When it comes to calcium, think moderation
There’s a new condition emerging among postmenopausal women: calcium alkali syndrome (milk-alkali syndrome).
Milk calcium what?!
A wonderful commentary slated to appear online this month in the Journal of the American Society of Nephrology highlights the dangers of consuming too much calcium . In it, the author tells the tale of Chicago bartender Bertram Welton Sippy, who in 1915, introduced his bar patrons with ulcers to the Sippy diet, hourly intake of milk, cream eggs and farina cereal interspersed with Sippy powders on the half hour (i.e. dissolvable antacid like minerals that included calcinated magnesia, sodium bicarbonate and bismuth subcarbonate). A recipe for disaster? You bet, because the overkill of calcium and minerals led to symptoms that include headache, nausea, vomiting, mental clouding, a distaste for milk and eventually, kidney failure. Yikes!
While men were the primary victims of the condition in the last century, it appears that a new group of victims started to emerge in the 90s – postmenopausal women who have increased their intake of calcium and vitamin D to combat osteoporosis. And although calcium, not milk, is the primary driver, the condition is the third most common cause of hospital admission for significantly elevated blood calcium levels.
It appears that the necessity to preserve our bones has created a modern version of the Sippy diet.
The best strategy for reducing the risk of calcium-alkali syndrome is to moderate your intake of calcium supplements. In fact, the authors say that although an average of more than 4 g/day of supplemental calcium is most commonly linked to illness, small numbers of women have developed it on as little as 1 to 1.5 g calcium a day. Of note, while younger adults are able to store excess calcium in bone, aging seems to reduce this natural defense and instead, calcium tends to leave the bone (thereby leaving us more susceptible to fragile bones and osteoporosis) and in turn, a potential build up in the bloodstream. Still, the authors emphasize that calcium supplements in moderation are a necessary and beneficial option for women at risk for osteoporosis. The trick is to limit supplemental calcium intake to no more than 1.2 to 1.5 grams daily because our bones need protection. Read the label. And speak to your healthcare practitioner. When it comes to protecting our bones through supplementation, moderation appears to be the key.
p.s. Stay away from the Sippy diet. It’s a sippier slope (sorry, couldn’t resist!).
Read MoreWednesday Bubble: bisphosphonates…enough to make your jaw drop
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Are you being treated for osteoporosis? Has your doctor told you about a rare but extremely serious side effect of drugs known as bisphosphonates that causes the jaw bone to collapse?
Osteonecrosis is a disease that occurs when the blood supply to bone is cut off. This results can result in pain, limited range of motion and an eventual collapse of the bone in the affected area. According to the American Dental Association, reports of jaw osteonecrosis among very small numbers of patients taking Fosamax for osteoporosis started to emerge in 2003. At higher risk were cancer patients who were receiving intravenous bisphosphonate therapy as part of their treatment. In the majority of patients, osteonecrosis developed after dental surgery.
As I’ve written previously, osteoporosis and low bone mineral density are well-known issues for menopausal women. 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.
Bisphosphonates are frequently prescribed as an alternative to estrogen therapy for preserving bone mass during menopause. Although less than 1% of jaw osteonecrosis have been reported in patients taking oral bisphosphonates, recent research suggests that the majority don’t know about possible side effects. In fact, in this particular study of 71 women and 2 men, 82% said they couldn’t recall or were unsure if their physicians had told them about jaw osteonecrosis.
What you need to know
Taking care of your mouth is essential at any age but particularly during menopause. During the transition, women are especially at risk for altered taste and burning mouth syndrome. Additionally, we are learning that the drugs that we take to prevent loss may actually cause bone death in some women.
The American Dental Association recommends that patients inform their dentist and hygienist that they are taking bisphosphonates to prevent osteoporosis so that extra precaution can be taken before any routine or major dental procedures. if you start to experience the following signs and symptoms while taking bisphosphonates, call your doctor and dentist immediately:
- pain, swelling
- gum or jaw infection
- gums that don’t heal
- loose teeth
- jaw heaviness or numbness
- impaired range of motion
- exposed bone
Undoubtedly, the benefits of bisphosphonate therapy definitely outweigh the risks. Still, it is unclear whether or not bisphosphonates will ultimately prove to be as risky as HRT, as there have also been reports of hip fractures in a very small amount of women taking these drugs for five years or more.
Unfortunately, there are few medicinal alternatives available in the United States, although a new drug Prolia, was approved for treatment of osteoporosis just yesterday. I don’t know much about Prolia, other than it is an agent that has been widely used in treating cancer patients. However, there are some early indications that Prolia might also cause jaw osteonecrosis. Only time will tell.
Meanwhile, I can’t emphasize enough that physical activity and ample calcium and vitamin D intake are essential. The risk of doing nothing now? Enough to make your draw drop…literally.
Read MoreNo bones about it: the best things in life are sea
Did you know that eating fish that live in the sea might help boost bone health and density? Although most of the attention on the link between osteoporosis and diet has focused on calcium, milk and soy, a few studies suggest that other nutrients, such as polyunsaturated fatty acids and omega-3s, may also play a role.
According to novel research published in the journal Osteoporosis International, a greater intake of sea fish, but not shellfish or freshwater fish, is linked to as much as almost a 7% increase in bone-mineral density and an almost 10% increase in bone mass in general and in the hip areas in particular. On average, the women studied, all of whom were menopausal, were eating about .8 ounces of sea fish a day — about 16% of their total daily protein intake, and about 2 ounces daily of sea fish and shellfish combined. Factors like body weight, smoking, and alcohol did not appear to influence the association between fish from the sea and bone benefits. (Note – the study did not specifically address the exact types of fish that they women were eating other than to say, it wasn’t freshwater or shellfish.)
Interestingly, prior studies have found similar links between higher bone mineral density and a high consumption of seafood among menopausal women. Researchers say that a higher intake of fish versus animal protein or low quality foods may account, at least in part, for the higher bone mass.And while they are unable to offer any reasonable explanation for why sea fish, especially the oily types like salmon or mackerel or tuna benefit bone health while freshwater fish does not, they say that it might be due to the high level of vitamin D , which has long been associated with favorable bone mass. Omega-3 fatty acids are also thought to play important roles.
The take-away on this is to eat more fish from the sea. Clearly, environmental concerns, like overfishing and high level of mercury, may influence your seafood selection, however, Seafood Watch offers some great resources how to make safe and careful choices. What I love about this information is that it not only serves to encourage healthier eating, which can help keep those pounds away (My friend Danielle Omar wrote a great guest post about sea veggies and weight about a month ago), but also provides another strategy for keeping bones healthy as we age. Yup, the best things in life are sea.
Read MoreWednesday Bubble: the soy controversy
Do they or don’t they?
Soy isoflavones have been touted as beneficial in everything from improving body composition and lowering breast and colorectal cancer, to addressing menopausal hot flashes and moods. You can read about some of these findings on Flashfree. This week, Reuters Health reported that eating foods rich in soy protein (i.e. 25 grams of soy protein and 60 mg isoflavones) daily did not provide favorable responses from blood fats, implying that soy has little benefit in terms of lowering cholesterol levels and in turn, promoting heart health.
Are you confused yet?
Increasingly, women are turning to soy and other compounds as alternatives to estrogen and hormone replacement therapy, which mounting evidence shows can be associated with a broad range of risks including increased breast, lung and ovarian cancer to heart disease. And yet, findings from clinical trials examining soy are often contradictory, making it difficult to come to any firm conclusion about its benefits.
What’s the problem? Well, researchers say that part of the problem is poorly designed studies, small number of study participants, wide range of ages and years from menopause, studies that don’t examine the pros and cons of an agent or strategy for a long enough period of time (i.e. longer than a year). In other cases (as I’ve argued previously), the study design does not account for certain factors that are critical to a therapeutic strategy, for example, the opportunity to clearly focus an intervention so that individual factors are accounted for (this was borne out by findings from a trial that examined and provided evidence for the role of acupuncture in easing hot flashes).
There’s good news though! Researchers finally appear to be getting their act together on the soy fron. They’ve announced that they are conducting a well-designed, large trial of soy phytoestrogens. Called SPARE (Soy Phytoestrogens as Replacement Estrogen), this new study will be looking at the effects of 200 mg soy versus sugar tablet daily — namely on bone health and symptoms — in 248 menopausal women over a two- year period. They will also be taking daily calcium carbonate plus vitamin D (in ranges of 500 mg to 1000 mg calcium and 200 to 400 IU vitamin D, depending on previous intake).
The study is specifically geared towards looking at spine bone density, but will also be looking at hip density, thyroid levels, menopausal symptoms, mood changes, depression, and quality of life, as well as any changes in blood fats. Study participants are between the ages of 45 and 60 and are within five years from menopause. What’s more, the researchers have also included a large percentage of hispanic women, which allows them to focus on how soy affects this minority group (Notably, the large multiethnic population of women in this study includes Asians, Blacks and Caucasians.)
The researchers say that they hope that the results of SPARE will provide a range of information that is especially relevant to Boomers reaching menopause. They also note that the dose of soy isoflavones being studied is much larger than what’s been studied in previously and are roughly twice that typically consumed in the Asian diet.
I realize that this post is pretty scientific. But what makes it most relevant is that it appears that researchers are finally starting to design studies that might actually show benefit of some of the alternative strategies we have available to us on the market. For those of you who insist on calling these alternatives “snake oil,” all I can say is ‘stay tuned.’
This bubble might finally be shattered; perhaps all that is needed is a better understanding of what it needs to test these substances appropriately.
Read MoreIs black cohosh a flash in the pan?
I am a true believer of black cohosh, that wonderful herb that for many women, simply stops hot flashes in their tracks. The clinical evidence in support of the effect of black cohosh on symptoms has also been pretty positive, except when it comes to bone health. Admittedly, I’m a bit in the dark on this one because I had never read anything associating the two…until now.
To examine the effect of black cohosh on bone density, researchers randomly assigned 128 postmenopausal to one of three regimens:
1) Six weeks of highly intensive exercise directed towards protecting bone mass (e.g., strength training, aerobic activity) interspersed with 10 weeks of moderate intensity exercise (e.g. brisk walking)
2) The above program plus 40 mg/day black cohosh
3) Wellness program (light exercise for one hour a week, such as stretching, walking, balance)
Although exercise had a definite and positive effect on bone mineral density, taking black cohosh provided no additional benefit. However, women who were assigned to wellness only did experience a minor decrease in the bone density in their spine compared with women who exercised. Other variables, including lean body mass, heart disease risk and menopausal symptoms, were also favourably impacted by physical activity but again, not by the addition of black cohosh. The study was published in the online edition of Menopause.
Clearly, when it comes to bone density, exercise is the winner. Black cohosh does not appear to add any additional benefits, although it may ultimately prove to enhance any positive effects on menopausal symptoms, especially since previous clinical trials have been favourably in this regard.
Time will only tell. In the interim, keep moving and don’t rely on black cohosh to preserve your bone health.
As always, Reuters Health has done great reporting on this same study. I encourage you to check it out!
Read MoreWednesday Bubble: osteoporosis – all bets are off!
Which came first? The chicken or the egg?
When it comes to osteoporosis, all bets are off. Researchers are now saying that age and not estrogen decline is the primary culprit in development of osteoporosis in women. Estrogen simply acts to “accentuate” the negative results.
Aging increases what science refers to as “oxidative stress.” This means that as we age, an imbalance is created between certain molecules that freely circulate in the body (better known as free oxygen radicals) and cause major damage to cell and vessels walls and the body’s natural ability to fight them off. Not surprisingly, oxidative stress has been linked to numerous chronic illnesses, including cancer, heart disease and diabetes.
In so far as osteoporosis goes, the loss of estrogen and androgens decrease our natural defenses against oxidative stress in bone in particular, leading to increased bone breakdown (resorption). The body also starts to overproduce certain hormones that directly affect the the vitality of the skeleton, causing bones to become brittle and more prone to fracture. However, studies also show that bone loss can begin in both women and men as early as age 30 or so, well before any major changes in sex hormone production.
The question is, what can we do about it?
Researchers have also found that there is a specific family of proteins in our bodies that act as a natural defense against oxidative stress. These proteins, better known as FOS (foxhead box transcription factors) are integral to a healthy lifespan and also, preserving bone mass. If researchers can identify what causes the decline in FOS, they may be able to devise strategies to preserve our reserves. Meanwhile, estrogen gets at least a partial reprieve this time.
Sources: Manolagas SC. Endocrine Reviews. 2010. Ambrogini E. Cell Metabolism 2010;2:136-146.
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