The following article has been reproduced with kind permission of the Institute of Optimum Nutrition, from their magazine Optimum Nutrition (Spring 1996). Institute of Optimum Nutrition, Blades Court, Deodar Road, London SW15 2NU. 020 8877 9993
A Skeleton in the Cupboard
by Kate Neil
Osteoporosis is the silent thief that robs your skeleton of up to 25% of its bone mass by the time you reach 50. Osteoporosis is now a serious epidemic in Britain. Every three minutes someone in the UK has a fracture due to osteoporosis. 1 in 3 women and 1 in 12 men have a fracture by aged 70. Thousands of women in their 50's suffer painful and deforming fractures. £750 million each year is spent dealing with the problem. Nearly one third of orthopaedic beds are filled by patients with the condition. It is estimated that there could be 5 million sufferers by the turn of the century unless major action is taken now. Kate Neil unearths some myths and explores new approaches to preventing and reversing osteoporosis.
Skeletal material dating from between 1729 and 1852, unearthed during the restoration of Christ Church, Spitalfields in London, showed significantly less bone loss in women of 200 years ago compared to modern women, despite our supposedly better diet. Investigators found no sign of menopausal change in the unearthed bones. This suggests that some aspect of modern living isn't suiting our skeletons.
Bones become porous, or 'osteoporotic' due to the progressive loss of minerals, mass and density which can result in fractures of the hip, shoulder, ribs, vertebrae, ankle and wrist. Ankle and wrist fractures are common in young middle aged women often after a minor bump or fall. Vertebral fractures are common when over 50 and are very debilitating and painful. Hip fractures ruin 60,000 lives each year, contributing to 15,000 deaths and severe pain.
Feminine Fragility
Women are more at risk than men for developing osteoporosis. The female hormones oestrogen and progesterone are protective to women's bones, just as the male hormone testosterone is protective to men's bones. From the age of 35 onwards women regularly fail to ovulate which leads to minimal production of progesterone, the major hormone for bones. Women at most risk for developing osteoporosis are those that have had an early menopause before the age of 45 either naturally, or surgically by removing the womb and one or both ovaries, or who have been on hormone treatments. Those women that suffer, or have suffered with anorexia or bulimia are at great risk, particularly those that experience irregular, or an absence of their monthly period.
The two most common treatments for osteoporosis are hormone replacement therapy (HRT) and replenishing the bones with calcium through supplementation. Both methods of treatment have a sound basis. However, they are simplistic approaches to a complex health crisis.
Major well known risk factors
· Early menopause
· Anorexia
· Bulimia
· Over dieting
· Over/under exercised
· Many missed periods
· Previous facture from slight injury
· Significant coricosteroid use
· Lost several inches in height
· Close relatives with brittle bones
· Heavy intake of alcohol and/or caffeine
· History of heavy cigarette smoking
The Oestrogen Myth
Without a doubt oestrogen is important for bones, but it's role has been inappropriately exaggerated. Women are recommended HRT in the belief that oestrogen will protect their bones from the ravages of osteoporosis. The only reason those women with a womb are given a synthetic form of progesterone, known as a progestogen, is to minimise the side effects of oestrogen, particularly the risk for uterine and breast cancer. Those women without a womb are recommended oestrogen only HRT, but this does not protect their breasts. Oestrogen's role in protecting bones is to clear out old bone making available space for new bone to be laid down.
Oestrogen is not currently known to have a direct bone building action. Oestrogen is unlikely to deal with this osteoporosis, but does increase risks for developing certain forms of cancer. In addition, women are naturally exposed to higher levels of oestrogen from the age of 35 onwards due to regularly not ovulating. Progesterone, which has a bone building effect, is only produced in significant amounts after ovulation. Oestrogen is produced in varying large amounts throughout the menstrual cycle, and only significantly declines just before a period, and still osteoporosis cripples thousands of people each year.
Osteoporosis is a slow progressive disease. Bone loss starts to occur in most women from the mid thirties. It does not happen overnight with the last menstrual period, but develops alongside high oestrogen levels. Specific bone cells, known as osteoblasts, have receptor sites for progesterone. This is the hornmone that ensures that new bone is built. Those women taking combined HRT do not experience much benefit from the synthetic form of progesterone added to it. Progestogens have been shown to have only a marginal effect on bone mineral density. There is no conclusive evidence that HRT will protect bones from the ravages of osteoporosis.
On the other hand, natural progesterone, when applied topically as a cream, in amounts normal to the physical needs of the body, and in a form identical to what the body produces has been shown to improve bone mineral density in women, irrespective of age, by 15% over a three year period. Dr John Lee from Sebastopol in California has been using natural progesterone with his patients for the last twenty years with excellent results. Progesterone in this form has no known side-effects according to Dr Lee. Natural progesterone is not patentable as it is a natural substance which inhibits vast profits being made through its sale. Synthetic hormones are patentable allowing a vast potential for profit. Natural progesterone is available only through prescription in this country (for further information contact Higher Natural on 01435 882880 in UK, +44 1435 882880 international)
Certain plant foods contain phytochemicals that have hormone-like activity. Those cultures whose diets are rich in soya and/or wild yam, both containing such phytochemicals, show little evidence of osteoporosis.
The Calcium Myth
99% of all the calcium in the body should be in the bones. Only 1% is needed in the blood to ensure that important reactions can occur in the body. Undoubtedly, calcium is important for bone strength, but it's not that simple. It may be very convincing for the Milk Marketing Board to understand osteoporosis as a calcium problem as milk is a very rich source of calcium, but I can assure you that the bones in your body do not see it so simplistically. The way the body absorbs and handles calcium is very complex. Let's take a look at why just taking additional calcium is only part of the answer.
Less well known risk factors
· Too much protein
· Inappropriate levels of stress
· Poor intake of specific nutrients
· Poor use of specific nutrients
· Too little stomach acid
· High use of stimulants
· Poor absorption of specific nutrients
· High intake of phytates
Too Much Protein
One of the most significant, yet less well-known risk factors, according to a World Health Organisation research survey, is excessive protein consumption. Excess protein immediately gives rise to two problems. One, protein is digested in the presence of high levels of acid in the stomach. Women, particularly those over 50 years of age often produce insufficient acid to digest the quantity of protein eaten in the diet. This acid, known as hydrochloric acid (HCl) initiates the digestion of protein by uncurling the protein strands and activating the protein digesting enzyme so that the enzymes involved can work on chopping them up into simple units that the body can absorb. At the same time this acid is vital for releasing the minerals from the food that is eaten. Low levels of acid can lead to poor absorption of minerals, including calcium, magnesium and zinc, all of which are vital for bone health.
The second problem is that foods high in protein, particularly the animal proteins are acid-forming. The body has to work very hard to neutralise them. It does this by calling upon the reserves of what are known as alkalising minerals in the body. An important alkalising mineral is calcium. To maintain life the blood has to be kept very slightly alkaline, and it will do this at all costs. Even if this means calling on your reserves of calcium in the bones. Calcium is called out of the bones to neutralise the acid, only to be excreted via the kidneys and is then lost in the urine. This can cause an over-alkaline urine and predispose the person to urinary infections.
Eskimos are the classic example of a high protein diet. They eat a diet dependent on seal meat and fish, with very few fruits and vegetables being available. They suffer the highest rates of osteoporosis, despite the fact that the high quality of unsaturated fat in the diet protects their arteries. Fruits and vegetables contain acids, but they are weak acids and it is very easy for the body to dipose of them within hours through the lungs. Red meat, chicken, fish, eggs and dairy produce are all high protein foods. The trend to eat low fat dairy foods may be protective to your blood vessels, but may not be as kind to your bones. As soon as the fat content of a food is lowered, the protein value will automatically increase. High intakes of cottage cheese and low fat yoghurts may not be such a good idea after all. These foods do not occur in nature. Neither is it vital for humans to eat animal produce at all, though small quantities of high quality animal produce is unlikely to do any real harm. Vegans, those that do not eat any animal produce are amongst the healthiest people.
Poor Absorption
Many factors can contribute to poor absorption of minerals, besides too little stomach acid. The small intestine is lined with thousands of minute structures called villi, that waft about maximising the ability for the body to absorb nutrients. Foods rich in gluten which are wheat, rye oats and barley, can damage the villi, decreasing the surface area for absorption. High intakes of dairy produce can also aggravate the gut wall leading to poor absorption. Although dairy produce is a rich source of calcium, it is not too easy for the body to absorb this form of calcium, known as calcium lactate. Cultures that do not consume dairy foods have little incidence of osteoporosis. Nuts, seeds and green leafy vegetables are rich in calcium and the balancing mineral magnesium, which is needed to absorb and use calcium properly in the body. Another major factor known to interfere with good absorption is an overgrowth in the gut of the yeast organism Candida albicans that is responsible for causing thrush. Diets rich in phytates, found in wheat and soya products can bind important minerals in the gut like calcium, magnesium and zinc, inhibiting good absorption. Eating a varied diet helps reduce the likelihood of overconsumption of any one food.
Too Much Stress
Just like too much protein, too much stress causes the body to leach calcium from the bones. Stressors include the use of caffeine and nicotine as well as any physical or emotional stressors that may be going on in your life. At regular intervals throughout the day, many people are giving their body a red alert signal. Every time this happens calcium gets called out of the bones to help prepare the body for the perceived danger. A stressful job, relationships, or relying on tea, coffee, chocolate and cigarettes to see you through the day will almost certainly rob your bones of calcium. To add insult to injury the calcium is not adequately called back into the bones, as the body hardly gets a chance over the day to perceive that the emergency is truly over. The body will very kindly dispose of calcium for you as it knows it can't keep it in the blood. It will deposit it out of immediate harms way on artery walls, dump it into joint tissue or it may end up for some as part of a painful gall stone or kidney stone.
Sub-optimum nutrition
Sub-optimum nutrition is the rule for most people, not the exception. It can occur simply through just not eating enough food, or as is more likely in the modern world eating a diet that is highly calorific, but nut nutrient dense. These are predominately the refined foods, alcohol and confectionery. Some foods are rich, as in dairy produce, in specific nutrients and low in others. A limited diet that repetitively uses the same foods is likely to be one that is unabalanced and unable to provide all the nutrients needed for health, and specifically for bone health. Sometimes, it is an excess of a particular nutrient that causes the problem in combination with low levels of other nutrients.
Other Important Bone Nutrients
Nutrient (Best Food Sources)
· Zinc (nuts, seeds and wholegrains)
· Manganese/Boron (unprocessed foods)
· Silicon/Copper (unprocessed foods)
· Vitamin A (yellow and deep green vegetables)
· Vitamin C (berries, potatoes, most fruit and vegetables)
· Vitamin K (cauliflower and green vegetables)
· Vitamin B6 (fruits, vegetables, wholegrains)
Calcium in Balance
Calcium needs a balance of phosphorous and magnesium to work effectively in building bone. Typical 'junk' food diets are rich in phosphorous which throws the balance out. Dairy produce is rich in calcium, but low in magnesium. Magnesium is needed to absorb and use calcium properly in the body. Nuts, seeds and green leafy vegetables are rich sources of both calcium and magnesium. Vitamin D, the sunshine vitamin is vital for the absorption of calcium and phosphorous and helps stop calcium and phosphorous being lost in the urine. Good weight bearing exercise, walking briskly on a regular basis is a fine way to stimulate healthy bones. Three brisk 20 minute walks a week are recommended.
Osteoporosis Prevention and Reversal Plan
Prevention is far better than looking for a cure. And, according to the work of Dr Lee, osteoporosis is a reversible disorder. Take heart, it appears that even in the seventh decade the condition can be reversed. The human body responds marvelously to being provided with the right raw materials needed for health. Here's what to do:
· take regular exercise
· eat plenty of wholefoods
· eat plenty of nuts, seeds and yellow and green leafy vegetables
· eat a varied diet that includes some soya milk, tofu and wild yam
· limit intake of animal protein to a minimum
· avoid 'junk' foods and stimulants, limit alcohol
· seek nutritional advice from a professional nutrition consultant to check out complicating factors like candidiasis, digestive function and individualised needs for supplements
If you suspect you may suffer progesterone deficiency:
· contact Higher Nature on 01435 882880
· read Balancing Hormones Naturally - Kate Neil
· read Natural Progesterone - Dr John Lee (both books available from ION)
· go to your doctor and let him know about natural progesterone and request a prescription
If you suspect that you are at risk of developing osteoporosis:
· ask your doctor for a bone mineral density scan either on the NHS or privately. If the result is positive follow the above prevention/reversal plan.
Be Informed
It's your life, your bones, and you have a right to the best possible approach to preventing and managing this very debilitating and life-threatening disease. There's absolutely no need for you to have this skeleton in your cupboard.
National Osteoporosis Society PO Box 10, Radstock, Bath BA3 3YB Tel: 01761 471771, Fax: 01761 471104, Helpline: 01761 472721