TONE
YOUR BONES
Osteoporosis Myths & Misconceptions
by
Carole Tashel, Clinical Herbalist
Osteoporosis (literally, holes in the bones), is characterized
by excessively thin and fragile bones that fracture easily. There
are around 30 known risk factors: Some are medical, such as various
diseases or long-term use of pharmaceuticals like thyroid hormone,
steroids, aluminum-containing antacids and diuretics; and some
are related to lifestyle, like smoking, coffee and alcohol use,
poor diet, very low body weight, etc. The entire health picture
must be examined. However, low bone density gets the lion's share
of the attention.
Until recently, Hormone Replacement Therapy (HRT), together with
calcium and exercise, were recommended to prevent loss of bone
density and subsequent fracture. Now with the bad news about HRT,
the drug Fosamax is frequently suggested (more on Fosamax later).
The trouble is, drugs are inadequate answers to a very complex
problem.
SURPRISING FACTS
There are a lot of negative messages out there these days, but
luckily, the they can be balanced with some hopeful news. Here
are a few facts that may surprise you and contradict what you've
been led to believe:
* The majority of people who fracture their bones have normal
bone density, and have none of the risk factors. This mystery
forces us to look deeply to gain a more complete understanding
of osteoporosis.
* Thin bones are not necessarily weak or unhealthy. And though
just about all 80-year-olds have thin bones, they don't all break
their hips if they fall.
* Not all women lose bone rapidly following menopause, and conversely,
it's not necessarily a problem when women do lose bone then.
* Worldwide, as people age, their bones get thinner; yet if they
are otherwise healthy, their bones remain strong and resist fracture.
For instance, at menopause, Mayan Indian woman in Mexico lose
bone at the same rate as US women, and their postmenopausal estrogen
levels are even lower than ours. Yet they don't break bones or
lose height.
* Osteoporosis can actually be halted and reversed through diet,
supplements and exercise. Even if you have already had an osteoporotic
fracture, you can prevent further fractures.
* In Sandra Coney's The Menopause Industry: How the Medical Establishment
Exploits Women, Dr. Bruce Ettinger, endocrinologist at Kaiser
Permanente Medical Center, explains, "The [vertebral] osteoporosis
that causes pain and disability is a very rare disease. Only 5-7%
of 70-year-olds will show vertebral collapse; only half of these
will have two involved vertebrae; and perhaps one fifth or one
sixth will have symptoms. I have a very big referral practice,
and I have very few bent-over patients. There’s been a tremendous
hullabaloo lately, and there are a lot of worried women -- and
excessive testing and administration of medications."
THE REDEFINITION OF A DISEASE
Women are usually encouraged to be screened for osteoporosis by
having a bone mineral density test (DEXA) around the time of menopause.
(DEXA is much more accurate than the heel or wrist tests offered
at shopping malls.) But there's a major problem: It can't predict
fractures that may occur 20 to 30 years in the future. For this
reason, most osteoporosis guidelines committees caution against
universal screening before the age of 60.
Interestingly, in the past, the diagnosis of osteoporosis used
to be applied only if a fracture occurred, or if there was a serious
deformity of the spine. But in 1992, the World Health Organization,
together with pharmaceutical and medical equipment companies,
redefined osteoporosis based upon low bone density revealed by
DEXA. Bone density is "scored" by comparing it to the "normal"
bone density of a 30-year-old woman.
To make things worse, eventually a new condition was defined --
"osteopenia," or somewhat reduced bone mass -- instantly placing
millions of women in a kind of "pre-osteoporotic" category. Dr
Susan Love, gynecologist and author, thinks osteopenia "isn't
a disease or even a risk factor, and should not be treated." In
this case, screening technology may be getting way ahead of the
understanding of a condition.
Many feel it's arbitrary and pointless to compare 55- or 65-year-old
bones to 30-year-old bones. The tests measure only density, but
cannot evaluate the infinitely more important qualities of bone
strength and flexibility. Remember, low density does not necessarily
translate into increased fragility. Instead, osteoporosis is a
degenerative disease where bones fracture not only because they
are thin, but because they are thin and substandard.
Calcium is in the limelight, so to speak, because you can see
it in the x-rays, measure it, and take it in pills. However, bones
that break lack not just calcium, but many other nutrients and
minerals, and suffer as well from a decrease in the non-mineral,
structural framework of the bone.
The pharmaceutical answer to low bone mass is a drug called Fosamax.
It deposits in the skeleton, coating bone cells with a crystalline
covering, while depressing bone breakdown as well as bone formation.
There are lingering questions whether the "old" bone retained
could then become brittle rather than stronger. The long-term
adverse effects of Fosamax are essentially unknown. And the advantage
of taking the drug compared to not taking it at all is extremely
modest. In a three-year study of older women with osteoporosis
and at least one previous fracture, 2% of the women taking a placebo
had a subsequent hip fracture, compared to 1% of those on Fosamax.
[Fosamax may be useful — even a life-saver — for someone with
a multitude of risk factors, previous fractures and in imminent
danger of breaking another bone.]
CREATIVE USE OF TESTING
Of course, there's nothing at all wrong with getting a bone density
test if you're simply curious (or worried) about where you stand.
But if you do, there are two other tests that can help you more
accurately monitor your progress in building bone density.
While DEXA is like a report card on how much bone has been built
over the past year or two, the NTx ("Cross-linked N-telopeptides")
is a urine test available through labs. It measures byproducts
from bone breakdown, indicating the rate at which you may lose
bone over the next few months. Whereas you have to wait at least
a year to have a second DEXA, a follow-up NTx test in three to
six months can assess the results of your bone-building efforts
(nutritional protocols, resistance training, etc.).
At home, you can check urine pH (measures relative acidity/alkalinity)
and get a daily report card. Diets high in animal protein (and
low in vegetables and fruits), as well as excessive amounts of
sugar, coffee, tea and processed foods will disrupt pH balance.
Body chemistry is pushed toward an acid state, and calcium and
other alkaline minerals are withdrawn from the bones to buffer
the acidity. The skeleton has been humorously compared to a large
antacid tablet, full of minerals to be drawn upon when the internal
environment becomes acidic.
The lower the value on your pH strip, the more acidic your body
chemistry is. The ideal is 6.5 to 7, just about neutral, which
indicates good reserves of the alkaline minerals. Try not to be
alarmed by low values -- it's a dynamic process that takes time
to correct, and there are ways to improve your score: Increase
vegetables (especially greens and yams) and fruits to about four
cups per day, and eat oats, quinoa, wild rice and seeds. Drink
green drinks, lemon or lime juice in water two or three times
a day. Use apple cider vinegar in your salad dressings, and enjoy
miso soup and seaweed. The Japanese umeboshi plum is a powerful
alkalinizer. Eden makes a product called "Ume Plum Balls" -- five
balls can be taken twice daily between meals.
BEGIN BUILDING BONE-HEALTH
Make your meals nutrient-rich bonanzas.
* There are not just a few essential nutrients for bone health
-- there are 18! You need calcium, phosphorus, magnesium, fluoride
(food sources only), silica, zinc, manganese, copper, boron, vitamin
D, vitamin C, vitamin A, vitamin B6, vitamin K, vitamin B12, folic
acid, essential fatty acids and protein. And you'll get these
from a well-rounded, whole foods diet.
Optimize mineral absorption.
* Animal fats, which contain vitamins A and/or D, are helpful.
All you need is a small piece of fatty fish or organic meat, a
little full-fat yogurt, butter or eggs with a meal. Vitamin D,
of course, is also made on your skin when you're outdoors. Don't
be too sun-phobic -- 10 to 15 minutes of exposure per day without
sun block is beneficial.
* Before cooking whole grains, soak them for seven hours in a
warm place with two tablespoons of lemon juice, buttermilk or
kefir. The fermentation process transforms the factors that make
minerals less available.
* Before meals, encourage strong digestive "fire" by sipping a
tablespoon of lemon juice mixed into one-half glass of room temperature
water, or nibbling on something bitter, like parsley. (Skip the
16-ounce glass of ice water.)
* Flavor foods with herbs like thyme, oregano, curry blends, or
a bit of ginger or black pepper. Chamomile is a classic digestive
tea. Sprinkle lemon juice or apple cider vinegar over your salads,
vegetables, etc.
* A mixture of herbs like horsetail, oatstraw, red clover blossoms,
alfalfa and nettles brewed overnight into a strong tea provides
ready-to-absorb minerals.
* Got yogurt? Cultured dairy products (yogurt and buttermilk)
are much better assimilated than milk. But the rate of calcium
absorption from dark green leafy vegetables like kale and collards
is far superior to milk.
* If you eat lots of protein (say the typical 95 grams a day),
plenty of salt and little or no vegetables, you require much more
calcium to stay in balance, even if you're taking the suggested
1200 to 1500 milligrams per day. You’re fighting a losing battle,
and making your kidneys work ever so much harder than they should.
A better amount of protein to strive for might be 45-60 grams
a day (for females), depending on your size.
* The calcium carbonate present in so many supplements is the
most difficult form to digest and absorb. Much better are calcium
citrate, aspartate, orotate or gluconate. (Avoid dolomite, bone
meal, oyster shell and coral calcium.)
Good stress management
Stress releases about 30 different acids into the bloodstream
and tissues, and accordingly, minerals are pulled from the bones
to neutralize them. You may think this is a small issue, but it's
not. (I’ve seen stress cause urine pH to plummet overnight.) All
the endocrine glands -- the hypothalamus, pituitary, kidneys,
thyroid, parathyroid, ovaries and adrenals -- support healthy
bone metabolism, and all can be negatively impacted by poorly-handled
stress. Exercise helps defuse the stress response. There are also
many "adaptogenic" herbs that regulate and balance the entire
endocrine symphony, softening the impact of stress and strengthening
these important glands. Eleuthero (formerly Siberian ginseng)
is a gentle adaptogen that's safe for anyone to take on their
own; be warned that cheap, supermarket products are often poor
quality. Consider also Ashwagandha and Licorice root.
Move it!
Bones are subject to the "use it or lose it" rule, and respond
quickly (in as little as three to five months) to the forces placed
upon them. Ideally, you want to build muscle, aerobic capacity
and bone. So if you are a couch potato, certain types of exercise
will be your saving grace. Not only can bone density be increased,
but the equally important qualities of muscular strength, balance
and flexibility are easily cultivated with yoga and tai chi. Brisk
walking is still a superb aerobic conditioner.
But it's resistance training (or weight training) that has the
most profound capacity to build strong bone. Even better, it can
specifically target the most vulnerable parts of the skeleton
such as the hips. And resistance training is effective not just
for 50- or 60-year-old women; studies show bone mass being gained
by women at age 70, and even 80-year-old women in wheelchairs!
The object is to work muscle and bone harder than they're accustomed
to working. One important move is the squat, which increases the
elasticity of bone in the hip area. A great workout doesn't have
to take more than 20-30 minutes, done three times a week. Consulting
with a professional trainer is helpful but not absolutely necessary.
If you do it on your own, though, learn about good form from someone
who knows, start with low weights, and increase gradually. If
you already have osteoporosis, there will be some moves you cannot
do, so you really must consult with someone knowledgeable.
A recent study from England shows that just two minutes per day
of vertical jumping (as in jumping jacks, jumping rope, two-legged
jumps) produces a remarkable 2% to 5% increase in hipbone density
within six months. Of course, if you have knee, ankle or back
problems, already have osteoporosis, or have serious balance problems,
this high-impact activity is not for you. Though jumping is recommended
only for premenopausal women, if you can jog, I see no reason
why you can't jump.
Copyright 2005 Carole Tashel
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