Osteoporosis



Osteoporosis

Agatha M. Thrash, M.D.

Preventive Medicine

Osteoporosis is the slow, gradual thinning and weakening of bones. It begins to develop many years before loss of height, curvature of the spine, and fractured bones. These fractures occur in the spine, ankles, hip, wrists, arms, and legs. Researchers have established that proper nutrition and weight-bearing exercises are successful in preventing osteoporosis and sometimes in reversing it.

It is estimated that 15 to 20 million people in the United States are afflicted with osteoporosis. Most of those afflicted are postmenopausal women and about 50% of those afflicted get bone fractures. Men are rarely affected because of a greater lifelong bone density.

Many factors contribute to osteoporosis. Among those well-known are zinc, calcium, and magnesium imbalance; heredity (especially prone are tall, thin, blue-eyed women); poor diet; lack of exercise; smoking; alcohol; coffee; prescription drugs (especially cortisone, prednisone, and their relatives); over-the-counter pain relievers; oral contraceptives; not enough sunlight; too many vitamin supplements, especially vitamins A and D, aluminum or phosphate baking powders; anorexia nervosa; diabetes, rheumatoid arthritis, and other bone diseases; sedentary lifestyle or periods of enforced bed-rest; long use of aluminum antacids such as Amphogel, Mylanta, Maalox, Aludrox, Gelusil; possibly aluminum deodorants, aluminum cookware, and cans used in canned foods and sodas, and excessive athletic or dance training.

BONE DEVELOPMENT

Bone constantly undergoes a process of remodeling. Vertical bone growth ends at approximately age 18, but bone continues to increase in mass for 10-15 years longer, until about the age of 35, when peak bone mass is reached. After peak bone mass is achieved, age-related bone loss begins to occur, slowly at first, but faster after menopause. About 1% average bone loss per year occurs from age 35 on, resulting in 20% already lost by age 55.

From childhood through adolescence, skeletal mineral demands for bone formation are at their highest. A high protein, sugar, fat, and salt diet; and physical inactivity during these bone-forming years can reduce bone density and lay the foundation for osteoporosis in later years. When peak bone mass is reached at age 35, the larger the bone mass, the less risk of developing osteoporosis.

Generally, women who have been pregnant have greater bone density than women who have never borne children. Calcium regulating hormones occur in greater quantities during pregnancy in preparation for lactation. During the first years after menopause, the skeleton undergoes a period of more rapid mineral loss, and then tapers off to a slower, but constant loss. Osteoporosis may begin with no outward signs or physical sensations. Major changes in bone can occur before any pain is felt. Therefore, in early menopause measures should be taken to prevent humpback and broken bones.

Sedentary work in middle age predisposes a person, male or female, to hip fractures in later life. Illness, surgery, or injuries requiring immobilization for long periods will also affect bone density, especially in older people. Without regular exercise, bone density decreases and muscles become weak, leading to falls and fractures. A good conditioning program should be maintained throughout life, and especially if work requires one to be seated most of the time.

High Risk Factors for Developing Osteoporosis

• Being female

• Being Caucasian

• Family history of osteoporosis

• Slender build

• Being inactive

• Low muscle mass

• Early menopause

• Being past menopause

• Fair or translucent skin

• Cigarette smoking

• Low calcium intake or high zinc or magnesium intake

• High alcohol consumption

• Drinking lots of soft drinks

• Consuming caffeine chinks

• High protein, sugar, fat, and salt diet

• Taking thyroid hormones or steroids such as cortisone and prednisone

• Long-term treatment with psychoactive drugs and antibiotics: isoniazid (for TB), tetracycline

• Having anorexia nervosa

CAUSES OF OSTEOPOROSIS

DRUGS: Osteoporosis can be a doctor induced disease. Several drugs are now known to be implicated in osteoporosis: Corticosteroids are famous for this (cortisone, prednisone, and all related steroids), thyroid hormone supplements such as thyroxine, isoniazid for tuberculosis, antibiotics—especially tetracycline and its derivatives, tranquilizers, and psychotropic drugs such as anti-depressants. This list will most likely increase as more cases of osteoporosis appear and more research is done. It is also important to beware of new drugs claiming to treat osteoporosis, because certain “miracle” drugs have actively increased the risk of developing this disease.

Estrogen is often prescribed to prevent osteoporosis. But there are many problems with synthetic estrogen. It can cause breast cancer and can worsen other cancers. It can cause endometriosis and certain blood-clotting conditions. It can also increase the risk of death from heart disease. The Centers for Disease Control published in 1991 their evaluation of estrogen use for five years. Women had a measurable increase in incidence of cancer. If they used estrogen for 15 years, they had a 30% increased incidence of cancer over the non-estrogen user. Because of the side effects of estrogen, physicians have tried using progesterone along with estrogen in the hope of preventing some of the problems. But progesterone carries risks of gallbladder disease, certain cancers, hypertension, and heart disease. And according to recent research, the bone-building qualities of estrogen appear to be minimal and short-lived, and after 9-15 months of using this drug, bone density may actually begin to decrease. The only time it is probably helpful is between the ages of 50 and 55, according to osteoporosis expert Dr. C. Conrad Johnston of Indiana University Medical School.

MINERALS: Fluoride is another drug prescribed to slow down bone loss. But any beneficial effects are accompanied by serious side effects in the stomach and joints. Furthermore, broken bones have been found to increase among patients treated with fluoride.

Calcium intake is promoted by the dairy industry as the primary factor in osteoporosis. Advertising campaigns have been designed to persuade us that taking calcium supplements and drinking and eating dairy products are absolutely necessary for bone growth. But research has proven that supplementing calcium beyond what the body needs does nothing to promote new bone growth. Calcium carbonate supplements (Tums) have been found to actually suppress bone growth.

DAIRY PRODUCTS: Because dairy products are high in protein, salt, fat, and phosphates, they may actually interfere with the retention of calcium stores and cause more calcium to be lost than saved when they are used in the large amounts usually promoted by the dairy industry. High levels of protein make an acid condition in the blood, tax the organs which must eliminate the excess, and trigger loss of calcium from the bones. The kidneys have to excrete the excess and the wastes left over from metabolism, increasing the risks of developing kidney disease. The calcium excess from so much dairy products may form kidney stones. This process of calcium loss due to daily consumption is not reserved for those over 35 who have reached peak bone mass and are experiencing age-related bone loss. Even younger people who consume a great deal of dairy have been found to have thinning bones. As dairy consumption in a population goes up, so does osteoporosis. Note the chart below on hip fractures.

In studies of the Chinese, it has been found that although the Chinese consume half the amount of calcium Americans do, osteoporosis is uncommon in China. Most Chinese people eat no dairy products, 1/3 the amount of fat and twice the complex carbohydrates as Americans. They eat 20% more calories, but Americans are 25% more overweight. The average Chinese diet consists of 7% protein from animals; Americans consume 70% of their total protein intake from animals.

IMBALANCE OF VITAMINS AND MINERALS: As more studies are being conducted, there is continued evidence that it is the proper intake and combined use of many foods containing different vitamins and minerals that protect one from osteoporosis, not just calcium intake. Vitamins A, C, and D, plus the B vitamins and K, all combine in the growth, repair, and maintenance functions in the body. Magnesium, manganese, folic acid, boron, strontium, calcium, silicon, zinc, copper, and iron all help keep the body in a positive state of balance. Taking heavy supplements, especially of vitamins A and D, can damage the delicate balance in the body, burdening the organs.

Vitamin D enables the body to absorb calcium, but too much synthetic vitamin D can cause heart problems. Low blood levels of vitamin C have been found in people with hip fractures, even when hipbone calcium quantities were the same as those people without fractures. Vitamin C promotes connective tissue in bone. It is on this framework of tissue that bone-hardening calcium is laid. Without adequate supplies of vitamin C, bones cannot utilize calcium. All these vitamins and minerals can be obtained in the right quality and quantity from food and sunlight.

Hip Fractures

Women of: Rate/100,000 Daily Dairy Protein

USA 102 462 gm/day 106

New Zealand 97 480 112

Israel 70 315 105

Singapore 15 113 82

Bantu 5 10 47

Eskimos—highest hip fracture rate in the USA. Yet their daily calcium intake is 1500-2500 mg, mainly from salmon eaten with bones. The high flesh diet gives them 250-400 grams of protein a day which spells osteoporosis.

HARMFUL EATING HABITS: The typical western diet of refined foods, meat, dairy products, eggs, sugar, alcohol, and coffee does not adequately supply our vitamin and mineral needs. Our weight-reducing diets are deficient in many essential nutrients.

Meat, like dairy products, has too much protein for the body to utilize efficiently. When we eat meat, an acid, high-phosphorus condition is created in the blood. Phosphorus is absorbed more easily than calcium, has a see-saw relationship with calcium and forces calcium down when it goes up, and can accelerate bone loss. The acid condition can dissolve calcium from the bones. If a high protein diet is consumed, it is impossible to maintain a positive calcium balance regardless of the amount of calcium taken in. Iron and zinc are also lost when a high protein diet is eaten. Some researchers believe zinc to be even more important than calcium in maintaining strong bones. Other foods high in phosphorus and best avoided are: sodas, instant soups, some gelatins, snacks (like pork rinds), baking powder and dish detergent (if not thoroughly rinsed off dishes can also be a source of excess phosphorous).

Too much salt interferes with calcium absorption and increases calcium loss. Sugars, including white sugar, syrups, honey, and malt cause calcium to be lost. Caffeine and other methylxanthines, as found in coffee, colas, tea, and chocolate, block calcium absorption from our food. Drinking 2-4 cups of coffee a day for a 15 year period can set the stage for developing osteoporosis. The same is true for alcoholic drinks. Tobacco has been found to alter natural estrogen metabolism and accelerate bone loss. Smoking causes about 1% bone calcium loss per year occurring from less than a pack per day. Cancer, heart disease, and diabetes can all promote osteoporosis, and all have dietary causes.

Osteoporosis is to a great degree a total dietary problem, not merely a calcium problem. Our bodies can adapt to a reduction in calcium intake by increasing the efficiency of intestinal calcium absorption. Usually only about 30% of the calcium we eat is absorbed. But when needed we can double or nearly triple the absorption. If we choose to eat a balanced vegetarian diet, we can prevent, and in many instances partially reverse osteoporosis. Studies done to compare bone density in meat eaters and vegetarians found that vegetarians had greater bone densities than meat eaters—even though the quantity of bone calcium was lower in the vegetarians. Those vegetarians who reach approximately 69 years of age appear to suffer no further decline in bone density, whereas, in meat eaters, bone loss continues.

HEALTHFUL EATING HABITS: Most mistakenly believe that the loss of natural estrogen during menopause, either natural menopause or surgical, is the most important factor leading to osteoporosis. Against the estrogen theory being an important factor is the generally observed development of strong bones in little girls who have even less estrogen than post menopausal women. But, if for many years a woman has been eating and drinking foods that contribute to bone loss, by the time estrogen production declines, her bones have already been weakened by a poor diet. Whereas, if a woman has been eating healthful, whole vegetarian foods, staying away from harmful foods, and engaging in regular exercise, by the time she reaches menopause, her bones are most likely in a strong state of health. Even when a radiologist judges a vegetarian woman's bones to be thin, she will rarely suffer a fracture.

There are certain plant foods that contain plant sterols similar to natural estrogen. We recommend emphasizing them in the diet. Whole, vegetarian foods are higher in carbohydrates and lower in protein than animal-based foods. The most favorable diet to prevent or treat osteoporosis is a totally vegetarian diet. The foods that are known to be rich in estrogen-like sterols are: whole grains, seeds, soybeans, calabar beans, peanuts, coconut, most nuts and seeds, beets, Brussels sprouts, carrots, corn, okra, radish greens, beans, barley and pea sprouts, yams, apples, cherries, figs, olives, plums, strawberries, and herbs like alfalfa, anise seed, garlic, licorice root, oregano, parsley, and sage.

WHAT TO EAT: Boxed, canned, and frozen foods should be avoided when fresh food is available, as they are often deficient in nutrients and loaded with bone-robbing salt, fat, or sugar. There are many cookbooks available today to teach you how to prepare natural foods in a variety of interesting, delicious ways.

Plant foods supplying calcium in adequate quantities so that questionable dairy products or calcium supplements will be unnecessary include most seeds; greens like spinach, kale, mustard, cauliflower, broccoli, Brussels sprouts and celery; carrots; green peas; green snap beans; oatmeal; cream of wheat; cashews; almonds; dried fruits; lentils; lima beans; soybeans and soybean products like tofu.

Spirulina and seaweeds have been reported to help re-mineralize bones. It was once thought that bones could not be recalcified, but it is now recognized that sometimes calcium can be replaced in the bones. Starting with a mild variety of seaweed, like Arame, is a good way to begin to get used to this new taste. Nori comes in dark green dried sheets. Seaweeds can be purchased in health food stores or Oriental groceries. Most have to be soaked and cooked, but Dulse and Seapalm can be eaten right out of the bag. Nori can also be eaten straight from the bag or lightly toasted until it turns a beautiful green. Vegetables can be added to a seaweed dish or seaweed can be added to cooking beans, peas or pasta or crumbled over cooked dishes. Care should be taken to rinse the extra salt off the saltier varieties.

Since every plant food contains protein, human needs are provided by a vegetarian diet. Fresh cabbage has more protein per unit volume than whole milk. Rice, corn, fruit, wheat flour, dried beans and peas supply enough usable protein to safely maintain our health. By eating a variety of whole foods, all vitamin and mineral needs are met, without burdening the body with toxic excess that creates disease.

Vitamin B-12, which is a cause of great concern to people considering a vegetarian diet, can be maintained in the body without supplements for 3 to 5 years. Dark, leafy green vegetables, olives, seaweed, wheat, fruit, soybeans, and root vegetables are at times vegetarian sources of B-12, but cannot be counted on as the B-12 is not always present in or on these foods. A constant source is the bacteria growing in or on the body. The only known available source of B-12 is germs. B-12 is present in or on any food only by contamination from germs. Most people get enough B-12 from the germs in the mouth, eyes, tonsils, esophagus, and upper stomach. The same type person who tends to get osteoporosis also tends to get B-12 deficient—tall, blue-eyed, thin, and over 50 years old.

Vitamin D, which is needed to absorb calcium and phosphorus into the bones, is not found in food. The safest source is sunlight. Being in the sun for 15 minutes a day is enough to ensure an adequate supply of Vitamin D. It can be stored several months. Vitamin C is best obtained from fresh fruits and vegetables.

EXERCISE: In long-term studies, researchers have found that regular participation in weight-bearing exercise leads to a significant increase in bone mineral content. In many instances, osteoporosis can be improved. The more active we are, the thicker our bones grow. There is a connection between muscle strength and bone density. When we move our muscles, the pull of muscles on bones and the jolting of exercise encourages the bones to absorb more calcium.

Exercise, to be effective in maintaining bone density and overall fitness, needs to be undertaken at all stages of life; from childhood on through advancing age. People who are just beginning to show signs of osteoporosis can prevent progression of the disease by adding an exercise program to their daily schedule. This is as important as beginning a new eating program. Healing is slow and gradual, and takes place over many months and possibly years. Once osteoporosis has developed to the point of a high fracture rate, extreme care must be taken when initiating exercise, because even small body stresses can cause fractures.

Another concern is exercising too much. Excessive exercise, such as the kind of training needed to participate in marathon running or professional dancing, can cause painful heels, shin splints, headaches, blood in the urine, irregular or stopped menstruation. It can also cause bones to become thin and weak. This type of osteoporosis has been found in women as young as 25 years.

Moderation and enjoyment are the keys to a beneficial exercise program. The amount of exercise will vary with each person depending on the overall health. Walking is good for a start; then aerobics, cycling, and purposeful labor are good weight-bearing activities. Swimming is not a good weight-bearing exercise because water reduces the effect of gravity and there is less weight demand put on muscles and bones. This kind of exercise is good for advanced osteoporosis. Stretching is also good for muscles and bones and helps prevent humpback.

Start slowly and increase your time weekly, until you’re exercising two hours per day. Then decide if you want to add more vigorous exercise, depending on your condition. Books in libraries and book stores teach different types of exercise, from easy stretching, to the most demanding labor. Warm up slowly each exercise period or you can get muscle and tendon strains. Cool down slowly for a few minutes before sitting or lying down to prevent heart and lung congestion.

SUMMARY OF TREATMENT:

Osteoporosis is found in greatest numbers in countries where the standard American diet and beverages are used (see first paragraph) and sedentary lifestyles are common. Drugs and calcium supplements have been shown to have little to no effect on progressive bone deterioration and they may cause more difficulties than they are trying to prevent.

1. Eat a diet providing not only calcium but also zinc and magnesium.

2. Avoid alcohol, tobacco, and its brown relatives.

3. Avoid drugs as much as possible as many cause osteoporosis, especially aluminum antacids.

4. Prevent anorexia nervosa and bulimia, diabetes, and rheumatoid arthritis if possible.

5. Avoid acid forming foods such as vinegar; animal products; baking powder; and foods high in sugar, salt, or fat.

6. Be physically active from the cradle to the grave.

7. Avoid the high risks listed.

REFERENCES

1. Carper, Jean. “Food Pharmacy,” The Atlanta Journal and Constitution, 1990.

2. Glassburn, Vicki. Who Killed Candida? Teach Services, 1991.

3. Palm Beach Post, 1990.

4. Yeater, Rachel A. PhD; Martin, Bruce R. PhD, “Senile Osteoporosis,” Post Graduate Medicine, 1984.

5. Gerber, N. J., Rey, B., “Can Exercise Prevent Osteoporosis?” British Journal of Rheumatology, 1991.

6. Oestreicher, Annette, Hippocrates, 1991.

7. Childers, Norman, Prof., Letter to Arthur Brown, Sec., Dept. of Agriculture, 1986.

8. Stevenson, John C. MB, MRCP, “Pathogenesis, Prevention, and Treatment of Osteoporosis,” Obstetrics and Gynecology, 1990.

9. Cooper, C., Wickham, C., Coggon, D. British Journal of Industrial Medicine, 1990.

10. Grant, Alexander, Dr., Health Gazette, 1989.

11. Rheumatology News, 1984.

12. Brody, Jane, “China Study Challenges Diet Myths,” The Atlanta Journal and Constitution, 1990.

13. Ellis, Holesh, and Ellis, “Incidence of Osteoporosis in Vegetarians and Omnivores,” Journal of Clinical Nutrition, 1972.

14. Thrash, Calvin, Dr., Thrash, Agatha, Dr., Nutrition for Vegetarians, 1982.

15. Dawson-Hughes, Bess, “Calcium Supplementation and Bone Loss,” American Journal of Clinical Nutrition, 1991.

16. “Premenopausal Bone Mass Related to Physical Activity,” Archives of Internal Medicine, 1988.

17. Mundy, Gregory R., MD, “Identifying Mechanisms for Increasing Bone Mass,” The Journal of NIH Research, 1989.

18. Kendall, Lee G., J., MD, “Postmenopausal Osteoporosis,” Arthritis Today, 1986.

For more information contact:

Uchee Pines Lifestyle Center

30 Uchee Pines Road #75

Seale, Alabama 36875

Tel. 334-855-4764



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