01 Sep Osteoporosis
I am increasingly finding a disturbing trend in my practice: more of my patients are being diagnosed with osteopenia and osteoporosis. What’s even more troubling is that many of these patients don’t fit the classic stereotype of the elderly, fragile woman. I have seen osteoporosis in young mothers and in young men! According to epidemiological studies, 24 million Americans are diagnosed with osteoporosis. Of these, the majority are women over 45 years of age. Osteoporosis is an important cause of morbidity (illness) and mortality (death) in the Western World. This month’s newsletter focuses on Osteoporosis. We’ll discuss common risk factors and the naturopathic approach to treatment.
What is Osteoporosis?: Osteoporosis is a progressive disease in which bones become more porous, brittle and breakable. It is characterized by a decreased bone mineral density (bones become more porous) and also by a deterioration of the micro-architectural structure (protein collagen matrix) of bone. Very often, in conventional treatment, the focus is on increasing bone mineral density without regard for the matrix structure. For treatment to be effective, both must be addressed.
Bones are Ever-Changing: Our bones are constantly undergoing a process of change known as remodeling. Old and damaged bone is broken down (bone resorption) and replaced by new, health bone tissue (bone formation). Stress placed on our bones causes the remodeling process to intensify (that’s why we see the bones of a pitcher’s throwing arm become stronger and thicker over time). Bones grow more dense and thick until peak bone mass is attained- generally in our early twenties. The rate of bone formation keeps up with bone resorption until our late thirties or early forties at which point the balance shifts towards more bone breakdown versus less new bone formation. Bone loss in women is accelerated at menopause because of the decline in estrogen and other hormones. Genetics, exercise, nutrition, and other lifestyle factors play a very important role in how healthy our bones become, and remain throughout life.
Who is at Risk? Many of the risk factors for osteoporosis are outside of our control. For example, advanced age, menopause (biological or surgical), being a woman, being Caucasian or Asian (in the US), having a genetic predisposition. That being said, many lifestyle choices can contribute to a reduction in bone mass:
• Smoking (alters metabolism and may contribute to earlier menopause)
• High alcohol intake (decreases calcium and magnesium absorption and increases excretion in the urine)
• High caffeine intake (increases calcium excretion)
• Salt consumption (increases calcium excretion, especially in a salt-sensitive individual)
• Soft drinks (contain phosphoric acid which leaches calcium from the bones and increases its excretion through the urine)
• Sugar consumption (hinders calcium absorption and increases excretion)
• Lack of exercise (“use it or loose it!”)
• Lack of sunshine exposure (Vitamin D is critical for absorption of calcium)
• Diets low in protein and micronutrients
• Acidic diets (more on this below) Many medication also increase bone loss. These include anticoagulants, anticonvulsants, anti-anxiety medication, aromatase inhibitors, steroids, diuretics, immunosuppressant drugs, antacids, and kidney dialysis solutions. Many diseases which affect nutrient intake, absorption can contribute to osteoporosis. These include anorexia and bulimia, celiac disease, Crohn’s disease, hypochlorhydria (low stomach acid).
So, what can you do about it? Of course, as always, prevention is key. This requires a focus on healthy nutrition, sunlight exposure, and exercise throughout life. That being said, when a patient comes to me with a diagnosis (usually through a bone density DEXA scan) of osteoporosis or osteopenia, I ask a very important question: WHY? Often in the medical world, we focus on the treatment of the symptom and do not seek the underlying cause. I use both intensive questioning and lab tests to determine what factors affect my particular patient’s bone health. Is the patient undernourished? Is there a particular nutrient deficiency? Is there an underlying medical condition? Many medical doctors test bone density once every one to two years (DEXA scans only pick up this type of long-range change in bone density) and neglect to do further testing. I like to get a baseline measure of bone turnover (either blood or urine testing) and then follow up every three months to see whether treatment is effective.
What is the treatment? As always, naturopathic treatment is unique to the individual but, in all cases, the following apply: Just as with a home remodeling job, two key elements are needed to remodel bones effectively: Quality materials (and by this, I mean the nutritional elements required to form bone) AND Effective labor (and by this, I mean exercise- which triggers the bone formation cells to get to work). Many nutrients are required for optimal bone integrity. These include:
• Calcium: of course. (More about dairy as a source of calcium below).
• Vitamin D: without this vitamin, calcium cannot be absorbed. Vitamin D maintains a healthy balance between calcium and phosphorus to build and maintain healthy bones.
• Vitamin K: is required for the production of osteocalcin, a protein found in the bone which is essential for structural integrity of the bone.
• Magnesium: must be balanced with calcium in order for bones (and muscles and nerves) to function properly.
• Phosphorus: must be maintained in proper balance with calcium. Most often, North Americans have too much phosphorus in which case, calcium is leached from other parts of the body to maintain balance of the two minerals.
• Protein: is essential for making the collagen matrix of bone. That being said, excessive amounts of protein (especially animal protein) cause an increased excretion of calcium in the urine and result in leaching of calcium from the bones to buffer the acidic breakdown of protein. Protein metabolism also increases phosphorus.
• Other vitamins which play a role in healthy bone formation and maintenance: Vitamin C, Vitamin A, Vitamin B6.
• Other minerals which play a role: Boron, silicon, zinc, copper, strontium. Dietary and Lifestyle Interventions for Osteoporosis (and Optimal Health in General):
• Eat plenty of fruits and vegetables (at least 9 servings a day): potassium, magnesium, Vitamin C, Vitamin A and beta carotene, Vitamin K are all associated with higher bone mass. Also, a plant-based diet decreases acidity in the body and thereby decreases the calcium leached from bones to buffer the blood.
• Get enough calcium: soymilk, tofu, sesame seeds, black-eyed peas, blackstrap molasses, poppy seeds, almonds, figs, fish (with bones and skin), dark leafy vegetables, and (maybe) some low fat dairy products. (See my previous newsletter on Calcium).
• Get enough Vitamin D: 10-20 minutes of sun exposure or supplementation. (See my previous newsletter on Vitamin D).
• Ensure intake of healthy fats and decrease intake of saturated fats.
• Limit caffeine, salt, sugar and alcohol.
• Decrease acidity in the diet (see below).
• Aim for at least 30 minutes of exercise 5 days a week.
High Acid Diet- perhaps the missing link? Despite the fact that we, in the Western world, consume an abundance of dairy products, the age-adjusted incidence rates of hip fractures is many times higher in affluent developed countries than in Africa and Asia. Here is a quote from the World Health Organization Report on Osteoporosis: “The paradox (that hip fracture rates are higher in developed countries where calcium intake is higher than in developing countries where calcium intake is lower) clearly calls for an explanation. To date, the accumulated data indicate that the adverse effect of protein, in particular animal (but not vegetable) protein, might outweigh the positive effect of calcium intake on calcium balance.”
Recent research suggests that eating a diet high in animal proteins and grains and low in fruits and vegetables can increase calcium loss in the urine. According to some controversial research, a diet high in animal products actually leaches calcium from the bones. Dairy is considered an animal protein. There is some very compelling research focused on a preference for non-dairy sources of calcium. For example, a 2005 study by Lanou in the respected medical journal Pediatrics concluded the following: “Scant evidence supports nutrition guidelines focused specifically on increasing milk or other dairy product intake for promoting child and adolescent bone mineralization”. At any rate, as I tell all of my patients, do decrease animal products in general and do rely more heavily on a plant-based diet.
Bottom Line: If you have been diagnosed with osteopenia or osteoporosis, you should have further lab testing to determine what factors may be at play. Ask your doctor about follow up testing every three months to see if treatment is working for you. If you are going to take a supplement to build bone strength, choose one which has a complete complement of nutrients needed to strengthen bone. Make certain that you incorporate highly nutrient dense foods and decrease the acidity of your diet. Exercise is an absolute requirement for bone health and optimal health in general. So, Lets Bone Up America!
Please Note: This information is for educational purposes only. Consultation with a licensed health care practitioner is recommended for anyone suffering from a health ailment. If you have any questions, or would like to schedule an appointment, please feel free to contact Dr. Leat Kuzniar, ND at 201-757-5558 or, through email at dr*******@ve*****.net.