bone health

Your bone health: the role of diet

Posted by Liz on Mar 11, 2011 in bone health | 1 comment

Osteoporosis. That scary condition that can result in bone fracture in up to 40% of US women after the age of 50. In the UK, it’s been estimated at least half of women over age fifty will have some sort of osteoporotic fracture. So it’s truly no laughing matter.

I’ve tried to cover osteoporosis extensively since starting Flashfree and you can find many of those posts here. However, I am especially intrigued by novel research that demonstrates that dietary pattern, that is, particular combinations of foods that we eat, may influence bone turnover, a term used to describe the balance between bone formation and bone loss (a process that goes on constantly through our lives) resulting in a net loss or gain in bone tissue. Moreover, dietary pattern may also specifically influence bone resorption, i.e., the process by which cells called osteoclasts break down bone so that minerals (like calcium) can be released into the bloodstream.

The researchers, who studied 3,236 postmenopausal women between the ages of 50 and 59, say that to date, most research has focused on link between specific nutrients and bone health, nutrients such as vitamin D or calcium. However, they point out that most individuals eat a variety of foods the contain combinations of nutrients. Therefore, they believed that there might be value in actually examining how the whole diet and the presence or absence of certain nutrients, affects the skeleton.

Consequently, they took initial body mass index measures, bone mineral density measures, assessed dietary habits by consumption of 98 foods, how often they were consumed and by portion size, and then, based on evaluation of how often these foods were consumed by the participants, further characterized them as the following dietary patterns: “healthy,” “processed,” “bread/butter,” “fish and chips” (the study took place in Scotland!) and “snack food.”

Overall, the women in the study actually consumed a large proportion of fruits and vegetables and on average, at least three cups of tea daily. Bread and potatoes tended to comprise the greatest source (at least percentage-wise) of “energy” to the diet. To a lesser extent, yogurt, cream, fats, oils, biscuits and milk also contributed a substantial amount of energy to the diet. However:

• Of the five types of dietary patterns, a healthy diet was most associated with better bone health, and specifically, a reduction in bone resorption. Specific foods included fruits and vegetables, white meat, white and oily fish and dairy, all nutrients that have been previously associated with beneficial bone health.This combination of foods also provided adequate protein.
• Conversely, eating mainly a ‘processed foods’ (i.e. cereal, processed meats, cake, desserts, dried fruits, soup, bread, and fats and oils) diet, and a “snack foods” diet (i.e. candy/cookies, potato chips, sauces) were both associated with reductions in bone mineral density.
• The results didn’t change when factors, such as whether or not women were taking drugs to fight osteoporosis, were taken into account.

The bottom line is that when it comes to bone health, it’s important to eat healthy, pack your diet with fruits and vegetables, and stay away from junk and processed foods. Focus on foods that are risk in calcium and balanced levels of good protein. Although this may seem intuitive, the findings emphasize that  a poor diet may ultimately result in poor bone health and increase fracture risk as you age.

Time to restock the fridge? No bones about it!

Dem bones! Isoflavones, S-equol and aging

Posted by Liz on Feb 7, 2011 in bone health | 1 comment

I love it when readers of this blog point me to research that I might have missed or just not stumbled across. That happened a few weeks ago after I wrote a post on soy and safety. By following the links, reader Carol Land directed me to a newly published study on S-equol and bone health.

S-equol is a metabolite of a major soy isoflavone called daidzein. It has a particular affinity for estrogen receptors and possesses some estrogen-type activity of its own. S-equol  is produced in the gastrointestinal tract however the ability to actually manufacture it depends on the presence of certain microflora. Consequently, only 30% to 60% of individuals are actually able to produce S-equol on their own (although this figure is believed to be higher among Asians and vegetarians).

The surge in interest in S-equol is related to its potential for augmenting the benefits of isoflavones; in fact, it is possible that women who are naturally producers of S-equol actually experience greater effects from soy products, and this is especially true when it comes to bone health.

I cannot stress enough the importance of bone health as we age. Declining levels of estrogen are a primary cause of bone loss and resulting osteoporosis in women; indeed, one in five American women over the age of 50 have osteoporosis and about half will experience a fracture in the hip, wrist or spine as a result. What’s more, because osteoporosis is silent in its early stages, causing no symptoms, it’s critical that bone loss is halted or at least slowed either before or during the most critical phases strike. There is no time like the present to take preventive measures, even if you are in your 30s and 40s.

Where does S-equol fit in?

For the first time, researchers have shown the daily S-equol supplements taken by women who are not naturally producers of S-equol, may improve bone metabolism and attenuate bone loss!

In this 1 year study of 356 healthy, postmenopausal Japanese women between the ages of 41 and 62, daily intake of 10 mg S-equol via supplement markedly reduced markers of bone resorption in blood and urine compared to women taking placebo pills or 2 mg or 6 mg of S-equol daily. In fact, in women taking the 10 mg dose for a year, declines in a  urinary marker of bone resorption (i.e. DPD) were roughly 21% greater compared to placebo. Measures of whole body bone mineral density also showed that S-equol supplementation protected against bone loss, although not to the extent as bone resorption. These results remained even after changes in height, weight, body mass index, lean and fat mass were accounted for. No participant experienced serious side effects from taking S-equol and hormone levels were not adversely affected.

Does this mean that you should rush out and purchase S-equol supplements?

One of the primary limitations of this study is that the process of bone recycling can take as long as 18 months and the time required to complete a cycle may actually increase with age. Thus, the duration of time that the women were studied might be too short to draw any definitive conclusions. Hence,  you may want to wait before you start taking S-equol. However, the evidence that’s building continues to put the weight on the benefits versus risks side. Only time will tell. Meanwhile – here’s to your bone health. Keep on doing all you can do to keep dem bones.

The B’s have it – bursting the belly and bones myth

Posted by Liz on Dec 3, 2010 in bone health | 2 comments

When it comes to aging and women, bone health is a big deal. As I’ve written time and again on Flashfree, women are at a particularly high risk for bone loss as they age because of declining estrogen levels, and in turn, a reduced ability to prevent an increase in net bone resorption (i.e. bone loss due to the activity of bone cells). And while we’ve been told that excess body fat actually protects against bone loss, novel research is putting that myth to rest. This news may affect the millions of women who are considered obese based on their body mass index (BMI > 30), who, although at greater risk for heart disease, diabetes and joint disease, were at least believed to have a weapon against osteoporosis.

In a small study that was presented at this week’s Radiological Society of North America meeting, an assessment of the abdominal and total fat and bone mineral density of 50 premenopausal women of varying BMI showed surprising results. According to the lead researcher, Dr. Miriam Bredella, “the general consensus has been that increased body fat protects against bone loss and obese women are at decreased risk for developing osteoporosis. However, we found that visceral fat — the deep belly fat — makes bone weaker.” In fact, the researchers found that women with more belly fat had significant declines in their bone mineral density and increases in the degree of fat within their bone marrow, but that total body fat or fat existing right below the skin had little impact on bones.

An important challenge for women is not only that metabolism slows and the risk for obesity increases as we age, but also, a natural increased risk for redistribution of fat to the abdominal area. And unfortunately, it’s one of the most challenging areas to address, requiring significant increases in physical activity and decreases in caloric intake. Some data suggest that isoflavones might help reduce waist circumference as well, although they are hardly definitive at this point. Still, a word to the wise: that belly fat is not going to protect your bones. Time to start moving and eating correctly; your bones will thank you.

Wednesday Bubble: Your bones, your health. The lowdown on bisphosphonates

Posted by Liz on Sep 8, 2010 in bone health, osteoporosis | 0 comments

For decades, physicians have been prescribing a class of medications known as bisphosphonates (e.g. Fosamax, Actonel, Boniva) to preserve bone health in menopausal women and prevent fractures in both men and women with osteoporosis at high-risk for them).  Bisphosphonates are often offered as an alternative to hormone replacement therapy or HRT.

Studies have shown that after age 35, women (and men) start to lose their bone density at a rate of 0.3% to 0.5% a year.  However, as estrogen levels decline through menopause, the rate of bone density loss accelerates. In fact, during the first five years after menopause, women can experience as much as a 30% loss of bone density. What’s more, experts estimate that by the time a woman reaches the age of 50, she has a 40% risk of suffering a fracture due to osteoporosis for the rest of her lifetime.

If you consider these statistics, it seems that using bisphosphonates is a good thing, right?

Well, not so fast. Earlier this year, I wrote a post highlighting reports of jaw bones collapsing among women taking bisphosphonates over a certain period of time. Included within the information were tips from the American Dental Association for protecting your jaw before any major dental procedures. This week, I want to add another facet to the bisphosphonate story, one that is definitely worth considering when weighing the benefits and risks of these drugs:

It is possible that use of oral bisphosphonates may increase the risk for developing cancer of the esophagus by as much as two-fold.

Here’s what you need to know:

• In this particular study, researchers compared over 15,000 men and women who had been diagnosed with esophageal, gastric or colon cancer over the age of 40 to five healthy individuals with similar characteristics. All study participants had been prescribed bisphosphonates at least once, with some receiving more than 10 prescriptions, which would imply that they used the drugs over time (over the 7-1/2 year period of times examined, a majority used bisphosphonates for at three years or more).
• Use of bisphosphonates over three years and having received at least 10 prescriptions was linked to a significant increase in cancer of the esophagus but not gastric or colon cancer.  People who used bisphosphonates for five years or more had twice the risk compared to those who did not. Note that these rates of cancer held regardless of the exact agent used.
• An increased cancer risk remained even after actors for esophageal cancer, such as age, smoking, alcohol and body mass intake, were accounted for.
• This increased risk, may be due, at least partly, to drug side effects that affect the esophagus directly, such as irritation and inflammation of the esophagus (i.e. esophagitis).

Now, mind you, esophageal cancer is extremely rare, affecting roughly 16,000 people in the US in 2010. However, death from esophageal cancer, is high and the disease is often fatal. Moreover, esophageal cancer tends to affect three to four times as many men as women, which is why this latest bit of information is as critical for men as it is for women entering menopause.

One important thing to keep in mind when you consider the risk and benefits of bisphosphonate therapy is that this particular study compared actual cases of these three types of cancer to healthy individuals in the population. Sometimes, the information yielded in these studies is not considered as conclusive as studies that are conducted proactively, and not retroactively. Still, this is not the first time that bisphosphonates have been linked to cancer of the esophagus.

Maintaining bone health and strength as we age, particularly as hormones decline, is critical to our health in the later years. It’s important to make the right decisions now, while we are still relatively young. Flashfree has plenty of posts on bone health and osteoporosis, and I encourage you to peruse them.  When it comes to your bones, it’s not just about ‘use it or lose it,’ but also, the three P’s:

Protection

Proactive

Prepared

Your bones, your health.

Hormone therapy and bones – fuggedaboutit

Posted by Liz on Aug 16, 2010 in bone health, breast cancer, HRT | 1 comment

Another HRT-busting post…straight from the archives of  the Ahead-of-Print edition of Menopause. I’m afraid to say that yet, another analysis of the now infamous Women’s Health Initiative Trial, you know, the one that was halted due to links between HRT and significant increases in breast cancer, suggests that hormones might not be so great after all, especially when it comes to bone protection.

The loss of lean body mass as we age contributes to redistribution of fat and  apparently contributes to falls and fractures in the later years. This is one reason why many physicians prescribe hormones. However, in the latest nail in the HRT coffin, it appears that despite earlier reports of significant reductions in fractures among women taking HRT based on body mass index, age and bone mineral density, the ability of hormones to preserve lean body mass is a fallacy. In fact, when researchers looked at almost 2,000 women who had been enrolled in the trial who were assigned estrogen plus progestogen, estrogen alone or placebo, they were unable to find any differences in lean body mass after six years, even though there was some indication of protection at the three year mark. What’s more, the researchers say that although women who took most of their hormone medication before the trial was halted seemed to fall less, it wasn’t because their lean body mass was preserved.

The main point in relaying this bit of information is experts want us to believe that HRT is the panacea for everything that ails as women age –from bone health to heart disease to dementia. And despite evolving evidence to the contrary, they continue to seek reasons why the data are wrong and look for ways to question every negative finding. Some Associations whose mandate it is to defend women’s health, like the Society for Women’s Health Research, take money from companies whose hormone products have been found to cause significant adverse effects in certain populations of women and yet, they continue to lead the charge favoring hormone therapy.

In general, I take no issue with Western medicine or pharmaceutical companies. If you look at my background, I have spent years writing favorably about many products and the research that backs them. But I maintain a standard of transparency and don’t choose to hide who’s paying the bills, And, when it comes to hormone therapy, I continue to smell a rat. Be assured that  I will continue to write about what’s really going on until more women understand how fucked up HRT really is.

If you choose to take HRT and it works in alleviating your flashes, sweats, mood swings, headaches, sex life and the like, more power to you. I support your right and decision to take HRT. But like any drug, be sure you know the facts before you believe the hype. Be certain to be diligent and ask the hard questions, even when the information comes out of seemingly expert sources or associations. Always, always, follow the trail. You might be surprised at what you learn.

This particular trail, the lean body mass trail? It’s a dead end. Fuggedaboutit.

Next.

Wednesday Bubble: protein, weight and bones – keep it in balance

Posted by Liz on Aug 4, 2010 in bone health, diet | 1 comment

Weight loss improves health, right? Well, yes, and no. Because it turns out that weight loss also increases the rate that the bone loses density, so in midlife and menopause, weight loss can be a double-edged sword.

In two recent studies published in the online edition of the Journal of Gerontology, researchers are reporting that women already at risk for osteoporosis due to their age and menopausal status may want to pay attention to what they eat when they try to lose weight. In fact, consuming large amounts of protein derived primarily from animal sources, e.g. lean meats like pork, beef and chicken, may negatively impact bone density and in turn, further increase osteoporosis risk.

Here’w what you need to know:

• In the first study, women between the ages of 43 and 80 reduced their daily caloric intake by 750 calories. Over three months, about half of the women ate meat-free diets that derived about 18% of their daily protein from vegetarian, dairy and egg sources and other half, ate diets comprised of about 30% protein derived from lean pork.

• In the second study, women between the same ages consumed about 1,250 calories a day in five meals over nine weeks. While the bulk of these calories were from a vegetarian diet, women were asked to eat either 250 calories of carbs daily (shortbread cookies, sugar coated chocolates), chicken (plus 10 grams of butter) or the equivalent in fat/saturated fat but as beef.

• Although women in the first study lost about the same amount of weight (~19 lbs), those eating animal protein has a 1.4% greater loss of bone mass. Likewise, in the second study, all the women lost weight but those women eating animal protein sources lost significantly more bone mass compared to women eating carbs.

• Women in both of these studies were considered overweight or obese based on their body-mass indices (BMI).

Importantly, many of the today’s popular diets for weight loss (e.g. South Beach, Atkins) emphasize increased intake of protein over carbohydrates (although the former also emphasizes good versus bad (i.e. glycemic index) carbs. What this means is that while you are cutting back, you may also be losing more bone mass than you normally would with weight loss.

Consequently, one of best approaches for women who are going through menopause and trying to keep the weight off may be to increase the daily  amount of so-called “good fats,” which as my friend Mollie Katzen, suggests should include nuts, avocados and fatty fish like salmon. Many of these foods are also good sources of protein and while not necessarily working to build bone, may stave off bone mass loss while you are trying to lose a few pounds or maintain your current weight.

At the end of the day, it’s all about balancing the good, the bad and the ugly. Our skeleton is fragile and it’s critical that we do all we can to keep it in one piece.

Want to learn more? I’ve dedicated several posts to osteoporosis, bone loss and bone health.