|Posted by email@example.com on May 10, 2017 at 11:25 PM||comments (3516)|
Osteohealth has long recommended a whole food, plant based diet for bone health. However, this is not the only benefit from eating this way.
|Posted by firstname.lastname@example.org on March 19, 2017 at 8:25 PM||comments (15)|
4,000 IU of vitamin D a day is recommended for elders at high risk for falling to improve muscle strength and balance, though there is something that works even better.
We’ve known for over 400 years that muscle weakness is a common presenting symptom of vitamin D deficiency. Bones aren’t the only organs that respond to vitamin D; muscles do too. But, as we age, our muscles lose vitamin D receptors, perhaps helping to explain the loss in muscle strength as we age.
And indeed, vitamin D status does appear to predict the decline in physical performance as we age, with lower vitamin D levels linked to poorer performance. But, maybe the low vitamin D doesn’t lead to weakness; maybe the weakness leads to low vitamin D. Vitamin D is the sunshine vitamin, and so, if you’re too weak to run around outside, that could explain the correlation with lower levels. To see if it’s cause and effect, you have to put it to the test.
There’s been about a dozen randomized controlled trials: vitamin D supplements versus sugar pills. Put all the studies together, and older men and women do get significant protection from falls with vitamin D, especially among those who start out with relatively low levels, leading the conservative USPSTF, the U.S. Preventive Services Task Force, the official prevention guideline-setting body, and the American Geriatric Society to recommend vitamin D supplementation for those at high risk for falls.
We’re not quite sure of the mechanism, though. Randomized, controlled trials have found that vitamin D boosts global muscle strength, particularly in the quads, which are important for fall prevention—though vitamin D supplements have also been shown to improve balance. So, it may also be a neurological effect, or even a cognitive effect. We’ve known for about 20 years that older men and women who stop walking when a conversation starts are at particularly high risk of falling. Over a six-month timeframe, few of those who could walk and talk at the same time would go on to fall, but 80% of those who stopped when a conversation is initiated ended up falling.
Other high risk groups that should supplement include those who’ve already fallen once, or are unsteady, or on a variety of heart, brain, and blood pressure drugs that can increase fall risk. There’s also a test called “Get-Up-and-Go,” which anyone can do at home. You time how long it takes you “to get up from an armchair, walk 10 feet, turn around, walk back, and sit down.” If it takes you longer than ten seconds, then you may be at high risk.
So, how much vitamin D should you take? It seems to take at least 700 to a thousand units a day. The American Geriatric Society recommends a total of 4,000 a day, though, based on the rationale that this should get about 90% of people up to the target vitamin D blood level of 75 nanomoles per liter. 1,000 should do it for the majority of people, 51%, but they recommend 4,000 to capture 92% of the population. Then, you don’t have to routinely test levels, since you would get most people up there, and it’s considerably below the proposed upper tolerable intake of 10,000 a day. They do not recommend periodic megadoses.
Because it’s hard to get patients to comply with pills, why not just give people one megadose, like 500,000 units, once a year, like when you come in for your flu shot, or something? That way, every year, you can at least guarantee an annual spike in D levels that lasts a few months. It’s unnatural, but certainly convenient (for the doctor, at least). The problem is that it actually increases fall risk—a 30% increase in falls in those first three months of the spike. Similar results were found in other megadose trials. It may be a matter of “too much of a good thing.”
See, “vitamin D may improve physical performance, reduce chronic pain, and improve mood” so much that you start moving around more, and, thereby, increase fall risk. You give people a whopping dose of D, and you get a burst in physical, mental, and social functioning, and it may take time for your motor control to catch up with your improved muscle function. It would be like giving someone a sports car all of a sudden when they’ve been used to driving some beater. You gotta take it slow.
It’s possible, though, that such unnaturally high doses may actually damage the muscles. The evidence they cite in support is a meat industry study showing you can improve the tenderness of steaks by feeding steers a few million units of vitamin D. So, the concern is that such high doses may be over-tenderizing our own muscles, as well. So, yeah, higher D levels are associated with a progressive drop in fracture risk, but too much vitamin D may be harmful.
The bottom line is that vitamin D supplementation appears to help, but the strongest and most consistent evidence for prevention of serious falls is exercise. If you compare the two, yes, taking vitamin D may lower your fall risk, compared to placebo. But, strength and balance training, with or without vitamin D, may be even more powerful.
|Posted by email@example.com on February 9, 2017 at 10:05 PM||comments (0)|
|Posted by firstname.lastname@example.org on December 4, 2016 at 8:15 PM||comments (2)|
|Posted by email@example.com on November 25, 2016 at 3:20 PM||comments (13)|
How can soy foods have it both ways—pro-estrogenic effects in some organs (protecting bones and reducing hot flash symptoms), but anti-estrogenic effects in others (protecting against breast and endometrial cancer)?
When the Women’s Health Initiative study found that menopausal women taking hormone replacement therapy suffered “higher rates of breast cancer, cardiovascular disease, and overall harm,” a call was made for safer alternatives. Yes, estrogen has positive effects, the Women’s Health Initiative found—such as reducing menopausal symptoms and improving bone health, reducing hip fracture risk; but also negative effects—increasing risk of blood clots in the heart, brain, and lungs, as well as breast cancer.
So, ideally, to get the best of both worlds, we’d need what’s called a selective estrogen receptor modulator, something that has pro-estrogenic effects in some tissues (like bone), but anti-estrogenic effects in other tissues (like the breast). Drug companies are trying to make them, but phytoestrogens—natural compounds in plants, like genistein in soybeans, that are structurally similar to estrogen—appear to function as natural selective estrogen receptor modulators. How could something that looks like estrogen act as an anti-estrogen?
The original theory for how soy phytoestrogens control breast cancer growth is that they compete with our own estrogens for binding to the estrogen receptor. As you drip more and more soy compounds on breast cancer cells in a petri dish, less and less actual estrogen is able to bind to them. So, the estrogen-blocking ability of phytoestrogens can help explain their anti-estrogenic effects. But, how do we then explain their pro-estrogenic effects on other tissues, like bone? How can soy have it both ways?
The mystery was solved when we discovered there are two types of estrogen receptors in the body. And, so, how a target cell responds depends on which type of estrogen receptors they have. This may be “the key to understanding the health-protective potential of soy phytoestrogens”—the existence of this newly discovered estrogen receptor, named estrogen receptor beta, to distinguish it from the classic estrogen receptor alpha. And, unlike our body’s own estrogen, soy phytoestrogens preferentially bind to the beta receptors.
If you have people eat about a cup of cooked whole soybeans, within about eight hours, genistein levels in the blood reach about 20 to 50 nanomoles—that’s how much is circulating throughout our body, bathing our cells. About half is bound up to proteins in the blood; so, the effective concentration is about half that. So, let’s see what that means for estrogen receptor activation.
This is the graph that explains the mysterious health benefits of soy foods. Down around the effective levels you’d get eating a cup of soybeans, there’s very little alpha activation—but, lots of beta activation. So, now let’s look at where each of these receptors are located in the human body.
The way estrogen pills increase the risk of fatal blood clots is by causing the liver to dump out all these extra clotting factors. But, guess what? The human liver only contains alpha estrogen receptors, not beta receptors. And so, maybe, if we ate like 30 cups of soybeans a day, that could be a problem. But, at the kinds of concentrations one would get with just normal soy consumption, no wonder this is a problem with drug estrogens—but not soy phytoestrogens.
The effects on the uterus appear also to be mediated solely by alpha receptors—which is, presumably, why no negative impact has been seen with soy. So, while estrogen-containing drugs may increase the risk of endometrial cancer up to ten-fold, phytoestrogen-containing foods are associated with significantly less endometrial cancer—in fact, protective effects for these types of gynecological cancers, in general. Women who ate the most soy had 30% less endometrial cancer, and appeared to cut their ovarian cancer risk nearly in half.
Soy phytoestrogens don’t appear to have any effect on the lining of the uterus, but still can dramatically improve menopausal symptoms. The Kupperman index is like a compilation of all 11 of the most common menopausal symptoms.
In terms of bone health, human bone cells carry beta estrogen receptors. So, we might expect soy phytoestrogens to be protective. And, indeed, they do seem to significantly increase bone mineral density—consistent with population data suggesting “High consumption of soy products is associated with increased bone mass.” But, can they prevent bone loss over time?
Soy milk was compared to a transdermal progesterone cream. The control group lost significant bone mineral density in their spine over the two-year study period. But, the progesterone group lost significantly less, and the two glasses of soy milk a day group ended up actually better than when they started. This is probably the most robust study to date, comparing the soy phytoestrogen genistein to a more traditional hormone replacement drug regimen. In the spine, over a year, the placebo group lost bone density, but gained in the phytoestrogen and estrogen groups, and the same with the hip bones.
The study clearly shows that the soy phytoestrogen prevents bone loss, and enhances new bone formation, in turn producing a net gain of bone mass. But, the only reason we care about bone mass is that we want to prevent fractures. Is soy food consumption associated with lower fracture risk? Yes. A significantly lower risk of bone fracture associated with just a single serving of soy a day—the equivalent of 5 to 7 grams of soy protein, or 20 to 30 milligrams of phytoestrogens. So, that’s just like one cup of soy milk—or, even better, a serving of a whole soy food, like tempeh or edamame, or the beans themselves.
We don’t have fracture data on soy supplements, though. So, if we seek the types of health benefits we presume Asian populations get from eating whole and traditional soy foods, maybe we should look to eating those, rather than taking unproven protein powders or pills.
Is there anyone who should avoid soy? Well, some people have soy allergies. A national survey found that only about 1 in 2,000 people report a soy allergy. That’s 40 times less than the most common allergen—dairy milk—and about ten times less than all the other common allergens—like fish, eggs, shellfish, nuts, wheat, or peanuts.
|Posted by firstname.lastname@example.org on November 23, 2016 at 4:50 PM||comments (15)|
3 cups rinsed, dry lentils, any color
1 jar of your favorite tomato-based pasta sauce
2-3 handfuls of rinsed Brussels Sprouts, cut in halves.
In a non-stick casserole dish, combine all 3 ingredients with about 2 1/2 cups of water. Bake at 375*F for about an hour.
YUMMY!!!! And your bones will be so glad you indulged them!
Note: the rinsing of the lentils is important here, to be sure you remove traces of soap that may have been added at the packaging facility. The soap helps keep insects, etc. away, but if dry beans and lentils are not rinsed, it can add to that airy issue some people experience when they start eating healthier!
|Posted by email@example.com on November 16, 2016 at 9:25 PM||comments (13)|
“Is sitting the new smoking?” This thought-provoking question has made the news a lot, thanks to the work done by Dr. James Levine of the Mayo Clinic. He’s compared the negative health effects of sitting to those of smoking — including higher risks of cancers and heart disease — and described our modern lifestyle of desk jobs and too much screen time as “lethal.”
I couldn’t agree with Dr. Levine more about the human body’s need to move. And new findings are showing that for millions of years our human ancestors had much high bone density than we do today.
Anthropologists discovered this when comparing the bones of modern humans and chimpanzees to fossils of extinct humans.
It seems that our modern, lighter, human skeletons evolved only 12,000 years ago — a very short time ago, anthropologically speaking! Specifically, what anthropologists see happening is a thinning of the weight-bearing, inner spongy trabecular bone and a subsequent weakening of bone architecture. This has occurred with the advent of a more sedentary agrarian lifestyle. And although we will never be as active as our foraging ancestors, there’s a lot we can do get in motion.
Here are some ideas for sitting less, moving more:
- Stand while you are on the phone
- Use a desk you can stand at or even better — a treadmill desk
- Take the stairs – at home, at the mall, everywhere
- Set a timer to remind you to get up and move every hour
- Walk over to a colleague’s desk, rather than emailing.
- Think of where you can shift your own patterns to include less sitting. For example, if you enjoy watching TV, can you watch it standing up? Or at least stand during commercials?
- Commit yourself to walking at least 15 minutes twice a day and use weighted vest as appropriate
|Posted by firstname.lastname@example.org on November 9, 2016 at 10:15 PM||comments (16)|
Watch and see how easy, quick and painless it is to get a bone density scan with Osteohealth NZ and Jude Kirk from CTV.
To book your bone density scan, phone Osteohealth on 03 357 4335 or email us on email@example.com.
|Posted by firstname.lastname@example.org on November 3, 2016 at 2:55 PM||comments (2)|
|Posted by email@example.com on October 31, 2016 at 11:15 PM||comments (29)|
Low bone density is one of the important risk factors for osteoporosis. It alone does not predict whether you’ll have a future fracture, but it is one of the four or five high-ranking risk factors. Currently, bone density testing is considered the best way to determine if a person has osteoporosis, osteopenia (density lower than the expected norm, but less than the level used to determine osteoporosis), or normal bone density for their sex and age. Sequential bone density testing done over several years is one means to determine an individual’s overall bone health.
There are several different ways to assess the health of your bones. The most popular method is by looking at your bone density to see if it is adequate for your gender and age. Osteohealth NZ in Burnside uses a form of ultrasound technology to detect low bone density in women and men over 30 years of age.
Ultrasound is a simple technique using sound waves to estimate strength of bones of the heel. Ultrasound measurements are best seen as “screening tests” that reveal the possibility of low bone density and bone weakness. There is a good correlation between ultrasound measurements of the heel and density of the hip or spine.
Osteoporosis is a "silent" disease, meaning that there are no symptoms until a fracture occurs. And while it can be difficult to treat, it is almost 100% preventable.
The limitations of BMD testing
While the bone density measurement indirectly estimates the mineral content of bone at any given time, the tests of bone mineral density do not reveal what is currently happening within bone. For example, your ultrasound might say you have low bone density as compared with the standard young reference range, but this does not give a sense of whether you have had thin bones since youth, or whether something caused you to lose bone after reaching a peak bone mass. A single bone density measurement also cannot distinguish if you are currently losing bone and thus experiencing ongoing bone density reduction. Regular tests are therefore best used as a way of looking for ongoing changes in bone over time.
Also, it’s important to realize that body type matters: people who are naturally thinner will always have lower bone density than their heavier counterparts. This does not mean they will automatically develop osteoporosis or fracture, but it does mean that in conjunction with other risk factors, such as poor diet, smoking, and a worried or anxious outlook on life, such thin people may be at a disadvantage when it comes to fracture risk.
Steps you can take to optimise accuracy in BMD tests
Always schedule your BMD test for the same time of year. Bone density fluctuates with the seasons, as sunlight and vitamin D production decline in winter months.
Always have your BMD test done with the same organisation and on the same machine. This will limit variation because of differences in technology used and machine calibration.
At Osteohealth NZ, we look for trends over time in bone density, but don’t get overly concerned with small variations. Significant changes are rarely seen in less than two years, so we recommend people with below average bone density get a scan done every two years. And in line with the most recent European and Canadian research we suggest that scans are done every five years for most other people.