Bone Health Vitamin D Osteoporosis X
We can't stay young and live longer without healthy bones!
Osteoporosis, a condition of weak, brittle bones that fracture easily, has become an epidemic among older people in the U.S. and other developed countries. So much so, that in response to the widespread risk of osteoporosis facing older Americans, the Surgeon General's Office, in December 2004, released The 2004 Surgeon General's Report on Bone Health and Osteoporosis.
In the U.S. alone, some 280,000 women and 70,000 men--almost all over 65 and suffering from osteoporosis--fall and fracture a hip each year. The experience is so devastating that 15 percent die within twelve months. Those that recover must usually walk with a cane or use a walker for the rest of their lives.
Osteoporosis is so common in modern, industrialized countries that we EXPECT to see our older citizens shrink in height and develop a hunched-over posture. Older women in particular are prone to fractures and to chronic pain in the middle of the upper back.
All are symptoms of osteoporosis and they are largely the result of our over-mechanized lifestyle and our almost total dependance on the automobile. Both have robbed us of the physical exertion people used to get by walking and bicycling (and by a dozen other healthful activities such as using a wheelbarrow instead of a garden tractor--one of many similar gas-guzzling status symbols which have helped make Americans the most flabby, overweight people on earth.)
To cap it all, we have almost eliminated fruits and vegetables from our diet, the very foods our bodies need to maintain a healthy calcium balance.
Osteoporosis isn't the only by-product of our sedentary lifestyle. Every year, millions of people as young as 35 are crippled by back pain, often for weeks or months at a time. And most back pain is due to the same weak, flabby muscles that lead to osteoporosis.
For several years following menopause, many women lose 3 percent or more of their bone mass each year. Which is why osteoporosis is four times as common in women as in men. But millions of men are also afflicted with the brittle bone condition, though usually it appears at an older age than in women.
In our sedentary culture, poor bone health can disable us anytime after our middle-thirties. No one can hope to stay young or live longer with chronic back pain or advanced osteoporosis.
But according to advisories by the world's top bone experts, none of this needs to happen
Through adopting the Live To Be 90 Lifestyle Plan we can build a youthful, robust skeleton that keeps our bones strong and healthy throughout life. The Live To Be 90 Lifestyle Plan is described in the report "How to Age-Proof Your Body Naturally" , listed on our Home Page menu and I strongly suggest reading it ASAP.
The Live To Be 90 Lifestyle Plan lets us replace all the bone-building exercise and nutrients that are missing in our modern, hi-tech way of life.
If we do have chronic back pain or osteoporosis, it lets us take back control of our skeletal health and we can continue to enjoy a high quality of life. In most cases, we can recover from ailments like a herniated disc or spinal fracture without surgery. And we can stabilize bone density and, very possibly, restore at least some of any bone strength we may have lost.
I can say this with some confidence because this report is a concensus of recent studies, opinions and advisories drawn from bone and aging research centers in some of the world's top university medical centers, and from leading bone experts around the world. Overall, these experts agree that for most people, a combination of bone-boosting exercise and diet can do more to upgrade bone health than any combination of surgery and drugs.
Antidote To Bone Loss
Exercise is the closest thing to a miracle therapy for restoring bone health. In at least one study, in which participants exercised aerobically one day and did strength- building exercises the following day--and kept up the program six days a week for several years--they gained an average of two percent in bone density and strength each year.
In the slow-moving world of bone metabolism, that's considered quite dramatic, especially when some of the participants were in their seventies and early eighties. Meanwhile, a sedentary control group lost two percent in bone density and strength each year.
Further proof comes from X-rays of tennis players which invariably reveal that the bones in the playing arm are bigger and more robust than the same bones in the non-playing arm.
Weight-bearing and strength-building exercises build stronger bones because they challenge our skeleton with physical demands to which the bones respond by increasing density and strength. Exercise also cuts risk of a hip fracture by at least 50 percent through improving balance and preventing falls. Exercise also promotes uptake of calcium in the body from the gut rather than from skeletal bones.
While exercise is undoubtedly the most powerful bone-builder in existance, it can't work without needed raw materials and nutritional support. In this case, the raw materials are Calcium and Vitamin-D . And the nutritional support is called Calcium Balance.
Understanding Calcium Balance is Key To Beating Osteoporosis
Our bones may seem solid but they consist of dynamic, living tissue, each with its own network of blood vessels and nerves. Each skeletal bone consists of a porous protein matrix through which calcium, phosphorus, magnesium and other minerals flow. In healthy people, new bone is always being laid down and old bone removed. Cells that build new bone are called Osteoblasts while cells that remove old bone are known as Osteoclasts.
Because bone is living tissue, exercise stimulates osteoblast cells to strengthen the matrix in our bones and to lay down more calcium, magnesium and other essential minerals. By contrast, a sedentary lifestyle stimulates osteoclasts to remove old bone without any replacement. This results in the net loss of bone density and strength we call osteoporosis.
Calcium is by far the most common mineral in our bones and we need adequate amounts of calcium (plus Vitamin-D) in our diet. But boosting bone growth isn't just about gulping down glasses of milk or calcium supplements and Vitamin-D pills. That's because foods that are high in calcium are not always the same foods that promote Calcium Balance.
Most foods are either alkaline or acidic. To remain healthy, our blood and bodies must be alkaline. Complex inner mechanisms ensure that we do not become acidic. Becoming acidic is actually a serious disease state called acidosis. Unless acidosis is quickly corrected, it can cause irregular heartbeats, muscle spasm, nerve paralysis and eventual death.
How do our blood and bodies remain alkaline when we indulge in acidic foods like meat, fish and cheese? When digested, these foods leave a strongly acidic "ash" in the gut. The body neutralizes this acid with calcium, a strong alkali. If there's sufficient calcium in the gut to do the job, fine. But all too often, there isn't.
Immediately it senses an alkaline deficiency, the body releases Parathyroid Hormone (PTH) from glands in the throat. This PTH then draws calcium from the bones to buffer the acid just like antacids do in TV ads.
The result: Calcium Balance is restored. But only at the cost of weakening the bones. If we keep on thinning our bones by eating meals high in animal protein, we may eventually develop osteoporosis. Meanwhile, the calcium from our bones is excreted in the urine.
The solution is to eat foods that are both alkaline AND high in calcium. Fruits, vegetables, nuts and similar vegetarian foods are often good sources of calcium AND they are strongly alkaline to begin with. This means they don't have to be buffered by calcium drawn from the bones, and they do not contribute to osteoporosis.
Testing Yourself For Mineral Deficiency
Most labs offer a simple blood test for PTH and Vitamin-D. If you suspect poor bone health, most experts recommend taking such a test to ascertain your PTH and Vitamin-D status.
It's even simpler to test the pH of your own body. pH stands for "Potential of Hydrogen" and all you need is some litmus paper and a color chart which you can buy in kit form at most health food stores.
To use it, take a sample of your urine and of your saliva first thing in the morning. Swallow your saliva a couple of times before taking the actual sample in a spoon. Test each sample with a small piece of litmus paper and allow them to dry for a few seconds. Then match their color with the color chart and read off your pH level.
The range of pH is from 1 to 14 with 7 being neutral. Above 7 is alkaline and below 7 is acidic. While not all our sources agreed on exactly the same reading for each color, the general concensus for pH Readings for both saliva and urine was as follows:
Putting it all together reveals the following picture.
LOW PTH and/or HIGH pH, 7 OR OVER
This indicates your calcium, magnesium and Vitamin-D intake is optimal, your alkaline level is high, you have no mineral deficiency, and your calcium needs are being met from your diet (the gut) and not from your bones.
You can create these healthy conditions by eating a diet high in fruits and vegetables especially dark green leafies such as kale, collards, broccoli, turnip greens, dark berries, bananas; sodium-free soy products; almonds, filberts, cashews and other nuts; seeds, including flax seeds; blackstrap molasses, and whole grains such as buckwheat, brown rice and millet. Consuming alkaline foods such as these also stimulates osteoblast cells to build new bone.
For best Calcium Balance, 80 percent of your food should come from plant (alkaline) sources and 20 percent from protein (acid) sources. While the excessive consumption of animal protein-- beef, chicken, fish or dairy--by many Americans causes huge acid overload and bone loss, we still need some protein to maintain the matrix in our bones. Studies have shown that approximately 20-25 percent of the calories in our diet should consist of protein.
Actually, we don't have to eat animal foods at all to have adequate protein. High quality protein is readily available from vegetarian sources such as beans and rice, nuts, seeds and soyfoods. This means we can obtain all the protein we need from alkaline foods that have a positive effect on our Calcium Balance.
For example, in the "Study of Osteoporotic Fractures" reported in the American Journal of Clinical Nutrition (March 2001, Vol 73), the authors concluded that a high ratio of animal to vegetable protein in the diet increased the rate of bone loss in postmenopausal women during the 7 year study period. The study was conducted with a cohort of 1,035 white women aged 65 or over. Women eating a high percentage of animal protein had a significantly higher rate of bone loss at the hip and a fracture risk 3.7 times greater.
The authors concluded that vegetable-based protein is better for bone health and suggested that bone density loss and hip fracture risk can be decreased by replacing animal protein with protein from vegetable sources. The same study found that diets high in animal protein create a net acid load that has a negative effect on Calcium Balance and other markers of bone turnover.
Another essential bone enhancer, Phylloquinone or Vitamin-K , is abundant in the alkaline-rich foods listed above. It works in conjunction with Vitamin-D to bind calcium into bone matrix. And it's considered such an important bone enhancer that Tufts University has its own Vitamin-K Lab.
When they looked at Vitamin-K consumption in 73,000 women in the Nurses Health Study, Tufts researchers found that women who consumed at least 109 mcg of Vitamin-K daily were 30 percent less likely to suffer a hip fracture during the ten year study period than women who consumed less. Calcium and Vitamin-D were still necessary but both worked better in conjunction with Vitamin-K.
Vitamin-K is abundant in such high-alkaline foods as kale, brocoli, cabbage, lettuce, chard, bok choy, seaweeds like dulse, wheat germ and Natto, a fermented soy product. But dark green leafy vegetables are the richest source.
Vitamin-K is also available in supplements. In one study, the authors found that taking 250 mcgs of Vitamin-K daily in supplement form reduced fracture risk by 65 percent. If you don't eat Vitamin-K rich foods, the authors recommended taking three separate doses of 100 mcgs of supplemental Vitamin-K daily.
Whether from supplements or food, Vitamin-K is best absorbed if taken with a fat like avocado or olive oil. Like all supplements that come in pills, it is probably absorbed faster if ground into a powder in a pestel and mortar, then mixed into food. (It should be used with caution if you are on blood-thinning agents.)
Magnesium is another bone-building mineral abundant in unprocessed plant foods especially whole grains, nuts, beans, avocado, soy foods and bananas. If you don't consume some of these foods daily, it can be taken in supplement form such as Magnesium Aspartate and you may need a 200 or 400 mgs supplement each day. Zinc is another essential mineral that is available in supplement form.
PTH MODERATE and/or pH 6.5-7.0
This indicates that our Vitamin- D intake may be adequate but our calcium intake is inadequate and that our calcium needs are being met from both gut and bones. While not too destructive, this situation is often due to eating too many foods that are neither strongly acidic nor strongly alkaline. Such neutral foods include fats and oils, beans, whole grain breads and cereals, peanuts and peanut butter, oranges, peppers, potatoes, rhubarb, root vegetables, milk and spinach.
PTH HIGH and/or pH 6.5 OR LESS
This indicates that both calcium and Vitamin-D intake are inadequate and that our calcium needs are being drawn from the bones rather than the gut. This condition is probably due to a diet high in acid-forming foods especially beef and other meats, cheeses, fish and fish oil, chicken, eggs, salted tofu or soy protein isolate, table salt, refined grains (white flour, sugar, candy etc.), caffeine, carbonated beverages and Vitamin-A (Retinol).
A diet high in these foods can cause a significant calcium deficiency. As the pH drops, osteoclasts draw calcium from the bones and bone density declines. Notorious bone destroyers include carbonated beverages (full of sugar) and Vitamin-A (Retinol).
Vitamin-A in the form of Retinol appears to speed up bone loss in older people while inhibiting absorption of calcium from the gut. Studies have shown that a Retinol intake above 1,500 mcg per day almost doubles the risk of hip fractures compared with an intake below 500 mcg. In the Nurses Health Study, for instance, women taking the highest amount of Vitamin-A had a 48 percent increased risk of hip fracture while those taking the least Vitamin-A had the lowest hip-fracture risk. Yet many multi-vitamin supplements contain 4,000-8,000 mcgs of Retinol while a single serving of cod liver oil or other fish oil may contain even more.
It's far better to meet your Vitamin-A needs by eating yellow-orange fruits and vegetables like carrots, cantaloupe melons or sweet potatoes. Each can supply your Vitamin-A needs without risk of overdose.
Long term emotional stress can also intensify bone loss by elevating levels of the steroid hormone cortisol. An emotional crisis can also trigger back pain by sending the back muscles into a painful spasm without any physical cause. So we need to keep our emotions in balance as well as our calcium.
If you've read this far, you've probably noticed that foods which promote bone growth bear a strong similarity to foods that protect against heart disease, cancer, diabetes and other killer diseases. If so, you are well on the way to becoming a medically-informed layperson, ready to take charge of your own bone health and well-being in cooperation with your health care professional. But you aren't quite there yet. There are still other important things to know about bone health and osteoporsis.
Win Back New Bone With Calcium
Calcium is the major mineral that fills the porous space in the matrix of our bones. Altogether, our bones contain about 1 kilo or 2.2 pounds of calcium.
In developed countries, most physicians and other people equate calcium intake with dairy foods. Certainly, milk can be advantageous for bone health but many people find milk difficult to digest while others are turned off by the natural growth hormones it contains, plus other hormones added to boost milk production.
Milk itself has a nearly neutral pH but cheeses and other dairy products may be strongly acidic. While dairy foods are good sources of calcium they do little or nothing to promote Calcium Balance in the body. And as we've learned, good Calcium Balance can be a stronger predictor of healthy bones than a diet overloaded with calcium.
Skeletons of early man show that people had strong, powerful bones long before milk first became a food ten thousand years ago. (Yes, researchers took age and other factors into consideration.) Researchers also found that primitive man consumed around 2,000 mgs of calcium each day and that 90 percent of it came from vegetable sources. Our ancestors thrived on a diet rich in calcium, potassium, magnesium, Vitamin-K and Vitamin-C, all supplied by wild plants that were strongly alkaline and that boosted Calcium Balance.
Adding more calcium to our diet in the form of dairy products doesn't seem to improve bone health. One study found that South African blacks have a calcium intake of only 200 mgs per day versus 1,000 mgs for African-Americans. Yet American blacks have 9 times more hip fractures than African blacks. Several studies have concluded that countries with the highest calcium and animal protein consumption tend to have the highest rate of osteoporosis. At least one study concluded that the more milk we drink, the greater the bone loss.
It has become increasingly clear that the ideal way to get our calcium is in the form of strongly alkaline vegetables that promote Calcium Balance while simultaneously meeting our calcium needs.
Foods that match these requirements are (in order of calcium content): collard greens, bok choy, turnip greens, mustard greens, kale, beet greens, broccoli, whole grain bread, okra, lettuce, green beans, potatoes, zucchini, sweet potatoes, brussels sprouts, and carrots.
Can Foods Like These Keep Our Bones Strong Throughout Life?
As nearly as possible, Yes! People with large, dense bones that were laid down by a combination of physical activity and a diet of bone-healthy foods in childhood, are less likely to experience bone loss and osteoporosis later in life.
Considering the sedentary lifestyle, constant sipping of soda pop, and the junk food indulged in by so many youngsters nowadays, the outlook for healthy bones in adults 40 years from now seems increasingly dim.
Our ability to absorb calcium decreases with age. By age 80, absorption has decreased by one-third from that at age 30. Approximately one-tenth of older women have lost 40 percent of the ability to absorb calcium that they had when younger. Regardless of age, however, we can absorb calcium better from foods than from supplements.
The Most Popular Calcium Supplements
Calcium Carbonate: made from oyster or egg shells, is the cheapest and most common supplement. Each 1 gram of supplement contains 400 mgs of elemental calcium, a fairly high concentration. Absorption is good if taken with meals and for most people, this is the one best choice.
Calcium Citrate, is bulkier, costlier, somewhat better absorbed and doesn't have to be taken with meals.
Calcium Aspartate is good but expensive and for most people, unnecessary.
All calcium supplements are best divided into two doses, one taken in the morning, the other in the evening.
Most sources recommend a total daily calcium intake of:-
(By the way, some women may still be taking HRT for bone health. The same study that found increased risk of breast cancer, heart disease and blood clots from a single HRT product found the same product cut risk of hip fractures by 34 percent and other osteoporosis-caused fractures by 23 percent.)
Now that so many foods are fortified with 100-600 mgs of calcium per serving, it's not difficult to consume 2,500 mgs a day or more. Everything from energy bars to waffles, breakfast cereals, orange juice, soy products and similar foods may all contain additional calcium. Anyone taking 1,200-1,600 mgs of supplemental calcium per day can easily overdose, especially if consuming dairy foods as well.
On the other hand, smoking or too much salt, caffeine or animal protein can inhibit calcium absorption. Meats and carbonated beverages are loaded with phosphate that has a detrimental effect on Calcium Balance. Yet sodas have become so popular they are rapidly replacing milk. Sodas contain nothing of value for bone health while milk at least contains calcium and Vitamin-D.
A deficiency of calcium can increase probability of gum or periodontal disease, which can lead to tooth loss and increased possibility of heart disease. But the right dose of calcium can also help control blood pressure and to prevent colon cancer.
Groundbreaking Discoveries About Vitamin-D
Whether our calcium comes from milk, vegetables or supplements, it must bind with Vitamin-D before it can become chemically-active in the body. Vitamin-D and calcium maintain a delicate balance in our bodies. Too much of one or the other can increase risk of certain cancers while too little can lead to loss of bone or teeth and to osteoporosis and fractures. One third of all people who fracture their hip are Vitamin-D deficient.
According to the Vitamin-D Council, Vitamin D occurs in two forms:
1} As Vitamin-D3 or cholecalciferol, produced by the skin on exposure to sunlight. Cholecalciferol may also be taken as a dietary supplement (be sure it does not contain any Vitamin A as do all D3 supplements made from concentrated fish liver oil). Either form becomes a pre-hormone that the body transforms through a 3-step process into a mild steroid hormone. Either form also acts as a catalyst for the absorption of dietary calcium into the skeletal bones and teeth.
2} As Vitamin D2 or ergocalciferol, which is an analog (chemical copy of D3) manufactured in the lab from irradiated yeast or fungi. Health food stores sell it as a supplement in pill form. D2 also acts as a catalyst for absorption of calcium from the diet into the body's bones and teeth. But, according to the Vitamin-D Council, D2 has none of the other properties of D3 and it is not transformed into a mild steroid hormone.
Understanding The Vitamin D Process
When sunlight strikes our skin, it forms molecules of cholecalciferol. These molecules are carried in the bloodstream to the liver. Here, they are transformed into the storage form of Vitamin-D called Calcidiol (aka 25OHD or 25hydroxy vitamin D). Calcidiol is a pre- hormone which is stored in fat cells and the bloodstream for later use.
When your doctor orders a blood test to check if you have a Vitamin-D deficiency, it is your Calcidiol level that is being measured. Labs used to quote the ideal level as between 35 and 48 ng/ml but new guidelines have raised the optimim level to 35-100 ng/ml.
Assuming your Calcidiol is in the recommended range, some is transported to the kidneys to help maintain calcium levels in the blood and bones. The remainder then enters tissues throughout the body where it is converted into Calcitriol , the biologically-active form of Vitamin-D. Calcitriol is a mild steroid hormone believed to have many health benefits.
For example, Calcitriol triggers your tissues to make a variety of enzymes and proteins needed by the body for optimum health and --according to the latest research--to help prevent a variety of common diseases ranging from cancer to heart disease, hypertension, diabetes, muscle weakness and even obesity and depression.
A similar process occurs when you take Vitamin D-3 (cholecalciferol) orally as a dietary supplement. But D2 (ergocalciferol) supplements have a different molecular structure and do NOT become Calcidiol or Calcitriol. In fact, the Vitamin-D Council does not consider D2 as real Vitamin D. Most Vitamin-D supplements are clearly marked as either D2 ergocalciferol (vegetarian) or as D3 cholecalciferol (from a synthetic pharmaceutical grade of D3).
Caution: scarfing down either D2 or D3 at higher doses neither prevents cancer nor builds stronger bone.
Many people obtain Vitamin D from fortified foods such as milk or breakfast cereals. But usually, there's no way of telling whether you're consuming Vitamin D2 or D3. And Vitamin D-3 is definitely the preferred form.
Most nutritionists today recommend taking at least 1000 I.U. per
day of Vitamin D3 in supplement form or a maximum of 2,000 I.U for the
average person. If you spend time outdoors each day in a sunny location
where your skin can absorb Vitamin D3 from solar exposure, you may need
less. Or if you are older, black or overweight, you may need more.
For more info on getting Vitamin D3 from sunlight or from supplements,
go to
www.vitamindcouncil.org/
By the way, Vitamin D3 is one of the least expensive supplements available. Most supplement makers charge the same for a bottle of a hundred 1,000 I.U. tablets as for a hundred 400 I.U. tabs. Thus it's appreciably cheaper to take a 1,000 I.U. tab 5 times a week, as to take two 400 I.U. tabs daily. A good synthetic pharmaceutical grade of D3, free of bone-destroying Vitamin A, is sold by Life Extension (www.lef.org) and by Source Naturals (www.sourcenaturals.com) .
Bone Health From The Sun
Until recently, most people in developed countries obtained 90 percent of their Vitamin-D from sunlight. Just about all measurements for Vitamin-D intake were made 20 years or more ago when people spent more time outdoors and fear of skin cancer had not caused older people to wear protective clothing or apply sunblock every time they went outdoors. Our modern fear of exposure to sunlight is at least partly responsible for our epidemic of osteoporosis.
Despite this, we still obtain up to half our Vitamin-D from exposure to the sun. The good news is that it's impossible to overdose on Vitamin-D obtained by exposing our skin to the sun. The bad news is that north of Latitude 30. from October through April, the sun is too weak to provide Vitamin-D through our skin. Latitude 30 degrees North runs roughly through Tallahassee, FL to New Orleans and Big Bend National Park. From here west, only a few places near the Mexican border might have adequate sunshine.
But everywhere else in the U.S., from fall through spring, unless you obtain Vitamin-D from food or supplements, you are likely to become Vitamin-D deficient. Surveys made in Boston have found that 60 percent of older people become Vitamin-D deficient each winter.
Moreover, ability to synthesize Vitamin-D from sunlight drops steeply after age 70 and those over 80 can synthesize only half as much Vitamin-D as they could at age 20. Cloudy skies or air pollution can reduce Vitamin-D from sunlight and in places like Boston, overall bone density drops and the fracture rate rises throughout the winter.
Solar Exposure Is Key To Obtaining Vitamin-D
Primitive people, who lived outdoors and exposed more skin surface to the sun, were able to build up a backlog of Vitamin-D during summer and store it in their fat cells to be drawn on in winter. Since Vitamin-D can be obtained from sunlight without risk of overdose, and without consuming strongly acidic fish or fish oil, many experts now recommend sunbathing as the ideal way to synthesize pro-Vitamin-D3 .
The average white person's untanned skin will synthesize sunshine into Vitamin-D3 only during the first 20 minutes of solar exposure. No more Vitamin-D is produced after that. Experts consider this too short a time to become sunburned or to significantly increase risk of skin cancer or melatonin. To be safe, most experts recommend sunbathing for only one-fourth the time it takes for your skin to begin to redden. Thus if it takes an hour of sunbathing for the first trace of redness to appear, you should expose your skin to the sun for only 15 minutes at a time.
People with tanned or dark skin usually require more than 20 minutes of solar exposure, possibly up to twice as long. The same cautions against sunburn apply, however, and the same amount of Vitamin-D can be synthesized as in fair people with white, untanned skins.
Although blacks tend to have stronger bones to begin with, their pigmentation reduces production of Vitamin-D from sunlight. The result: they tend to have a greater Vitamin-D deficiency than whites. Some researchers believe that reduced Vitamin-D intake due to dark skin pigmentation at least partly explains why black men have a higher rate of prostate cancer than whites.
Rather than stay in the sun longer, you can boost your Vitamin-D intake by exposing more skin surface to the sun. Just exposing your arms and legs can triple the Vitamin-D normally supplied by your skin. But when a woman wears a swimsuit or shorts and halter , or a man wears only shorts, Vitamin-D production soars--and all without spending more time in the sun.
To sunbathe safely without burning means taking your Latitude, cloud cover and the season into consideration. You will also burn faster at higher elevations. Except in winter, mid-morning or mid- afternoon may be the safest time for sun exposure. Sunbathing only twice a week may be adequate in summer while 3 short exposures a week may be needed in fall, winter or spring.
It's often possible to combine sunbathing with outdoor exercise like walking. Begin sunbathing gradually and never get even slightly sunburned. Older people or those unaccustomed to sunbathing, even for brief periods, should consult a physician before starting. People with certain disease conditions should not sunbathe nor take Vitamin-D supplements.
To estimate your Vitamin-D intake from all sources, it's smart to begin with a Vitamin-D Test at a lab. The test to ask for is called "25hydroxyvitaminD" or 25(OH)D and it's considered a better marker than an older test, still in use, called 1,25(OH)D3. The test measures your Vitamin-D level and the higher the number, the less likely you are to have a Vitamin-D deficiency.
Some authorities believe that any reading under 32 indicates a Vitamin D deficiency. However, the Vitamin-D Council recommends keeping your level between 35 and 80 ng/ml. Milk also has about 100 I.U. per cup but the actual amount varies widely and it may be D2 rather than D3. Milk is the only dairy food fortified with Vitamin-D.
Vitamin-D tests are cheap and if yours is too low or too high, you should recheck it every 90 days, or every 180 days the second year.
Most doctors advise older people to take 1,500 mgs of calcium and up to 2,000 I.U. of Vitamin-D each day. They rarely say where the Vitamin-D is to come from. Yet there's little doubt that solar exposure is the one best source. This combination then provides the raw materials our bodies need to build strong bones through exercise.
Walk Away From Bone Loss
Bone health is influenced 33 percent by diet and solar exposure; and 66 percent by exercise. Working in the research labs of Tufts University, scientists have developed the ultimate exercise program to stimulate bone growth.
It consists of a program of weight-bearing aerobic exercise one day followed by a program of strength-building exercises the following day. Working out for only 30 minutes on six days each week, this scientifically-tested program has boosted muscle strength and bone density in thousands of postmenopausal women, many in their seventies and even eighties. Invariably, the women became stronger, fitter and more youthful while their ability to balance improved so much that fractures due to falls were almost eliminated.
Both muscle and bone gain size and strength in direct proportion to the physical demand placed on them. Each time a weightlifter adds more weight to the barbell he lifts, his muscles grow in size and strength. Tufts researchers discovered that this same technique not only made muscles bigger and stronger. It also increased the size and strength of the bone to which the muscles are attached.
Granted, bone growth is slower and less dramatic. But bone can be strengthened just as surely as muscles. And the way to strength bone is to strengthen the muscle to which it is attached.
Weight-bearing exercise, such as brisk walking, imposes the body's full weight on the legs. In response to this challenge, leg muscles grow stronger. And slowly but gradually, the density of the thigh and leg bones increases. Or at very least, it may stabilize or, perhaps, lose density at a much slower pace.
Since walking briskly makes muscles grow faster, it follows that the more briskly you walk the more the density of your leg bones and spine increases. In one study, women who walked briskly for 30 minutes 3 times a week increased the Bone Mineral Density (BMD) of their spine by 1.1 percent over a 7 months period.
But low-intensity walking actually resulted in a BMD loss of one percent (compared to a loss of 1.7 percent in sedentary controls). Slow-intensity walking still showed loss of BMD. Yet when a similar cohort of slower women walked TWICE as far in a similar study, their BMD ROSE nearly one percent.
Aerobic exercise builds bone density fastest when you walk or exercise in your Heart Target Zone. You can find your personal heart target zone like this. Assuming your age is 70, subtract your age from 220. (Example: 220 - 70 = 150.) Your maximum heart rate is thus 150 beats per minute (bpm) which you should never exceed.
Next, take 60 percent and 80 percent of your maximum heart rate (which in this example is 90 and 120 beats per minute). Your heart target zone is 90-120 bpm, with an average of 105. While exercising, you can estimate your actual heart rate by how hard it feels.
The BMD of your leg bones and spine will increase fastest when you are walking near the upper end of your heart target zone. The harder it feels, the more your BMD should be growing. One way to ensure you stay in your heart target zone is to walk uphill. You could also carry a weight of 5 or 10 pounds, wrapped in a towel and worn in a rucksack . If walking in your heart target zone is too difficult, however, simply walk twice as far, or for twice as long, at the best pace you can make.
Traditionally, it's always been thought that walking was the most effective aerobic bone-building exercise. Yet a 1993 study of cycling by Bloomfield et al., demonstrated that partial weight-bearing exercise may also increase spinal BMD in postmenopausal women.
After pedaling stationary bikes at 70 percent of maximum heart rate 3 times a week for 30 minutes over an 8 month period, participants INCREASED their lower spine density by an average 3.3 percent compared to a LOSS of 2.44 percent in sedentary controls.
More important, femoral neck density increased by 2.5 percent while decreasing .75 percent in the controls. The femoral neck (of the thigh bone) is where hip fractures occur. All participants were also taking calcium and Vitamin-D and HRT, hormone replacement therapy.
Presumably, the same result could have been achieved by cycling for twice as long at a slower pace. Experienced cyclists who can ride their own bikes safely on the road at 70 percent of maximum heart rate, could expect similar bone density gain. (Caution: not all studies have found that bicycling increases bone density. In fact. bike racers and swimmers tend to have a lower BMD than runners or tennis players--due perhaps to lack of impact.)
High or low impact exercise, like skipping rope or tennis, have shown an inconsistent ability to increase BMD. Swimming does not improve BMD either though it does improve aerobic fitness. For people with arthritis or joint problems, swimming has slowed bone loss due to age (and it has reversed drug-induced osteoporosis in mice).
Best Exercise For Strong Bones
Strength-training means using your muscles against a gradually-increasing resistance, usually either free weights or Nautilus-type machines in a gym. For older people, especially women, working out on machines in a gym is safer and easier than using free weights. But you can also work out in your living room, using only a few light dumb-bells together with a chair, a doorway, a sofa and a wall as your equipment.
The basic idea is to strengthen your bones by strengthening your muscles. That's why we perform strength-building exercises on alternate days, providing our bones with a day of rest during which they can grow.
To begin strength-training, I strongly recommend ordering the video BE BONE WISE--EXERCISE, available On-Line from the National Osteoporosis Foundation at www.nof.org. Or you can use a book like STRENGTH TRAINING FOR STRONG BONES by Susie Dunan, or EXERCISES FOR OSTEOPOROSIS by Dianne Daniels. Also well worth reading is STRONG WOMEN, STRONG BONES, G. P. Putnam & Sons, by Miriam Nelson Ph. D., associate chief of the Human Physiology Lab at Tufts University--it tells how to avoid osteoporosis or mitigate it if you have it. All are available On-Line from www.amazon.com
Alternatively, you can begin a strength-training program at a local gym. Have a fitness trainer or, preferably, a physical therapist, prepare a special bone-strengthening program that includes exercises to improve your balance. Similar programs are being offered by many Ambulatory Care Centers in conjunction with local hospitals. You will be shown, first, how to use the machines. From then on, you can work out on your own 3 times a week for the cost of the regular membership fee.
Good bone-building results have been obtained by using machines like the following which are commonly found in gyms: Leg Press; Standing Calf Raise; Leg Extension; Leg Curl; Multi-Hip Muscle Trainer; Abductor/Adductor Muscle Trainer; Butt Blaster; Back Extension; Abdominal Crunch, and Stair Climber.
Anyone 55 or over or who is frail, falls frequently, or has had a fracture, should consult a physician or, preferably a sports-medicine orthopedist, before beginning a strength-training program.
Among the benefits of strength-training are a stronger lower back, a fitter and more youthful appearance, greater flexibility and a reduced risk of falls. That's because 90 percent of osteoporosis-related hip fractures, and 80 percent of spinal fractures, are all caused by falls.
When balancing exercises are included in a strength-training program, your risk of falling is cut in half or less. Yet among those who don't exercise, one-third of women over 65 and one-half of women over 80, experience a fall every year. Strength-training programs that focus on combating osteoporosis almost always include balancing exercises.
Overall, weight-bearing aerobic exercise tends to increase or stabilize BMD, while strength-building exercise increases or stabilizes bone strength. Which is exactly why Tufts University uses both types of exercise to promote healthy bones.
Don't Panic If Your BMD Is Low
If a Bone Density Test shows you have a low BMD, don't panic! A BMD (Bone Mineral Density) test measures only the amount of mineral in your bone. It does not measure the microscopic structure of your bone known as the matrix. And actual bone strength depends on both bone density AND the structural integrity of the matrix. So while your BMD is the best current method of assessing bone health, it does not provide a complete assessment of bone strength.
People with a low BMD do not automatically progress to a hip fracture, while some people with a normal BMD still manage to fracture their hip. Basing treatment on a low BMD alone remains controversial. A low BMD may lead your doctor to over-treat you while a high BMD may turn out to be a false reassurance that detracts from healthy bone behaviour such as exercise, diet and preventing falls.
1. HIGH-NORMAL: to determine your T-SCORE, your BMD is compared with the optimal and peak bone density of a healthy 30- year old. As BMD falls, your T-SCORE rises into negative territory. A score of -1 to -2.5 is classified as Osteopenia while a score of 2.5 or higher is classed as Osteoporosis. A T- Score of -1 indicates a loss of 11 percent in bone density while a score of -2.5 is equivalent to a loss of about 27.5 percent.
2. AGE-MATCHED: to arrive at your Z-SCORE, your BMD is compared with the average BMD of people of the same age, sex and build. Since most older people have a low BMD, the Z-SCORE can be misleading.
Basing diagnosis on the T and Z scores is often considered debatable. Regardless of bone health, older people have a lower BMD than younger people. Some bone experts fear that comparing the BMD with that of younger adults leads to a higher proportion of older people being diagnosed with Osteopenia or Osteoporosis than is actually the case.
OSTEOPENIA: is a condition of Low Bone Mass assumed to exist when you have a T-Score between -1. and -2.5. A reduction in bone mass is a universal function of aging and all too often, Osteopenia becomes a precursor of Osteoporosis. However, Osteopenia is still an intermediate level of bone loss which can usually be slowed, halted or gradually reversed by the diet and exercise program in this report.
OSTEOPOROSIS: is assumed to exist when your T-Score reaches a level of -2.5 or more below the young adult mean. Bones become weak, brittle and porous and break easily. Osteoporosis in women is related to a reduction in estrogen after menopause and in the post-menopause years some women may lose as much as six percent of bone density per year. By age 60, the loss rate falls to about one percent a year and after age 70 to only .5 percent.
As men become 70 or older, their risk of fracture may equal that of women 7 years younger. Hip fractures in men are apt to be more devastating. Starting at age 58, most men begin to lose about one percent of their bone mass annually unless they practice a bone-healthy lifestyle.
Other Osteoporosis Risk Factors
Besides a low BMD, other osteoporosis risk factors are:
Preventing A Hip Fracture
Regardless how advanced your bone loss is, you can continue to lead a fairly normal life provided you can avoid fracturing a hip. A hip fracture means spending 3 weeks or more in hospital, followed by a month in a nursing home, and being partially disabled for the rest of your life. In developed countries, one women in 5 will fracture a hip and at least 15 percent will die within a year.
Yet 90 percent of hip fractures are caused by falls, most of which could be easily avoided by steps like the following.
Choosing The Best Health Care Professional
Except for simple backache, anyone with a painful spine, back or other skeletal problem should consult a health professional--preferably an osteopathic physician or a sports- medicine orthopedist or a Geriatrist--before treating chronic back pain or osteoporosis with exercise and diet. Doctors of chiropractic, such as those practicing the Gonstead or McKenzie methods, are also knowledgable--and often very successful--in treating back pain and bone health.
But all too many American physicians are physically unfit themselves and tend to medicalize natural body processes like aging or menopause by classifying them as diseases and treating them with surgery or drugs. So be sure any physician you consult is pro-exercise and not obsessed with pharmaceuticals.
While you may need an X-ray or MRI or bone scan to measure your bone density, or to confirm a damaged disk or fracture, most skeletal conditions respond far better to a healthy lifestyle and diet than they do to medical treatment. For some skeletal ailments, new minimally-invasive surgery or drugs like bisphosphonates may still be the best option. But most top bone experts today agree that exercise and diet should be given a fair trial first.
It's important not to let the thought that you have bone loss prevent you from exercising. Provided your health care professional says it's OK for you to walk or do strength-training exercise, then be sure to do it. The days when it wasn't feminine to exercise or sweat are long gone.
Throughout Europe and America, rural women have 20 percent less bone loss than urban women. Rural women may drink more milk. But they have stronger bones because they exercise their muscles doing farm work for several hours each day.
So this report will not go into the pros and cons of bone-building drugs. Suffice to say that every drug is a double-edged sword with adverse side effects that can make it far from a perfect solution. Another reason pills may fail to work is that people often forget to take them. (See National Osteoporosis Foundation website below for review of medications.)
All of which implies that the facts in this report should be regarded as information only and they should not be misconstrued as medical advice. For more information about osteoporosis, click on these official websites.
www.nof.org National Osteoporosis Foundation, the American view. Click on "Patient Information" for medications. Also has full 2004 Surgeon General's Report on Bone Health and Osteoporosis.
www.maleosteoporosis.org Men's Osteoporosis Support Group, packed with info about bone loss in men
www.strongwomen.com Good info from Tufts University about the Holistic Approach to treating osteoporosis in women and men.
www.vitamindcouncil.org
The Vitamin D Council focuses on Vitamin D Deficiency Syndrome which
is reaching unprecedented levels in Western nations and is responsible
for an epidemic of osteoporosis and related diseases.
www.sunarc.org/ ( Sunlight, Nutrition and Health Research Center. Preventing chronic disease, including osteoporosis, through lifestyle and dietary choices, with focus on the special benefit of sunlight and Vitamin D3.
Dr. Mercola: Vitamin D Lowers Inflammation
Dr. Mercola: Ten Important Facts About Vitamin K.
Also go to www.mercola.comand type "Osteoporosis" or "Vitamin D" into the search field.
The Big Question For Most Americans Is:
"I don't have time for all this exercise, sunbathing and the litmus tests. And how can I control my diet when I eat out?"
Answer: the Centers for Disease Control, and most other health advisory agencies, have almost unanimously agreed that, to prevent heart disease, cancer and diabetes, most Americans need to exercise for a full hour and to eat 7-9 fruits and vegetables each day. Since you can exercise and sunbathe outdoors at the same time in summer, and pop a pill for Vitamin-D in winter, exercising for bone health takes no more time than following exercise advice that already exists.
The same foods that cause our 3 big killer diseases are also detrimental to bone health. So if you're already exercising daily, and following a heart-healthy diet, you're already covered for most aspects of bone health. Thus, following our Live To Be 90 Lifestyle Plan should not require any additional time.
And if you doubt that a Vitamin D deficiency has already created an epidemic of osteoporosis in America, read the story below by Scott Allen, published in the Boston Globe, December 30, 2004.
Vitamin D deficiency tied to host of dangers
A growing body of scientific evidence suggests that the widespread deficiency of Vitamin D among Americans is more harmful than once believed, increasing their risk of fractures, muscle weakness, and even cancer as they age. In response, two key scientific panels are considering how to close the nutrition gap without compromising another important health campaign: the fight against skin cancer.
More than 40 percent of American adults have low blood levels of vitamin D, which people can get from foods such as milk and wild salmon as well as nutritional supplements. During nonwinter months, however, people can also get vitamin D from standing in the sun for a few minutes several times a week. That amount of exposure may seem trivial, but many dermatologists worry that any sun exposure may increase the risk of skin cancer and, more significantly, that encouraging some sun exposure will lead some people to overdo it.
Until recently, public health officials advised people to avoid sun exposure altogether and regarded Vitamin D deficiency as far less important, believing that the danger of low Vitamin D levels was mainly an increased risk of fractures among the elderly and a rare disease called rickets among children. But recent research has shown that older people with adequate Vitamin D levels have better muscle control, lower blood pressure, and fewer ills such as multiple sclerosis and arthritis, compared with people with lower vitamin levels.
Now, a forthcoming Harvard School of Public Health study is expected to show that adequate vitamin D levels reduce cancer risk by 30 percent, increasing pressure on the US Department of Agriculture to raise the recommended daily consumption of the nutrient. The new data also are likely to add to the chorus of Vitamin D advocates who say it is time to lighten up on the anti-sun message.
"We absolutely have a huge problem with vitamin D deficiency," said Dr. Bess Dawson-Hughes, director of the Bone Metabolism Laboratory at Tufts University, who argues for both more dietary vitamin D and sun exposure just long enough to trigger the body's Vitamin D machinery. "It's hard for things to be so polarized because a little sunlight goes a very long way in producing Vitamin D. . . . I don't think there's a villain here."
For most people, she said, 10 minutes a day of sun exposure to the face and arms without sunblock protection is enough to trigger Vitamin D production in the skin during warm weather. However, from mid-October to mid-March, the sun's rays in northern cities such as Boston are too weak to generate Vitamin D, causing a regionwide drop-off in blood levels through the winter.
Vitamin D researchers say the attention to the issue is overdue. Researchers such as Dr. Michael Holick of Boston University School of Medicine argue that the anti-skin cancer campaign actually made the Vitamin D deficiency worse by keeping people out of the sun while not at the same time advocating increased Vitamin D consumption in diets. Since Vitamin D is not found in many foods, and many adults are lactose-intolerant, he believes the sun is the leading source of Vitamin D for most people.
"There hasn't been a balanced conversation about what compromise we can reach for best protecting people for Vitamin D and still protecting against skin cancer," said Connie Weaver, director of the Botanical Center for Age-Related Diseases at Purdue University. "Now [Vitamin D] is getting a lot of attention. The science is driving it."
Work in Dawson-Hughes's lab, for example, showed that Vitamin D is important for muscle performance in older people, and those who had higher levels could get up from a chair and walk better than those with lower levels. As a result, Dawson-Hughes suggests that Vitamin D, which helps the body retain calcium, is important for preventing falls and fractures as people age.
Other studies have suggested that higher Vitamin D levels help protect against colon, prostate, and breast cancer, but a long-term study of 50,000 men by researchers at Harvard School of Public Health suggests Vitamin D may reduce the risk of all cancers. The study, which is still under review for publication, found that men who consumed higher levels of Vitamin D reduced their overall cancer risk by at least 30 percent, according to lead author, Ed Giovannucci. The findings were statistically significant, he said, and a separate study of women is expected to produce similar results.
Giovannucci, who declined to discuss details of the study before publication, said cells in general use Vitamin D to remain normal, making them less likely to grow out of control the way a tumor does. If everyone had adequate Vitamin D levels in their bloodstreams, he said, "It would be equivalent to eliminating a big portion of cancer."
The American Academy of Dermatology, a leader in the anti-skin cancer crusade, held a conference last summer on how to respond to the findings about the risks of Vitamin D deficiency. The group's conclusions have not yet been released, but it is expected to recommend increased Vitamin D consumption, especially for the elderly, but only through food and vitamins.
Research has shown that sunburns, particularly during childhood, increase the risk of developing skin cancer. Though the evidence is less clear for shorter exposures to sunlight, the dermatology group advises sunscreen and clothing protection for anyone in the sun 20 minutes or longer. And they fear that any encouragement to go into the sun will cause people to be unprotected for much longer.
"The public would love to have the message that they should go to the tanning booths or go to the beach" without sunscreen, but that isn't safe, said Dr. Barbara Gilchrest, chairwoman of the dermatology department at Boston University School of Medicine. Gilchrest said people worried about low Vitamin D levels should take a vitamin supplement.
Earlier this month, the scientific panel that advises the USDA on nutrition met on whether to recommend increasing the daily consumption of Vitamin D. Current guidelines are based on 1997 science, when little was known about the nutrient's role in muscle strength or cancer protection.
In addition, nutrition specialists were concerned that excessive Vitamin D could also be dangerous, so the USDA approved daily Vitamin D consumption of no more than 600 international units for people over 70 and as little as 200 for those under 50. Today, vitamin D researchers such as Dr. Joel Finkelstein of Massachusetts General Hospital suggest people of all ages should get 800 units of Vitamin D or more, the equivalent of eight cups of milk or two Vitamin D supplements (of 400 I.U. each).
The Food and Nutrition Board of the Institute of Medicine, as the government advisory panel is known, has not decided whether to open a formal review of the science of Vitamin D, but the board's director, Linda Meyers said there appeared to be plenty of support among scientists. Its recommendations would then be used by the USDA to change its nutritional advice to the country.
© Copyright 2004 The New York Times Company and reproduced here under the Fair Use provision of the U.S. copyright law.
CAUTION: Though these reports are based on documented studies in professional journals or on advisories from leading university medical schools and research institutes, they are intended for information only and should not be regarded as medical advice or instruction. For diagnosis and treatment of specific symptoms and diseases, disorders or dysfunctions, consult your physician. If you smoke or are over 35 or have symptoms of--or are at risk for--any chronic or degenerative disease, you should check with your doctor before beginning to exercise or making any changes in lifestyle or diet. However, fitness organizations like the American College of Sports Medicine invariably believe that the risk of NOT exercising far exceeds any risk in beginning a gradually increasing program of daily exercise. Thus if you experience any pain or problem while exercising, or making any other lifestyle change, stop and see your doctor at once.