This bone disease kills more women than breast cancer
You may be surprised but in the
USA more women die from facture of the neck of femur than die of cancer of the breast, cervix and uterus COMBINED
(it is a similar story in other developed countries). A fracture of the femur is dangerous for an elderly man or
woman, because it leads to immobility. That in turn increases the risk of pneumonia, which is the usual cause of
death in these sad cases. The femur fractures easily in older people because of bone thinning or osteoporosis,
which in turn is caused by gross ignorance of nutritional essentials.
I have said often that osteoporosis is a whole body disease; it is NOT a lack of
calcium. We’re awash with calcium! (calcium is hardening of the arteries, brain plaques, crusty joint and
other
aging deposits: who needs calcium?)The trouble with aging is that, as we grow
older, the calcium
ends up in the wrong place. That’s caused by having the faulty nutritional
dynamics. Bone is a living tissue, it is built up and broken down constantly. Doctors and drug companies who
try
to portray bone as a static vessel, filled with a certain amount of calcium—like
a full, half-full or quarter-full cup—are just plain idiots.
Your entire skeleton replaces and remodels itself every few months; and I mean every molecule! If you help
your bones, by doing it right and feeding them well, they will support you into your ninth, tenth, even
twelfth decade.
The Chinese Story
It’s widely held that calcium deficiency is the cause of osteoporosis and that if
you consume plenty of milk, you will get all the calcium you need and never experience
osteoporosis.
That’s pure bunk. A myth that sticks and sticks…Consider that in China, where the
traditional diet included no dairy products whatever, osteoporosis was completely unknown until
Westernization.
Next consider the USA, which has the highest consumption of dairy products in the
world and yet also has the highest incidence of osteoporosis. What does that tell you about the value of
milk? In fact I’ll shock you by saying that a handful of doctors like me have been arguing for 40 years that
milk is mainly what CAUSES osteoporosis, through malabsorption due to gut inflammation
from
milk.
Hip Fractures and Bone Strength
Hip fractures are the most serious consequence of
osteoporosis.
About 20 percent result in death, and those who survive often have disability
and
about 20 percent result in death, and those who survive often have disability and
loss
of independence. The cost is an estimated $12.8 billion to $17.8 billion per year
for
medical care, extended treatment facilities, and the value of lost productivity.
Yet, this important anti-aging factor is often overlooked. Hormones and super
nutrients
may be more glamorous. But basic nutrition is, and always will be, the number one
factor in bone health. There is no reason to suffer this infirmity or risk a
disastrous fracture.
It’s true that bone loss is a natural part of the aging process. Starting around
the fourth
or fifth decade of life, both men and women lose bone mass at a rate of 0.3 to
0.5
percent per year.
But after the onset of menopause, the rate of bone loss in women can increase as
much
as 10-fold due to the reduced production of estrogen. In fact, women can lose up
to 20
percent of their total bone mass in the first 5 to 7 years following menopause.
By age 70 or 80, women have typically lost about 30 to 50 percent of their bone
mass,
compared with a loss of only 20 to 30 percent among men.
Bone Densitometry
Probably the single biggest factor in whether a woman will develop osteoporosis
is
whether she starts out with thin bones or not! Those with dense bones at the age
of
35 are unlikely to reach severe osteoporotic levels even during the seventh and
eight decade.
Those whose bones are thin even before menopause are likely to end up with
difficulties, no matter what treatment is attempted.
So it is important to find out where you stand. Bone densitometry, a simple
screening,
should tell you where you stand. It is to be hoped that routine bone densitometry
screening will be available to all women, even
pre-menopausally.
Use your doctor to get densitometry but don’t pay too much attention to what is
says
to do (which is just what drug reps tell him to say to
you)
The best treatment by far is avoidance.
That comes from wise nutrition, as I’ll explain later. The trouble is, existing
therapy is largely unsuccessful. The reason is, it’s based on the obsession to find patented and expensive
“cures”, instead of correcting basic nutritional factors. The current approach focuses mainly on estrogen,
supposedly to retard the advance of the menopause, and calcium supplementation. However, estrogen therapy
really only defers the inevitable and therefore its ‘success’ as a treatment is debatable. Moreover, some
doctors would see the risk of hormone replacement therapy as
wholly unacceptable when used for this purely prophylactic
reason.
Calcium supplements (around 800 to 1500 mg a day) are usually recommended but it
must be said that studies on how effective this is are confused and contradictory.
Calcium supplementation will not restore lost bone tissue.
The paradox is, as I said, that calcium deposition is a factor in many aging
conditions,
such as hardening of the arteries, arthritis, kidney stones, gallstones, and
cataracts, so
for some patients taking calcium supplements, it may be a question of aging one
way
or decaying another! The really important nutrients, as we shall see, do not
include calcium
Hormone Supplements
These do have a beneficial effect but at what price? We all know the inherent
dangers of taking estrogen replacement therapy. Most women in the Western
world today are already estrogen dominant and the risks of hormonerelated breast
cancer etc. simply goes up, the more estrogen the woman takes. Actually, progesterone supplementation
makes more sense. This brings back the estrogen dominance to more of a
balance.
Estrogen does, in fact inhibit the osteoclast cells that function to resorb bone
and as a
result can slow the rate of bone loss.
But estrogen cannot rebuild bone. Progesterone rebuilds bone by stimulating the
osteoblast cells, which re-mineralize and restore bone mass.
Estrogen without the balance of progesterone is fraught with side effects:
hypertension is one example. Also, salt and water retention, increase in blood clotting, promotion of fat
synthesis, hypothyroidism, fibrocystic breast disease, increased risk of gallbladder disease and gallstones,
liver dysfunction, increased risk of endometrial cancer of the uterus, pituitary prolactinoma tumor and
probably breast cancer are also possible.
Pueraria mirificais a herbal preparation from Thailand (we sometimes jokingly call it
HRT, meaning “herbal remedy from Thailand”). It is one of the most potent
estrogen
antagonists known, yet quite safe. It does not block all estrogen functions. But
I study I found on PubMed made it clear that it does reduce alkaline phosphatase, a marker for bone breakdown
and resorption [Menopause. 2008 May-Jun;15(3):530-5]. It’s
probably just as good for men as they age, too. Another study on PubMed, on castrated rats, showed that they
did not fall into the rapid female pattern of bone loss [Maturitas. 2007 Mar 20;56(3):322-31. Epub 2006 Nov
13].
Dosage: 1 -2 mg per kilo of body weight per day
Bisphosphonates
Marketing this class of drugs has been a triumph of marketing spin over science
and common sense. They don’t work as described and the “science” is very hazy.
Not
enough to justify the risk.Yes risk. Everybody knows now about jaw necrosis and
that bisphosphonates can increase the risk of certain fractures of the femur.
Other detrimental effects they wreak of healthy metabolism will certainly come to
light, as time goes by.
Brands include: Actonel, Atelvia, Boniva, and Fosamax. As soon as the patents run
out, all the science about their dangers and ineffectiveness will surface.
Till then, Big Pharma is keeping the lid on problems
What About Exercise?
Exercise has been shown to have a positive effect on bone density; thus, those
who
lead sedentary lives are more likely to develop osteoporosis. Animal studies show
that
lack of use leads to rapid bone re-absorption (breakdown by cells). Therefore, it
is likely
regular gentle exercise will benefit all women at or beyond the menopausal
years.
However, no study I know of has shown that older women are able to replace lost
bone
through exercise. Moreover, if you overdo it, excessive exercise causes cessation
of periods. That’s due to lack of estrogen. Well, for reasons already explained, lack of estrogen is a prime
factor
in osteoporosis, so you do NOT want to over-exercise
So What Does Work?
Nutrition
The truth is that osteoporosis is a holistic condition and needs treating
holistically. It is doubtful if single nutrient supplements, even such obvious ones as calcium and vitamin D,
would be
effective in the absence of good whole-body nutrition. Bone, remember, is more
than just a collection of calcium apatite crystals. It is an active living tissue, constantly remodeling
itself
through deposition and absorption and continually participating in a wide range
of biochemical reactions — reactions that will be compromised by any degree of under
nutrition.
We can consider several of these. As usual, all play a part and you can’t get
much benefit from just concentrating on one.
Magnesium
Without doubt, the number one deficient nutrient and the KEY to this problem, is
magnesium.
The critical bone enzyme alkaline phosphatase (involved in forming new calcium
crystals) is activated by magnesium. Its relative lack, therefore, could be expected to block the deposition
of new bone tissue. Whole-body concentrations of magnesium were found to be below normal in 16 out of 19
osteoporotic women. Take 300- 400 mg daily, in addition to rich dietary sources.
Vitamin D
We all know vitamin D prevents rickets, which is softening of the bones. It does
this by
making calcium more available to the bones (where is should be). It must make
sense
to take vitamin D.
Now we know now how good an anti-oxidant, immune modulator and antimicrobial.
It even lowers the risk of cancer. So don’t hesitate to take vitamin D in large
amounts:
take only vitamin D3 (cholecacliferol).
Forget the pathetic RDA: take 4,000- 5,000 IU. It’s dirt
cheap.
Vitamin K
This may surprise some people. Vitamin K is known to be important primarily for
its
effects on blood clotting. However, it is also required for synthesizing
osteocalcin, a
protein found uniquely in bone and on which the calcium crystallizes.
It is usually assumed that vitamin K deficiency is rare, but in one study (of
only 16
patients) with osteoporosis, their mean serum vitamin K levels were only 35% of
those
of age-matched controls.
Take vitamin K2 (not K1): 10 mg daily if you can afford it (it is rather
expensive).
Manganese
This is also required for bone mineralization. Rats fed on manganese-deficient
diets
had smaller and less dense bones. In one study of osteoporotic women, blood
manganese levels were found to be only 25 per cent of those of controls!
About 5 mg daily is accepted generally as a suitable
supplement.
Folic Acid
The interest in this vitamin co-factor stems from the fact that homocystine
metabolism
seems to be at least partially folic acid-dependent, and patients with a genetic
failure in
the metabolism of homocystine are known to develop severe osteoporosis at an
early
age. Folic acid deficiency is relatively common, particularly in those who do not
follow
a hunter-gatherer type diet.
Supplementation would therefore seem to be prudent. Try to get 500 mcg daily.
Some
countries have a legal upper limit. You really need 3 mg. You’ll need a script
for those levels
(it may expose vitamin B12 deficiency, which is
dangerous).
Boron
Previously thought to be important only for plants, we now know that boron plays
a
role in human nutrition, particularly in relation to bone health.
Supplementing the diet with boron was shown to reduce urinary calcium excretion
by
44%. Interestingly, it also increased the serum concentration of the hormone
17-betaoestradiol, which may be the most biologically active form of naturally occurring human estrogen.
Dietary requirements are not known. I have found that 3 mg daily will produce
benefits.
Strontium
Strontium has been shown to prevent chemical irritations of the skin, it plays an
important role in building strong bones, reduces dental cavities, and bone
pain.
In the largest published clinical trial, 1,649 postmenopausal women with
osteoporosis
received 680 mg per day of strontium or placebo for three years. Compared to
the
placebo group, strontium reduced the incidence of vertebral fractures by 49% in
just
one year.
We used to get adequate strontium through our drinking water, and through foods
since it is naturally present in water and soil. However, these days it’s almost
impossible
to get strontium this way because of water treatment that kills strontium and
soil that
has lost all of its nutritional value because of overuse.
According to one study, 170 mg of strontium per day, seems to be more effective
than
680 mg per day for reducing fracture risk, which raises the question as to
whether a
lower doses might be as effective.
My colleagues and I who are in the know think more in terms of 5 mg or 10 mg
daily.
Other Important Nutrients
Attention has also been focused on a number of other nutrients including silicon,
vitamin B6, zinc, copper, and vitamin C. In other words, we are working towards
the
conclusion that any important nutrient could lead to as yet undiscovered
deficiencies
in bone metabolism; good holistic nutrition is vital
Things To Avoid
Some drugs accelerate bone loss. Particularly important are steroids such as
prednisolone, though it appears that the type of osteoporosis this can lead to is quite different
biochemically
from post-menopausal osteoporosis. Certain anticonvulsants (phenytoin, for
example) may also lead to increased bone reabsorption. The science for bisphosphonates is beginning to fall
apart. Women who took bisphosphonates for five years or longer were found to have a 2.7-fold greater risk for
certain thigh fractures than women who took them for less than 100 days. The researchers concluded that some
long-term bisphosphonate users may benefit from a “drug holiday”
-- stopping the drugs for a while and then restarting. But Park-Wyllie, quick to
protect its profits, says this has not been studied.
Smoking is said to hasten the menopause by about five years and reduces oestrogen
levels thereafter. Other evidence suggests that smoking may alter osteoblast
function
(osteoblasts are the cells that ‘build’ bone).
There are also racial and genetic factors that you can’t avoid. However, remember
there
are epigenetic factors which can switch off bad genes and switch on good ones.
In any clinical evaluation of osteoporosis, a number of disease states need to be
considered. All are rightly the preserve of a qualified physician, and are not
for self
-medication. They include anorexia nervosa, testicular failure, thyrotoxicosis,
bone
cancer disease, and immobilization after surgery
Thyroid Hormone and Osteoporosis
Now something new and up-to-date:
An important hot study (British Medical Journal, April 28th 2011) has linked
having too
much thyroid replacement therapy to a significant increase in bone fractures in
the elderly.
Obviously, this knowledge needs to be part of any comprehensive report on bone
strength and nutrition. Older individuals already have an increased risk of
fractures, so
this may make the problem much worse.
Previous studies have told us there is a problem; in fact it is 120 years since
the effect
of excess thyroid hormone on bone was first described. Yet research, to date, has
been
slight. It is clear: too much levothyroxine can lead to much reduced bone density
and
therefore increased risk of fractures (an excess of thyroid hormone can also
affect
neuromuscular function and muscle strength and increase the risk of arrhythmias
and
falls, which can raise the risk of fractures independent of bone
density).
The researchers reviewed over 200,000 cases, so this is a pretty major study. The
individuals were all 70 years or older and taking levothyroxine. They were
followed up
for almost 4 years, looking for fractures of the wrist or forearm, shoulder or
upper arm,
thoracic spine, lumbar spine and pelvis, hip or femur, or lower leg or ankle. ,
continued
until March 31, 2008 (mean duration of follow-up, 3.8
years).
The 3 defined groups of levothyroxine levels were: high (> 0.093 mg/day),
medium
(0.044 - 0.093 mg/day), and low (< 0.044 mg/day), in the year before
fracture.
About 10% of levothyroxine takers (22,236) had a fracture during follow-up;
18,108
(88%) were women, which just goes to show how much more at risk women
are.
The incidence of fractures went up in direct proportion to the dose of
levothyroxine.
This study was not able to review the original case notes for laboratory and
radiologic
data. Nevertheless, I rate this as a very significant study and it showed that
the optimal
dose of levothyroxine for an elderly person is surprisingly
low.
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