©2003 Alva Irish

Osteoporosis is a major health problem that affects about one fourth of women over the age of 60. Persons with osteoporosis suffer from a loss in bone mass and bone strength. Their bones become weak and brittle which makes them more prone to fracture. Any bone can be affected by osteoporosis, but the hips, wrists and spine are the most common sites. Peak bone mass is reached between the ages of 25 and 35 years. After 35, bone mass is stable until, in women, it starts to drop with menopause. This drop occurs more slowly in males. About one in two women over the age of 65 will develop fractures due to osteoporosis.

The actual causes of osteoporosis are unknown. Certain risk factors, however, increase the likelihood of developing osteoporosis:

Being female - women are four times more likely to develop osteoporosis than men. The reasons are:

• Their bones are generally thinner and lighter.
• They live longer than men.
• They have rapid bone loss at menopause due to a sharp decline of estrogen.

The risk increases for women who have:

• Natural menopause before age 40; a hysterectomy which includes removal of both ovaries with no hormone replacement therapy (HRT); a lack of/or irregular menstrual flow.
• Having a thin, small framed body.
• Race - Caucasians and Asians are at a higher risk than African Americans.
• Having red or blond hair or freckles may also increase the risk.
• Lack of physical activity especially activities such as walking, running, tennis and other weight-bearing exercises.
• Lack of calcium and vitamin D - adequate intake of these nutrients throughout life helps to insure that calcium deficiency does not contribute to a weakening of bone mass.
• Heredity - the risk increases if there is a history of osteoporosis and/or bone fractures in your family.
• Cigarette smoking.
• Alcohol - regularly consuming alcoholic beverages, even as little as two to three ounces per day, may damage bones. Heavy drinkers often have poor nutrition and may be more prone to fractures from their predisposition to falls.
• Taking certain medicines such as corticosteroids (anti-inflammatory drugs used to treat a variety of conditions such as asthma, arthritis, lupus, etc.) and aluminum containing antacids like Rolaids or Di-Gel.
• Some anti-seizure drugs and inappropriate overuse of thyroid hormones may also increase the risk.
• Other disorders such as hyperthyroidism, hyperparathyroidism, certain forms of bone cancer, anorexia nervosa, scoliosis and gastrointestinal disease can also increase the risk.

Signs and Symptoms
Osteoporosis is a silent disease because it can progress without any noticeable signs or symptoms. The first sign is usually when a bone fracture occurs. Symptoms include:

• Osteoporosis, continued
• A gradual loss of height.
• A rounding of the shoulders.
• Gum inflammation and loosening of the teeth.
• Acute lower backache.
• Swelling of a wrist after a minor fall or injury.
• Self-Care/Prevention Procedures

To prevent or slow osteoporosis, take these steps now:

• Plan to get enough calcium every day: The Recommended Dietary Allowance (RDA) for females aged 11-24 is 1,200 milligrams (mg)/day. For women 25 years and older, the RDA is 800 mg/day. The National Osteoporosis Foundation recommends 1000 milligrams a day for adult women and 1,500 milligrams a day for post-menopausal women not on hormone replacement therapy.
• Choose high calcium foods daily:
  • Skim and low-fat milks, yogurts and cheeses. [Note: If you are lactose intolerant, you may need to use dairy products that are treated with the enzyme lactase or you can add this enzyme with over-the-counter drops or tablets].
  • Soft-boned fish and shellfish, such as salmon with the bones, sardines and shrimp.
  • Vegetables, especially broccoli, kale, collards.
  • Beans and bean sprouts as well as tofu (soy bean curd, if processed with calcium).
  • Calcium-fortified foods such as some orange juices, apple juices and ready-to-eat cereals and breads.
  • Get adequate vitamin D. You can get vitamin D from exposure to sunlight and from foods such as vitamin D-fortified milks; salmon, tuna and shrimp. The RDA for vitamin D ranges form 250 to 500 IU (International Units) per day for females. Vitamin D helps your body absorb calcium.
• Check with your doctor about taking calcium and vitamin D supplements.
• Follow a program of regular, weight-bearing exercise at least three or four times a week. Examples include: Walking, jogging, low-impact or non-impact aerobics.
• Do not smoke. Smoking makes osteoporosis worse and may negate the beneficial effects of estrogen replacement therapy (ERT).
• Limit alcohol consumption.
• Pay attention to your posture. Keep your back straight when you sit, stand and walk.
• Take measures to prevent falls and injury to your bones.
• Use grab bars and safety mats or non-skid tape on your tub or shower.
• Use handrails on stairways.
• Stay off icy sidewalks and wet or waxed floors.
• Don’t stoop to pick up things. Pick things up by bending your knees and keeping your back straight.
• Wear flat, sturdy, non-skid shoes.
• If you use throw rugs, make sure they have non-skid backs.
• Use a cane or walker if necessary.
• See that halls, stairways and entrances are well lit. Put a night light in your bathroom.
• Avoid taking sedatives or tranquilizers or be careful when you take them as prescribed. They can increase the risk of falls.

Your Health Depends upon What you EAT!

What you eat has a major influence on your health. That principle is so simple and so logical that it is surprising the medical profession has had such a difficult time grasping it. The average doctor, despite having taken the Hippocratic Oath, rejects the famous words proclaimed by Hippocrates: "Let your food be your medicine and let your medicine be your food." Had these doctors only met my late Uncle Ruben, who, well into his nineties, was still able to walk a brisk five miles every morning, they would have understood why he believed that "health comes from the farm, not the pharmacy."

A theme that keeps recurring in nutritional medicine is that degenerative diseases are caused, at least in part, by our modern diet, which contains too much sugar, fat, salt, refined flour, caffeine, alcohol, processed foods, and food additives. I routinely advise my patients, regardless of their specific medical problems, to try to clean up" their diet; that is, reduce their consumption of these junk foods" and to increase their intake of whole grains, fruits, vegetables, nuts and seeds, beans, and other unprocessed foods. The majority of people who follow that advice find that their health improves in some way. Many individuals report an increase in energy, less depression and anxiety, fewer headaches, better bowel and bladder function, and less fluid retention. They often sleep better, their joints do not hurt as much, and they are more alert and productive. Laboratory reports, such as serum cholesterol, triglycerides, liver enzymes, and uric acid also improve in many cases.

Specific medical conditions may also be relieved as a result of these general dietary changes. Patients with asthma, irritable bowel syndrome, peptic ulcer, gallbladder attacks, acne, psoriasis, high blood pressure, diabetes, angina, or other problems frequently find that their symptoms are better when they eat a healthier diet. Part of the appeal of improving your diet is that, even if it does not help, it rarely causes harm.

Diet and Bone Health
Considering that bone is living tissue, just like the rest of the body, it is likely that what you put in your mouth will determine in part how strong your bones will be. Many people believe that, aside from its calcium content, diet has little to do with osteoporosis. However, that assumption ignores the fact that bone tissue has diverse nutritional needs and engages in complex interactions with the rest of the body. It is improbable that our modem-day diet could be sparing our bones while damaging the rest of our body. Although it is impossible to determine the precise effect of diet on bone health, there is at least circumstantial evidence that the typical American diet promotes the development of osteoporosis.

There are three reasons that our modem diet might not be good for our bones. First, many of us ingest too much sugar, caffeine, salt, and alcohol. Consumption of each of these substances is reportedly associated with an increased risk of osteoporosis. Second, because of the way our food is grown and refined, today's diet probably contains much lower quantities of various vitamins and minerals than it used to. As you will learn later, some of these vitamins and minerals play a key role in maintaining healthy bones. Third, some of the processing techniques used by the food industry cause chemical changes in our food that may adversely affect the health of the tissues in our bodies, including bone. The possible influences of diet on bone health are reviewed next.

Sugar
In the early part of the nineteenth century, sugar was considered a condiment, rather than a major component of the diet. Back then, the average per capita intake of sugar was only about 10 to 12 pounds per year. Today, according to some statistics, the average American ingests approximately 139 pounds of refined sugar each year. That enormous quantity translates to about 41 teaspoons of sugar per day, or 19% of all of the calories we consume. Since refined sugar contains virtually no vitamins or minerals at all, it dilutes our nutrient intake, resulting in an across-the-board 19% reduction in all vitamins and minerals in our diet. Thus, because of our high intake of sugar we are getting less magnesium, folic acid, vitamin B6, zinc, copper, manganese, and other nutrients that play a role in maintaining healthy bones.

Ingesting sugar may also deplete our bodies of calcium. In one study, administering 100 grams (about 25 teaspoons) of sugar (sucrose) to healthy volunteers caused a significant increase in the urinary excretion of calcium. When the same amount of sugar was given to people with a history of calcium oxalate kidney stones or to their relatives, the increase in calcium excretion was even greater.) Since 99% of the total-body calcium is in our bones, this increase in calcium excretion most likely reflects a leaching of calcium from bone. This study suggests that a high-sugar diet may reduce the calcium content of bone, and that people with kidney stones or their relatives are especially susceptible to the adverse effects of sugar. Thus, the extent to which dietary sugar affects calcium metabolism is in part genetically determined, just as there is a hereditary component to osteoporosis risk. It is interesting to note that individuals with a history of kidney stones are at increased risk for developing osteoporosis. Researchers have also suggested that consumption of refined sugar is one of the factors that promotes kidney stones. Perhaps what people with kidney stones and osteoporosis have in common is an increased sensitivity to refined sugar.

Ingestion of large amounts of sugar has another effect on the body that may promote osteoporosis. Dr. John Yudkin, a British physician, has been studying the effects of dietary sugar for more than thirty years. Yudkin found that ingesting large amounts of sucrose by healthy volunteers causes a significant increase in the fasting serum cortisol level. Cortisol is the primary corticosteroid l (cortisone like hormone) secreted by the adrenal gland. Although corticosteroids have important biological functions, an excess of these hormones can cause osteoporosis. Indeed, doctors are reluctant to prescribe corticosteroids precisely because they can cause severe bone loss. Yudkin's work demonstrated that eating too much sugar is in a way analogous to taking a small amount of cortisone, which could cause your bones to become thinner. This possibility is supported by a study on hamsters, in which feeding a diet containing 56% sucrose caused osteoporosis, despite adequate intake of calcium.

Refined Grains and Flour
Another significant dietary change occurring during the past century is an increase in the consumption of refined grains, such as white bread instead of whole wheat bread, and white rice instead of brown rice. During the refining of grains and flour the nutrient-rich germ and bran portions are removed, resulting in a significant loss of vitamins and minerals. For example, when whole wheat is refined to white flour the following percentages of selected vitamins and minerals are lost: vitamin B6 (72%), folic acid (67%), calcium (60%), magnesium (85%), manganese (86%), copper (68%), zinc (78%).4 Since grains make up about 30% of the average diet, consumption of refined grains would have a substantial impact on the total daily intake of micronutrients (vitamins and minerals). Because nearly 50% of the typical American diet is composed of nutrient-depleted sugar and refined grains, the intake of many important micronutrients is probably much lower than it was during the previous century

Caffeine
Caffeine is found in coffee, tea, cola beverages, and certain pain medications. Substances similar to caffeine are also present in chocolate. Caffeine has certain pharmacologic (drug like) effects in the human body and is known primarily as a stimulant of the central nervous system. Tens of millions of people depend on caffeine to help them wake up in the morning and to stay alert during the day. Athletes sometimes use caffeine to enhance their performance.

Although the dangers of caffeine have long been a topic of debate, it is well known that caffeine is an addictive substance. Withdrawal from caffeine after prolonged use usually results in severe headaches, which can last several days. It is also well known that excessive caffeine use is a cause of anxiety and insomnia.

Nutrition-oriented practitioners and some conventional doctors believe that caffeine can also cause certain other problems in susceptible individuals. Problems attributed wholly or in part to caffeine include fibrocystic breast disease, cardiac arrhythmias (heart rhythm disturbances), diarrhea, constipation, abdominal pain, elevated serum cholesterol or blood sugar, high blood pressure, and chronic migraines or other headaches. There is evidence that caffeine may also promote heart disease and cancer, although the studies in this area are conflicting.

It should not be surprising that a substance that appears to cause problems in so many different systems of the body would also adversely affect bone tissue. Most of the evidence is circumstantial, but studies do suggest that caffeine ingestion may contribute to bone loss. In one study, thirty-one women ingested a cup of decaffeinated coffee on three different occasions. In two of the cups, caffeine was added at concentrations of 3 mg/kg and 6 mg/kg of body weight, respectively. The excretion of calcium in the urine during the next three hours was significantly greater after caffeine ingestion than after decaffeinated coffee. The increases in calcium excretion were 50% and 69%, respectively, after low and high doses of caffeine. These results demonstrate that ingestion of caffeine causes excess calcium loss from the body in the short term.

Another study suggests that this effect of caffeine is not just limited to the short term. Calcium balance, a measure of the amount of calcium retained in the body, was assessed in 168 women between the ages of 35 and 45. The results showed that calcium balance decreased with increasing dietary intake of caffeine. In other words, women who habitually ingested a great deal of caffeine retained less calcium than did those who used little caffeine. Women who consumed 50% more caffeine than average had an estimated; reduction in calcium balance of 6 mg/day.6 Although 6 mg/day might seem like a small amount, a loss of that much calcium every day for years would add up to a significant degree of bone loss.

The potential consequence of caffeine ingestion on bone health was assessed in a study of 84,484 women the ages of 34 and 59. In 1980, each of the women completed a questionnaire pertaining to their intake of various foods and beverages. During the ensuing six years, there was a positive association between caffeine intake and the risk of sustaining a hip fracture. That is, the risk of a hip fracture increased with increasing levels of caffeine intake. Women who consumed the most caffeine (above the 80th percentile) had nearly three times as many hip fractures as women who consumed the least caffeine (below the 20th percentile). One possible confounding factor in this study is that women who use caffeine also tend to smoke cigarettes, which are known to contribute to the risk of osteoporosis. It is possible that some of the risk attributed to caffeine intake was actually due to tobacco. However, the weight of evidence suggests that anyone interested in maintaining healthy bones should avoid excessive caffeine intake.

Alcohol
Consumption of excessive amounts of alcohol is a known risk factor for osteoporosis. In a study of ninety-six male chronic alcoholics): ages 24 to 62, 47% had osteoporosis. Among those under the age of 40, 31% had osteoporosis.8 Although a similar study has not been done on women, it is likely that drinking too much alcohol would also promote osteoporosis in women. The effect of moderate alcohol consumption on bone health is not known.

Protein, Phosphorus, and Sodium
The American diet tends to contain too much, rather than too little protein. Studies have shown that excessive dietary protein may promote bone loss. With increasing protein intake, the urinary excretion of calcium also rises, because calcium is mobilized to buffer the acidic breakdown products of protein. In addition, the amino acid methionine is converted to a substance called homocysteine, which is also apparently capable of causing bone loss.

Animal studies have shown that excessive intake of phosphorus can cause osteoporosis, as well. The effect of dietary protein on osteoporosis might be explained in part by the phosphorus content of many high-protein foods because phosphorus does appear to have an adverse effect on bone health. High-phosphorus beverages such as colas (which also contain a lot of sugar and caffeine) are among the worst foods imaginable for someone trying to prevent osteoporosis.

Several studies have shown that individuals who consume a vegetarian diet have stronger bones later in life than those who eat animal flesh. However, other studies have failed to find a difference in bone mass between vegetarians and meat eaters.

A substantial minority of human beings also appears to be Susceptible to the effects of high-sodium intake. When these individuals ingest moderate amounts of salt, their urinary excretion of calcium increases markedly." In people with this sodium-dependent hypercalciuria, ingestion of too much salt probably increases the risk of both kidney stones and osteoporosis. In today's fast paced society, great emphasis is placed on readily available, easily prepared food, which can be stored on the shelf for prolonged periods of time. The food technology industry has developed many ways to achieve these goals. Unfortunately, the nutritional quality of processed, adulterated food is far inferior to that of fresh, perishable foods. Modern food is bleached, radiated, extracted with organic solvents, subjected to enormous temperatures and extremes of acidity or alkalinity, and contaminated with thousands of chemicals designed to preserve, texturize, color, or otherwise modify the food so that it will look, feel, and taste like the real thing.

Hundreds of articles have been written about how these harsh processing techniques can affect the nutritional value of food. One I example is the possibility that food processing can promote lysine deficiency. Lysine is one of the eight essential amino acids from which protein molecules are synthesized in the body. Studies have shown that when proteins are subjected to alkali treatment (as in the production of isolated soy protein or textured vegetable protein), a substantial amount of the lysine is destroyed. Exposure of lysine to temperatures of 250C for one hour also caused significant losses of lysine. Heating proteins even at moderate temperatures in the presence of sugars such as lactose, glucose, or sucrose can also destroy significant amounts of lysine. Thus, in the baking of pies, cookies, breads, and other grain products, where flour and sugar are heated together, substantial amounts of lysine may be lost.

You might assume that, with all of the protein in the American diet, it would be difficult to develop a deficiency of an amino acid. The problem is, however, that amino acid imbalance can be just as damaging as amino acid deficiency. Animal studies have shown that the ratios of essential amino acids in the diet are as important as the absolute amount of each. If a single amino acid, such as lysine, is being systematically destroyed by food processing, then ingesting more of all of the amino acids will not correct a relative lack of lysine.

It is therefore possible that millions of Americans are marginally