Vitamin D for Young People

Children don’t spend any time thinking about their bones. So here’s some news for those who care for children: Make sure they get enough vitamin D. A recent study published in the Archives of Pediatrics and Adolescent Medicine found that low vitamin D levels were associated with stress fractures.

The study followed 6,712 athletic girls aged nine to sixteen for seven years, monitoring dairy, calcium, and vitamin D intakes. Over the seven years, 3.9 % developed stress fractures. Those with the highest vitamin D intake, though, suffered the fewest fractures.

This agrees with the correlation that many researchers are finding between bone health and vitamin D levels, and points to the need to protect bones even in childhood.

I recently listened to a fascinating lecture by Dr. Stasha Gominak on vitamin D. She’s a neurologist who has identified a most interesting connection between low vitamin D levels and poor sleep quality. She makes so many fascinating comments on the subject that I recommend you listen to all four parts of the lecture. However, something she brought to my attention that particularly relates to this post about children is the extent to which our vitamin D intake from sun exposure (the optimum kind of D) has dropped in one generation.

When I was growing up in the 60s and 70s no one in my suburb had central air conditioning; we played outdoors, and when the house got really hot we even ate outside, with no gazebo. We hadn’t yet heard of sunscreen, so our skin was fully exposed to the sun. Kids walked or biked to their destinations, and we were free to wander the neighbourhood. Our favourite activities involved a lot of moving around, usually with others, especially since there was nothing to watch on TV for most of the day. At least for the summer, we got all the vitamin D we needed (as well as a good bit of bone-building exercise).

By contrast, when my children came along in the late 80s the house was pleasantly cooled, so they stayed indoors a whole lot more to keep comfortable. Whenever they were outside we made sure they were slathered in sunscreen, effectively preventing their skin from making that essential vitamin D. Furthermore, since the world had grown much more aware of predators and other nasties, we drove them around as much as we could. And by then VCRs and video games gave them a lot of indoor entertainment. All told, in the name of improving their lifestyle, we deprived them from what’s proving to be a vital vitamin in preventing a dizzying number of diseases.

My conclusion from reading about vitamin D? When possible I must get 15 minutes per day of sun exposure on bare skin, no sunscreen. If I had children now I’d make sure they did, too. The rest of the year, supplements are essential.

Now back to the study I mentioned above. To the surprise of researchers, those with the highest dairy and calcium intakes also suffered the most fractures:

“In contrast, there was no evidence that calcium and dairy intakes were protective against developing a stress fracture or that soda intake was predictive of an increased risk of stress fracture or confounded the association between dairy, calcium or vitamin D intakes and fracture risk,” the authors comment.

The authors also note that in a stratified analysis that high calcium intake was associated with a greater risk of developing a stress fracture, although they suggest that “unexpected finding” warrants more study.”

Yup, calcium is not the key bone-builder. Make sure you get your vitamin D.



Low Density History

My grandmother probably never heard of osteoporosis. For most of her life the disease was rare and largely unknown.  But in 1982, right around her 90th birthday (and by then she was too old to care) the word osteoporosis was suddenly thrust into the common vocabulary. A massive public information campaign began, warning post-menopausal women by every means possible of imminent danger and disfigurement from weakened bones. The pharmaceutical companies, pushing their lucrative hormone replacement therapy (HRT), sponsored the campaign that sent a generation of fearful women scurrying to their doctors for prescriptions. No one seemed concerned about the absence of studies that proved HRT could prevent or reverse osteoporosis. Soon, though, a problem did emerge: there was no easy way to test the strength of bones in living people. So the Dual Energy X-ray Absorptiometry (DEXA) machine was developed in 1988, and finally our bones could all be compared on the basis of density.

Subsequently, the World Health Organization established a large database of DEXA readings, and in 1994 they announced international standards for osteoporosis. They also changed its definition. It went from being a disease characterized by fragility fractures to a condition marked by low bone mineral density, no fracture needed. Suddenly half of all post-menopausal women – and quite a few other people – were painted with the ominous diagnosis.

But the 1994 definition has some obvious shortcomings. It doesn’t take into account the fact that bone mineral density alone can not adequately predict the quality of our bones or their tensile strength which are most significant predictors of fractures. Also, the standards compare my bones with those of young women on a normal curve, not considering what might be normal and healthy and perfectly suitable for me. Furthermore, the DEXA machine that set the standards has some serious limitations, typically rating larger bones higher than smaller bones of the identical density. (There are more details here.) In other words, being diagnosed based solely on a DEXA score should not be nearly as scary as our doctors tell us.
Of course, fragility fractures truly are a serious problem, and I don’t want any. So I’m taking charge of all the factors that are within my control. I’m optimizing my nutrition and exercise, and minimizing the risk of falling. To reduce stress I’m turning back the clock on history, and living like my grandmother did, letting my bones do their work.

Carry your weight and surprise your bones.

Aside from optimizing our nutrition through diet and supplements, the best gift we can give our bones is weight-bearing exercise. Study after study confirms that putting certain kinds of stresses on bones helps them to grow, or at least to resist shrinking.

So what exercise makes the difference for bones? Weight-bearing exercise includes almost any kind we do on our feet while working against gravity. Some examples are walking, jogging, hiking, dancing, and climbing stairs. Good news for me – gardening also counts! Swimming and biking are great for other reasons, but they are not weight-bearing because they don’t involve working our muscles and bones against gravity; therefore they aren’t the best for building bones.

If it were only as simple as going for a walk each day… But the problem is that our bones quickly adapt to the level of stress they usually encounter, then need new challenges to stimulate them to grow. So it helps to surprise them with new moves and greater intensities; for that reason it’s important to choose a variety of activities, and to alternate between lower and higher intensities. One study found that “inserting a 10-s rest interval between each load cycle amplifies bone’s response to mechanical loading”. That suggests that our bones are more stimulated to grow by a sequence of high intensity short bursts interspersed with 10-second rests, than by longer periods of sustained exercise. So digging the garden – as soon as I can get to it – will be better for my bones than a long run.

Exercise on our feet is vital for our vulnerable hip joints (femoral necks), as well as our spines and femurs. While those are the sites that the DEXA machines scan for density, we have other bones to consider: wrists and upper arms are also prone to fractures. So it makes sense to include a range of activities that stress those bones, like pushups, triceps dips, and carrying heavy groceries. Here’s a link to a site with lots of exercise suggestions.

Anything that improves our balance helps reduce the likelihood of falling. Lately I’ve opted to spend life’s less interesting moments standing on one foot, then switching to the other. It hasn’t taken long for me to develop impressive flamingo skills, which I practise while brushing my teeth, putting on socks, waiting in line, or talking on the phone. One day this should help me catch myself before falling.

But what about all the warnings for people with osteoporosis?  “BE CAREFUL. Don’t run, or jump, or twist, or hug anyone, or sneeze.” Yes, if you have osteoporosis it’s essential that you exercise appropriately for your condition, and with medical approval. Consulting a qualified trainer is a good idea. These warnings are particularly important:

  • Do NOT do any high impact exercises without medical approval. These can result in stress fractures.
  • Do NOT do exercises that involve bending forward at the waist, such as toe-touching. These can result in spontaneous crush fractures of the spine when coming back up from this position.

Personally, I’ve been able to continue hugging and sneezing without breaking anything. I also run gently on a treadmill (lower impact than on the road), and I might have mentioned that I plan to garden…soon. For anyone concerned about bone density – find some activities you can fit into your day and DO THEM. Life as you know it may depend on it.

Believable Good News

A new Canadian study has followed a group of people just like me: those who are responding to osteoporosis purely with lifestyle adjustments, without taking bisphosphonate drugs. Medical researchers from the University of Alberta and University of Calgary prescribed six micronutrients and an exercise program, then tracked the results. I’m delighted to see that over the year of the study the bone density of the participants increased more than it would have with the standard pharmaceutical drugs.

Of course, one reason I like this study is because it seems to validate my approach. Another is that no drug company funded the work, and for me that adds credibility. The authors appear to be squeaky clean with regard to conflicts of interest that may have skewed the results.

On the negative side, the sample wasn’t entirely representative of the low-bone-density population; the authors worked exclusively with people the doctors call “non-compliant”, who had already decided not to use the recommended drugs. Some had abandoned the drugs after experiencing continued decline of their density while taking them. Others had explored their options and just wanted a non-pharmaceutical approach. To me that suggests a cohort that is more health-aware than the average population, more likely to do their own critical investigations, eat a better diet, and resort to fewer pharmaceutical products in general. Really, though, I’m not concerned about the non-representative sample: when it comes right down to it, all I want to know is what will work for ME and the people I care for! And with that prescription I will comply.

Lifestyle adjustments in the study

So what did the participants do? Here’s the list:

Table 1: Combination of micronutrients (COMB) Protocol for Bone Health.

COMB protocol for bone health

(1) Docosahexanoic acid or DHA (from Purified Fish Oil): 250 mg/day
(2) Vitamin D3: 2000 IU/day
(3) Vitamin K2 (non-synthetic MK7 form): 100 ug/day
(4) Strontium citrate: 680 mg/day
(5) Elemental magnesium: 25 mg/day
(6) Dietary sources of calcium recommended
(7) Daily impact exercising encouraged

In earlier posts I’ve already talked about vitamins D and K2, strontium, magnesium, and calcium. Although I take fish oil containing DHA for general good health, I hadn’t heard that it’s particularly helpful for bones. According to the study: “Both DHA and vitamin D are involved in the regulation of many genes and…associated with improved bone strength.”

As for the exercise component, the authors said: “Patients were also instructed to commence and maintain a regimen of daily impact exercises such as jumping jacks or skipping where possible as impact has been associated with prevention of bone density loss.

How much did it help?

The mean improvement in BMD (bone mineral density) was impressive: 3% in the hip, 4% in the neck of the femur, and 6% in the spine. That was contrasted with a continued decline in BMD among the study dropouts, and substantially lower improvements using bisphosphonate drugs. Unlike the drugs, the study protocol delivers no side effects.

What will I change?

I’m already taking the micronutrients suggested by the study, although in different amounts. My calcium is not exclusively from food sources, as I consume very little dairy food, and I’m not confident that I can meet all my requirements all the time with my diet. These days I take 200 mg of DHA, 6000 IU of D3, 100 micrograms of K2, 340 mg of strontium citrate, 420 mg of magnesium citrate, and 1000 mg of a calcium supplement. I plan to leave those as they are for now. At the moment I get impact exercise three or four times a week at the gym, with some walking in between, and heavy gardening all summer. That didn’t prevent osteoporosis in my case, but adding some jumping jacks into my non-gym days is worth a try.
Combination of Micronutrients for Bone (COMB) Study: Bone Density after Micronutrient Intervention

They wouldn’t lie to us, would they?

On a very interesting website Vivian Goldschmidt first defines a lie as  “something meant to deceive or give a wrong impression.” She goes on to mention the following five statements of the medical system. I’ve shortened her comments, but you’ll get the idea from what I’ve included:

Big Lie #1: Osteoporosis is a devastating disease.

In essence, the medical establishment wants you to believe that you are disease-ridden and your bones have deteriorated to the point of no return… unless you take the miraculous osteoporosis drugs.

Big Lie #2: The most popular Osteoporosis drugs significantly reduce the risk of fractures.

Leaving all the terrible side effects aside, bisphosphonates – and other drugs as well – have shown a very poor (if not practically insignificant) fracture risk reduction. That is, if you know how to read between the lines.

Big Lie #3: When it comes to treating osteoporosis, you should always listen to your doctor.

Doctors are taught in medical school that “to cure” is “to prescribe”. I can’t help but think of what Einstein said: “The only thing that interferes with my learning is my education.” Fortunately, a select minority breaks away from the herd.

Big Lie #4: Diet has no effect on osteoporosis.

Mainstream medicine insists that bones can’t renew themselves after you’ve reached a certain age. But nothing is further from the truth. Bones are active tissue, that react astonishingly well if you give them what they need.

Big Lie #5: Osteoporosis is the main cause of fractures.

Not so. Fractures occur in people of all ages, and most often without Osteoporosis.

There’s something very reassuring about Vivian Goldschmidt’s conclusions. So I’m NOT diseased. I’m NOT chasing an impossible dream by rejecting a drug in favour of nutritional healing. I’m NOT necessarily doomed to become a painful heap of broken bones.

I don’t believe my doctor is intentionally lying; I trust that she fully believes what she’s been taught, even though I don’t. However, as for me, I’ve chosen to take charge of the variables I can control. I must optimize my nutrition, and my other lifestyle factors.

And to read the rest of the quoted article follow this link.

A new reputation for prunes

I was 10 years old when I first encountered prunes. It was breakfast time at Girl Guide camp, and no one could leave the table without a mandatory serving of the sweet stewed fruit. Why were the girls groaning and giggling? With a food this delicious, why did there have to be a rule?  It seems I’d come from a family where bowels moved on schedule without drama, so I hadn’t yet heard about the laxative effect of prunes.

Now prunes are becoming known for a new superpower: Reversing osteoporosis. Here’s what one study found:

In a clinical study of 58 women, eating 100 grams of dried plums per day improved bone formation markers after only three months, compared to a control group served 75g of dried apples.

via Reverse Osteoporosis with Prunes.

It seems the first benefit to bones is from the high boron content of prunes. This stimulates the bone-building cells, the osteoblasts, and increases calcium absorption so less is lost in urine. It also helps convert vitamin D into the active form that helps direct the calcium into the bones. Then the polyphenols in prunes have an anti-inflammatory effect, inhibiting the osteoclasts, which are the clean-up cells that can be overactive in osteoporosis. More bone building and less bone removal? Higher density.

So the study I referenced above found that 100 grams of prunes per day would have a major impact on bone density. From what I learned at camp, that level of consumption would not be wise for someone like me, and on that point I won’t elaborate. However, it isn’t hard to fit a few prunes into my diet. These days I use them as a reward to cover the nasty taste of my daily silicon drops.

One concern about prunes is that they are slightly acid-forming in the body, and too much acid has a negative impact on bone density. As part of a diet balanced by alkaline foods, though, a few prunes can really encourage bone health.

Strontium: a new kind of weapon

In the early 1960s when my first baby tooth fell out I made a big decision: rather than leave it under my pillow for the tooth fairy, I helped my mother put my tooth in an envelope to send it away. Before long a small package arrived in the mail addressed to me. Inside was a button with the picture of a gap-toothed child, and the words, “I gave my tooth to science”.

What did “science” do with my tooth? It turns out I was part of the Montreal Baby Tooth Survey that was tracking the concentration of radioactive strontium-90 in the population. At that time, as the nuclear arms race  heated up there was widespread concern about the dangers of radiation that was being absorbed in bones. And the most available supply of bone that could be used for testing was discarded baby teeth. Correlating these with the date and place of birth, researchers could determine how much radiation was affecting people in the year those teeth were formed.

Now I have a new interest in strontium. Rather than hoping to minimize it, I’m deliberately adding it to my bones. One important distinction: this time it’s not the radioactive isotope, but a naturally-occurring salt called strontium citrate. This strontium is an abundant mineral that is chemically similar to calcium, and absorbed by bones in comparable amounts. Once inside, it increases the activity of the bone-building cells (osteoblasts) while slowing down the clean-up cells (osteoclasts).

Strontium-rich foods include beets, brazil nuts, and cabbage, and a typical daily intake is estimated at 1 – 5 mg.  A wide variety of studies have shown that intakes quite a bit higher than this – between 340 and 680 mg per day – build significant bone density, while reducing fractures. The effect is so pronounced that the pharmaceutical companies have grasped the possibilities and  found a way to combine naturally-occurring strontium that can’t be patented with a synthetic compound that can to make a drug called Protelos, made of strontium ranelate. So far this drug is only marketed in Europe, so Canadians like me can enjoy the benefits of the cheaper, safer over-the-counter form.

Because strontium competes with calcium for absorption, it must be taken hours after calcium-rich foods. If I don’t snack in the evening I can take it at bedtime; otherwise I’m trying to take it in the night when I get up to the washroom.

There is some controversy over strontium as a bone-builder because the necessary dosage so far exceeds the amount of strontium a person would normally consume. Still, despite long-term safety studies, the only issues that have come up so far have been with the expensive synthetic prescription version, which leads to increased incidence of blood clots and drug hypersensitivity syndrome.

One important warning if you choose to take strontium citrate for your bones: make sure you always ingest more calcium than strontium.