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Osteoporosis Overview

Here we discuss nutritional strategies for combatting bone density issues (osteopenia and osteoporosis) and minimising fracture risk


Understand this Key Consideration:

Osteoporosis is associated with dietary calcium intake but only indirectly: it more often occurs as a result of hypovitaminosis D. When blood vitamin D levels are low, the requirement for calcium increases dramatically.


Disbelieve this "orthodox medicine" myth:

Myth: "Osteoporosis is caused by insufficient levels of dietary calcium: those who get the disease, were not getting enough calcium for years." End of Myth.

The reality is that osteoporosis is caused by levels of absorbed calcium being low so it is, in a crude sense, correct that one way to cure the problem is to maintain quite high levels of calcium continuously through life. However the key issue is the absorption of dietary calcium which is itself largely determined by the level of vitamin D. If a given individual is replete with vitamin D, then relatively lower levels of calcium will not likely trigger osteoporosis as a higher percentage of the relatively low absolute level of dietary calcium will be absorbed and bone density will be sufficiently maintained. This is what explains the fact that osteoporosis has traditionally been very rare in warm countries where the abundant year round sunshine keeps blood levels of vitamin D high year round.

The converse situation, the risky one, is where average vitamin D levels tend to be low a good deal of the time, as here in Ireland and in all northern latitude countries. It is simply not possible to live in such countries, Scandinavia and Canada in particular, in the absence of supplementation not to be deficient in vitamin D for perhaps half or three quarters of the year. For these people, with relatively low levels of D, the required levels of dietary calcium soar if they are not addressing the D problem via supplementation.

Disbelieve this "naturopathic" myth:

Myth: "HIgh consumption of dairy foods actually causes osteoporosis as the extra acid load is continually balanced by leaching calcium from bone" End of Myth.

This is a commonly circulated notion in "naturopathic" circles. Proponents typically begin the reasoning by saying that the requirement for high levels of calcium is an invention of "Big Dairy" and that in fact, the countries that consume the highest amounts of dairy actually tend to have the highest rates of osteoporosis. (The latter part is true but for other reasons as we shall see.) The supposed explanation for this is generally stated with minimal if any scientific support: it is based on the idea that all animal foods including dairy push the system in the direction of marginal systemic acidosis. The suggestion then is that the body must work against this in order to maintain blood at the proper pH. This it does by a number of means, principally leaching calcium from the bones. So goes the theory.

In general this notion has been rejected by a majority of independently minded researchers although certainly an interesting possibility (and one to which we ascribed here ourselves until we did some more digging). It seems that the most likely way the body deals with minute movements in systemic pH is by increasing the flow of carbonic acid in the blood to the lungs where a marginal increase occurs in the rate of blown off carbon dioxide in the breath. Readers interested to pursue this one could do worse than read this study where this notion was investigated and disproven on 2 counts. (It turns out that not only does a dietary "acid ash" not impact on serum pH at all but in fact dairy produces a slightly alkaline ash in any event!)

http://www.ncbi.nlm.nih.gov/pubmed/22081694


The cause of the cause: low vitamin D means "low" calcium

Vitamin D as cholecalciferol is made from cholesterol and D precursors created by the action of direct sunlight on our skin. Eating animal foods (real ones that have been out in the sun) provides some vitamin D but the standout source is sunlight. Hypovitaminosis D is not just common but inevitable in those living in Northern latitudes for a large percentage of the year unless supplements are being used. So, at its simplest. the root cause of osteoporosis is low levels of sunlight: the solutions are more sunlight or supplemental Vitamin D and/or increasing the amount of calcium in the diet.

When average levels of sunlight are low, as for us Irish most of the time, and certainly in latitudes above us, (the Swedes, Finns etc.), the need for dietary calcium soars as there is simply not enough circulating vitamin D to make use of a "typical" amount of calcium. Osteoporosis is basically a symptom of hypovitaminosis D mediated by calcium levels.

Historically it was only really the Scandinavians, Canadians, Northern North Americans, us Irish and our English neighbours who suffered from this condition. This fact, the prevalence of osteoporosis in the big dairy using countries allowed some to erroneously conclude that the dairy use was actually causing the problem via the "acidic blood theory" noted above. The reality re dairy and osteoporosis seems likely to be the very opposite of the naturopathic theory: it was precisely the move into heavier consumption of dairy foods that allowed life to be possible at all in the upper latitudes. No dairy no Vikings!

So that is the key factor: the lower the vitamin D level, the higher the demand for calcium. That's it !

If you compare older and newer prevalence data of osteoporosis by country, the trends are less "nearness to equator" defined as they previously were. Why? On the one hand, the US and Canadian picture has improved in terms of osteoporosis prevalence, presumably since they began fortifying all their milk with vitamin D. Perhaps surprisingly, osteoporosis has recently become an issue in the Middle East! This is thought to be linked with the increasing use of sun block and the rise in the practice of covering all skin especially in females and associated with the drift toward increasingly radical Islamic cultural practice. The WHO has confirmed that hypovitaminosis D is now a big problem in the middle East. So even newer trends are, once examined, reinforcing the link that what lies behind the calcium issues is a vitamin D issue.

Other factors

1: Magnesium

It is generally known that magnesium levels in our modern world are deficient in approximately 3/4 of us. As magnesium is a fundamental requirement in order to make vitamin D from sunlight, a low magnesium level means one is not getting the full "D impact" from a given amount of sun exposure.

2: Movement of people and skin colour

Darker skin colour lets in a great deal less sunlight than pale skin such which all worked fine when just about everybody never travelled far and lived out their lives under the "right" amount of average sunlight to match their specific skin tone. Today, people of darker skin tones due to their ethnicity but living in northern latitudes are at the greatest relative risk of osteoporosis. (This is of course the opposite of skin caner risk where for example the native Swede living in Kenya is at a relatively high risk)

3: Thyroid dysfunction

There are 2 key key hormones which control both the usage of calcium in building up and breaking down bone and simultaneously, circulating levels of calcium in the blood. (Calcitonin and "PTH" or parathyroid hormone). Both hormones are manufactured in the thyroid and so a variety of thyroid disorders can be associated with disordered blood calcium levels and therefore potentially altered osteoporosis risk.


General Dietary Advice

Key issues are to ensure optimum supply of vitamins and minerals associated with this disease. As we look at below, Vitamin D in particular is absolutely crucial regarding bone health as indeed is weight bearing exercise.

The standout source of calcium alone is of course dairy in all its guises. If one can tolerate it, various animal milks, ferment (yoghurts, kefir), butter, cream and cheese are ideal to include in the diet. This is especially true for children for whom dairy is generally less of problem that it can be in some older people.

For most people, the ideal thing is to take a majority of one's total dairy in the form of yoghurt or better still, kefir as these contribute many other key benefits not found in simple milk or cheese products alone and are non-acid forming.

In addition, there are several other foods which can supply the right mix of vits and minerals going beyond just calcium to include the also crucial magnesium in particular . The main foods in this regard are green leafy vegetables, cabbages, chards, broccolis, spinach in particular etc. (There can be an issue with phytic acid in some of these foods so it is best not to rely on them entirely for calcium).

All beans provide a source of calcium, in particular white coloured ones. Eating seeds is generally a good idea and best for bone issues are sesame seeds and sesame seed products like tahini. Almonds are the best nuts for those with bone density issues.

All oily fish contain relatively high levels of calcium (salmon, mackrel, herring, tuna to a lesser extent) but above, all sardines. (These fish also provide vitamin A and especially D, critical for bone density and of course are precisely the same foods which are the most potent sources of vital Omega 3 oils).

Points to Note / Warnings?

  • Maintaining a good level of D will enable you to worry less about maintaining high levels of calcium. This is key if you are vegan our avoid all dairy for any reason
  • Best calcium source is dairy and best dairy is kefir!

  • Drinking plenty of water is very important (ideally a quality mineral water).
  • Overall body "alkalinity" is likely a minor factor with respect to bone health but may be a key factor for other matters (avoiding cancer etc.) and can be promoted by green vegetables in particular, including some alkaline teas and cutting back on the main “acidifiers” such as coffee, sugars and excess meats.

Sample Citations?

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Specific Foods - to consume

  • As much high quality dairy as you can manage: consider things like kefir, goat's cheese etc.instead of just "regular" milk. Buffalo mozzarella is another nice option for many
  • Dairy generally: cow's milk, goat's milk, yoghurt, kefir, cheese; butter ...
  • Green leafy veg generally esp spinach; also kale, chard, broccoli, cabbage etc.;
  • Oily fish such as salmon, mackrel, herring, also tuna and especially sardines
  • Legumes generally especially all white beans: soy, haricots, cannellinis and chick peas.
  • Fruits of all kinds especially the most alkylizing or least acidifying (different from least acidic!): all dried fruits such as raisins but especially figs; apples; peaches; bananas (best under-ripe); melons, watermelons, grapefruits, lemons, limes avocados
  • Other important vegetables include onions, garlic and cucumbers; also turnips; most herbs, especially parsley and basil.
  • Sesame seeds in particular;
  • Oats (porridge for breakfast?)
  • Almonds; hazlenuts
  • Sea vegetables
  • Lots of water
  • Alakaline tea (something containing 1 more of dandelion, chamomile, fennel & nettle)

Points to Note / Warnings?

  • Caffeine slightly increases excretion of calcium; high potassium intake decreases it. In general, evidence is that coffee slighly exacerabates bone density problems whereas tea, on balance of evidence, is fine in modest quantities.
  • Best not to consume whote grains and calcium together as the whole grains can interfere somewhat with optimum absorbtion of the calcium ingested alongside it. This is significant as most people automatically take milk with cereral, put cheese with bread etc. Putting it another way, do not fully rely only on calcium sources which are ingested with whole grains as there will be a loss of some of the calcium where eaten together.

Sample Citations?

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“Near-food” supplements

“Green powders” (capsules; pills etc. made from dried wheat grass, barley grass, alfalfa etc.) are excellent for all round health. Particularly useful for those with bone density concerns who are unable or unwilling to eat sufficient green veg.

Points to Note / Warnings?

  • Best buy organic green powder supplements

Sample Citations?

n/a

Vitamins & Minerals

Vitamins A, B complex especially B6, B9 & B12, C, D, E, K1, K2; Calcium, Magnesium, Phosphorous, Potassium, Zinc, Copper, Boron, Manganese & Strontium

Points to Note / Warnings?

  • Do not supplement with calcium alone; use an approved combination formula which must have Vitamin D at an absolute minimum but also ought ideally to contain many of the above such as folate, magnesium and boron

Sample Citations?

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Other Supplements, Nutraceuticals

There is some evidence that soy isoflavones can help, particularly for post-menopausal women where their estogren like activity can assist generally, but the balance of the evidence to date in terms of combatting bone density problems in general and per se is not that compelling. The advice would be to eat soy products by all means but perhaps only to consider supplementing with soy isoflavones if one is a menopausal or post-menopausal woman desiring the slight estrogen replacement effect of the isoflavones whatever about any assistance that might or might not occur in terms of stemming bone loss.

L-Lysine, L-Arginine and Methylsulfonylmethane are also recommended for bone and connective tissue health. Consult your health care provider.

Points to Note / Warnings?

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Sample Citations?

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Botannicals

Alfalfa, Barley Grass, Black Cohosh, Boneset, Chamomile, Comfrey, Dandelion root, Dong Quai, Fennel, Fenugreek, Helonias, Horsetail, Lobelia, Liquorice, Meadowsweet, Mullein, Nettle, Parsely, Pimpernell, Plantain, Pook Root, Rest Harrow, Rose Hips, Shepherd's Purse, Silverweed, Toadflax, Unicorn root, Yucca.

Points to Note / Warnings?

  • Good habit to cultivate is the drinking of an alkaline tea perhaps containing nettle, fennel, dandelion and/or chamomile

Notable Citations?

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Other Recommended Wellness Considerations

  • Getting sufficient weight bearing exercise is critical to combatting bone density problems; in other words, it is not optional!
  • Getting sufficient sunlight is also vital, particularly in Winter in Nothern Lattitudes like here in dear old Ierland ... Recall that wearing make-up or moisturisers with UVB blocks will inhibit the desired Vitamin D production so try to leave them off when you are outdoors

Points to Note / Warnings?

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Sample Citations?

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Recommended Reading

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Comments (4)

  1. admin:
    Dec 31, 2011 at 02:50 PM

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  2. conor@smarteaters.org:
    Jan 04, 2012 at 02:55 PM

    This is a test comment?







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