Doctor’s Tip: Strong bones aren’t about milk and supplements
Our bones are constantly remodeling, with osteoblasts building bone and osteoclasts resorbing bone. An imbalance in this process causes osteoporosis, or “thinning of the bones.” This results in increased risk of fractures, particularly of the hip, thoracic (upper) spine and wrist. In the U.S. osteoporosis causes some 2 million fractures every year, including 547,000 vertebral fractures and 300,000 hip fractures.
Osteoporosis is more common in women than men, with Caucasian women having a 40 percent lifetime risk of one or more osteoporotic fractures. These fractures cause disability and can even result in death. Up to 50 percent of people age 65 or older who suffer hip fractures die within six months, and many who survive never get back to baseline function. Vertebral fractures cause a bent-forward upper spine deformity, which interferes with quality of life.
Some of the common causes of osteoporosis are:
• Menopausal estrogen deficiency in women; low testosterone in men.
• Hormone excess such as treatment with cortisone; an overactive thyroid; too much parathyroid hormone (regulates calcium metabolism).
• Vitamin D deficiency.
• Celiac disease; inflammatory bowel disease (ulcerative colitis, Crohn’s disease).
• Diets which are high in animal protein and dairy and low in plant protein, such as the Western diet.
• Lack of weight-bearing exercise.
Osteoporosis can be diagnosed on plain X-rays if it is severe, but at least 30 percent bone loss must be present before it shows up on X-rays. Densitometry (DXA scan) is a more sensitive and accurate test. Screening is recommended for all postmenopausal women, all men 70 and older and younger people with risk factors. The DXA involves measurement of bone density at two or three sites, including the hip and spine. If any of the measurements are minus 2.5 or a more minus number, osteoporosis is present. If the number is between minus 1 and minus 2.5, osteopenia is present, which is not a disease and usually doesn’t require treatment, but is considered pre-osteoporosis.
Osteoporosis is a disease associated with the high dairy and animal protein Western diet. In the 2005 China Study, the lead scientist, T. Colin Campbell, Ph.D., found no osteoporosis among rural Chinese who were too poor to afford to eat animal protein. This might seem counterintuitive to some, due to the millions of dollars spent by the dairy industry in advertising (Got Milk?) and in lobbying Congress to ensure that dairy remains on the U.S. food pyramid. But Dr. Michael Greger (“How Not to Die,” nutritionfacts.org) and other nutrition experts cite many recent studies showing that the higher the milk and animal protein consumption in children and adults the higher the risk of eventually developing osteoporosis and osteoporotic fractures.
What is also counterintuitive is the fact that calcium supplements have not been shown to prevent osteoporosis. We did not evolve to get vitamins and minerals like calcium in pill form, but rather in the food we eat. Although the supplement industry would prefer that you remain unaware of this, calcium supplements have not been shown to prevent osteoporosis or fractures. Furthermore, there is evidence that the huge rise in blood calcium levels that occur for several hours after taking a calcium supplement can contribute to cardiovascular disease.
Of course we all need calcium in our diets, but the best way to get it is by eating plants, particularly greens. Here’s an example of milligrams of calcium per calorie in various foods:
• Bok choy, 775.
• Turnip greens, 685.
• Tofu, 287.
• Soybeans 59.
• Fish, 33.
• T-bone steak, 3.
Exercise also helps keep your bones strong, particularly weight-bearing exercise (e.g. jogging versus swimming). Maintaining strong bones is just another of many reasons to exercise regularly.
There are several classes of medication effective in treating osteoporosis including: estrogen in women and testosterone in men; bisphosphonates (Fosamax and others); selective estrogen receptor modulators (SERMS) such as raloxifene. However all of these can have side effects, some of them serious.
Phytates are natural plant compounds that keep your bones strong by the same mechanism as Fosamax but without the side effects. Phytates are present in whole grains, beans, nuts and seeds. If you have severe or worsening osteoporosis and your doctor recommends a medication such as Fosamax, you should certainly consider it, because the risk of an osteoporotic fracture outweighs the risk of possible side effects from the medication. You should ask about the pros and cons of the different classes of medications. And you will also want to optimize your diet. To learn more, go to nutritionfacts.org and search osteoporosis.
Dr. Feinsinger, who retired from Glenwood Medical Associates after 42 years as a family physician, now has a nonprofit Center For Prevention and Treatment of Disease Through Nutrition. He is available for free consultations about heart attack prevention and any other medical concerns. Call 970-379-5718 for an appointment. For questions about his columns, email him at email@example.com.
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