Tag Archive | BMD

I passed the test!

First, I should apologize for the long gap between posts. My writing time has been absorbed into 1400 square feet of gardening bliss, which legitimately counts as bone-building activity. But now that we’ve had our first heavy frost, I’m down to a couple of short rows of greens under covers, and it’s time to get back to my desk.
It’s also time to announce that my bones passed their big test – the one that really counts: They held together beautifully when I had a bad fall. The scene was the garden, and the accident involved me recklessly trying to move an oscillating sprinkler while outrunning it to stay dry. I scrambled onto the half-meter high stile to get over a fence, but when my wet feet met the slick top step I crashed down – very hard – my entire weight on my hip onto the packed path. There I lay, stunned and wetter, but suddenly very excited: Nothing broke!!!  I wore a mammoth bruise for a long time, yet wasn’t even stiff the next day. Despite my doctor’s dire warnings, and the High Risk of Fracture on my chart, my bones were able to do their job and absorb the impact.
Now, a year after my bone density T-score of -4, I can reflect on the approach I’ve taken, as my bones seem to be serving me well:
  • Exercise: I changed my gym workout, now choosing the treadmill over an elliptical trainer. This causes more impact to my bones, which should challenge them to grow stronger. I’ve continued using weight machines to work my lower body, but now choose free weights for upper body work, and do those exercises standing up so my spine can carry the extra weight. On days I don’t get to the gym I go for a brisk walk. Keep moving.
  • Supplements: I added strontium citrate (680 mg per day), Vitamin K2 (100 mcg per day of the MK7 or menaquinone form), silica, and 3 mg per day of boron. I was already taking B complex, a balanced mineral supplement, fish oil, magnesium, Vitamin D, and Vitamin C.
  • Diet: I gave up most dairy products. Yup, to improve my bones I stopped drinking milk. I found out through testing that I’m sensitive to milk (not that I noticed any symptoms) which means it would have tended to cause inflammation, and that is bad for bone health. Also, dairy products metabolize to form acidic residue, which increases bone loss. I get my calcium from leafy greens, nuts, and salmon, with about 600 mg per day from a supplement. (The 1500 mg per day supplement my doctor recommended is way too much!) I put more emphasis on making and drinking mineral-rich bone broths. I already ate a lot of vegetables, and that hasn’t changed. I had already given up gluten, and any foods that contain it. Since lower body weight is one of the major risk factors for osteoporosis, I gave myself permission to abandon my life-long pursuit of weighing a little less. That must have been effective, as I have gained about 3 kg, and mostly feel fine with that :).
  • Reading: I devoured some excellent books that helped form my understanding. My favourites are Your Bones by Lara Pizzorno, The Whole Body Approach to Osteoporosis by R. Keith McCormick, The Myth of Osteoporosis by Gillian Sanson, and Vitamin K2 and the Calcium Paradox by Kate Rheaume-Bleue.
  • Support: I joined an online community of people who share what they’re learning about osteoporosis. I also continue to meet with a local Health Pursuits Reading/Study Group where lots of wise people have spurred me on with their insights into natural approaches.
  • Drugs: I have not taken any. I don’t plan to take any. Since I haven’t needed to return to my nice well-meaning doctor who told me I had no choice but to take Actonel, she doesn’t know. I have a choice, and I’m exercising it by venturing into realms that are beyond her training.
  • Followup bone density test: Although I was told I would get an automatic recall, that hasn’t happened. I considered initiating the appointment  myself, but then wondered: What would I do differently if I got a worse test result? I’m already doing everything I know how to improve my bones. Since I’m very numbers-oriented, I know I’d obsess over the new scores, way beyond their accuracy or their ability to predict fractures. So I’ve let it go, and I’ve stopped having bad dreams in which I’m about to get my retest scores. One day, if the test centre calls, I’ll go for a repeat test. But I am more than a test score.
Still, I made a note to myself to avoid risky activities like outrunning sprinklers in wet obstacle courses. Instead I should focus on developing true superpowers that will allow me to leap over garden stiles in a single bound.
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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.

D is for Dense

Vitamin D is known as the sunshine vitamin, because it’s created in our skin in response to sunshine. What an amazing system – our bodies know how to make what they need with just one necessary addition! In my part of the world, though, I spend at least two thirds of the year with everything except my face and hands covered up, so that vital ingredient is missing. While we can store Vitamin D for periods of time, eight months is way over the limit. Essentially everyone in my latitude is deficient in this vitamin by the time we can peel off our parkas.

What difference does it make? Well, we need this vitamin to prevent practically any disease we don’t want, starting with cancers and cardiovascular disease. The Vitamin D Council site contains a wealth of well-documented information about Vitamin D.

And wouldn’t you know: Vitamin D deficiency is a factor in osteoporosis, because D is needed in order for calcium from the diet to be absorbed in the intestines. Without enough absorbed calcium, the body robs calcium from its best storage supply – the bones. Not enough calcium in the bones? Low density.

In recent years there’s been a lot of controversy over how much Vitamin D is enough. It seems the pharmaceutical companies recommend the lowest amount, and natural practitioners the highest. (Regular medical doctors rely on the drug companies for recommendations.) Everyone agrees, though, that most of us need way more than we’re getting.

So what’s a northerner to do through the long winter? Ideally, the ultimate approach would be to spend every second week at a tropical resort lapping up the rays, but my lifestyle can’t accommodate that. It’s not possible to get all the Vitamin D we need through diet, either; we’re left with supplements. The most absorbable form is D3, or cholecalciferol. We’re each biochemically unique, but through regular testing of my levels I’ve found that I need about 6000 IU per day of this through the winter, and about 3000 IU per day through the summer, just to keep me from deficiency. (That’s just me, so do your own research and don’t copy!) Be sure to always take Vitamin D with a bit of fat to help its absorption, as D is fat soluble.

Trying to build bone density? Keep on top of your Vitamin D.

The gluten story: well-fed malnutrition

In my early reading, The Myth of Osteoporosis by Gillian Sanson served to calm me down. The author methodically debunks several key tenets of the medical approach to osteoporosis. For instance, less dense bone is not necessarily brittle bone. (Think of peanut brittle: dense but fragile.) And other factors than low density seem much more significant to the question of fracture risk. For example, risk of falling, regardless of bone density, is a better predictor of broken bones.

Dr. Alan Gaby, in Preventing and Reversing Osteoporosis, as well as in his mammoth work entitled Nutritional Medicine, outlines a very practical response to osteoporosis. That brings me to the gluten story.

The gluten story

Almost two years before my bone density test, a chance encounter with an alternative health practitioner convinced me to try eliminating gluten from my diet. While demonstrating a novel non-invasive testing method she diagnosed me with low levels of Vitamin A, Vitamin B6, Vitamin B12, and iron. Although I was aghast at her suggestion that I was malnourished (“But you don’t know me: I eat an excellent balanced diet!”), I set about researching symptoms of gluten intolerance, and found my family tree riddled with them, although never diagnosed as gluten issues: anemia, peripheral neuropathy, colon cancer, depression. The information was compelling enough that I made radical changes in my eating, and watched the following symptoms all disappear: daily headaches, eczema, insomnia, joint pain. I felt healthier than I had in decades, and I watched my nutrient levels rebuilding. When my daughter eliminated gluten, her depression and brain fog resolved within a week, as did her persistent bloating after meals. My sister’s “irritable bowel” was healed.

In those who are sensitive to gluten, ingesting a small amount causes severe inflammation of the small intestine in the area where several key nutrients are meant to be absorbed. This prevents their absorption, resulting in malnutrition. The effects of this can impact any system or organ of the body. The only treatment for gluten intolerance (or celiac disease, which is the best-known form) is strict adherence to a gluten free diet for life.

Because there is no pharmaceutical solution to this, the conventional medical profession has paid little attention to the growing problem, believed to affect around 1% of the population, although most are undiagnosed.

But now I learned something new and troubling from Dr. Alan Gaby’s work: Osteoporosis is commonly caused by gluten intolerance, and can even be the primary manifestation of celiac disease! So it’s quite likely that my bones never did reach the peak density they should have in my 20s, and the bone that did form has been leaching away silently for many years.

Enter the medical profession. They happily diagnose osteoporosis. They have a drug for that.

Why blog? It’s in my bones.

I was stunned. This wasn’t the news I was expecting. When my doctor’s office called me in for a non-urgent followup after my first ever bone mineral density test, I anticipated being told that the aging of my bones might lead one day to osteoporosis, and being urged to take a drug to prevent that.

“You have severe osteoporosis. A diagnosis of this begins at a T-score of -2.5 Your spine measures far worse than that – it’s -4! You’re at high risk of a spinal fracture. We have no choice but to prescribe bisphosphonates.”

She went on to warn me: “Make sure you don’t fall. You mustn’t do any activities that may cause you to fall. No more ice skating, no skiing, no climbing on ladders, no riding bicycles. Be careful. A fracture could happen at any time. Be very careful. Take lots of calcium.”

I left the office in a blurry fog of unreality, and stepped cautiously across the parking lot to my car, feeling like a piece of delicate crystal. How could I have felt so fit and healthy just a half hour ago, when my body really was critically frail?

As I tried to process the report, the doctor’s dark words hung over me, and I felt my confidence ebbing. Was it safe to lift a full laundry basket? To twist around to look in the back seat of the car? To bound up the stairs like I always had? My initial Google search just confirmed the worst: I have elderly bones in a 54-year-old body. No running, no jumping, no twisting for the rest of my life, or face cruel years of handicap and pain.

My first response

I cried. I fussed. I stayed home from the gym and wallowed in my mortality.

What about the prescription?

Then there was the drug. I already knew that taking bisphosphonates risked some serious side effects – atypical brittleness of the thigh bone, almost at its thickest point; and an untreatable necrosis of the jaw. And that a very high percentage of users suffered with digestive issues, joint pain, bone pain, and flu-like symptoms while on the drug. I did not want to ingest anything like that if there was an alternative.

As I looked into it further, I discovered that until around 1990 bisphosphonates were just industrial corrosion inhibitors. Then someone had the idea of having women take them internally to build bone density. The particular drug prescribed for me is called Actonel, and it was developed by Proctor and Gamble, the chemical company we’ve all heard of. The story of them getting it on the market includes a plot of intrigue and controversy, as the high level scientist whose name was used to publish the glowing research report complained that P & G had withheld the raw data even from him, only giving him access to the small subset that seemed to show benefits of the drug in bone density. He asked to have his name removed from the published paper.

It turns out that bisphosphonates work by killing off the osteoclasts in our bones. These are cells that function to break down old bone, effectively cleaning up the regular debris from wear and tear in our skeletal systems. Osteoporosis happens when these osteoclasts are too active, cleaning away old bone cells faster than new ones are built. The drug gives an initial increase to bone density, as no more bone is taken away.

The resorption work of osteoclasts is normally complemented by the work of osteoblasts. They serve to build new bone, repairing our frequent little micro-tears, and replacing elderly cells. Unfortunately, it seems that these osteoblasts eventually stop working in the absence of their clean-up partners. So after an initial increase in bone density while on bisphosphonates, the density levels off. Worse than that, repair of minor damage ceases, and old cells aren’t cleaned away. The bone that remains may be more dense than before, but evidence suggests it is also more brittle.

Was it true I had no choice?

It didn’t make sense to me that an industrial chemical taken internally, resulting in continuous pain and eventual bone failure, was a good solution. When it came right down to it, I thought I’d rather spend a cloistered life in a bubble but feeling healthy. Or face an early death from bone collapse after a life fully lived. I folded the prescription and hid it in the bottom of a drawer.

Wasn’t there another approach? Surely our bodies are created to heal, and optimum diets can provide what we need. What had gone wrong with my body that some cells were overperforming? What could I do to turn things around?

I began reading everything I could find on the subject, and that pointed to the reason I’m blogging: There is an astounding amount of information available on natural approaches to osteoporosis that have worked for real-life people! Since my diagnosis, two of my sisters have followed up with their doctors – and ended up with the same label as mine: osteoporosis. Recognizing a genetic link, as our mother and her sister were also afflicted, I’m thinking ahead to the bones of our children as they age. Obviously, I’m not the only one urgently searching for answers, and it makes sense to me to consolidate what I’m learning and share it with others.