Women's Bodies, Women's Wisdom (124 page)

L
OW
-A
CID
D
IET:
B
ETTER
T
HAN
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ALCIUM FOR
P
REVENTING
O
STEOPOROSIS

While for years doctors have been recommending dietary calcium as the best way to ward off osteoporosis, many studies cast doubt on this idea. For example, a 2003 Harvard study looked at diet and hip fractures among 72,337 older women for eighteen years and concluded that “neither milk nor a high-calcium diet appears to reduce [fracture] risk.”
⁶⁸
A more recent Harvard study, this one from 2007, analyzed seven trials that followed a total of 170,991 women for several years and found no association between total calcium intake and hip fracture risk.
⁶⁹

The truth is that calcium isn’t all it’s cracked up to be when it comes to bone health. After all, in Africa and Asia, where people generally don’t take calcium supplements and after infancy consume little or no dairy, fracture rates are 50 to 70 percent lower than they are in the United States. Statistics show that most industrially advanced countries have the highest fracture rates, although they consume more dairy products than other countries.

Amy Lanou, Ph.D., an assistant professor of health and wellness at the University of North Carolina, Asheville, and medical writer Michael Castleman came to a remarkable conclusion after reviewing 1,200 studies on the dietary risk factors for osteoporosis in researching their book,
Building Bone Vitality: A Revolutionary Diet Plan to
Prevent Bone Loss and Reverse Osteoporosis
(McGraw-Hill, 2009). Of the 136 trials they found that examined the effects of dietary calcium on osteoporotic fracture risk, two-thirds of them showed that a high calcium intake does
not
reduce the number of fractures—even in those who took calcium (with vitamin D) during childhood. They also found that eating fruits and vegetables improved bone density in a whopping 85 percent of studies that looked at the effects of such foods.

It’s not that calcium isn’t valuable; it’s just that it’s not the holy grail it’s been made out to be. “Think of calcium as the bricks in a brick wall of bones,” Castleman writes in an article in
Natural Solutions
. “Bricks are essential, for sure, but without enough mortar— which comes in the form of about 16 other nutrients—the wall can’t hold itself up.”
⁷⁰

The key to preventing osteoporosis, they determined, is eating a low-acid diet. The basic idea is that a diet high in animal protein (including meat, poultry, fish, milk, and dairy), grain, and high-glycemic-index foods (refined carbs) makes blood slightly more acidic. When blood is more acidic, the body tries to balance or neutralize it by adding alkaline material the only way it can—by leaching some of the calcium compounds stored in bone. Eventually, osteoporosis results.

Whether a food is considered alkaline or acidic depends on the effect it has on the body after it’s digested. Generally fruits and vegetables are considered alkaline, while meats and dairy products are considered acidic. It’s important to note that while some foods (such as tomatoes, citrus fruits, and apples) may
taste
acidic, the effect they have on the body when they’re metabolized is actually alkaline. Also, just as the proteins from animal sources are responsible for meat and dairy having an acidic effect, so are the proteins found in soy and most lentils and beans—although vegetable proteins do not generally have as strong an acidic effect as those from animal sources. (See
Building Bone Vitality
for charts showing the relative acidity and alkalinity of several different types of foods.)

In general, it takes three servings of fruits and vegetables to neutralize the acid in just one serving of animal food, and two servings of fruits and veggies to neutralize the acid in one serving of grain. (By the way, consuming dairy foods does add back calcium, but calcium from animal sources such as dairy is highly acidic, so it’s like taking one step forward and two steps back.)

The bottom line: For healthy bones, your blood needs to maintain a slightly alkaline pH level (a measure of relative acidity or alkalinity), which you can achieve by eating at least five servings of fruits and vegetables for every one serving of red meat, chicken, or fish. (Another good idea is to eat vegan—no meat or dairy—one day a week, which is very easy given the wide availability of beans, tofu, and other plant-based proteins these days.)

Diet

Bones are dynamic organs that thrive in a mineral-rich environment. A refined-food diet is everywhere associated with weak bones and poor teeth. Follow the dietary program in chapter 17.

Exercise

Two forty-minute sessions per week of weight training have been shown to increase bone density as much as estrogen, according to research by Miriam Nelson, Ph.D., director of the Center for Physical Activity and Nutrition at Tufts University and author of
Strong Women, Strong Bones
(Perigee, 2006). Dr. Nelson further reports that higher-impact activities (including vertical jumping and stair climbing), when done safely, can also help build bone. She recommends a comprehensive exercise program that includes weight-bearing aerobic exercise, strength training, vertical jumping (when appropriate and for women under fifty), balance exercises, and stretching. Walking, bicycling, and climbing all keep bones well mineralized by putting stress on them, which creates a mini-electrical current that draws minerals into the bone.

Proper alignment of the skeleton is also crucial for maintaining healthy bones and hips throughout life (See
chapter 18
, on exercise). Pilates and yoga are excellent for alignment.

Reduce Phosphorus Consumption

Phosphorus directly interferes with calcium absorption. Eliminate cola and root beer drinks, which are too high in phosphorus and which also contain coloring agents that interfere with calcium absorption.

Quit Smoking and Cut Back on Alcohol

Since smokers, along with women who consume two or more alcoholic drinks daily, are at highest risk for osteoporosis, women should refrain from smoking and limit alcohol intake.
⁷¹

Limit Caffeine

Caffeine increases the rate at which calcium is lost in the urine. Daily intake should be limited to no more than the equivalent of the caffeine in one to two cups of coffee.
⁷²

Decrease Stress Hormones

If you are depressed or under chronic stress, get help. Depression increases the risk for osteoporosis. The stress hormone known as cortisol higher in depressed or chronically stressed individuals, and over time, this hormone results in bone (and skin) breakdown.

Vitamin D

As you will recall from the breast chapter, an optimal level of vitamin D is from 40–100 ng/ml. According to Michael Holick, M.D., Ph.D., chief of Endocrinology, Metabolism, and Nutrition at Boston University School of Medicine, blood levels less than 20 ng/ml can cause osteoporosis,
⁷³
while the lowest average blood concentration for vitamin D that demonstrates fracture reductions is equivalent to 30 ng/ml.
⁷⁴
Consuming adequate levels of vitamin D is associated with lower risk of hip fractures in postmenopausal women, according to research from Brigham and Women’s Hospital and Harvard Medical School.
⁷⁵
Take at least 2,000 IU of vitamin D per day.
⁷⁶
(For a more detailed discussion of the importance of vitamin D, see
chapter 17
.)

Beta-carotene

Take 25,000 IU per day (15 mg). Beta-carotene is converted into vitamin A in the body. Vitamin A promotes a healthy in testinal epithelium, which is important for optimal absorption of nutri ents, and it also promotes strong joints. It is found in abundance in yellow and orange vegetables such as acorn squash and carrots and also in dark green leafy vegetables.

Natural Progesterone

Progesterone’s role in bone metabolism is well documented but frequently overlooked.
⁷⁷
I recommend one-quarter to one-half teaspoon of percent cream daily on the skin.

Vitamin C

This nutrient assists in collagen synthesis and repair. The recommended dose is 2,000 mg per day.
⁷⁸
The work of Dr. Linus Pauling suggests that optimal vitamin C intake should be much higher than we’ve been taught. An orange provides only 60 mg per day, but Dr. Pauling’s evidence is quite convincing that vitamin C is beneficial and has no side effects at levels around 2,000 mg per day or even more.

Magnesium

Though calcium gets all the credit when it comes to bone health, magnesium is equally important. Magnesium is a con stituent of bone and is essential for several biochemical reactions involved in bone building. As already mentioned in the discussion of adrenal health, the standard American diet is low in magnesium. A diet low in magnesium and relatively high in calcium actually contributes to osteoporosis. Though blood levels of magnesium may be normal, this is misleading. A more accurate test is red blood cell magnesium, which is often low in cases of depression and fatigue. (See the section on magnesium in chapter 17.) Overconsumption of processed food is usually the culprit in magnesium deficiency. This nutrient is found in organically grown vegetables, whole grains, sea vegetables, and meats such as turkey. I recommend a magnesium supplement daily at a dose of 400 to 800 mg per day, depending upon the quality of your diet.
⁷⁹

Manganese

This nutrient should be supplemented in the form of man ganese picoli-nate. The recommended dose is 15 mg per day.

Calcium

Taking calcium without vitamin D is almost useless. That said, calcium supplementation is valuable. Take 1,000 to 1,500 mg per day in the form of aspartate, citrate, or lactate. You can take less if you obtain sig nificant amounts from your food. Despite widespread promotion of the antacid Tums as a way to obtain needed calcium, better supplements are available. Although the calcium carbonate found in Tums has been shown to increase bone density, it also reduces stomach acid, thereby inhibiting calcium absorption and increasing the risk of kidney stones.
⁸⁰

Boron

Boron is a trace element found in fruits, nuts, and vegetables. It has been found to reduce urinary calcium loss and to increase serum levels of 17-beta estradiol (the most biologically active estrogen); both of these effects help bone health. The minimum daily dose of boron needed (2 mg per day) is easily met with a diet rich in fruits, nuts, and vegetables; supplements can be taken up to 12 mg per day.
⁸¹

A W
ARNING
A
BOUT
B
ISPHOSPHONATES
(F
OSAMAX
, A
CTONEL, AND
B
ONIVA
)

I’m very concerned about the long-term safety of bisphosphonates, drugs including alendronate (Fosamax), ibandronate (Boniva), and risedronate (Actonel) that are heavily marketed to women to prevent osteoporosis fractures. They are not the panacea for bone health that they appear to be. In fact, they can be downright dangerous. They inhibit bone resorption by cells known as osteoclasts, which are necessary for the continual remodeling of bone that occurs throughout life. Here’s the problem with that. Suppressing bone turnover creates excessive mineralization of bone, which makes it more brittle. When bone gets too thick, blood vessels can’t get in to nourish it, either. Animal studies indicate that alendronate also inhibits normal repair of microdamage to bone, resulting in eventual accumulation of microdamage and loss of bone strength. For these reasons, studies have shown spontaneous nontraumatic spinal and also atypical femur fractures in individuals taking this drug. In one study, severe reduction in bone formation was found in all the patients studied.
⁸²
Orthopedic surgeons have increasingly been reporting atypical femur fractures that don’t heal in women on alendronate.
⁸³

Though drug companies quote the widely publicized study showing a 50 percent reduction in risk of fracture with alendronate, what they don’t tell you is that this result is seen only in those who already have osteoporosis, not healthy women who are taking the drug to prevent the problem. It is estimated that you’d have to treat a hundred women with the drug to benefit just one woman.
⁸⁴

More confusion resulted when two studies reported in 2009 appeared to link taking oral bisphosphonates (including alendronate) with a decreased risk for breast cancer—one study by 32 percent and the other by 34 percent.
⁸⁵
Yet even top cancer doctors were hesitant to get too excited about this association for some very good reasons. First of all, neither of these studies was a randomized clinical trial— both were observational studies of data that already existed. Also, women taking these drugs for low bone density often have lower estrogen levels, which may give them a lower breast cancer risk to begin with, because a woman’s risk for breast cancer increases with higher exposure to estrogen over her lifetime.