New study shows that probiotics may improve bone health.

A new study, published recently in the Journal of Internal Medicine, showed that probiotic supplementation may have a positive affect on bone health in humans. The double‐blind, placebo‐controlled study involved 90 women aged between 75 to 80 years old and had low bone mineral density (BMD). They were randomized to receive daily oral supplementation (1010 colony‐forming units of L. reuteri 6475) or placebo over a 12 month period. The results of the study showed that daily supplementation reduced bone loss in older women with low bone density. While more studies are necessary to back up these results, this study introduces new possibilities for those who are looking for non-pharmacological approaches to treating osteoporosis in the aging population.
Read the abstract, here, or read the study in its entirety below.
For more on how probiotics can improve your health, watch Dr. LeBaron’s lecture: “What’s Your Gut Feeling?
[gview file=”//kaplanclinic.com/pdfs/Nilsson_et_al-2018-Journal_of_Internal_Medicine.pdf”]

Q&A: Maximizing Calcium Intake From Leafy Greens

Q:
“I love green, leafy vegetables, but need calcium. How long should I wait between eating foods with calcium and green, leafy vegetables to prevent oxalate binding of the calcium. I usually eat spinach and kale with some kind of fat, like eggs, salad dressing or other oils. Thank you!”
A:
Adequate calcium intake is important for maintaining healthy bones. Dietary calcium can be found in a number of dairy foods, sardines, certain legumes, even oranges! But when you eat calcium-rich foods along with foods that contain oxalate, a type of antinutrient found in certain vegetables, legumes and grains, calcium bioavailability and absorption is compromised. Examples of foods high in oxalates (also called oxalic acid) are spinach, parsley, beet greens, kale, chard, peas, fava beans, navy beans, rice bran, soy flour, and wheat berries. Other common antinutrients found in greens, legumes and grains are: phytate, tannin, saponins, lectins and isoflavaones.
In order to prevent oxalate from binding to calcium is to eat foods known to contain oxalic acid 2 hours apart from dietary calcium sources. Doing this will allow enough time for the body to absorb it.
Research show that soaking green, leafy vegetables in water for at least 30 minutes, or boiling them, can significantly reduce their antinutrient content. Other methods include sprouting, and fermenting.
by Nour Amri, MS, CNS, LDN
 


 
https://kaplanclinic.com/recipe/spinach-salad-pomegranate-glazed-walnuts/

exercise for bone health

7 Steps That Can Help You Prevent Painful Compression Fractures!

Research shows that one quarter of post-menopausal women eventually suffer from the compression or collapsing of some vertebrae, the bones that comprise the spinal column. Compression fractures can compromise one’s ability to function or cause disabling, chronic back pain.
Although these injuries are common, they usually can be prevented, delayed, or mitigated by adopting a healthy lifestyle that includes:

  1. Engage in resistance training, such as weight training and yoga, every other day, for 30-60 minutes per work-out ideally. There is good news for those who struggle to find those 30-60 minutes: a 10 year study that was completed in 2015 measured the bone mineral density (BMD) of 741 participants pre and post yoga regimen. Participants who routinely engaged in 12 yoga poses per day for just 12 minutes showed a reversal of osteoporotic bone loss.
  2. Do some weight bearing exercise like running, walking, or hiking, for at least 30 minutes per day. Weight bearing exercises work against gravity and stimulate bone cells to produce more bone.
  3. Get your Vitamin-D levels tested to ensure that they’re between 50-100 mg. If your levels are low, consider getting more sunshine (exposing some of your skin surface for about 15-30 minutes per day) and taking a supplement. Most people need between 3,000 to 5,000 iu of supplementation, but some may need up to 10,000 iu. If you take Vitamin-D supplementation, make sure to have your 25-hydroxy, Vitamin-D level checked two to four times per year.
  4. Check your calcium intake. Women should consume a total daily amount of calcium between 1200 and 1500 mg, with no more than 600 mg from supplemental calcium. Taking in more than this amount in supplemental form can lead to increased risk of heart disease and kidney stones. Good sources of dietary calcium are sardines, white beans, almonds, oranges, leafy greens, and dairy.
  5. Consider bioidentical hormone replacement therapyBefore prescribing medications, I explore the possibility of using bioidentical estrogens and progesterone or estrogen analogues like Evista to prevent bone loss.
  6. Talk with your doctor before using medications to treat bone loss. Because most of these medications work by decreasing bone breakdown, this can potentially cause more brittle, unhealthy bone and result in fractures of the femur and jaw necrosis. I would reserve medication treatment for those with severe osteoporosis or history of pathological fractures. Before considering bisphosphonates, like Fosomax, Actonel, Boniva, Reclast, or a newer injectable, Prolia,  it is recommended to complete any dental procedures before starting treatment for osteoporosis. Be sure to report any persistent jaw or thigh pain to your doctor immediately. Another treatment option is Miacalcin, a synthetic version of the hormone, calcitonin. It has been shown to build bone more so in the spine than in the hip, and it offers users some pain-relief. Two alternatives to the bisphosphonates and Miacalcin are Forteo and Tymlos, synthetic versions of a hormone called parathyroid hormone which also builds bone. Some of these drugs however, carry warnings about an increased risk of bone tumors called osteosarcoma.
  7. Ask your doctor about Bone-Density Imaging and “Urine osteomark.” It’s important to evaluate the effectiveness of any medications or hormone replacement therapies you may use because each individual inevitably has their own unique response to a given treatment. A urine test, called a “urine osteomark,” tracks bone breakdown, and therefore, is great way to measure the therapeutic benefits of treatment between bone-density-imaging studies.

In sum, there’s a lot you can do to keep your bones strong! So, do it!
//kaplanclinic.com/videos/osteoporosis-treatment-prevention/

vitamin d

Vitamin D – For More Than Strong Bones

Though there is an abundance of research on the health benefits of Vitamin D, some estimate that up to 80% of certain populations in the US may have lower than advisable levels in the body. Furthermore, the definition of what constitutes a deficiency has changed over the years, making analysis of the scale of the problem more difficult.

Mechanisms of Vitamin D

Vitamin D receptors are present in nearly every tissue and cell in the body, making it essential in maintaining many of the body’s physiological functions. At a minimum, Vitamin D maintains bone health by helping the body to absorb calcium, keeping bones healthy and strong. A deficiency over a prolonged period of time can lead to a loss in bone density and a higher likelihood of fractures and falls as a person ages.
We also know that adequate Vitamin D levels can lower the risk of developing heart disease. Research shows that a 10ng/ml increase in Vitamin D levels results in a decrease in C Reactive Protein (CRP), which is a marker associated with heart disease (the higher the CRP levels, the higher the risk of heart disease). Higher CRP levels are also indicative of other inflammatory illnesses in the body.
Vitamin D is essential for the normal and healthy functioning of the immune system. When adequate levels of Vitamin D are not maintained, the microglia – the immune cells of the Central Nervous System that initiate temporary inflammatory responses to attack foreign invading organisms – are unable to function optimally. Subsequently, people with low levels of Vitamin D are at higher risk of developing a host of inflammatory conditions such as Arthritis, Multiple Sclerosis, Type1 Diabetes, Migraine, Depression, Fibromyalgia and various forms of cancer.

Vitamin D Intake

Vitamin D can be obtained in the following ways:

  1. Exposure to sunlight. Vitamin D3 is produced when bare skin is exposed to UV rays. Factors such as sunscreen use and geographic location can affect a person’s Vitamin D level. Experts say that approximately 5-10 minutes per day without sunscreen, 2-3 times a week,
  2. Food. While there are not too many foods that naturally contain Vitamin D, good sources include fatty fish such as tuna, salmon, sardines, and mackerel. It can also be found in eggs (specifically the yolks) and in liver.
  3. Nutritional supplements. Taking a daily supplement of Vitamin D is an easy and effective way to maintain adequate levels in the body. However, because Vitamin D is fat-soluble, it is harder for your body to eliminate it if levels get too high. Therefore, make sure to talk to your physician about the dosage that’s best for you. Make sure also to only use supplements from a reliable manufacturer given that supplements are not FDA regulated.

How much Vitamin D is enough?

Vitamin-D is a fat-soluble vitamin, which means that it is stored by the body in fat tissue and remains on reserve for future use. This also means, of course, that it is possible to reach toxic levels if too much is taken.
The Institutes of Medicine (IOM) recommends supplementation of up to 600 IUs per day, and up to 800 IUs per day for those over 70 years old. The IOM also suggests, however, that a person may need a much larger dose depending on his/ her state of health.
These are general recommendations – the only way to determine appropriate dosage is by having serum levels measured by asking your doctor to order a “Vit. D 25-OH-D” test (also called Vit. D 25, Hydroxy). This is the best test to accurately determine if you have adequate levels of Vitamin D in your body.
Serum levels are considered normal in the 30-100ng/ml range, but when the goal is optimal health, maintaining a level of 50-60ng/ml is ideal.
 
 

Does Raw Kale Interfere with Calcium Absorption?

Q: I know that calcium is a necessary mineral and one that, if properly assimilated, is useful in many pain situations. I, and many others, have been adding kale, spinach, beet greens, and chard to protein shakes, a current “thing to do.”
But I have read that kale and spinach, among other foods, contain oxalic acid and as such interferes with calcium absorption in the intestines. I have also read that casual consumption is ok. Can you talk about this in terms of whether adding kale in my morning shake inhibits all calcium absorption for the whole day or whether a little each day is ok? Thank you!

Maria Hepler, RDN, CLT: Calcium, which is an essential nutrient for strong bones, can be found in many green leafy vegetables, such as collard greens, spinach, mustard greens, kale, and Swiss chard. However, oxalic acid, an organic acid found in spinach, chard and beet greens, and moderately in kale, among other plants, binds with the calcium they supply and reduces its absorption, so in their raw form these should not be considered a good source of calcium.
Does this mean you should not add kale or other greens that contain oxalic acid to your smoothies? Not necessarily. Cooking or steaming these vegetables can significantly reduce the amount of oxalic acid present, which will help with calcium absorption (make sure to drain your greens thoroughly as the oxalates go in the water).
My suggestion would be to precook your leafy greens and store them in the freezer (in individual portions) for quick access. When you’re ready to make your smoothie, just grab a portion and throw it in! Cooked and drained, kale is also a great addition to soups, stews, and even pizza!
Other foods that will boost the calcium content in your smoothie, are unsweetened Greek yogurt (which also contains a good amount of protein), almonds, and flax seeds.
– Maria

Preventing & Treating Osteoporosis with Yoga, Diet, & Medications

We often consider the frailty and disability associated with osteoporosis and osteopenia (bone loss that is not as severe as osteoporosis) as a normal part of aging. Medical research shows, however, that it’s not aging, but inactivity that causes bones to weaken and easily break. Although medications may be necessary to treat severe osteoporotic conditions, the best preventative strategy is to engage in bone-strengthening exercises, like yoga, and to make sure that you are getting the bone-healthy nutrition you need.

How Common Is Osteoporosis?

It is estimated that more than 40 million Americans suffer from osteoporosis or are at high risk of developing the condition due to low bone density.1 In its early stages, the disease is likely to be painless or nearly painless, but as osteoporosis progresses and bones become brittle and break, the pain and disability can be severe. Many hip fractures occur when someone with osteoporosis falls. The complications associated with these fractures can require long-term nursing care or even lead to death.

In addition to osteoporosis, there are many other age-related health problems that increase one’s risk of falling, including poor balance and posture, poor vision, inner ear imbalances, a decline in proprioception (which helps us know where our body is in space), poor circulation and medications that can cause dizziness. Each of these problems, especially in combination with a decline in bone strength, increases the likelihood of fracturing a hip or vertebrae.

Risk Factors: The condition is usually seen in individuals over 50, but it can strike at any age, and there are factors that put you at higher risk, such as:

  • Being female
  • Low body weight
  • Lack of physical activity
  • A family history of osteoporosis
  • Early menopause without hormone replacement
  • Prior bone fractures
  • Chronic use of steroid medications
  • Smoking
  • Drinking alcohol excessively

Prevention and Treatment:

Yoga: One of the safest preventative measures and treatments for osteoporosis and osteopenia is yoga. It’s something that anyone, any age, can do anywhere; the benefits are many and risks few if done correctly.

A pretty amazing pilot study performed by Dr. Loren Fishman, Medical Director of Manhattan Physical Medicine and Rehabilitation in New York City, showed that when individuals practiced yoga for merely 10 minutes per day over a two-year period, their bone density increased!2 How is this possible? In the 19th century, a German anatomist and surgeon, Julius Wolff, theorized that bone will adapt to the load which is placed on it, i.e., it becomes stronger to resist the load.3 The inverse is also true; as the load decreases, bone becomes weaker. This phenomenon is perhaps best demonstrated by what happens to astronauts in space, who without the force of gravity working on their bones, are at great risk for developing osteoporosis.

In holding yoga poses, tensile (stretching) force and isometric, compressive (weight-bearing) force stimulate the osteocytes (cells found in mature bone) to produce proteins and lay down new bone. Yoga produces both the stress of dynamic loading when moving into a pose and static loading by holding a pose. In addition, yoga stimulates the production of synovial fluid, which not only lubricates and nourishes the joints but also activates chondrocytes (the cells found in healthy cartilage) to lay down new cartilage. By engaging our muscles to both pull and push on the bone, yoga surpasses the bone-strengthening benefits of gravity. The benefits occur when you hold a pose for anywhere between 12 and 72 seconds. I suggest holding each pose long enough to take five to seven deep breaths (about 30 seconds).

Is “the pain worth the gain”? In his book, Yoga and Osteoporosis, Dr. Fishman quotes an ancient guru, who said, “At first, medicine can feel like heaven, but it eventually resembles poison; whereas yoga may feel like poison at first, but eventually it resembles heaven.”4 Even if you already have osteoporosis, practicing yoga can be beneficial in strengthening muscle tissue and bone; however, certain joint movements should be modified or avoided altogether. Consequently, for these individuals, I highly recommend beginning with a customized, one-on-one session with a therapeutic yoga instructor.

A Healthy Diet: To keep our bones strong, it’s also essential that we get enough of the following nutrients:

  • Vitamins: C, D, B6, B9, B12, K
    Minerals: Calcium, Magnesium, Zinc, Manganese, Copper, Boron, Silicon
    Omega-3 fatty acids

Nutritional Supplements: Generally speaking, a diet rich in fruits, vegetables, mono- and poly-unsaturated fats, complex carbohydrates and lean meat (in moderation) will provide the majority of the vitamins and minerals you need. As we age, however, our individual dietary needs and our body’s ability to absorb vital nutrients may change. For this reason, if a patient’s risk factors for developing osteoporosis are high, I often recommend measuring the vitamin and mineral concentrations within his or her body so we can supplement any nutritional deficiencies.

In addition to the nutrients listed above, Strontium has recently been identified as a promising agent in promoting healthy bone maintenance. It has been labeled as a “dual-action bone agent” because of its ability to both decrease osteoclast activity (bone-destroying cells) and increase osteoblast activity (bone-forming cells). In the US, it available in the form of Strontium Citrate, and it has been found to be effective in promoting healthy bone mineralization, supporting healthy vertebrae composition and promoting healthy hip bones. Research studies have demonstrated that the supplement is well tolerated by patients and can be used as an effective alternative to osteoporosis medications.5

Medications: Bisphosphonates, such as Fosamax, Actonel, Boniva, and Reclast, are the usual “go-to” medications for treating osteoporosis because of their effectiveness in reducing osteoclast activity. Unfortunately, however, some of the medications that are used to strengthen bone can produce poor quality bone by interfering with the osteoclastic activity that cleans up dead bone. In addition, patients who take these drugs can experience unpleasant side effects, such as acid reflux, nausea, irregular bowels, musculoskeletal pain, and in rare cases, osteonecrosis of the jaw and femoral fractures. For example, Boniva as an oral or once-monthly injection can increase blood pressure, and Reclast, an annual intravenous infusion, has been associated with atrial fibrillation exacerbation (heart rhythm disorder).6

There are other classes of drugs that can be used to treat osteoporosis such as selective estrogen receptor modulators like Raloxifene; and hormones, such as Miacalcin, Forteo, and Estrogens. Prolia is a monoclonal antibody medication aimed at decreasing the osteoclast (bone destroying) activity that can suppress the immune system and, in some cases, lead to serious infections, including myocarditis (infection of the heart muscle).7 So although there are medications available that can help reduce bone loss, in some patients their side effects may be worse than the risks of living with osteoporosis! (For additional information regarding these drugs, watch: Naturally Healthy Bones: How to Prevent & Treat Osteoporosis, 3-Part Video Series.

How Healthy Are Your Bones?

One indication of bone health is its density, but in terms of strength, the quality of bone is even more important. Its architecture, quality of collagen, the rate of bone turnover, and the size of mineral crystal, all contribute to good bone.

Ask your physician about the painless and brief procedure called a DexaScan that uses two different strength x-ray beams to measure the thickness of a person’s hip or spine. The test results are reported as a percentage from the mean density of a healthy 25-year old (T score). Any value below -2.5% is considered osteoporosis, and any value in the range of -1% to -2.5% is considered osteopenia, which can, but doesn’t always, lead to osteoporosis. There is also a supplemental test called “Ntx” that measures collagen breakdown in the urine associated with increased bone turnover.

These test results, used in combination with other measures of your health, can give you and your doctor a good indication of your bone health and the steps you need to take to prevent or counter osteoporosis. Osteoporosis can’t be cured, but yoga and good nutrition are the best things you can do to prevent the disease or forestall its progression.

References:

1 Fast Facts: What is Osteoporosis? National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center (online resource visited 9/3/13).

2 Wolff, Julius. The Law of Bone Remodelling. Berlin: Springer-Verlag, 1986. Print.

3 Rubin CT and Lanyon LE. Regulation of bone formation by applied dynamic loads. Journal of Bone and Joint Surgery. 1984. 66-A: 397-402. Fishman, Loren, and Ellen Saltonstall. Yoga for Osteoporosis: The Complete Guide. New York: W. W. Norton &, 2010. Print.

4 Fishman LM. Yoga for Osteoporosis, a pilot study. Topics in Geriatric Rehabilitation. 2009. 25(3): 244–50.

5 Genuis SJ and Schwalfenberg GK. Picking a bone with contemporary osteoporosis management: nutrient strategies to enhance skeletal integrity. Clinical Nutrition. 2007. 26; 193-207. Nielsen SP. The biological role of strontium. Bone. 2004. 35: 583-8.

6 Jordan N, Barry M, Murphy E. Comparative effects of antiresorptive agents on bone mineral density and bone turnover in postmenopausal women. Clinical Interventions in Aging. 2006. 1(4): 377-87.

7 FDA Approved, Medication Guide: Prolia. Amgen Manufacturing Limited, a subsidiary of Amgen Inc. One Amgen Center Drive Thousand Oaks, California 91320-1799. Accessed July 2013.