
other major calcium thieves that attack our bones - namely, those hiding
in things that we ingest. Let�s see how a moment of pleasure to entertain
the tongue can rob precious calcium from the bones and weaken our very
skeleton.
The �calcium thieves� that gain �oral entrance� into our
bodies commonly include:
a. Concentrated animal protein. Chicken, fish, and other
meat-based products (burgers, hot dogs, fish fillets, etc.) all contain
concentrated protein whose acidic nature dissolves calcium out of the
bones. The dissolved calcium is washed through the bloodstream and is
excreted by the kidneys into the urine. This phenomenon is well known to
nutritional scientists and is called �protein-induced hypercalciuria�4.
This means that diets high in meats and other animal products produce a
sustained loss of calcium from the body.
It has been known for years that the ethnic group with
some of the most severe osteoporosis on the planet are the Native American
Inuit living in the Arctic. This is due in significant part to their
ingestion of large quantities of high-protein fish and seal meat. This
high-protein diet apparently results in high losses of calcium from their
bones and leads to advanced osteoporosis among their women.5
What this effect means to your bones is that most every
time you have a meal based upon a large piece of chicken, fish, or red
meat, for the following several hours, precious calcium is leached from
your skeleton into your urine - destined for the sewer system. Therefore,
it is wise to minimize the portions of animal protein on your plate and
look for more skeleton-friendly foods in the plant kingdom. Fortunately,
most proteins of plant origin, especially those in whole grains, potatoes,
fruits, seeds, and green and yellow vegetables, are significantly less
acidic than animal-based proteins - and thus they have far less tendency
to steal calcium from the bones. It's been observed for many years that
osteoporosis is less of a problem among vegetarians than among omnivores.6
So, to reduce your loss of bone calcium from your food
choices, stop seeing chicken, fish, and lean beef as "health foods." Begin
to base more of your meals on whole, plant-based foods, like Oriental
vegetable stir-fries over rice, bean burritos, whole grain casseroles,
potato-based entrees, as well as other high-fiber meals which can be found
in the recipe books listed in the �Resources� section. If you are trying
to decrease the amount of carbohydrates in your diet, increase your
proportion of vegetable-based entrees on your plate (stews, soups, salads,
stir-fries, etc.) and reduce the proportion of pastas or other
high-carbohydrate foods.
Although animal proteins are among the most pervasive of
�calcium thieves� in the Western diet, there are other common culprits
that we ingest that cause our bones to age and weaken prematurely. These
include:
b. Sugar (as in cakes and candies), which makes the
kidneys urinate out calcium.7
c. Phosphoric acid, a common ingredient in cola drinks
that gives the cola its �bite,� is a potent calcium thief8, as is
d. Caffeine in coffee, tea, or cola drinks.9
e. Cigarette smoke10, and
f. Alcohol both leach calcium out of the bones11,
(alcoholics and cigarette smokers both suffer high rates of osteoporosis).
g. Finally, excessive amounts of salt12 (actually, the
element sodium) in some people can cause excessive urinary calcium loss.
People at risk for osteoporosis should avoid pickled foods, preserved
meats, chips, and other high-salt foods.
Well, there you have the recipe for osteoporosis: Be a
woman (women start with less calcium in their bones than men), work at a
sedentary desk job, eat your tuna fish or chicken breast for lunch, sip
all day on your diet cola, smoke your cigarettes, have a glass of wine or
beer after work, and do as little physical exercise as you possibly can.
This is a sure way to waste away the very element needed to keep your
bones strong, and to hasten your trip to a fractured hip - a predictable,
but fortunately avoidable, course.
Dairy Reconsidered
For people who dutifully drink milk and swallow cheese,
ice cream and yogurt, believing that the magic of cow�s milk will ward off
fractures in old age, be advised that there is very little evidence that
dairy products prevent osteoporosis - in fact, just the opposite may be
true. Surprisingly, the nations who consume the most dairy products - the
United States, Israel, the Netherlands and Scandinavian countries - suffer
the highest incidences of osteoporosis13. If dairy products actually
prevented osteoporosis, it would be rare in America and these other
countries - yet, it is actually more rampant in these nations than in less
developed countries.
Conversely, most humans on our planet, in Asia, South
America, and Africa, virtually never consume cow's milk products - the
milk, transportation, and refrigeration simply are not available. Yet,
osteoporosis is not a common condition in these countries. Most of these
people (barring starvation or parasitic diseases) enjoy strong bones
throughout their physically active lives, deriving essentially all their
calcium from green vegetables, seeds, grains, and from their drinking
water.
Incidentally, seeing cow's milk and dairy products as
far from essential for bone health can be advantageous for the rest of
your body. Cow's milk contains proteins and other substances that are
thought to play a major role in many serious diseases, like asthma,
rheumatoid arthritis, recurring ear infections, eczema, colitis, and
various autoimmune diseases. Don't be surprised if, after a few weeks
without dairy products, your body feels and functions better in many ways
- less swallowed phlegm, intestinal gas, runny nasal secretions, and other
common, milk-related symptoms. Fortunately, these days, going dairy free
is no great hardship. It is easy to find non-dairy replacements for milk,
yogurt, ice cream, cheese, and other cow's milk-based products - just
check in the refrigerator and freezer cases of your local natural food
store or supermarket.
Supplements and Other Strategies
Although calcium intake alone is not to be relied upon
as the total osteoporosis prevention or reversal program, an abundant
calcium intake should be part of everyone�s diet. Aiming for a calcium
intake of 1000 mg. to 1200 mg. a day is a good idea. Until the last fifty
years, our diets contained far more whole fruits and vegetables - and thus
significantly more calcium - than we consume today. Unless you eat several
helpings of dark green leafy vegetables and a cup of nuts or seeds daily �
not impossible, just uncommon - one would be wise to consider including in
the daily diet calcium-fortified orange juice from the supermarket, or
beverages such as calcium-fortified soy milk and rice milk from the
natural food store. You can also take a calcium supplement, as a tablet,
liquid or powder - 500 to 1000 milligrams per day. (This amount of
supplemental calcium should be sufficient, since the calcium found in
other foods and drinking water predictably provides at least 500 mg. - 700
mg. of calcium per day.) Preferably, supplemental calcium is always
balanced with approximately equal amounts of magnesium, as magnesium is
essential for retaining calcium in the skeletal structure.
Remember, however, that you cannot prevent or reverse
osteoporosis just by swallowing large amounts of calcium supplements.
Excessive amounts of calcium can lead to precipitation of
calcium-containing kidney stones as well as calcium deposits in muscles,
tendons, and other vital tissues. Osteoporosis is a disease of the active
dissolution of bone structure - calcium first, and then the structural
collagen protein � and the entire process must be reversed.
As important as it is for us to avoid �calcium thieves,�
there are several additional nutritional components to bone health that
must be consumed in order to prevent or reverse osteoporosis. These
nutrients include: Vitamin K, Vitamin B‑6, and the earth elements,
manganese, copper, zinc, boron, and silicon. These nutrients are all
present in whole, plant-based foods, such as dark green leafy vegetables,
root vegetables, nuts, seeds, grains, sea vegetables (nori, arame, wakame,
etc.), and fruits.
Vitamin D is essential for us to absorb calcium from our
food into our bloodstream. Vitamin D is made naturally in our skin as
sunlight falls upon it (15 minutes per day of gentle sunlight on the skin
of the arms is all that is required. If such sun exposure unavailable, an
oral Vitamin D supplement should be taken).
In view of the foregoing, if you are taking a
multivitamin/mineral supplement, be sure it contains the following
nutrients in approximately the indicated amounts. To gain the most
benefit, try to consume the supplements twice daily, with or shortly after
meals:
Calcium 250-500 mg., Magnesium 250-500 mg., Zinc 15 mg.,
Copper 1-2 mg. 5-10 mg. Boron 1-3 mg. Silicon 1-2 mg. Vitamin B-6 5-25 mg.
Folic Acid .08 - 5 mg. Vitamin C 100-1000 mg. Vitamin D 100-200 I.U.
Vitamin K 100-500 mcg.
[A person who is being medicated with the anticoagulant
drug, warfarin, should not take supplements with Vitamin K, as that
vitamin can counteract the effects of their �blood thinner.�]
The above nutrient recommendations, along with a full
discussion of the diagnosis and management of osteoporosis, are presented
in the excellent book, Preventing and Reversing Osteoporosis, by physician
and educator, Alan Gaby, M.D. (See �Resources� section.)
Hormone Replacement Therapy
It is true that the hormones estrogen and progesterone
play a significant role in keeping bones well calcified. After a woman
reaches menopause, and her ovaries produce less of these essential
hormones, bone strength may suffer. Hormone replacement has been seen as a
major answer to the osteoporosis problem; however, it has now become
evident that swallowing oral estrogen tablets alone is not the answer.
Although possibly offering benefits for the skin and
other tissues in the body, in the skeleton estrogen replacement therapy
inhibits the action of osteoclasts. Thus, estrogens act by retarding
normal bone breakdown. In this way, estrogens stop the breakdown of bone,
but they do not increase the rate of bone formation by the osteoblasts.
This is important because inhibiting the action of osteoclasts does not
make for stronger bones. Osteoclasts have an important function, namely
removing old bone spicules that have been micro-fractured through the
shocks of daily living. It is essential that the osteoclasts remove these
weakened bone struts to make way for new bone construction by the
osteoblasts. In this light, it can be seen that the action of estrogens
may ultimately not decrease the rate of fractures. In other words,
estrogen-like drugs may slow down the removal of old bone - and thus
create denser-appearing bones on x-rays and scans - but it is far from
proven that estrogens actually make the bones stronger and (the ultimate
test) reduce the incidence of osteoporosis-related fractures.
On the negative side, estrogen therapy can produce
adverse effects, such as enlarging breast lumps and making menstrual
bleeding heavier and more painful. They may even put a woman at higher
risk for several types of cancers, including of the breast and uterus.
Should a woman and her doctor decide upon estrogen therapy, some of these
problems may be avoided through the use of a �balanced estrogen�
containing appropriate amounts of the three most abundant estrogens in the
body, estrone, estradiol, and estriol. (See Natural Hormone Replacement in
�Resources.�) Balanced estrogen patches, tablets, and vaginal
creams/suppositories are available through compounding pharmacies.
A woman may also want to talk to her doctor about a new
class of drugs, the so-called �selective estrogen receptor modifiers� like
raloxifene.
These drugs may slow down bone loss� although they are
not free of side effects and are certainly not the entire solution to the
osteoporosis puzzle. Again, the woman and the physician are the best
people to make the decision as to the appropriateness of this therapy.
Incidentally, just because a woman is past the age of
menopause and does not produce large amounts of estrogen from her ovaries,
it does not mean her body is completely incapable of producing estrogen.
Her adrenal glands, as well as the subcutaneous fat stores under her skin,
are two tissues still capable of producing estrogen - if the woman
consumes the appropriate essential fats in her diet. Adequate essential
fat intake can be assured through ingesting a teaspoon or two of flaxseed
oil or hempseed oil daily (along with 200-400 I.U. of Vitamin E to prevent
oxidation in the body). A handful (one-half cup) of green, organic pumpkin
seeds or raw walnuts will also help provide these essential omega-3 fats,
as will the soybean oil in one-half cup tofu. The judicious use of these
omega-3-containing oils will not only help maintain normal hormone balance
and stronger bones, but also help create a more moisturized,
youthful-looking skin.
If estrogen replacement therapy is decided upon, it is
also wise to consider including natural progesterone as part of the
hormone replacement program. Natural progesterone is also produced by the
ovaries and is capable of stimulating new bone growth, thus actually
helping bones grow stronger. There are advantages to specifying the form
of progesterone to be �natural progesterone.� �Progestins� like the
commonly-prescribed medroxyprogesterone (sold under the name, �Provera�
and other brands) are chemically modified and can cause headaches, mood
swings, and other adverse side effects. Natural progesterone is available,
currently without prescription, at natural food stores and pharmacies.
With medical guidance, natural progesterone can be used with good effect
in conjunction with or in place of estrogen-based therapy.
When using powerful hormones like progesterone, more
than �just enough� is not better. Usually, just one-half teaspoon of
progesterone cream rubbed into the skin of the forearm will produce the
desired effect. If the woman is still having menstrual periods, the
progesterone cream should be used during the last two weeks of her monthly
cycle. If she is past the age of menopause, the small amount of
progesterone cream can be applied daily. It is important to work with the
physician to check the progesterone levels in the saliva to determine the
best dose of cream. Both the woman and her doctor can learn the
fundamentals of using natural progesterone in the prevention or treatment
of osteoporosis in the excellent monograph, Natural Progesterone, by John
R. Lee, M.D. (See �Resources.�) Research is also beginning to accumulate
that men with low bone density can benefit from small doses of
progesterone cream, as well. Men do make progesterone naturally and it is
an important hormone in maintaining healthy bones and tissues in both
sexes. (See �Resources� section.)
Biphosphonates
A philosophy similar to that for estrogen replacement
therapy in the prevention of osteoporosis can be applied to the
�biphosphonate� drugs such as alendronate and etidronate. In other words,
�biphosphonate� drugs may slow down the removal of old bone, and thus
create denser-appearing bones on x-rays and scans, but whether they
actually create stronger bones that will resist fracture for many years is
far from clear.
The studies done to date on the action of biphosphonates
on bones have only been carried out to a total of five years of treatment.
We may well see an increase in bone fractures in biphosphonate drug users
after five or more years of use. At this time, these drugs should be
viewed as a �stop gap� measure that may �plug the leak� of calcium from
the body. However, they should not be viewed as the long-term �cure� of
the problem � that goal has been presented in the previous pages and is
summarized below.
Reversing Bone Loss
If a diagnosis of osteoporosis has already been made on
a bone density study, then increasing your bone density should become
priority number one. Yes, osteoporosis can be reversed. Even into old age,
the osteoblasts still retain the ability to deposit calcium in the bone
structure - and indeed they do so on a daily basis. Because bone building
is constantly in progress, bones � even osteoporotic ones - can be helped
to make themselves stronger. A basic bone-building plan should utilize all
of the modalities below:
1. Eliminate all �calcium thieves� � especially excess
animal protein, sugar, salt, cigarette smoke, alcohol, and phosphoric
acid-containing cola drinks.
2. Be sure your intake of calcium and magnesium exceed
1000 mg. of each daily.
3. Assure an adequate intake of other trace minerals,
especially boron, manganese, chromium, copper, zinc and silicon in the
dosages previously given.
4. Assure adequate vitamin intake, especially vitamin
B-6, folic acid, vitamin C, and vitamin K at the dosages given previously.
5. Consult with your physician about the role of hormone
replacement, especially natural progesterone for women and testosterone
for men. For the lean, athletic woman whose menstrual periods have
stopped, she is at risk for osteoporosis due to excessively low hormone
levels. In her pursuit of a low-fat diet, she may be ingesting so little
fat that she cannot make adequate levels of progesterone in other
bone-protecting hormones. (For that reason, she would be wise to increase
the amount of fat in her diet via ingesting two to three teaspoons daily
of an omega 3-rich oil such as flax seed oil or hemp seed oil, available
in the refrigerator case of natural food stores.) Such a small amount of
fat will not result in weight gain, but can be instrumental in maintaining
healthy bones and other hormone-dependent organs.
6. Institute a regular program of weight-bearing
activity, possibly including exercise with elastic-resistance bands.
Conclusion
If this common sense approach to building and
maintaining bone strength is diligently practiced, you can look forward to
enjoying strong bones that will serve you well throughout a long, active,
and healthy life.
RESOURCES
Preventing and Reversing Osteoporosis
by Alan Gaby, M.D.
Prima Publishing
P.O. Box 1260BK
Rocklin, CA 95677
Natural Progesterone
by John R. Lee, M.D.
BLL Publishing
P.O. Box #2068
Sebastopol, CA 95473
The John R. Lee Medical Letter
c/o Publisher�s Mgmt. Corp.
P. O. Box 84900
Phoenix, AZ 85071
Phone: 1-800-528-0559
URL: www.johnleemd.com
Natural Hormone Replacement
by Jonathan V. Wright, M.D. and John Morgenthaler
Smart Publications
P. O. Box 4667
Petaluma, CA 94955
Phone: 1-800-543-3873
URL: www.smart-publications.com
Delicious, low-fat meals made with calcium-sparing,
moderate-protein, whole-foods ingredients can be found in:
Food for Life
by Neal Barnard, M.D.
Harmony Books
CalciYum!
by David and Rachelle Bronfman
Bromedia Inc.
Box 778, 181 Bay Street
Toronto, Ontario, Canada M5J 2T3
The Peaceful Palate
by Jennifer M. Raymond, M.S.
1418 Cedar Street
Calistoga, CA 94515
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