Category: Bone Health

by Marcelle Pick, OB/GYN NP

One factor that’s often overlooked in the prevention of osteoporosis is reducing chronic inflammation. It’s important to take a look at this, because inflammation can interfere with your own body’s natural ability to repair bone mass. Over time, this leads to brittle bones that are common in osteoporosis. You have several choices to help you limit the damage caused by chronic inflammation. Let’s look at them together.

A closer look at your bone health

Let’s look at some of the small changes you can make in your lifestyle and dietary habits to help maintain your bone health. Whether you are concerned about maintaining bone health, or you’ve already been told you have osteoporosis or osteopenia, it’s always a good idea to take good care of yourself. Symptoms of an inflammatory condition, including osteoporosis, can be managed in safe and natural ways which are effective. Changes you make today help shape your future!

1. Nurture healthy bacteria. Your gastrointestinal system is the source of nutrition for your cells daily functioning. If your cells are having trouble absorbing nutrients from the foods you take in, you are at risk for inflammation and osteoporosis.

Part of the problem we often have with absorption starts because we don’t have enough of the “good” bacteria that helps in digesting food and absorbing nutrients. This necessary bacterium also helps us to fight off substances like systemic yeast. Some steps you can take to help keep maintain good levels of gut flora are:

• Get plenty of fiber in your diet. Friendly bacteria love fiber.
• Add foods to your diet like yogurt, kefir, kimchee and sauerkraut. These are “living” foods.
• Try to gradually decrease your intake of red meat.
• Try taking a probiotic supplement on a regular basis if you have digestive troubles. This can help restore the natural bacteria in your GI system.

2. Pursue a high-alkaline, anti-inflammatory diet. An anti-inflammatory diet has a lot in common with an alkalizing diet that supports bone health. Consider these suggestions:

• Try adding extra servings of alkalizing fruits and vegetables, lean proteins and high-quality fats to your daily diet.
• Try cooking foods slowly or simmering, instead of frying. Foods retain more nutrients when they are cooked slowly; deep-fried foods are more difficult for our bodies to digest.
• Try to avoid red meat and processed foods. Other things to limit in your diet are refined sugars and grains as these often contain high amounts of additives, artificial colorings, flavorings and preservatives.

3. Take gluten off your menu. Research has shown a direct link between gluten reactivity and bone health. Whether you have been diagnosed with celiac disease or just have a mild intolerance to gluten, it sets off an inflammatory process which places your bone health at risk.

It’s much easier to implement a gluten-free diet now that there is such a wide variety of a food available. Many stores have whole sections dedicated to gluten-free foods. There is an extra benefit in eating gluten-free: since many foods which contain gluten are acid-forming, removing these will naturally lead you in the direction of a more alkaline dense diet.

4. Detoxify. Sometimes we don’t realize a certain food is making us feel sick until we eliminate it. Food sensitivities and allergies place our bone health at risk by stimulating the body’s inflammatory process. To help identify foods you may be sensitive to, experiment by removing a suspected substance from your diet for two weeks. Then reintroduce it and see how you feel.

5. Add omega-3s to your diet. I really can’t overstate the importance of these fatty acids. They stop inflammation and reduce the risk of complications in many areas of our health, including our bone health.

Foods which are especially rich in omega-3s include wild-caught Pacific salmon, mackerel, flax seed and walnuts. It’s easy to include these in your diet and reduce inflammation. You may also want to think about supplementing with an omega-3 supplement.

6. Vitamin D. Nature provides us with Vitamin D through sunlight, but not everyone spends enough time in the sun. It’s been estimated that up to a billion of the world’s population is Vitamin D deficient!

Vitamin D is important, not just for bone health. Low levels of this important vitamin have been linked to diabetes, increased risks of cancer and to heart disease. All of these diseases have a component of inflammation.

Vitamin D is important in helping our bodies absorb calcium and also aides in the removal of old bone tissue. At Women to Women we recommend 2,000 IU of supplemental Vitamin D3 daily to ensure your health.

7. Vitamin K. Vitamin K has been somewhat of a mystery until recently. Now we have discovered that there is a whole family of these K vitamins. We know that they help limit the loss of calcium from the kidneys, and help to retain several of the proteins needed for bone production. Certain plant foods contain vitamin K1, and some traditional fermented foods contain vitamin K2 (sauerkraut, natto and kimchee). Most of us don’t get enough Vitamin K in our diet.

8. Magnesium (Mg). Research has shown low magnesium levels to be associated with decreased bone mass, which leads to brittle bones. Foods to include in your diet which are high in magnesium include spinach, almonds, avocados and soy. Taking a good multivitamin with minerals, including magnesium is also a good idea.

Looking ahead

It’s good to know there are steps you can take now to help support your bones. You don’t have to let inflammation disrupt your body’s natural balance as it processes healthy bone tissue. You can calm inflammation and feel healthy and whole today and in the future.

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by Marcelle Pick, OB/GYN NP

New research is revealing connections between vitamin D deficiency and a myriad of health concerns, including cancer, depression, osteoporosis, immune dysfunction, diabetes, heart disease, and more. In fact, mounting research documents the impressive degree of disease prevention that can be obtained from higher vitamin D blood levels. Thankfully, more and more conventional practitioners are testing vitamin D levels in their patients these days. Since there are several forms of D, be sure you request evaluation of 25[OH]D, which is short-hand for 25-hydroxyvitamin D. This is the test that accurately detects vitamin D status. The normal range varies from lab to lab, and protocols used in some labs may be less accurate than others.

The issue for many people is that long-term effects of vitamin D deficiency may not be visible for many, many years, so it’s easy to overlook — for both patients and practitioners. But if you’re serious about disease prevention and fracture prevention, I recommend vitamin D level testing twice a year, at the end of the summer and mid-winter. The National Institutes of Health sets the normal vitamin D range at 16–74 ng/mL, but leading vitamin D experts are calling for the low end of this range to be moved upward. Here are the levels we strive for:

• For basic bone protection and optimum calcium absorption you need at least a 32 ng/mL vitamin D (25[OH]D) level all year round.
• For degenerative disease prevention, a higher level of 50-70 ng/mL is better.

Studies have shown a 60-77% reduction in cancer risk with vitamin D supplementation and research suggests that hip fracture could be reduced by 50-60% by bringing vitamin D blood levels into the therapeutic range.

Research is showing that we use between 3000 and 4000 IU of vitamin D daily — much more than previously expected. So how do we replenish these stores? Nature intended us to get most of our vitamin D from exposure to sunlight. Studies show that bathing suit exposure during summer, until the skin just begins to turn pink, results in skin production of 10,000–50,000 IU of cholecalciferol (pre-vitamin D). I know it’s difficult in our modern society to spend enough time in the sun to fill our vitamin D stores (especially if you live in northern latitudes). And vitamin D is also not found in very many foods. So a quality vitamin D3 supplement is one of the best ways to cover your disease-prevention bases.

Women to Women has formulated our own high-quality vitamin D supplement enhance your health – click here to find out more.

Currently vitamin D researchers are suggesting supplementing with 2000 IU of D3 daily along with 15 minutes of sunlight. For details on this current recommendation see the Scientists’ Call to Action published by Grassroots Health, a Public Health Promotion Organization (refer to their website, GrassrootsHealth). For addition in-depth discussion, see our articles on vitamin D deficiency and Vitamin D Testing and Treatment.

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by Marcelle Pick, OB/GYN NP

Osteoporosis is a progressive condition where more bone is lost than is formed, resulting in decreased bone mass, or a bone mineral density (BMD) that deviates two or more points from the norm. Over time whatever bone is left is thin and porous and fractures easily doing everyday things—like walking and coughing.

Women with osteopinea experience a weakening of the bone matrix and a loss of flexibility, but bone mineral density deviates only 1-1.5 points from the norm. It is considered a precursor condition to osteoporosis.

Osteoporosis occurs earlier and more severely in white women from Northern European descent who are small-boned and thin. Asian women also have a slightly higher risk. Other risk factors include:

• Post-menopause, either natural or surgical
• Delayed puberty, persistent amenorrhea, low hormone levels
• Poor diet, including vitamin D, calcium, and/or magnesium deficiency
• Advanced age
• Heavy alcohol consumption
• Smoking
• Under or overexercising
• Less than 15% body fat
• Elevated blood acid levels
• Use of corticosteroids or other medical drugs
• Thyroid or kidney disorders
• Bone cancers or other malignancies
• GI conditions that interfere with natural mineral absorption

When diagnosing osteopinea and osteoporosis, most doctors rely on a bone density scan, usually dual-energy X-ray absorptiometry, or DEXA. There are other tests, including CT scans, dual photon asroptiometry (DPA) and ultrasound, but DEXA is by far the most prevalent.

In this test an X-ray is focused on a body site (usually the wrist, hip or lumbar spine). Particles that don’t hit a mineral will pass through tissue and can be measured—the more roadblocks along the path the greater the loss of energy in the beam of light. In this way, bone mineral density can be measured. But no two women are the same, even though the test holds them to the same norm. A larger boned woman may have more bone tissue, thus more minerals and may score a higher density then a smaller boned woman.

A bone scan that deviates 2 or more points from the baseline indicates osteoporosis by traditional standards. A score above 1.5 indicates osteopenia, although I have seen women put on Fosamax who deviated only 1.3 points. Different machines will give different readings, so look at your bone scan results with a healthy dose of skepticism.

And realize that while it is one of the best tools we have right now, measuring BMD is more important as a point of comparison over time than your number. Despite what you may have been told, low-density bone is not necessarily weak.

by Marcelle Pick, OB/GYN NP

Bones are complicated living tissue, not ossified shells around marrow like soup bones you bring home from the butcher. Bones are 35% latticed protein—an infrastructure known as the collagen matrix—and 65% mineralized collagen, which gives the bone its strength.

Bone health depends on a give-and-take process, called remodeling. During this process, bone cells called osteoclasts travel through bone tissue retrieving old bone and leaving small, jagged spaces behind. This triggers their counterparts, called osteoblasts, to come in and fill these spaces and deposit new bone. About 5-10% of all our bone tissue is replaced—or turned over— in a year in this way. Osteoblasts cannot work properly without sufficient osteoclast activity, and new bone is stronger and—this is key—more flexible than old bone.

Healthy bones store about 99% of the body’s calcium; the rest is used throughout the body for other vital functions. Bones also house about 85% of the body’s phosphorous, and about 50% of the body’s total sodium and magnesium.

Women with healthy bones still experience bone loss as they age. The bell curve looks something like this: During puberty, when our body and skeleton are growing, bone formation outpaces bone loss. By our early 30’s, most women (and men) have reached peak bone mass. By the late 30’s, bone resorption is slightly higher than formation (about .5-1%). After menopause this rate accelerates to 1-5% , on average, depending on a woman’s diet, exercise, body frame, drug intake, and overall health. Within five years after menopause, bone loss evens out again to a gradual and healthy decline of 1-1.5% per year. If you have osteoporosis, however, this rate of bone loss goes into hyper drive. Some women can lose up to 25% of their bone density in the ten years following menopause.

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by Marcelle Pick, OB/GYN NP

The battle cry around osteoporosis and women has only been raised in the past twenty years, coinciding with incomplete research put forth by the pharmaceutical industries in support of HRT. While accelerated bone loss and fractures have always been a concern for people over 65, younger women got dragged into the fray when research indicated that the natural, gradual decline in bone loss accelerated in the 3-5 year period after menopause.

I want you to understand first and foremost that losing bone is a natural—in fact vital process. Only bone loss (also called resorption) can trigger healthy new bone formation (also called deposition or formation). As with all things in nature, good bone health relies on a balance between this action and counter-action, like breathing out and breathing in.

New bone is strong, flexible with the ability to forbear both compression (running, jumping) and tensile (flexing) pressure. In some women, the balance between bone growth and loss gets severely thrown off —when this begins happening is highly individual, but estimates suggest as much as 20 years before menopause.

What about the idea that menopause triggers bone loss? Most women aren’t given a bone mineral density test (BMD) until mid-life unless they experience an unusual fracture (like a hip fracture) at an early age. Who’s to say what’s normal for you if you don’t have a baseline to compare to?

What’s more, advancements in technology allow us to diagnose bone density more efficiently—a factor that must be taken into account when you look at the statistics on osteoporosis risks. It may seem as if the condition is on the rise, but we only recently developed appropriate tools for measurement!

I think it is no coincidence that much of the fuss about osteoporosis coincides with the marketing of HRT to the public. Since bone loss accelerates briefly during menopause, osteoporosis has come to be viewed as a treatable “symptom” of the “disease” of menopause—yet another indictment of natural aging that women can feel bad about and “cure” through potentially hazardous (and expensive!) drugs.

What’s given less press is the fact that bone strength depends on several factors—not just density— and focusing so much on one side of the equation (inhibiting resorption) to the exclusion of the other (supporting new bone growth) comes at its own price.

The fact is bone strength requires a balance of both and this is influenced by many factors:  genetics, body frame size, diet, calcium intake, vitamin D levels, hormonal balance, stress, and lifestyle. And because bones are constantly regenerating, every positive step you take to support their function will make a big difference.

by Marcelle Pick, OB/GYN NP

Over the past twenty years, women have been hearing more and more about the grave dangers of osteoporosis, and its precursors, osteopenia and osteomalacia. Simultaneously, prescriptions for drugs that build bone density, like Fosamax and Actonel, have risen quickly, with no research to support their safety and efficacy for long-term use.

Admittedly, osteoporosis is a serious condition that sharply raises the risk of a debilitating fracture in older women—but it is treatable and easily preventable. What troubles me is the growing number of younger women who are being labeled “at risk” for osteoporosis and given prescriptions. By mainstream medicine standards, almost half of white baby-boomer women in this country are considered at risk—no wonder the makers of Fosamax boast that they’ll have 40% of American women on their product in the near future. It’s a case of the tail wagging the dog.

What doesn’t get said is that a certain annual rate of bone loss is a natural part of aging,  (between 1-1.5% per year, with a few years of acceleration after menopause) and that bone loss is a necessary stimulant to bone formation. What’s more, studies just don’t support the connection between maintaining bone density and a decrease in fractures later in life.

Read our articles on Osteoporosis to learn more!

by Marcelle Pick, OB/GYN NP

There is no hard evidence that bone density correlates with bone strength or flexibility—the two factors that prevent fractures. In fact, bones can be dense (rich in calcium and hard), yet brittle—what matters more is the health of the collagen matrix, which keeps the mineralized bone supple and resilient.

The collagen matrix is a bedrock of nutrients and minerals that allows the bone to expand, contract, and mend without breaking. Think of the difference between a living, breathing sand dollar or sea urchin and its ossified shell. Or the difference between a slab of dried wood and a thinner piece that has been saturated in protective oils. While this is not an exact correlation, it may help you understand why a dense, hard covering can actually be more breakable than a thin but well-integrated whole—and why drugs like Fosamax and Actonel that focus only on bone density are not the answer.

In fact, BMD is not a reliable predictor of fractures. A study published in the 1995 New England Journal of Medicine reported that in 65-year-old women with no previous history of hip fracture, several other factors were more significant than bone density, such as tranquilizer and sleeping pill use, coordination, poor vision and depth perception; past history of hyperthyroidism, being tall, low blood pressure and rapid pulse, and lack of muscle strength.

In another study, published in JAMA in 1989, use of anti-anxiety medication like benzodiazapenes and other tranquilizers increased the risk of hip fracture by 70%. More recently, a large percentage of falls (and ensuing fractures) reported in a nursing home study were attributed to women rushing to the bathroom in the dark. For more on this and bladder control issues, please see our articles.

If this is the case, why has there been so much focus on density? One answer is that we actually have a test for it. Other factors influence bone health (and general health) are harder to quantify.

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by Marcelle Pick, OB/GYN NP

Your bones, including your hair, teeth and nails, are mirrors of what you put into your body. At Women to Women, we encourage our patients to try a combination approach to preventing and treating osteoporosis that begins with optimal nutrition.

In short, this means:

• Take a daily medical-grade nutritional supplement rich in the minerals and nutrients that support bone function. Your vitamin should contain calcium and magnesium as well as vitamins A, D, K and B6, B12, and folate. Calcium is only as good as its rate of absorption, so buy the best quality you can afford.
• Eat a balanced diet rich in whole grains, leafy green vegetables, fruit, and seaweed products. These are much richer sources of calcium and vitamins then dairy products. If you consume dairy, try to buy organic.
• Limit protein and avoid refined carbohydrates and simple sugars. Avoid sodas and limit caffeine—both are bone weakeners.
• Add a portion of healthy fats to each meal. Essential fatty acids are closely involved with calcium absorption. Bone building vitamins A, D and K are fat-soluble and a certain amount of fat is needed for proper hormone and immune function.
• Support hormonal balance during perimenopause. Talk to your practitioner about using progesterone cream to help maintain a healthy rate of bone formation during this time and throughout menopause.
• Exercise daily, include weight-bearing exercises. Bones are kept healthy with use! The more you ask of them, the stronger they’ll become with the right support.
• Maintain a healthy ratio of body fat. This is one area where thin is not better. Some practitioners think that women naturally gain weight after menopause to warehouse estrogen to combat bone loss. 20-25% body fat is normal.
• Get some daily sun exposure to trigger natural production of vitamin D, at least 15 minutes of unprotected sun in the early morning and evening.
• Examine your feelings about aging and weakness. Strength comes in many forms.. Don’t let other people’s definitions define you and your experience.
• Listen to your body and respect its desire to heal itself—in many ways it often knows best and may need just a little more support.
• After 50, continue to get bone scans every couple of years to check your own individual progress.

Solid bones, healthy body

In the end, osteoporosis is only as frightening as the power we give it. With some attention to your diet, a good supplement, and a few healthy lifestyle changes, most women can prevent, treat, even reverse bone loss without drugs and painful side effects.

For many millennia women and men have been gradually losing bone as they age – today your bones may need some extra help with so many burdens to contend with. If you give them what they need, you’ll find that healthy bones will help you do in life what they do best in your body – adapt, regenerate, and support.

by Marcelle Pick, OB/GYN NP

An emerging area of study is the relationship between bone loss and blood acidity. It has been known for a while that vegetarians and women eating a low-protein diet have a lower rate of bone loss.

New studies are showing that high levels of the pro-inflammatory blood acid called homocysteine double the risk of osteoporosis-related fractures. Homocysteine is an amino acid that is a natural byproduct of digesting protein. It has been linked to other inflammatory conditions like heart attack, stroke, and Alzheimer’s disease.

A recent report published last year in the New England Journal of Medicine asserted the idea that elevated homocysteine levels inhibit new bone formation by interrupting the cross-linking of collagen fibers in bone tissue. It’s also possible that the body tries to stabilize a lower pH (more acidic) blood serum by releasing more bone calcium. Homocysteine levels can also be stabilized by taking a vitamin supplement with folate, B12 and B6.

Other foods that cause blood acidity are refined carbohydrates and simple sugars.

So, if we know that all this and more go into the proper balance of bone formation and resorption—and one function can’t thrive without the other—why is mainstream medicine so skewed to one side?

by Marcelle Pick, OB/GYN NP

Calcium is one of the most important minerals in the body, not only for bones which store up to 99% but other physiological functions, including nerve transmission, blood clotting, muscle growth and contraction, heart function, hormone function, and metabolism.

Whenever your body needs calcium, it calls upon the bone tissue to release some of its stores into your blood. Your bones comply by upping the rate of resorption (osteoclasts skim off old bone into the blood stream). Whatever doesn’t get used gets excreted through the kidneys—this is why doctors test your urine for calcium as one marker of bone loss. Excessive calcium can cause other difficulties, like kidney stones, gallstones and hypercalcemia.

If your body can’t metabolize calcium properly from your diet because of deficiencies elsewhere it won’t matter how much calcium you eat, your body will take it from your bones. This triggers more osteoblast activity, but bone needs the same nutrients to form—so over time the whole system weakens and affects other body functions.

Even though we have an ample supply of calcium in our diets through dairy products, leafy green vegetables, and seaweed products, many women lack the other minerals necessary for the proper absorption of calcium. A mineral deficiency is usually seen first in non-vital areas like your teeth, hair, and nails.

Vitamin D is crucial to the proper metabolism of calcium, in conjunction with stomach acids and vitamin C. One reason older women have a hard time absorbing calcium is that they lack the digestive acids necessary to break down the mineral.

Magnesium is another mineral that must be present for you to utilize calcium. Magnesium increases calcium absorption form the blood into the bone. Dairy products contain little magnesium and alcohol depletes it. Too much calcium blocks the absorption of magnesium, leading to  a deficiency characterized by hair loss, muscle cramps, irritability, trembling, and disorientation.

Trace minerals like boron, selenium, copper, silicon, manganese, and zinc are also important in supporting the healthy balance that makes bone. For an in-depth explanation of all this and more, I encourage you to read Annemarie Colbin’s wonderful book, Food and Our Bones.

Calcium metabolism is dependent on a range of other factors, but I’ll cover only two other substances here: calcitonin and parathyroid hormone—both secreted by the thyroid gland. The former is excreted to stabilize high levels of calcium; the latter is triggered by low levels of calcium, usually characterized by high levels of phosphorous in the blood. Phosphorous is as important to bone strength as calcium, in the right amount. Soda and red meat—two staples of the American diet—are chock full of phosphorous.