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Yoga for the Prevention, Treatment, and Reversal of Osteoporosis and Osteopenia - A Low-Cost, Low-Risk Way to Strengthen Bones, Improve Balance & Prevent Fractures

Tree Pose

"Physical activity is profoundly  beneficial for bone health. Sure, walking is great for the prevention of hip fractures, but it won't do much for wrist or spinal fractures, so we need other exercises to keep our upper body bones strong.  And the bones that are strongest are the bones that we put stress on."

-Dr. Walter Willett, M.D. PhD, Harvard School of School of Public Health from the "Building Bone Vitality" People's Pharmacy Podcast  click here-

"Evidence in the animal literature confirms that unconventional tugs of the sinews and ligaments can not only arrest, but reverse osteoporosis.   In a pilot study we compared twelve people who completed two years of yoga (the intervention group) with seven people that did not do yoga, the controls. These people had the same average age (66 years), very nearly the same amount of bone loss when the study started, and all had normal laboratory values.  By doing 10-12 minutes of yoga a day, the mean bone mineral density of all the patients  has improved well beyond that of the controls."

-Dr. Loren Fishman, M.D., chief investigator, Columbia College of Physicians-

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Back in March 2010 I was on a mission to find studies that showed the benefits of yoga on bone strength.  It made good sense to me.  One of my yoga instructors said she went from osteopenic to normal after practicing yoga regularly for a few years.  And two friends of mine noticed improved DEXA scans after they began a regular yoga practice. 

Hmm?  Could it be?  Is yoga equal or perhaps superior to Fosamax?  What exactly is all that positive weight-bearing stress that's put on every single bone in the body while practicing yoga doing for our bones?  Think about it--what other exercise targets all the bones that we can potentially fracture?  Wrists, ankles, spine, hips, ankles, the whole package.

All I came up with was one promising article out of Thailand, of all places.  Click here to read that post.

Then, right before I left for vacation, 3 weeks ago, I serendipitously came across Dr. Loren Fishman's exciting pilot study, that looked at a group of men and women--all with osteoporosis or osteopenia--practicing 10 specific yoga poses for about 10 minutes a day--and holding each pose for 20-30 seconds.  Modifications were made for those with osteoporosis--or limited abilities.   Dr. Fishman's article can be found here:  "Yoga for Osteoporosis: A Pilot Study"  Topics in Geriatric Rehabilitation   25(3):244-250, 2009. 

Here is the evidence that a simple yoga practice can improve and prevent osteoporosis and osteopenia if followed regularly.

Fishman had observed that yoga practitioners "seem to live long and fracture-free lives that suggests that the unusual and unusually prolonged pulls they voluntarily self-administer may be a stimulus to bone health."  Many animal and human studies have shown that muscle stress & strengthening improve bone density--so he figured, "Why not take a look at the effects of yoga on osteoporosis?"

Turns out Fishman's hypothesis was right.  Everyone in the yoga group (except for one participant-whose BMD remained close to baseline) improved their bone density well beyond that of the control group after 2 years of practice.

Why so few participants in the study?  It was very hard to get people to follow-through with a home-based practice.  Although 110 participants entered the study, compliance was poor.  In the end, only 11 people completed the 2 year study--with an additional 7 in the control group.  This was a disappointment to Fishman--but have no fears.  He's dedicated to continuing with the study until he gets a statistically relevant group. Phase II began in September 2009 and is on-going. 

Note: To be included in the pilot study patients had to free of bone, metabolic, or endocrine diseases.  They also had to have  normal lab values for parathyroid hormone, thyroid stimulating hormone, electrolytes & blood chemistry, blood cell count, vitamin D 25-OH, & the D1,25-dihydroxy tests.

Yoga Group Improvements

• Hip BMD:  mean increase of .867 units on the T-scale. 
• Spine BMD:  mean increase of .563 units on the T-scale
• Five patients with osteopenia were reclassified as normal after 2 years of practice
• Two patients with osteoporosis were reclassified as osteopenic after 2 years of practice
• Compared to the controls, the yogis gained .76 T-scale points in their spines
• Compared to the controls, the yogis gained .94 T-scale points in their hips

Control Group's Bone Loss

• Hip BMD:  mean loss of -0.12 units on the T-scale.
• Spine BMD:  mean loss of -0.07 units on the T-scale.

What could be easier than doing 10 or 12 yoga poses for 10 minutes every day? 

No side effects like those associated with the typical osteoporosis drugs--like GI discomfort, esophageal erosion, osteonecrosis of the jaw or other sites, leg cramps, or bone pain. Who knows what adverse effects are still yet to be uncovered?  Don't forget about the drug cost savings!

And then there are the side benefits that come with practicing yoga--all of which in one way or another actually prevent potential falls--which is the best way to prevent fractures.

• Reduced back pain
• Reduced anxiety
• Reduced arthritis
• Gait improvement
• Better balance
• Neural plasticity improvements associated with motor learning

Poses used in the pilot study:

1. Triangle Pose
2. Upward-facing dog
3. Downward-facing dog
4. Bridge pose (a moderate back-bend)
5. The Wheel or the Iyengar modification  (a back-bend)
6. 1-legged & 2-legged forward bends--with careful attention to form
7. The Boat pose--stimulates the most vulnerable parts of the spine
8. Supta Padangusthasana (a lying down forward bend that supports the spine)
9. Seated spinal twists
10. Jathara Parivarthanasana (a lying down twist) A pose that stimulates the spine without exacerbating arthritis of the hips.

If you're new to yoga don't get put off by the names of these poses.  Everyone can learn do them--and the benefits extend far beyond bone strength.

The Potential for Continuing Bone Strength Improvements

Fishman says it's likely that the benefits of an on-going yoga practice will just continue to grow.  Practicing for 6 years would likely give one 3 times the benefit that his participants saw after one year.

Here's the best part:  According to Dr. Fishman, "At that rate, a person with osteopenia (a T-score of -1.0 to -2.5) or minimal osteoporosis (a T-score of -2.5) will have spine and hip bone mineral density that is neither osteoporotic nor osteopenic within 6 years of a quiet, costless, and virtually riskless practice of 10 minutes a day."

Now For The Twelve Bone-Strengthening Poses in Fishman's Phase 2 Study

You can find detailed photos, instructions, and modifications for all these poses at this link to Dr. Fishman's web site. 

It may still be possible (can't really tell) to sign up for this study, which includes a timed DVD of the poses, and involves follow-up.  Click here & scroll down to "Open Door Policy" for more info, or contact Dr. Loren Fishman at  e-mail: [email protected]

1. Tree pose--It stresses and thereby stimulates the bones of the hip, pelvis, spine and shoulders. It also improves balance, and thereby reduces the likelihood of falls.
2. Triangle pose--This pose is good for sacroiliac joint pain, and puts strong, stimulating pressures on the bones of the hip, lower lumbar spine and pelvis.
3. Warrior pose II--This pose strengthens muscles of the legs, trunk and shoulders, and places strong but safe stress on the femur, lumbar and thoracic vertebrae, pelvis, knees hips and ankles.
4. Side angle pose
5. The Revolved Triangle
6. The Camel
7. Mild backbends like, the Sphinx, Cobra, Bridge, or Locust
8. Downward-Facing Dog--This pose is a valuable transition from back bends to forward bends, but also stimulates the posterior vertebral bodies as well as the bony elements of the many facet joints in the spine, while putting major stresses front-to-back on the hips, pelvis, shoulders and arms.
9. Reclining leg stretch--This is one of the few forward bends that does not even tempt you to curve your back forward in a dangerous way. It is nearly ideal for osteoporosis for another reason: it engages just about every muscle and stresses almost every bone below the neck.
   
10. Seated twists--Marichyasana III or Ardha Matsyendrasana
11. Lying-down twist--Jathara Parivatanasana.  People with limited hip range of motion have trouble with twists, but they are all-important for retaining strength in the transverse vertebral processes and contiguous vertebral bodies. This twist is easier on the hips than some others, but strengthens the trunk muscles well.
12. Savasana--Corpse Pose.  Mr. Iyengar (the founder of a safe therapeutic style of yoga) comments:  "By remaining motionless for some time and keeping the mind still while you are fully conscious, you learn to relax. This conscious relaxation invigorates and refreshes both body and mind. But it is much harder to keep the mind than the body still. Therefore, this apparently easy posture is one of the most difficult to master." (Light on Yoga,1979 edition, Schocken Books: page 422).

A Must-Read Comment I Received From a Study Participant

Coincidentally, a week ago, out of the blue, I received an email from a current participant in Dr. Fishman's 2nd-round yoga study, after she had read my previous post on the Thailand yoga & osteoporosis study.  Here's what she had to say:

"Hey, there! I can tell you, your friends' (BMD)improvement was definitely related to yoga.

In 2007, Dr. Loren Fishman of Columbia University started a pilot yoga program to study the effects of yoga on osteopenia and osteoporosis.

The study lasted for two years, ending in the summer (Fall?) of 2009. Every single woman who was in the program (and practiced faithfully) made significant gains in BMD. One woman gained 1.5 points in her hips. On average, the scores were +0.7 in the hips, and +0.5 in the spine.

I joined the second round of the study which began in September of 2009, and after only 10 months of daily yoga, I have gone from osteoporosis to osteopenia in three out of five test sites (only my left hip neck and femur are a little sluggish).

You can read more about my particular journey over on my blog thebonearchitect.blogspot.com, and you can read more about the yoga study at www.sciatica.org. 

NOTE:  Be sure to read the updated comment from Raye Lankford.  Her full DEXA scan was even better than she thought!

It's Not Just Bone Mineral Density & DEXA Scans That Count

Bone mineral density is just one measure of bone strength--and maybe not the best. Bones aren't solid--they have an inner network, called the trabecular, which is a crisscross of crosspieces & struts that support the bone, making it strong, and preventing fractures. 

The ability of bones to withstand traumatic stress also depends on the quality of the bone (the strength of the inner trabecular support system)--in addition to the bone mineral density.

Important point:  There is good evidence that only exercise increases the "all important" trabecular bone.  The bisphosphonates primarily add density to the outer cortical bone, which of course is what is measured with the DEXA scan.

Unfortunately, the DEXA scan doesn't measure the strength of this inner network--it measures the outer region of cortical bone.  Which means that it's very possible to have an adequate BMD & still be at risk for fractures because the bone quality is poor.

If you want to really know how strong bone is--you would need a non-invasive way to measure this inner trabecular core of the bone.  That's still in development.

Source:  Fishman's article and Dr. John Abramson's book, Overdosed America: The Broken Promise of American Medicine.  3rd ed.  HarperCollins, 2008.  Chapter on Osteoporosis.

So, What's It Going to Be?  A Pill or Twelve Poses?

I'm putting my money on the poses.  My question to Dr. Fishman is whether the daily 10 minute pose practice trumps taking an hour-long yoga class 2 or 3 days a week.  I'll let you know if I get an answer.

Dr. Loren Fishman's newly released book, Yoga for Osteoporosis

Huffington Post article by Fishman

Take Your Vitamin D at Dinner! You'll Increase Absorption and Boost Your Vitamin D Levels by 50%

"In our practice, it is common to see patients treated with vitamin D supplements who do not achieve an appreciable rise in their serum 25OHD level after therapy despite large prescribed doses.

A consistent increase of 50% or greater was seen in the serum 25OHD concentration when patients consumed the vitamin with the largest daily meal."

-Drs. Angelo Licata, MD, PhD. and Guy B. Mulligan, MD., Cleveland Clinic Foundation Metabolic Bone Clinic, "Taking vitamin D with the largest meal improves absorption and results in higher serum levels of 25-hydroxyvitamin D", J Bone Miner Res Feb. 8, 2010 (ahead of print)-

Click Here for the web version of this post (and all the links) if you've received post this via email.

OK, we all know by now how important it is to raise our vitamin D levels to "optimally" around 50 ng/mL--or at the very least to 32 ng/mL.  If you need a refresher in the importance of vitamin D, click here, here, and here.

But guess what?  It's easier said than done.  I, for one, have found out how slowly those levels really do rise. So what's a person to do--especially if you aren't able to get out into the sun 3 times a week?

All I can say is, "Thank you Dr. Angelo Licata for devising this simple, straightforward research project that's provided an answer for all of us!  From now on, I'm taking my vitamin D with my dinner.  No more taking it on an empty stomach, on the fly, in between meals!"

Licata and Mulligan figured that since vitamin D is fat-soluble, absorption just might improve if patients took their supplements with their largest meal of the day!  How simple is that?  See the Iowa State salad dressing/vitamin absorption study

Who participated in this study?  There were 17 patients, a mix of men & women, with an average age of 64.5, and an average 25OHD level of 30.5.  All were being seen at the clinic for vitamin D deficiency, and they were selected for this study because they were unable to achieve adequate increases in their vitamin D levels despite taking vitamin D supplements.  Turns out, all of these patients were taking their vitamin D either on an empty stomach, or with a small meal, usually breakfast or lunch.

This was great mix of patients.  Because of different factors, some were on "average" doses of vitamin D, and some were on megadoses.  Some were taking D2.  Some were taking D3.  Some were taking an oil preparation.  Some were taking a solid preparation.  And all were having difficulty getting their levels up to optimal levels.

• One group was taking about 1,400 IUs of vitamin D3 (either oil or solid capsule) a day, with a baseline 25OHD averaging 28.9
• One group was taking 50,000 IUs of vitamin D2 (oil preparation) per week with a baseline 25OHD averaging 31.3
• One small group of 3 was taking >50,000 (average dose of 183,333 IUs a week) IUs of vitamin D2 (an oil preparation) per week with a baseline 25OHD averaging 32.4

What were the participants asked to do?  All 17 participants were told to keep taking their usual vitamin D supplement, but take it with their largest meal of the day, usually dinner. 

And the envelope, please.  After 2-3 months the participants had their 25OHD levels measured, and everyone ended up with an amazing average increase of around 50% over baseline in their vitamin D levels. 

• The 1,400 IUs of D3 folks went from 28.9 before to 45.4 ng/mL after.
• The 50,000 IUs of D2 folks went from 31.3 before to 48.3 ng/mL after.
• The >50,000 IUs of D2 folks went from 32.4 to 48.7 ng/mL after.

Big point:  the type of vitamin D preparation taken made no difference--whether it was D2 or D3--oil or solid.  All three groups achieved increases over baseline of around 50%.

Why concerns about taking high doses of vitamin D are unfounded.  Why a Doctors' Care is Critical.

According to Drs. Licata and Mulligan, some patients clearly require very large doses of vitamin D to achieve a mid-range  level.  They recognize that many physicians are concerned about vitamin D toxicity at such high levels.

"However, it is not the dose prescribed alone which should be considered, but how much is actually absorbed.  Some patients require very large doses to achieve mid-normal levels.  Monitoring the serum level is critical. 

A recent study (click here) indicates that serum concentrations of 25OHD only in the high-normal reference interval prevents non-vertebral fracture.  (normal range: 31-80 ng/ML)

Hence, striving to achieve this level (i.e. ~50 ng/mL) may be optimal, rather than a level at the low-end of the normal range."

Thoughts about Citracal:  In light of Dr. Licata's study, I couldn't help but think about how many women depend upon getting their vitamin D from Citracal--the calcium/vitamin D capsule that prides itself on being easy-to-take-and-absorbable on an empty stomach!

Limitations to the study:  This study was small, there wasn't a control group, and there wasn't a way for the researchers to "know exactly how the patients took their supplements." 

"But despite of these limitations, "the results are striking, and consistent across a heterogeneous group of patients (ie different disease states and different preparations and doses of vitamin D).  

It therefore seems reasonable to ask patients to take vitamin D supplements with their largest meal, as it may be a cost-effective strategy that could very well help patients achieve optimal serum levels of 25OHD."

 

Weight-Bearing Yoga Can Have a Positive Effect on Bone Health - Strengthening Bones and Reducing the Risk of Osteoporosis

"The weight-bearing yoga training had a positive effect on bone by slowing down bone resorption which was a very essential indicator for human health because it reduced the osteoporosis risks in this group of postmenopausal women."

-Phoosuwan, M. et al.  "The Effects of Weight Bearing Yoga Training on the Bone Resorption Markers of the Postmenopausal Women"  J Med Assoc Thai 2009; 92(Suppl. 5):S102-8

"Physical activity is profoundly beneficial to bone health & every study that has looked at this has shown a much lower risk of fracture among people who are physically active."

"This really applies to the bones that are exercised--the bones that are stressed.  Walking & other weight-bearing exercise reduce rates of hip fracture--but may not do much for wrist fracture, so we need other exercises for our upper body bones to keep them strong."

--Walter Willett, MD, DrPH, is Chairman of the Department of Nutrition and Frederick John Stare Professor of Epidemiology and Nutrition at Harvard University's School of Public Health--

Click here if you've received this post via email to get to the web version with all the links.

I've been wondering for awhile about the connection between yoga & bone-strengthening.  Here's why.  

• My high school friend Sheila is petite, small-boned, very thin, and osteopenic.  She's sees a rheumatology/osteoporosis specialist, takes bone-strengthening meds and yet she still continued to lose bone density.  When she switched her exercise routine to include a power-sculpt class & yoga she started to see improvements.  She doesn't know if it's because of the yoga or the weights, so she's not about to stop either.

• My college friend Cindy is small-boned, thin, and osteopenic.  She sees an endocrinology/osteoporosis specialist, takes bone-strengthening meds, and recently noticed improvements in the bone density of her wrists--while here hip and spine remained stable.  She wondered if her more regular attendance at yoga classes could be responsible--and the downward-facing dog pose, in particular.

• My yoga teacher mentioned 3 weeks ago that before she started to practice yoga regularly her bone density scan put her in the osteopenic range.  After a few years of regular yoga practice she  moved solidly into the normal bone density range.

Is it really possible that a regular yoga practice can improve one's bone density?  I decided to see if I could find a yoga/bone strength connection in the medical literature. 

Makes sense to my lay-person understanding of bones. 

"Bones are similar to muscles.  Use muscles, and they become bigger and stronger.  Stop using them, and they weaken and atrophy.  Like muscles, when bones are used--when they support weight or carry a load (within reason)--they get stronger.

When bones bear weight, they experience strain.  Strain produces microscopic weak spots.  As those weak spots develop, the bone cells in the vicinity release chemicals that signal the body:  Weak spot!  Send help! 

Bone-clearing osteoclasts converge on the problem area and dissolve the weakened bone.  Then osteoblasts migrate from nearby bone marrow, enter the tiny breach, and create new bone. 

Normal strain stimulates the creation of new, strong robust bone.  In other words: weight-bearing activities give bones a reason to thrive.

--Amy Lanou, PhD & Michael Castleman, Building Bone Vitality.  NY:McGraw-Hill, 2009.  pgs. 154-155.--

Full Disclosure:  Lanou & Castleman are huge advocates of walking outdoors--up & down hills, or up & down stairs, or carrying a load--as a dynamic bone-strengthening exercise.  Dr. Walter Willett is also a big fan of walking for bone health--but he says it strengthens the hip primarily, and we need to stress all the bones in the body.  That's where yoga enters the picture.

Searching the Medical Literature for the Yoga/Bone Strengthening Connection

As crazy as it sounds there is next to nothing written on this subject.  But, I did come across one well-constructed preliminary report published in 2009 in the Journal of the Medical Association of Thailand, of all places.  Click here for the article

Before writing this post, I went back to PubMed and bingo, there's a brand new pre-publication article--hot-off-the-press, called, "Yoga might be an alternative training for the quality of life and balance in postmenopausal osteoporosis,"  Tuzun, S. et al,  European Journal of Physical and Rehabilitation Medicine.  Click here to read the full article.

If you are reading this post you will probably be one of the few people in the country who will have heard about this article.  The Journal of the Medical Association of Thailand can be found in only 12 libraries in the U.S.  With over 5000 medical journals currently competing for attention the odds are slim that this preliminary report will get much notice by anyone.

The Cliff Notes on the Thailand Study

What happens to the bones of women once estrogen walks out of their lives?   Bone resorption begins, and new bone formation decreases.  And we all know what that means.

Knowing that weight-bearing exercises like jogging, walking, and aerobic dancing benefit bone, the author's of this study set out to see if 5 yoga poses would have a similar positive effect.

• Tree Pose
• Downward Facing Dog Pose
• Warrior III Pose
• Triangle Pose
• Half Moon Pose

Who was in the study:  33 healthy, postmenopausal women, between the ages of 50-60 years old.  None of them smoked, drank alcohol, used hormone replacement therapy, or drank more than 2 cups of coffee a day.  No one exercised more than twice a week.  No one had osteoporosis, or a bone mineral density of -2.5

Who did what in the study:  19 women chose to take the weight-bearing yoga training class.  14 women preferred to join the control group, and just continue with their "normal lives."

The Before & After Tests:  Everyone had a blood tests to measure measure their biochemical bone markers.  This included the Beta-CrossLaps Test, which measures bone resorption and is used to monitor antiresorptive therapies (eg, bisphosphonates (click here to learn more), and the P1NP Test, which measures bone formation markers.  Quality of life was also measured with the SF-36 questionnaire, but that isn't my interest here.

The yoga routine for the study:  10 minutes of stretching before and after yoga, to prevent injury.  The group practiced for 50 minutes, 3 times a week, for 12 weeks.  They performed 3 sets of 6 yoga poses. 

This description seems unclear to me, since the authors only discuss 5 poses--but that's how it's written up in the article.

The Results:  After 12 weeks the bone resorption markers (Beta-CrossLaps) of the control group & the yoga group were significantly different (p = .0003).  More importantly, the bone resorption marker of the yoga group was significantly reduced by -26.939% from when they started, compared to the control group's reduction of only -0.77.1%  That means, the markers for bone loss of the yogis was significantly reduced and those yoga poses were clearly having a positive effect on the control group's bones.

What does the improvement in the yoga group mean?  It implies that weight-bearing yoga training could reduce the rate of bone loss in postmenopausal women, and decrease the risk of osteoporosis.

Why does it work?  The poses (postures) used in this study put appropriate and equal stress on a variety of bones throughout the body--the hips, the wrists, the spine, and the arms.  For example, in some poses the participants had to stand on one leg, forcing that leg to bear all the weight of the body--using more leg-muscle contraction to obtain better balance.  That muscle force stresses the bone and kicks in the whole bone remodeling process that is so well explained above by Lanou & Castleman.

Downward Facing Dog Pose and Half Moon Pose stress the bones of the upper body, such as the chest, the back, arms, and wrists.  Tree Pose and Warrior III stress the leg and hip bones.  Triangle Pose stresses the back, hip, and legs.  Doing all 5 poses continuously, and repetitively 3 times a week was enough to wake up the the body's bone remodeling system--resulting in a significant reduction of bone resorption/loss.

Anyone who regularly practices yoga would probably agree that there are far more than 5 poses that put stress on one's bones, muscles, and balance--and often far more than a free weight work-out.  Plank pose, Chaturitanga, Up Dog, Eagle Pose, and toe balances--to name a few.

The Yoga Poses Used in the Study

 

Take Away Point:  This was just a preliminary study, but certainly the results seem promising to me.  Combined with the N=3 experience of my 2 friends & my yoga teacher--maybe yoga has real promise as a way to stave off osteoporosis, de-stress, and improve balance all at the same time.  A 3-for-one exercise.

Don't Miss This Story of "How a Bone Disease Grew to Fit the Prescription", by NPR's Alix Spiegel.  Click here to read or listen to the story.  You can even read the full transcript if you don't want to miss any of it. 

This first class piece of journalism will open your eyes to the whole controversy of whether or not osteopenia is a disease that needs to be treated with a drug.  I'm choosing treatment with yoga, walking, weight-training, vitamin D, and lots of vegetables, especially the greens, and fruit.  More on this later!

Do any yogis out there have some positive bone density scans to add validity to the Thailand study?  I'd love to hear about it.

From the Archives of Internal Medicine--Seven Good Reasons to Exercise and Increase Your Chances For Healthy Aging

Exercising Ladies in their Eighties

Weight Machine Workout for Muscles and the Mind

"Exercise is better than any drug or anything else we have for aging.  There's no downside.  If this were a drug, it would be the safest, most effective drug in the universe."

Dr. James O. Hill, Director of the Center for Human Nutrition at the University of Colorado at Denver

Seven articles--count them!  All in the January 25, 2010 issue of the Archives of Internal Medicine.  

All of them saying the same thing, "Exercise works. Just do it.  Whatever your age.  Start now!"  click here for the Table of Contents.

I must be an exercise geek, because honestly, I find this kind of news exciting, encouraging, and hopeful.  It shows how we really can change our health.  Sure diet is an important partner in health--but exercise has a dual, and synergistic role in the equation.

Why Exercise?  What We Can Learn from Six New Studies & One Editorial?

• Weight-lifting improves the brain. "Resistance Training and Executive Functions,"  Liu-Ambrose, Teresa et al, University of British Columbia.   The Study: Women aged 65-75 who spent 1-2 hours a week on progressive strength/resistance training with dumbbells and weight machines significantly improved their cognitive function after 12 months.  They improved their performance by 10.9-12.6% on the most important brain function: executive ability.  They saw improvements in their decision making, their ability to resolve conflicts, and they were better able to focus on subjects without becoming distracted by competing stimuli.  But alas, no improvements were seen in 2 skills: keeping numbers in their working memory, and shifting from one task to another. The strength training group's skills were measured against a control group who only did balance & toning exercises.  As for the balance and toning group--their scores on executive ability deteriorated by .05%.  The added bonuses found in strength-training?  It counteracts the inevitable muscle loss of aging while improving bone density and strength.  The Canadian group also improved their walking speed--which is a predictor of substantial reduction in mortality.  Big Point: The cognitive benefit showed up after 12 months of training--but not after 6 months.  Those who lifted weights 2 x a week experienced less muscle discomfort than those who lifted only once a week.  No surprise!  Take Away Message: Add strength-training to your exercise routine.  2 or 3 times a week is best.

•  Start exercising at middle-age if you want to stay healthier as you age.  "Physical Activity at Midlife in Relation to Successful Survival in Women at Age 70 Years or Older,"  Sun, Qi et al, Harvard School of Public Health and Harvard Medical School.  Click here for the article.  Harvard researchers looked at the health of over 13,000 women from the well-known Nurses' Health Study who had reached 70 years of age without any physical or mental impairment. Those who had higher levels of physical activity beginning at midlife were less likely to have chronic diseases, heart surgery or any physical, cognitive or mental impairments as they aged.  Take note: regular moderate-intensity (not wimpy) midlife physical activity made all the difference in the world to one's health after age seventy! Those who regularly walked at a moderate pace starting from midlife had a better chance of exceptional health than those who walked at an easy leisurely pace.  Picking up the pace made a huge difference in health--the fastest walkers significantly increased their odds of successful aging over the lollygaggers!  And don't despair, moderate walking improved later-life health in both lean and overweight women.  But those who kept their weight down (BMI range of 18.5-22.9) and exercised more vigorously than moderate walking improved their odds the most. 

Understanding METS.   For women, these are the METS for 1 hour of activity: 12 for running, 8 for stair-climbing; 7 for jogging; bicycling; lap swimming; and playing tennis; 6 aerobics or calisthenics; 2.5 to 4.5 for walking, depending on the pace--easy (<2 mph) normal (2-2.9 mph) brisk (3-3.9 mph) very brisk (4 mph or more)  To get over 15 METS a week you would need to walk 3.5 hrs./week at 4 mph or more.  Example: 30 METS=2.5 hrs of running; 30 METS=6.6 hrs of walking at a pace of 4 mph or more

• Exercise for stronger bones, a better heart, less chance of falls, and to decrease your health care costs. "Exercise Effects on Bone Mineral Density, Falls, Coronary Risk Factors, and Health Care Costs in Older Women-the Randomized Controlled Senior Fitness and Prevention (SEFIP) Study," Kemmler, Wolfgang et al, the Friedrich-Alexander University of Erlangen Nuremberg, Germany. 

"Contrary to pharmaceutical agents, which are typically dedicated to specific diseases, physical exercise affects a variety of risk factors and diseases and therefore plays a vital role in general disease prevention and treatment of the elderly."

In this randomized single-blinded controlled German study, 227 women over age 65 participated in an either an 18 month group exercise program, or in a wellness program (the control group).  The exercise program included 2 60-minute group exercise classes, and 2 20-minute at-home sessions--including aerobic exercise at 70%-85% maximum heart rate, balance training, isometric floor strength training for the lower body, stretching, and upper body thera-band strength training.  The wellness group participated in low-intensity exercise,walking at 50%-60% maximum heart rate, very low-moderate intensity strength training, and progressive relaxation exercises.  Results: Compared to the wellness group, the exercise group significantly improved their bone mineral density in both the lumbar spine & hip; their fall risk decreased with a 50% lower fracture incidence; and both groups (wellness & exercise) significantly reduced their 10-year coronary heart disease risk, mainly because both groups lowered their blood pressure.  Interesting Finding: Participation and adherence was much better in the group exercise classes than with the home exercise component.  Not a surprise to me at all.  I prefer group exercise, hands-down.  Take Away Point:  Even starting after age 65, exercise has a tremendous impact on one's health--and strength training definitely improves bone density.

• Moderate physical exercise reduces the risk of cognitive impairment. "Physical Activity and Incident Cognitive Impairment in Elderly Persons. The INVADE Study,"  Etgen, Thorleif et al, Technische Universitat Munchen, Germany.  This study followed a large group of Bavarians (3,903) age 55 and older for two years.  At the end of the period they compared the incidence of cognitive impairment in the group with their levels of physical activity. The researchers adjusted for all the usual vascular risk factors that might contribute to cognitive impairment.  The Results:  Moderate or high physical activity was associated with a reduced incidence of cognitive impairment after the 2 year follow-up.  For those with no physical activity the incidence of cognitive impairment was 13.9%.  In those with moderate physical activity (less than 3 x a week) the incidence of impairment was 6.7%.  The high physical activity (greater or equal to 3 x a week) seniors had a 5.1% incidence of impairment.  Take Away Point: Exercise can the lower the risk of cognitive impairment--and the more days the better!

• Even in a nursing home exercise can improve the quality of life--but not by that much. "Effects of Exercise Programs to Prevent Decline in Health-Related Quality of Life in Highly Deconditioned Institutionalized Elderly Persons," Dechamps, Arnaud et al, Universite Victor Segalen, Bordeaux, France.  This study included 160 institutionalized out-of-shape elderly (average age of 82) who were still able to understand basic motor instructions & who could move from one position to another.  They were divided into 3 groups: adapted tai chi for 30 minute sessions 3x a week; a cognitive action program which is a type of exercise that is related to everyday actions--from 30-40 minutes 2x a week; and a control group which had no exercise program.  Results:  After 12 months, the non-exercising control group experienced a greater decline in the activities of daily living than the exercisers.  Those in the  exercise programs slowed their health quality decline, however, the improvements experienced by the elderly exercisers weren't considered clinically significant.  Bottom Line:  Although exercise programs in nursing homes can slow down health decline, expecting actual physical improvements may be too much to ask. Don't wait until your eighties to start that exercise program.  You will have a much better shot if you start young--or at middle-age.

• Add exercise and weight loss to the DASH Diet and you will see even greater improvements in blood pressure. "Effects of the DASH Diet Alone and in Combination with Exercise and Weight Loss on Blood Pressure and Cardiovascular Biomarkers in Men and Women with High Blood Pressure," Blumenthal, James et al, Duke University Medical School, North Carolina.  The DASH Diet emphasizes moderate calorie, low fat, low sodium, whole grain foods, along with 6-12 servings of fruits & vegetables a day.  Click here to learn more. The Study: 144 participants with an average age of 52, with an average blood pressure of 138/86 mm Hg, and not on any BP medication were enrolled in the study, and divided into 3 groups: 1. DASH Diet alone with counseling, 2. DASH Diet with a behavioral weight loss program & a supervised exercise program 3x a week at a level of 70%-85% heart rate, or 3. The  "usual diet control" group.  The study lasted 4 months.  Results: The DASH diet + weight loss & exercise group did the best, of course.  Their blood pressure was reduced by 16.1/9.9 mm HG.  Those on the DASH diet alone reduced their blood pressure by 11.2/7.5 mm HG, and those in the  "usual diet control group dropped theirs by only 3.4/3/8 mm Hg. Weight loss: The DASH Diet + exercise & weight management group lost an average of 19.1 pounds.  The DASH Diet alone group lost .7  of a pound.  The "usual diet group" gained 2 pounds.  Cardiovascular Markers:  The DASH Diet + exercise  weight loss group had the greatest improvements in this area-- including less arterial stiffness as measured by pulse wave velocity, an average of 19% improvement in their aerobic capacity (VO2 max), improved baroreflex sensitivity of 33% (less stiffness in the arteries--which is an early side effect of hypertension), and decreases in the size of the left ventricle--a side effect of high blood pressure (increases in the muscle tissue that makes up the wall of the heart's main pumping chamber-the left ventricle).  TAKE AWAY POINT:  The DASH Diet (high in fruits & vegetables, low in salt) + weight loss + exercise is the best combination to lower blood pressure and improve cardiovascular risk factors.

• Exercise--the most effective prescription out there.  It's the best "drug" available to prevent dementia and insure successful aging.  "Evidence Regarding the Benefits of Physical Exercise,"  Drs. Jeff Williamson & Marco Pahor, Institute on Aging, University of Florida.  This editorial in the Archives of Internal Medicine highlights the benefits of exercise on successful healthy aging.

"It is now well established that higher quantities of physical activity have beneficial effects on numerous age-related conditions such as osteoarthritis, falls and hip fracture, cardiovascular disease, respiratory diseases, cancer, diabetes mellitus, osteoporosis, low fitness and obesity, and decreased functional capacity, all conditions that greatly increase the risk of reduced independence in late life. 

Two of these studies (in the Archives of Internal Medicine) evaluated the relationship between physical exercise and decline in cognitive function, a major contributor to loss of independence and related institutionalization in elderly individuals.

Optimism in this area is sorely needed owing to the failure of promising interventions aimed at preventing cognitive decline and dementia in the recent past.

Physical inactivity is one of the strongest predictors of unsuccessful aging for older adults and is perhaps the root cause of many unnecessary and premature admissions to long-term care."

It's the Start of the New Year, the Start of the New Decade, and the Start of My Sixties. Some Simple Strategies for Staying Healthy and Happy. At Least I Can Hope!

Author Dan Buettner has scoured the Earth — not for the fabled Fountain of Youth — but for the key to a happy old age. He spent five years visiting areas of the world where people tend to live longer, healthier lives, areas he calls "Blue Zones."

Buettner says he has identified four things people can do that can potentially increase life expectancy:

• Create an environment that encourages physical activity
  
• Set up your kitchen in such a way that you're not overeating
  
• Cultivate a sense of purpose 
  
• Surround yourself with the right people.

"These are long-term fixes that have been shown over and over to add not only more years of life, but better years of life."

-NPR story, "Can 'Blue Zones' Help Turn Back the Biological Clock?", June 8, 2008-

If you're reading this through via email, click here to get to the more readable web-version.

 

It's the start of the New Year. 

It's the start of a new decade.

It's the day I turn sixty.

Look, I'm not a big-birthday-celebration-kind-of-person.  They come and go and I don't even think about the years.  But turning 60 is different.  It's the last quarter of life, with no guarantees on what that quarter is going to look like.

Judging by my parents--that last quarter of life doesn't look so promising.  Which is exactly why I've been paying attention to exercise and eating right since I turned 30. 

That's when my dad had one of those massive debilitating strokes that left him unable to communicate, unable to read or fully understand speech, and eventually unable to walk or do anything.  He was 69 at the time--just when he was getting ready to kick back a little, work a little less, travel, and just enjoy life.  He spent 16 years living in this kind of post-stroke-limbo-state, spiraling downward.

My mom was 62 at the time, and my dad's stroke changed her life in an instant.  One minute she was planning all the trips they'd finally have a chance to take--and enjoying their new role as grandparents--and in the next she was jockeying the world of wheelchairs and therapists.

With the stress of full-time care-giving, and years of no exercise or attention to diet, by 72 she had developed severe coronary artery blockages, hypertension, kidney stones, and painful spinal fractures.  Then came the mini-strokes that finally added up to vascular dementia in her eighties.

And unfortunately, this scenario is all too common.  "[M]ost elderly Americans – more than two-thirds of current 65-year-olds, according to a detailed 2005 projection by a team of health policy analysts — at some point will need assistance to cope with daily living, either paid help or unpaid, at home or in a facility."

So, sixty seems kind of scary to me.

Which is exactly why I'm ready for a more "Conscious Aging" plan.  We already have all the evidence we need to stay healthy.  It's not about adding more years to our lives.  It's all about adding more life to our years!

Just a sampling of the evidence.

• The 52 country INTERHEART study was very clear.  There are 9 easy-to-modify risk factors that are associated with 90% of heart disease.  This was a huge study--30,000 people from every inhabited country--and the results were the same for all races, all sexes, all countries.  All 9 of these risk factors are within our control--and would eliminate 90% of heart disease, regardless of one's genetics. 1. Keep lipids (cholesterol & triglycerides) down; 2. Stop smoking; 3. Prevent or control hypertension; 4. Prevent or control diabetes; 5.  Reduce belly fat; 6.  Find ways to control psychological and social stressors; 7. Increase fruit and vegetable consumption; 8.  Moderate alcohol consumption is protective; 9. Get regular physical exercise   Lancet 364:937-952, Sept. 11, 2004.
• The Nurses' Health Study and Health Professionals Follow-up Study.  "The largest and longest study to date, done as part of the Harvard-based Nurses' Health Study and Health Professionals Follow-up Study, included almost 110,000 men and women whose dietary habits were followed for 14 years.  The higher the average daily intake of fruits and vegetables, the lower the chances of developing cardiovascular disease...[F]or every extra serving of fruits and vegetables that participants added to their diets, their risk of heart disease dropped by 4%." Harvard School of Public Health

• The China Study.  This is Dr. T. Colin Campbell's mammoth 2006 study on the effects of a plant-based diet on health--citing over 750 studies.  The conclusion: People who ate the most-animal-based foods got the most chronic disease.  People who ate the most plant-based foods were the healthiest and tended to avoid chronic disease.  According to Campbell, "Good nutrition supported by exercise, clean water, and sunshine is greater than the sum of its parts.  It's a biological symphony.  My introduction to Dr. T. Colin Campbell

• The Longevity Personality.  From the Journal of the American Geriatrics Society, April 2009 comes this conclusion: Those who live the longest are more outgoing, more active, more easy-going, more empathetic, and more agreeable than those who live a normal life span. The Blue Zones calls it, "likeability".

Here's My Strategy for Staying Out-of-Trouble After Sixty

Some of these are long-time habits, and they're easy for me to follow.  Some of these I don't do as regularly as I should.  Some of these are new goals.  But this much I do know:  If I don't have a plan, if I don't do these consciously, and if I don't carve out time to make them happen--they won't.

1.  Stick with 7-9 servings of fruits and vegetables a day.  The Green Smoothies make it easy.  I get 6 servings in a 27 ounce Klean Kanteen that I divide over breakfast and an afternoon snack.  I calculated the nutritional info on my daily 27 ounce serving that includes, 2 1/2 cups kale, 8 mini-carrots, 1/2 cup pomegranate juice, 1/2 apple, 1/2 orange, 1/2 kiwi, and 3/4 cup frozen black raspberries.  Check out the nutrient content for 27 ounces:

Nutrition Facts The Healthy Librarian's Green Smoothie-kale,blackberries,carrots,orange,kiwi,pom juice,apple
Serving Size: 1 serving
Amount Per Serving
Calories	342
Total Fat	2.2g
Saturated Fat	0.2g
Trans Fat	0g
Cholesterol	0mg
Sodium	140mg
Carbohydrate	82.1g
Dietary Fiber	13.8g
Sugars	49.1g
Protein	8.9g
Vitamin A 729% Vitamin C 485% Calcium    35% Iron 28%

 

Then throw in some veggie-based soup, a salad, a veggie-based dinner entree, some fruit for dessert, and I'm good to go. 

This eating plan is the same as the DASH Diet (Dietary Approaches to Stop Hypertension)--guaranteed to stop hypertension.  The Cache County (Utah) Study on Memory shows it also prevents cognitive decline.   Dr. Amy Lanou and Michael Castleman, authors of Building Bone Vitality claim it will build and strengthen bones--because the 17 nutrients necessary to build strong bones are all found in a diet high in fruits and vegetables.

2.  A balanced exercise plan.  It's not just about cardio--there are 4 areas that need attention: Cardio (spinning-my fave), Weight-training, Flexibility & Balance (yoga-my fave), and Core Strength.  No, you can't just walk and think you're in good shape.  I'm super regular with my cardio, and not as regular with the weight training and yoga.  Click here to see what my workout looks like. As for core strength--that's pretty much non-existent.  And when it comes to weight-training, according to Randy Raugh, the Canyon Ranch physical therapist, and author of the excellent Prime for Life--Functional Fitness for Ageless Living--to get the maximum benefits you need to do it for 3 non-consecutive days a week--2 at the minimum.  Unfortunately, I often weight train only 1 day a week.  If you want to build strong bones and prevent osteoporosis, and maintain your muscle strength as you age--weight-bearing exercise for the lower body, and weight-training for the upper body is a must-do!  Yoga, helps with balance, preventing future falls, and building strength.  As for core strength, I'm upping my game with Dr. Stuart McGill's routine, and my birthday-present to myself is the physical therapist-designed Pelvicore exercise ball.

3.  A plant-based diet with minimal added fat.  I'm nearing the 2 year mark on eating plant-based, so this is the easy part. I've got this down pat. I still use a little olive oil for cooking and in salads, and very occasionally eat some seafood or dairy when eating with friends.  I'm convinced.  If you want to lower your cholesterol, reduce your risk for type-2 diabetes, lower your blood pressure, reduce your risk of heart disease & stroke, and reduce your belly fat--this is the way to go.  Dr. David J. Jenkins of St. Michael's Hospital in Toronto is one of the pre-eminent researchers on the benefits of a plant-based, low-glycemic diet (like beans, nuts, oats,& quinoa) for improving diabetes control, lowering cholesterol, and preventing cardiovascular disease.  Click here for Jenkins research.  And that's not all--keeping your blood sugar stable with low glycemic plant-based foods and exercise will preserve your brain.  Click here.  And as for too much fat--not only is it bad for your belly--it's bad for your brain--so just ditch it Click here.

4. No time urgency.  This is what keeps the Okinawans calm, relaxed, and living longer.  I'm really working on this one--which goes hand-in-hand with flexibility.  Things don't always go as planned--you either go-with-the-flow or get stressed and anxious.  My favorite 2 words, "Oh well."  Life goes better when you stay in the moment, chill, and don't worry about getting there fast.  When our Christmas Day trip to New York City was aborted because of an ice storm, we checked into a hotel at noon, and enjoyed a dinner of cranberry nut mix, Larabars, Cliff Bars, and clementines.  All the restaurants were closed in this Pennsylvanian town.  Oh well.  We had a good time, and made it to New York safe and sound the next day.

5. More Dancing, Singing, Laughing, Playing, Schmoozing, and Mahjing.  What's the point of staying healthy without having fun?  That's the reason we work at staying healthy. Cool fact: There's a little organ deep in the ear, called the sacculus--and it gives us a great sense of pleasure and well-being when it's stimulated.  But, it can only be stimulated through singing!  So, bring on the Singstar Karaoke!  Click here.

6.  The Supplements.  I'm really bad at regularly taking supplements.  I'm good at counting them out, taking them to work, and bringing them back home with me.  Truth is, there are some supplements worth taking because there's no easy way to get enough of them through diet alone.  Here are my favorites:  Omega-3s (I use Omega-Brite), DHA, (an omega-3 for brain health), Magnesium, Citracal, Vitamin D (I'm up to 3000 IUs), Curcumin (also known as turmeric, the yellow color in curry), and Juvenon (the combo of acetyl l-carnitine & alpha lipoic acid) developed by Dr. Bruce Ames.  Click here to read more about what I take, and what some prominent physicians take.  

7.  Eliminate the time-wasters from my day.  Except for watching "The Middle" or "Glee", TV watching always leaves me bored and unsatisfied.  So, why bother wasting the precious time?  The same goes for my mindless internet cruising, checking in more than necessary with email, the NYT, and other favorite sites.  Enough already!

8.  Maximize my peak energy times of the day.  Over a year ago I blogged about getting in sync with our natural energy ebb and flow throughout the day.  It works--and I intend to start planning my day around them, when possible.  For instance, 9-11 is the peak time for brain work-creativity-and analytical work.  On days when I don't work I would usually use this time for exercise & errands.  Poor use of brain time.  Better to exercise between 3-6.  To read more, click here:  Maximize Your Energy-Match Your Tasks to Your daily Energy Levels.

9.  Give a gift a day for 29 days a month.  When 36 year old Cami Walker of LA learned she had multiple sclerosis, her spirits flagged.  She was tired, in pain, and had the prospect of a debilitating disease ahead of her.  When a holistic health educator gave her the prescription of giving 29 gifts a day for a month she thought it sounded it crazy.  Nothing big (and that's the point)--something like making a supportive phone call or saving a piece of yummy cake for her husband.  Of course the prescription didn't cure her,  but it had a startling effect of helping her cope with her illness and gave her a more positive outlook on life.  I love this idea.  It's a planned regular way to just think about kindness.  No big acts, just something little-done everyday.  To read more, click here.

10. Cultivate my garden of friends and family.  Regular phone calls, visits, dinners, outings, and celebrations.  At 60 there's no time to delay any of these.  It's the glue that keeps us together and makes life worth living.

11.  Once You're Through Learning--You're Through.  This is the philosophy of John Wooden, the 97-year-old retired UCLA basketball coach.  No doubt about it, learning and sharing what I learn is my purpose in life.  I'm lucky to have a job that gives me access to learning about health and medicine, and a hobby that gives me a chance to share what I learn.

12.  Start Eating Less.  OK, I'm ready to shed a few pounds, and I know from past experience that writing down exactly what I eat, and how much I've exercised, really works.  I use something called MyFoodDiary.com and it's set up with all my favorite recipes.  Unfortunately, I haven't used it in quite some time.  The new year is a great time to start!  To read more about this tool, click here.

For some good reasons to eat less, read:  CALERIE: The NIH Calorie-Restriction Experiment. Lessons for Health, Slowing Down the Aging Process, Longevity, and Disease Prevention 

 

 

Time to end this list.  I've already maximized my 9-11 brain time and written this post.  It's now time to make my smoothie, do some core exercises, take those supplements, answer birthday phone calls, enjoy a birthday lunch, followed by an evening out with friends who all share the same wedding anniversary--if we can just make it through our foot of snow!

I'd love to hear from anyone who is 60 or over with advice, tips, and wisdom about maximizing life in the sixties, seventies, and more.

 

 

The Healthy Librarian's Brain Backup: Is Your Cell Phone Safe? - Keeping Facebook Private - The High Cholesterol Osteoporosis Connection - Why Pregnant or Breastfeeding Moms Need Flu Shots - Fat & the Brain Chemistry Connection and more

"Once You're Through Learning, You're Through"

-John Wooden, retired UCLA basketball coach, 98 years old-

So, how do I decide what I'm including in my brain back-up?  Simple.  If it's something new to me--something I'd never heard about before--or if it's a piece of information that brings new understanding to something I already know, "I back it up".

I'm trying to make these just "Info Nuggets" with links to the source if you want to know more.

How Safe Is Your Cell Phone?  Check Out the New Environmental Working Group Report 9/11/2009

Cell phone safety is near the bottom of my worry list, which is why I took the cheapest phone Verizon was offering when I needed a new phone & wanted one that with a keyboard for texting.  Big Mistake!  Turns out my phone (the LG EnV2) is on the lower end of the safety scale (Maximum radiation 1.28 W/kg) and the EWG suggests I ought to replace it with something safer, or start using a head set.

Why should we care about our cell phones?  Although the research is still ongoing, four billion people around the globe own cell phones, and more of us are choosing to use cells over landlines. 

What are the risks from the radiation cell phones emit?  There are significantly higher risks for brain and salivary gland tumors among  people using cell phones for 10 years or longer.  Children are at a greater risk--and men carrying phones clipped to their waist or in a front pocket put their sperm at risk--where soft body tissues absorb radiation.

This was news to me. Ways to limit radiation exposure:

1.  Listen More, Talk Less:  Your phone only emits radiation when you talk or text, but not when you're receiving messages, or listening.

2.  Choose Texting Over Talking:  Phones use less power (which means less radiation) when you text--and when you text, the phone is away from your head.

3.  Poor Signal? Stay Off the Phone:   Fewer bars on the phone means that it emits more radiation to get the signal to the tower.  Make and take calls when your phone has a strong signal.  I never gave this a second thought!

Check out how safe your cell phone is here.  There's no "search screen", so click on your Edit button on the top toolbar, and type in your cell phone name.  Keep hitting "next" until your model number appears.

To look at the Environmental Working Group's Best & Worst Phones, read a summary of their report, get tips on limiting your radiation exposure, click here.

Five Easy Steps to Stay Safe (and Private) on Facebook.  Read Sarah Perez' step-by-step guide to changing your Facebook settings

Full Disclosure:  I don't use Facebook, (so I'm in no position to have an opinion here) but now that I've read Sarah's article I'd feel a lot more in control of my privacy if I decide to sign up.  Read her original article--the one posted on ReadWriteWeb on 9/16/09 for an easy-to-understand graphic step-by-step guide on how to change your settings and restrict access in very specific ways.  You can be as safe and as private as you like!

This version, beats the New York Times version of her article, hands down!

Step 1:  Why You Need to Make Friend Lists (and no--your friends won't know what lists they are on)

Step 2:  Restrict Who Can See What's On Your Profile

Step 3:  Restrict Who Can See Your Address & Phone Number

Step 4:  How to Change Who Can FIND You on Facebook via Search

Step 5:  How to Stop Sharing Personal Info With Unknown Applications

And be sure to scroll down to read comment #12 which basically warns against using any apps (like quizzes) & how your information is still vulnerable if your friends use apps--regardless of your settings.

"There are two separate privacy concerns with apps:

1) If you personally run any app, like our (ACLU) quiz, that app has access to almost all of the information in your profile, on your wall, and so forth. Currently, there is NO privacy setting that limits what the apps you choose to run can access - every app you run has access to almost everything (contact info being one of the few exceptions).

2) If your friend runs an app, like our quiz, that app has access to your information based on your "application privacy settings" (see step 5 above). You can opt out, but (as Sarah said) if you don't the default is that your friends' apps have access to most of your information."

--Chris,creator of the ACLU Quiz application, ACLU Northern California-

If You've Got High Cholesterol, You Might Want to Consider a Bone Density Test

Scientists at UCLA have figured out exactly how a fatty diet and high cholesterol contribute to bone loss--which helps to explain why bone fractures are reduced when cholesterol levels are reduced.

Here's the deal:  That nasty oxidized LDL cholesterol causes our immune T cells to pump out a chemical--called RANKL--which in turn causes bone damage.  Eating a diet high in saturated fats increases the level of oxidized LDL--and in turn signals the T cells to produce a higher level of bone-damaging RANKL---and when RANKL is manufactured for long periods of time it results in excessive bone damage.

Dr. Rita Effros, a UCLA professor led the study, and published it in Clinical Immunology on 8/20/09.  Read about it here.  One more reason to ditch a high-fat-cholesterol-producing diet.

Why Women Who Are Pregnant or Breastfeeding Need to Get the Seasonal Flu Shot and the H1N1 When It's Available

1.  Pregnant women in South America, Central America and Australia fared less well than others during their recent outbreak of H1N1.  CDC data from April 15-May 18, 2009, on the first US cases of H1N1 in pregnant women, showed 32% of pregnant women infected with H1N1 were hospitalized, and by June, 6 had died.  Read the Lancet article here

2.  Pregnancy puts women at a higher risk of complications from flu because as a woman advances in her pregnancy her immune system becomes compromised.

3.  Both the CDC (Centers for Disease Control) & the American College of Obstetrics & Gynecology recommend pregnant women get both the seasonal flu shot--which is available now--and the H1N1 shot when it becomes available in mid-October.

4.  120 expectant women around the country are currently participating in a clinical trial with the H1N1 vaccine.  Those results are expected in the beginning of October.

Excerpts From the Empowered Patient: Surviving H1N1 With Baby in Belly 9/17/09   click here for this excellent review

If I get the vaccine while pregnant, will this also protect the baby when he/she is born?

"One of the things the body does very well is give antibodies to the babies," says Dr. Buddy Creech, a researcher conducting clinical trials on pregnant women at Vanderbilt University. "It's one of the greatest reasons we vaccinate pregnant women."

Creech says past flu studies have found that when women get flu shots before giving birth, they help build immunity for their child that is particularly helpful during the infant's first few months of life.

"If we're going to protect those children, it'll be with vaccines rather than drugs," Creech says.

Is it safe to get vaccinated while breastfeeding? Should my newborn also be vaccinated?

According to the Advisory Committee for Immunization Practices, the H1N1 vaccine will be recommended for children ages six months and older. Newborns and infants younger than 6 months cannot receive the vaccine.

Health officials say breastfeeding is one way a mother might be able to help protect her baby. "The vaccine is safe if she breastfeeds, and she may even pass along some immunity to her infant," says Tepper of the CDC. "It will also reduce the chance that [the mom] will get the flu and pass it to her infant."

According to the CDC:  Mothers who are breastfeeding should continue to nurse their babies while being treated for the flu. Breast milk passes on antibodies from the mother to a baby. Antibodies help fight off infection.

Be sure to read the CDC seasonal & H1N1 site for pregnant & nursing mother!  click here

Sabriya Rice's CNN Empowered Patient article on H1N1 & Pregnancy  click here for this excellent review

Ice Cream on the Brain.  How Eating Tasty High Fat Foods Like Meat, Milk, Butter, & Cheese Changes Our Brain Chemistry and Makes Us Just Want to Eat More

I found the summary of this "fat addiction" research fascinating.  It was led by Dr. Deborah Clegg, out of the University of Southwestern Texas Medical Center.  Reminds of Dr. David Kessler's book.  Here's an excerpt:

Dr. Deborah Clegg and colleagues suggest that fat molecules from certain foods can change brain chemistry in a very short period, causing appetite-suppressing signals to be ignored.

“Normally, our body is primed to say when we’ve had enough, but that doesn’t always happen when we’re eating something good,” said Clegg, senior author of the rodent study appearing in the September issue of The Journal of Clinical Investigation.

“What we’ve shown in this study is that someone’s entire brain chemistry can change in a very short period of time. Our findings suggest that when you eat something high in fat, your brain gets ‘hit’ with the fatty acids, and you become resistant to insulin and leptin,” Dr. Clegg said.

“Since you’re not being told by the brain to stop eating, you overeat.”

The foods that are responsible for this brain chemistry change contain Palmitic Fat--and it's found in ice cream, butter, cheese, milk, and meat.  Not exactly a big surprise.  Maybe that explains why I have no self-control with ice cream or cheese. 

To read the PsychCentral article, click here

To read the UT Southwestern Medical Center press release, click here.

A Poor Night's Sleep Can Give You a Cold.  More Proof of What We Already Know

No excuses!  It's cold & flu season.  No matter how busy you are, make sure you get a good night's sleep.  Plain & simple, and coming out of the Archives of Internal Medicine:  If you don't get enough sleep prior to exposure to cold viruses, you are lowering your resistance and have a better chance of getting sick.

Read the study here

Read Anahad O'Connor's article in the NYT's  Really? The Claim: Lack of Sleep Increases the Risk of Catching a Cold.  Click here 

Sleep is part of my research-backed method to knock-out colds--if you missed that post, click here.

Worried About Your Tap Water and Don't Won't To Invest In A Water Filtration System?  Give Up Bottled Water with the Z-Pitcher from ZeroWater

For $40 you can get a BPA free water filter pitcher that outperforms Brita.  I heard about this a couple months ago from Beth Greer, of SuperNaturalMom, and it's recommended by The Daily Green, Consumer Reports, Bottlemania author, Elizabeth Royte and more.  

The company's effective demo showed Houston, TX water at 271 ppm and Bensalem, PA water at 157 (New York City's was at 11 ppm--phew!). After running the water through a ZeroWater filter, a follow-up TDS meter test read 000 for all samples.  -from the Daily Green-

It is a five-stage unit that takes almost everything out of the water- it is certified to meet the highest standards for removal of lead, iron, zinc and mercury. Although there are no standards to certify it for antibiotics, hormones and perchlorate, they tested it and it removed almost all of them as well. -from the Tree Hugger-

Read More Reviews on ZeroWater & the Z-Pitcher here

Preventing Bone Loss & Osteoporosis Through a Plant-Based Diet & Weight-Bearing Exercise--Dr. Amy Lanou & Michael Castleman's Research-Backed Case for Building Bone Vitality

"If milk, dairy foods, and calcium supplements prevent osteoporosis and its most catastrophic result, hip fractures, the countries that consume the most calcium should have the lowest hip fracture rates. But they don’t. They have the world’s highest rates.

Four worldwide epidemiological surveys conducted by different research teams over twenty years agree that the countries that consume the most calcium (the U.S., Western Europe, Australia, and New Zealand) have the highest rates of hip fracture. Meanwhile, countries that consume little or no milk, dairy, and calcium supplements (much of Asia and Africa) have fracture rates 50 to 70 percent lower than those in the U.S. "

-Taken from the synopsis of "Building Bone Vitality"-

At the end of my post on Osteopenia I mentioned that I had picked up this book at my local library & I was anxious to take a closer look.

One of my readers emailed me that he had heard Dr. Amy Lanou speak this summer and he was very impressed with her message.  Long story short--he forwarded me a synopsis of her book--I was impressed and wanted to share it with you.  I emailed Dr. Lanou and she gave me permission to post excerpts of the synopsis--and if you're interested--just go directly to this link & read it all.

Full Disclosure:  When I first heard the evidence about milk, meat, cheese, and yes, too many cereal grains having a negative effect on bones, I thought, "No way.  Couldn't be."  The research and the evidence has since changed my mind.  See what you think.

Why Am I Recommending "Building Bone Vitality"?

• Lanou and Castleman have taken a researcher's careful review of over 1200 studies from respected medical & scientific journals to sort through what causes bone loss, and what can prevent it.  They make a fair & balanced presentation of the evidence--including what supports their position & what doesn't!  As a medical librarian--I approve!  Does Lanou have the credentials to make her case?  I think so. To read her bio click here

• I was already aware of some of the research that explains how animal protein (meat & dairy) causes calcium to be removed from bones--but the Lanou/Castleman book took my understanding to a new level.  Dr. Bess Dawson-Hughes, the Director of the Bone Metabolism Lab at Tufts University and a past president of the National Osteoporosis Foundation, published an article supporting this claim in 2009.  My first inkling of the negative effects of animal protein--including dairy--upon bones was in 2008 through Dr. T. Colin Campbell's China Study and Dr. Caldwell B. Esselstyn's research.

• The authors present an elegant case for eating a wide-ranging plant-based low-acid diet and include tables showing the best & worst foods for osteoporosis prevention. 

Who knew that "dried fruits (especially apricots & raisins) are the most alkaline (the best) plant foods, and cheeses, particularly hard cheeses, are the most acid-forming animal foods?  The reason is that both are dehydrated.  The water in fruit and milk dilutes the protein and alkaline material.  Remove much of the water to make dried fruit or cheese, and either the alkaline material or the protein becomes more concentrated."

• Lanou & Castleman present a balanced analysis of the research, the evidence, and the pros & cons of all the current osteoporosis drugs.  They support their use for people with substantial bone loss or fractures.

• The authors present a thorough research-supported explanation of the less publicized risk factors for osteoporosis and what you can do about them.  This includes diabetes, salt, caffeine, alcohol, prescription drugs, and smoking.

• This is not a meat-bashing vegan book with no options for omnivores.  "They advise eating six to nine daily servings of fruits and vegetables and avoiding or limiting (to no more than one or two servings) high-protein foods such as meat, dairy and eggs daily. Why? Because protein is composed of amino acids. As the body digests high-protein foods, the blood becomes more acidic, leaching calcium from the bones. It's all about balance.
  

The Best & Worst Foods for Bones (how common foods affect urinary acidity)

The Best:  Dried apricots, raisins, chard, kale, and spinach (the most alkaline)
The Worst:  Corned beef, hard cheeses, salami, egg yolks & egg noodles (the most acidic)

Excerpts from the Synopsis of "Building Bone Vitality"  click here for the entire synopsis

Amy J. Lanou, PhD. University of North Carolina at Asheville  Read more about Dr. Lanou here & here


The Countries with the Highest Animal Protein Intake Had the Highest Fracture Rates

The Countries with the Highest Plant Protein Intake Had the Lowest Fracture Rates

Everyone knows how to prevent osteoporosis, right? Drink milk. Eat cheese and yogurt. And take a calcium supplement. This is the familiar “calcium theory of osteoporosis”—endorsed by the nation’s leading health experts.

Only it’s simply not true.

That’s right. Amy Lanou, Ph.D., an assistant professor of health and wellness at the University of North Carolina, Asheville, and noted medical journalist Michael Castleman reviewed 1,200 studies dealing with risk factors for osteoporosis to write Building Bone Vitality, a book that proves the calcium theory wrong and presents a more sensible, scientifically credible explanation of what causes osteoporosis and how to prevent it.

MILK, DAIRY FOODS, AND CALCIUM SUPPLEMENTS
BY THEMSELVES OR IN ANY COMBINATION
DO NOT PREVENT FRACTURES

In addition to the four epidemiological surveys, the human experimental studies (clinical trials) also show that the calcium theory is wrong. Since 1975, when the medical literature became easily searchable by computer, 140 clinical trials have explored calcium’s effects on osteoporotic fracture risk. One-third of these studies (47 trials) show that as calcium consumption increases, hip fracture risk decreases. But two-thirds (93 trials) show no benefit from high calcium intake (even with added vitamin D). Several of the negative studies are huge—40,000 to 60,000 women followed for 10 to 20 years. If calcium prevents osteoporosis, shouldn’t such enormous, extended trials show at least some benefit? But they don’t. Overall, the clinical trials dealing with fracture prevention run two-to-one against calcium.

Unfortunately, the minority of studies showing fracture reductions with calcium have garnered just about all of the publicity. That’s a big reason why the calcium theory is still accepted. Only one study showing no benefit from calcium has ever made headlines—a 2006 Harvard trial. As a result, most of the news about osteoporosis prevention supports calcium even though the weight of the evidence runs two-to-one against it.

THE DIETARY KEY TO OSTEOPOROSIS PREVENTION:
LOW-ACID EATING

If calcium doesn’t prevent fractures, what does? A diet high in fruits and vegetables and low in high-protein foods: meats, poultry, fish, milk, and dairy.

Why? Strange as this may sound, osteoporosis prevention begins in the bloodstream. Blood chemistry is very complicated. But for good health, the blood must maintain its pH (relative acidity or alkalinity) within a very narrow range.

Protein is composed of amino acids. As the body digests high-protein foods, amino acids flood the bloodstream, and the blood becomes more acidic. People who eat a high-protein Western diet—lots of meats, poultry, fish, milk, and dairy foods—have blood that’s too acidic for the body to function properly. The excess acid must be neutralized quickly to avoid life-threatening problems.

Have you ever taken Tums for acid indigestion? Its active ingredient is highly alkaline, which neutralizes excess stomach acid. The alkaline ingredient in Tums is calcium carbonate.

The body does something similar to neutralize excess acid in the bloodstream. It draws on the body’s reservoir of alkaline material, the calcium compounds in bone. Neutralizing excess blood acidity releases calcium, which eventually leaves the body in urine. Dozens of studies show that as protein in the diet increases, so does the amount of calcium in urine. A high-protein Western diet draws so much calcium from bone that a diet high in milk, dairy foods, and calcium supplements can't replace it. In other words, a high-protein diet—a typical American diet—sucks calcium from bone and eventually causes osteoporosis. 

In the words of researchers at the University of California, San Francisco Medical Center:

“The high incidence of hip fracture in Western countries is caused by the cumulative effects on bone of the body’s chronic high acid load. This high acid load is the result of disproportionate consumption of animal (acid) foods relative to vegetable (alkaline) foods. The body adapts through dissolution of bone. Over decades, blood that is chronically too acidic induces osteoporosis.”

THE BEST WAY TO IMPROVE BONE MINERAL DENSITY:
A DIET HIGH IN FRUITS AND VEGETABLES

By a margin of two-to-one, the fracture studies show that a diet high in calcium does not prevent fractures. But fracture studies are very expensive. It’s cheaper to study bone mineral density (BMD), the amount of calcium and other minerals in bone.

Since 1975, there have been more than 300 studies of calcium’s impact on BMD. Fifty-two percent show that calcium improves BMD. Many of these studies have been publicized, reinforcing belief in the calcium theory. But we already know that two-thirds of studies show that calcium does not reduce fracture risk. How can a majority of studies—albeit a slim majority—show that calcium improves BMD while two-thirds of trials show that it doesn’t reduce fractures?

Because bones are composed of much more than calcium. Strong, healthy, fracture-resistant bones require 17 nutrients. Consuming lots of calcium without enough of the other 16 nutrients is like building a brick wall with no mortar. Where are these other 16 nutrients found? The richest sources are fruits and vegetables. While calcium improves BMD in 52 percent of studies, fruits and vegetables improve BMD in 85 percent of trials. In other words, the best way to improve bone mineral density is to eat a diet based on fruits and vegetables—which makes sense because the same diet is the key to preventing fractures.

Bottom line: The calcium theory is bankrupt. It just doesn’t explain what causes—and prevents—osteoporosis. The best approach to osteoporosis prevention, the only one that makes scientific sense, is a diet low in animal foods and high in fruits and vegetables, combined with walking or equivalent exercise for 30 to 60 minutes a day, every day. That’s the safe, simple, scientific prescription for osteoporosis prevention—and for optimal health and longevity.

I've just included excerpts from the synopsis of "Building Bone Vitality".   Click here to read the full synopsis.  Better yet, get a copy of the book!

What's the Best Way to Treat Osteopenia? Diet, Vitamin D, Calcium, Drugs Like Bisphosphonates, or Weight Training? Check Your Fracture Risk with the W.H.O. FRAX Tool to Help You Decide.

Is Osteopenia As Normal As Wrinkles?

"Indeed, it was a W.H.O. panel financed by the pharmaceutical industry that in 1994 defined normal bone mass as that of an average 30-year-old woman. Because bone naturally deteriorates with age, anyone  much older than 30 is likely to qualify for a diagnosis of osteopenia; using similar logic, a middle-aged woman might be said to have a skin disorder because she had more wrinkles than her 30-year-old daughter."

-Kate Murphy, "Splits Form Over How to Address Bone Loss"  New York Times, Sept. 8, 2009

Should We Hold Off On the Bone Drugs Until We Get Osteoporosis?

 

"...some researchers argue that it makes more sense for a woman to delay taking medications until she crosses the line from osteopenia to osteoporosis.  'The less time a woman's on drug therapy, the less chance for adverse events,' says Bess Dawson-Hughes, M.D., director of the Bone Metabolism Laboratory at Tufts University and chair of the committee that updated the National Osteoporosis Foundation guidelines."

-Nissa Simon, "Are Women Being Overtreated for Bone Loss?  Many Drugs Have Serious Side Effects" AARP Bulletin Today, March 27 2009-

Are Drug Companies Pushing Drugs to Treat Osteopenia?

 

"The drug industry has already begun marketing its osteoporosis drugs to the large group of women defined as having osteopenia: potentially half of the world's postmenopausal women.  Notwithstanding the geniune value of these drugs in reducing fracture risk for some women, we need to ask whether the coming wave of marketing targeting those women with pre-osteoporosis will result in the sound effective prevention of fractures or the unnecessary and wasteful treatment of millions more healthy women."

-Pablo Alonso-Coello, MD & colleagues, "Drugs for Pre-Osteoporosis: Prevention or Disease Mongering", BMJ 336:126-29, Jan. 19, 2008

 

 

What Is Osteopenia?

Note that the baseline for normal is for an average 30-year old woman.

What your T-score means:

• A T-score between +1 and -1 is normal bone density. Examples are 0.8, 0.2 and -0.5.

• A T-score between -1 and -2.5 indicates low bone density or osteopenia. Examples are T-scores of -1.2, -1.6 and -2.1.

• A T-score of -2.5 or lower is a diagnosis of osteoporosis. Examples are T-scores of -2.8, -3.3 and -3.9.

  The WHO classification of osteoporosis (notice that 80% of women over 50 have either osteopenia or osteoporosis)

Bone mineral density* T score Prevalence (%)** Normal <1 SD >–1 20 Osteopenia (or low bone mass) 1-2.5 SD –1 to –2.5 52 Osteoporosis 2.5 SD –2.5 28

*Below the young adult mean.

**In white women older than 50 years

from BMJ 336:126-29, Jan. 19, 2009

Why is Osteopenia Now on My Radar Screen?

On Tuesday morning I read the New York Times piece, "Splits Form Over How to Address Bone Loss" , which highlights the controversies on whether or not to treat osteopenia (aka pre-osteoporosis) with bone-strengthening drugs. 

There are also some docs who question the use of the new World Health Organization online tool, FRAX (click here for the tool), which is intended to help women and their doctors figure out what their risks are for future fractures.  It's a decision tool--to help you sort out whether or not you need to start on Fosamax, Boniva, Reclast, Actonel, or Evista. 

What Are the Concerns About FRAX? 

1.  The FRAX tool doesn't take into account factors like: vitamin D deficiency, physical activity, and the use of drugs that can erode bone, like epilepsy drugs and antidepressants, or how long or how much someone has been smoking or drinking. Good point.  I'll buy that!

I noticed that it only takes into account a parent with a fractured hip--not one with spinal or wrist fractures or diagnosed osteoporosis--as in my case.  Isn't a parent with osteoporosis an important risk factor? 

2.  Some physicians think the tool causes women undue worry (please!!) and may encourage them to start bone-strengthening drugs sooner than necessary.  But wait-check this out:  One of the physicians who expressed this concern for FRAX in the NYT article is Dr. Nelson Watts of Cincinnati.  He thinks it should be abolished.  Look what I found from my H.H.L.L. March 2008 post about FRAX:

Rosemarie Moenster, a 65-year old Cincinnati teacher, was being treated with 2 medicines, Actonel to rebuild bone, and Evista, to prevent bone loss.  When she started to experience complications her doctor advised stopping the Actonel.  She was terrified of worsening osteoporosis, but when her doctor, Nelson Watts ran the new FRAX risk tool, the news was good.  Her risk of hip fracture was less than 1%, and the risk of major breaks was 12%.  She could safely stop the Actonel, and is continuing the Evista.

The NOF recommends treatment when the 10 year hip fracture risk is 3% or higher, or if the risk of other major fractures in the spine, shoulder or arms is 20% or more.  According to FRAX, it looks like Ms. Moenster might not need the Evista either--but then I don't have all the facts.

As for me--I don't understand the concern about FRAX.   My T-score is a not-so-great -2.1 (not so far from the -2.5 osteoporosis diagnosis).  I'm almost 60 (can't believe it!), have a strong family history of osteoporosis, a small frame and guess what?  There's no need for me to use drugs. 

According to FRAX my long-term risk of a hip fracture is 1.3% and my major fracture risk is 9.3%--which improved from my last BMD scan. (Remember: It's a 3%/20% To Treat Guideline)  So...the FRAX didn't cause "undue worry"--it allayed my worries--thank you very much!

 What Are the Concerns of Medically Treating Osteopenia?

2.  Exaggerated benefits. Some experts believe that testing and subsequent drug prescriptions for women over 50 may be a waste of time and money.  There are concerns that the drug companies are strongly marketing drug treatment for osteopenia.  Be sure to read Pablo Alonso-Coello's  article:  "Drugs for Pre-Osteoporosis: Prevention or Disease Mongering", BMJ 336:126-29, Jan. 19, 2008. 

He has serious concerns about the drug company sponsorship of articles that have "reanalyzed" data for patients with osteopenia.  There is a huge potential market out there--50% of women over 50 have osteopenia--and Alonso-Coello and many other physicians  believe the benefits of drug therapy do not warrant treating millions of women.

The National Osteoporosis Foundation recommends screening women without risk factor at age 65--and men at 70.  For a list of the NOF Guidelines, click here.

3.  Playing down side effects. Do we really want to subject women with normal bone loss--at low risk of fracture--to drugs with potential side effects?   Consider the rare osteonecrosis of the jaw from Fosamax, the more common and sometimes serious gastrointestinal side effects, and the increased risk of stroke and venous thromboembolism from Evista.

4.  "The drugs work if you have osteoporosis.  But some studies suggest there is little benefit, if any benefit at all, if you take these drugs when you have osteopenia,"  according to Dr. Steven Cummings, Professor of Medicine and Epidemiology at the University of California at San Francisco.  

A study published in the Mayo Clinic Proceedings 80(3):343-49, Mar. 2005, found that Fosamax quickly becomes effective in women with osteopenia or osteoporosis, but the authors conclude:

"The absolute risk of vertebral fracture is low in osteopenic women without a previous fracture; thus, the number of fractures that would be prevented with Fosamax therapy is small.  For women who already have a vertebral fracture the risk of a new fracture is 5 times higher." 

My comment:  If drugs like Fosamax work so well & so quickly--why not just "watch & wait"--with regular BMD scans--and start treatment when bone loss increases?

 

 

My Experience with a Diagnosis of Osteopenia

Rather than prescribe drugs, my doctor ordered tests--lots of tests.  She wanted to figure out if there was an underlying cause for my bone loss, besides my age.  Here's what she checked for:

1. Vitamin D.  I had my vitamin D level checked.  It was a too-low 29, and she immediately advised me to add 1000 IUs of vitamin D3, in addition to the maybe 800 IUs I was already getting from Citracal & a multi-vitamin.  A 3 month follow-up showed improvement up to the barely acceptable level of 33. 

She has since advised me to take 2000 IUs.  It's been a few years since I've had this tested, but I'm anxious to see where I am now.  According to Dr. Michael Holick, the vitamin D maven, a score closer to 50 (but under 100) would be better; and  Dr. Heike A. Bischoff-Ferrari concluded that the optimal level of vitamin D to prevent hip and nonvertebral fractures in older adults should be at 75 nmol/l.  ("Optimal serum 25-hydroxyvitamin D levels for multiple health outcomes" in Sunlight, Vitamin D and Skin Cancer, edited by Jorg Reichrath, 2008)

2. Celiac Disease Blood Test.  This under-diagnosed condition can be a cause for low bone mineral density.  This checked out just fine for me.

3.  Parathyroid Hormone Test (PTH).   Was my parathyroid in working order or was it causing calcium to be removed from my bones?  Again--no problem here.

4.  Calcium-Phosphate Urine Test.  With this test you collect all your urine for 24 hours. It's done to see if you're losing too much calcium or phosphorus--which the body needs to build & repair bones & teeth.  And no, you can't venture far from home when you're collecting a 24-hour urine sample.  This was loads of fun, especially carrying  a big plastic jug filled with pee to work.  I passed this test too!

5.  Turns out I have run-of-the-mill old-age osteopenia.

My Bone Strengthening Plan:

1.  Vitamin D3--close to 2400 IUs a day  (note: as of 2011 this is up to 4000 IUs) + sensible sun-exposure in the Spring & Summer when I can--which isn't often.  The recommendation from Dr. Michael Holick for my fair skin type & location: around 2-3 days of sun exposure of arms & legs for about 10-15 minutes between the hours of 10 am-3 pm.  Sunscreen on the face.  

Note:  The NOF recommends adults 50 and over need 800-1,000 IUs of vitamin D daily.  And although previous research showed D3 to be superior to D2, recent research has showed both types are equally effective.

2.  Magnesium--200 mg in the morning & 200 mg before bed with Citracal. 

3.  1200 mg of calcium a day--some in supplement form--some in food.  (note: as of 2010 this has changed)

4.  I take a low (1/4 dose) of Estrasorb--a transdermal estradiol--which has been shown to maintain bone density--along with a 100 mg of Prometrium (progesterone) 12 days a week.

5. Weight-bearing and muscle strengthening exercise.  I lift weights and practice yoga to improve my balance--and prevent falls.

6.  I keep alcohol consumption down to less than 2 glasses of wine a week.

7.  I load up daily on bioavailble-calcium-rich greens like kale in my green smoothies.

8. I follow the research-backed advice of Dr. Bess Dawson-Hughes, the director of the Bone Metabolism Laboratory at Tufts University, and one of the developers of the U.S. FRAX guidelines.  I eat lots of vegetables and fruit, plant protein, and ease up on the cereal grains.

"Diets high in protein (especially animal protein) and cereal grains produce an excess of acid in the body which may increase calcium excretion and weaken bones, according to a new study accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM)"

When older adults eat diets high in protein & grain, acid is produced, and as we age our bodies are less able to excrete this acid.

 

"One way the body may counteract the acid from our diets is through bone resorption, a process by which bones are broken down to release minerals such as calcium, phosphates, and alkaline (basic) salts into the blood.  Unfortunately, increased bone resorption leads to declines in bone mass and increases in fracture risk."

For a link to my post about Dr. Dawson-Hughes' study,  "Osteoporosis Prevention.  A Diet High in Fruits and Vegetables and Low in Animal Protein and Grain"  click here.

9.  Are these interventions working?  Yes!  My 2 year follow-up BMD shows that I'm maintaining my bone density.

Note:  I recently picked up a provocative book at my local library, Building Bone Vitality.  A Revolutionary Diet Plan to Prevent Bone Loss and Reverse Osteoporosis by nutrition professor Dr. Amy Lanou and health writer Michael Castleman.  It just came out in May 2009. 

The authors looked at over 1200 studies and present an argument that turns the idea of drinking milk and eating dairy for bone health on its head.  They recommend that the most effective way to prevent bone loss is a combination of daily walking and eating more of the low-acid foods like fruit, vegetables, legumes, and soy--with little, if any, meat, dairy, and fish and a modest amount of breads, cereals, and pastas.   Dr. Dean Ornish has written their foreword.  I'll let you know what I think of it when I have a chance to look at it more carefully.  UPDATE:  I reviewed the book & included a synopsis here

Be sure to read:

 From the NYT: "Splits Form Over How to Address Bone Loss"

From AARP: "Are Women Being Overtreated for Bone Loss?  Many Drugs Have Serious Side Effects"

From BMJ: "Drugs for Pre-Osteoporosis: Prevention or Disease Mongering"

For a list of the NOF Guidelines, click here.

From HHLL: "Osteoporosis Prevention.  A Diet High in Fruits and Vegetables and Low in Animal Protein and Grain"  click here.

Take the FRAX Test here.

From HHLL: New WHO Tool to Assess Osteoporosis Risk - Deciding If You Need a Prescription

 

 

 

 

 

 

 

 

 

 

 

Is It Time to Reconsider Hormone Replacement Therapy? Winnifred Cutler's "Hormones and Your Health: The Smart Woman's Guide to Hormonal and Alternative Therapies for Menopause"

"Unfortunately....one large study (the Woman's Health Initiative - WHI) sent us back into the Middle Ages, because its data were misunderstood, misinterpreted, and misreported...But keep in mind that the majority of postmenopausal women who do not use hormonal-replacement therapy will not merely experience unpleasant symptoms; they will risk diseases brought about by loss of bone, loss of blood vessel elasticity, and decreased protection from cardiovascular disease."

Winnifred Cutler, PhD.

"Most experts say women should take hormones for only a few years after menopause, and only if their symptoms are severe. Now, in a new book, biologist Winnifred Cutler claims that Hormone Therapy is safe for long-term use and highly beneficial -- as long as you do it right. Here, she makes her case."

Stephanie Young, "The Other SIde of the Hormone Controversy. A New Argument for Hormones"

Oh Boy.  This book is sure to be controversial.  Ever since the WHI was halted in 2002 the "standard recommendation" has been:  Only go on hormones if your menopausal symptoms are intolerable, and then go on the lowest possible dose for the shortest possible time! 

Dr. Cutler believes  this is not only unwise, it's an incorrect assumption.  "Panic trumped good science."

I happen to have a very savvy physician who is a national expert on menopause and women's health.  We've discussed at length the whole hormone issue and how the results of the WHI (the Women's Health Initiative) were misinterpreted, which basically brought the use of hormone replacement therapy to a screeching halt.

I read the results and the interpretations of the WHI study in the medical journals for myself, and together with my doctor's advice I made the completely radical & unorthodox decision to start hormone replacement therapy even though I didn't have any "intolerable" menopausal symptoms--which post-WHI, is the only reason to start HRT.

Full Disclosure Here:  I decided to take HRT for prevention--and because I knew from the literature, and the WHI, that if one wanted to receive any of the benefits of hormone replacement--like prevention of osteoporosis, urogenital health, possible brain health & flexible blood vessels--there is just a small window of opportunity when you can begin HRT.  If you wait too long after menopause to start, once blood vessels start to stiffen, you could put yourself at risk for adverse cardiovascular effects.

But I wasn't about to take Premarin, the equine-derived estrogen or a synthetic progestin like Provero or the combination of the two, called Prempro.  Let's just say, these are the synthetic hormones that were probably responsible for some of the adverse results of the WHI.

Together, we decided upon a regimen that closely duplicates a woman's natural cycle; the daily use of a bio-identical topical estrogen (estradiol-17 beta) cream called Estrasorb; and for 12 days a month--a bio-identical pill form of progesterone, called Prometrium.  As time went by--the doses of both of these have been cut in half.

Books and articles cross my desk constantly, but last week when I spotted Hormones and Your Health: The Smart Woman's Guide to Hormonal and Alternative Therapies for Menopause by Winnifred Cutler, I scooped it up and couldn't put it down.

What a find!  Finally, a book written in plain language by a biologist who has studied and written extensively about hormones and has reviewed many of the studies on the subject. Cutler studied over 3,000 peer-reviewed articles--and she cites 880 of them in her book.  

I've reserved a copy at my local library and I can't wait to read the entire book.  Dr. Cutler certainly has the credentials and background to write such a book, and she has no vested interest in selling hormones, no pharmaceutical research funding, or hidden agenda.

Be sure to read Stephanie Young's interview with Dr. Winnifred Cutler, "The Other Side of the Hormone Controver--A New Argument for Hormones" in More magazine, April, 2009.   Click here.

A Study You Should Know About But May Not:  KEEPS is an ongoing study--"Kronos Early Estrogen Prevention Study"--which aims to study what the WHI did not.  Can HRT prevent  cardiovascular disease (atherosclerosis in particular) in women, if it's given early--immediately after menopause.  Unlike the WHI, it's comparing a bio-identical estrogen/progesterone combo with the synthetic Premarin.  Many researchers feel that bio-identical hormones given transdermally & right after menopause will make all the difference. For more click here.

In other words--it's the study that's answering the questions that the WHI did not.

Here are a few highlights from "Hormones for Your Health":

1.  How hormones got a bad name from the WHI study

• One result cannot be applied to all.  Dr. Fred Naftolin, an eminent biomedical scholar at Yale has said the "WHI has been inappropriately used to create guidelines (for physicians) that are incorrect for any group other than the overweight, average-seventeen-years-postmenopausal population on which the particular regimen (synthetic Premarin, Provera or Prempro) was tested."
• The study participants weren't particularly "healthy".  "The WHI participants ranged in weight from simply overweight to frankly obese, with an unusually high incidence of arterial hypertension and a high prescription drug use to control other conditions.  Nearly 50% of the study population started out with several serious cardiovascular risk factors."
• The WHI was not a preventive study.  The WHI, contrary to its claims, wasn't designed to study "primary prevention"--which is preventing disease in an already healthy population.  You can't study "primary prevention" in healthy women when the majority of the women  enrolled either already have cardiovascular disease or are at a high risk for getting cardiovascular disease, because they were overweight, well past menopause, & hypertensive.
• Not all progestins and estrogens are alike.  Synthetic progestins (medroxyprogesterone acetate-generic Provero) affect the body differently than bio-identical progesterone.  Research has long shown adverse cardiovascular effects from the synthetic form. The bio-identical variety is also dosed in a cycle that is similar to a woman's natural cycle--taken only 12 days a month.  Transdermal (topical) estrogen has a more favorable and safer effect than oral forms.

2.   Postmenopausal hormone deficiencies can lead to:

• Decline in bone quality
• Diminished cardiovascular health
• Urogenital atrophy--atrophy of the urogenital tissues in up to 47% of women.
• Wrinkled skin
• Blood vessel thickening and atherosclerosis
• Cognitive decline
• Increase in fat, decrease in muscle.

3.   Benefits of Hormonal Therapies--The Well-Known & Lesser-Known

• Skin benefits with increased thickness, greater blood flow, faster wound healthing, greater water-holding capacity, less wrinkling
• Healthier vaginal tissues.  Responsible for higher acidity which prevents infections; less dryness, less atrophy, less thinning, less urinary tract infections
• Less hot flashes & night sweats
• The nose benefits from estrogen & progesterone.  Without hormones the nose is drier, feels stuffier, produces less mucus.  Since the nose is the first line of defense against airborne infections, hormone therapy helps the body to fend off colds & flu.
• Estrogen and your voice.  There are estrogen receptors in the voice box--women taking HRT had fewer voice complaints, hoarseness, vocal cord dystrophy.
• Estrogen and your teeth.  More estrogen--less tooth loss.
• Estrogen and progesterone and your eyes.  Hormone users had better vision and fewer eye conditions.
• Estrogen and progesterone and sleep quality.  Hormone users had superior sleep quality compared to non-users.
• Estrogen as an antioxidant--lessening the damage of oxygen free radicals that attack the cell membranes of blood vessels.
• Estrogen and gut/intestinal function.  Helps the absorption of key minerals, like calcium,  and helps to maintain the healthy functioning of the gut
• Estrogen, more positive profile for maintaining stable blood sugar, and preventing type II diabetes.

4.  The Big Scare: The Hormone Breast Cancer Question

• Cutler devotes an entire chapter to explaining the entire controversy--how to understand in real numbers the actual risks; why the type of hormones; the kind of dosing & regimen (mimicking a natural cycle); and the method of delivery (oral vs. transdermal) are important to understanding this controversy.
• Breast cancer rates with statin therapy are comparable to breast cancer rates with HRT.
• "Even in the WHI study, the risk of breast cancer on an individual basis was low. In the WHI, of the 8,506 women taking Prempro, 166 cases of invasive breast cancer occurred; in the 8,102 assigned to placebo, 124 cases were detected, that is, 1.95 percent versus 1.53 percent, or a difference of 0.42 percent. So 99 percent of women will not be at increased risk of breast cancer regardless of which hormones they take."

  "And remarkably, most studies show that postmenopausal women who develop breast cancer when they are on hormones are less likely to die from it than postmenopausal women who have breast cancer and are not on hormone therapy. This points to the complexity of the relationship between hormones and breast health."

5.  Choose Hormones Wisely - What Should You Take?

• Estradiol-17 beta taken transdermally (patch, cream, gel).  This mode will not increase triglycerides, and it will enhance heart rate variability.
• Bio-identical progesterone like Prometrium taken on a natural cycle of 12 days a month.  A sequential regimen lowers the risk of breast cancer, builds better bones, better mental function and a healthier cardiovascular system.
• For urogenital health, consider the ESTring which delivers a very low dose of estrogen  (estradiol) at a steady rate locally, not systemically.  It's a small flexible ring inserted vaginally.  It's an option for women who aren't able to take hormones.

6.  Hormones and the Brain

• Estrogen increases the electrical activity of the regions of the brain responsible for verbal and spatial working memory.
• Hormone users perform better in tests of executive function, except when using the synthetic form of progestin (medroxyprogesterone acetate, Provera)
• The brain is receptive to estradiol-17 beta--accept no substitutes.
• Conjugated equine estrogens like Premarin, Prempro or their generic equivalents do not produce the same benefits as the bioidentical estrogen and Cutler believes they may be actually detrimental.  Steer clear of synthetic progestins, like Provera or the generic medroxyprogesterone acetate.

7.  Hormones and the Heart

• Women who start hormone therapy before age 60 have a significantly better likelihood of enjoying good cardiovascular health.
• The best scores of heart health in the Nurses Health Study were in women using hormones, and who had their uteruses & ovaries intact.
• Once women stopped taking hormones they lost their advantage over "never-users".
• A Swedish study found hormone users had lower triglycerides, lower LDL cholesterol, less obesity, less type-II diabetes, less carotid atherosclerosis and lower risk of developing calcium deposits in the coronary artery.

Click here for an excerpt, the Table of Contents & the Index.

Obviously, hormone replacement therapy isn't for everyone.  It's a decision for both you & your doctor.   We're all different, with different risk factors and family histories.  Cutler's book advises us to not get so easily scared by the WHI--to not dismiss the hormone option out-of-hand.  Read the book--and then make a decision.  But remember, there's only a small window of opportunity to start--should you choose to take the HRT route.

Good health isn't found in isolation--with just a pill, a patch or a cream--it must include exercise, a healthy diet, stress reduction, and a healthy lifestyle.

Osteoporosis Prevention. A Diet High in Fruits & Vegetables & Low in Animal Protein & Grains

 

If you think calcium pills & vitamin D are all you need to protect yourself from bone loss, think again!  

"Diets high in protein (especially animal protein) and cereal grains produce an excess of acid in the body which may increase calcium excretion and weaken bones, according to a new study accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM)"

I Thought Protein (especially Dairy Products & Poultry/Fish/Beef) Was Necessary for Building Bone.  How Could It Cause Bone Loss?

• Dr. T. Colin Campbell explains this counter-intuitive situation best.  An animal protein diet creates an acidosis state in the body that diminishes vitamin D, which is needed to build strong bones.  In addition, when acidosis exists, the body pulls out calcium from the bones in an attempt to neutralize the acid state.
• Dr. Bess Dawson-Hughes, the lead author in the JCEM study, explains that when older adults eat diets high in protein & grain, acid is produced, and as we age our bodies are less able to excrete this acid.
  

"One way the body may counteract the acid from our diets is through bone resorption, a process by which bones are broken down to release minerals such as calcium, phosphates, and alkaline (basic) salts into the blood.  Unfortunately, increased bone resorption leads to declines in bone mass and increases in fracture risk."

So What Can I Do to Avoid the Calcium From Leaching Out Of My Bones?

• The Dawson-Hughes research team found that:

"When fruits and vegetables are metabolized they add bicarbonate, an alkaline compound, to the body.  Our study found that bicarbonate had a favorable effect on bone resorption and calcium excretion. This suggests that increasing the alkali content of the diet (eating lots of fruits & vegetables-less animal protein) may attenuate bone loss in healthy older adults."

• Dr. Joel Fuhrman weighed in on the study with these specific recommendations: 
  1. Limit animal protein consumption to 15 ounces per week or less  2. Keep salt consumption under 1200 mg per day  3. Eliminate caffeine, refined sweets & vitamin A supplements.
• Fuhrman wholeheartedly agrees with the Tufts researchers.  Osteoporosis is "also due to factors that accelerate the loss of calcium in the urine. Controlling the factors that work together to leach calcium from the bones and increase calcium in the urine (by reducing and eliminating them) is much more important than taking extra calcium. 
• For those of us less inclined to make the dietary changes--there is good news. The Tufts study also found that you can get your "Alkali Fix" in pill form as well:

"In this study we demonstrated that adding alkali in pill form reduced bone resorption and reduced the losses of calcium in the urine over a three month period. This intervention warrants further investigation as a safe and well tolerated supplement to reduce bone loss and fracture risk in older men and women."

How Was This Study Set Up?

• 171 men & women over the age of 50 participated in a double-blind, controlled trial. The groups received one of the following: a placebo,or 67.5 mmol/d of potassium bicarbonate, sodium bicarbonate, or potassium chloride for 3 months.  All the groups were given 600 mg of calcium & 525 IU of vitamin D3 daily.
• The urinary excretion of calcium was measured when they started & after 3 months.
• It turned out that the Bicarbonate (the alkali compound) was key to reducing calcium excretion.  The potassium had no effect upon the results.
• Take home message:  A diet high in fruits & vegetables would have the same calcium-sparing effect as the bicarbonate pill, with the additional benefits of vitamins, minerals & anti-oxidants. To stop bone loss, it's all about increasing the alkali content of the diet!

Article cited:  Lisa Ceglia, Susan S. Harris, Steven A. Abrams, Helen M. Rasmussen, Gerard E. Dallal, and Bess Dawson-Hughes.  "Potassium bicarbonate attenuates the urinary nitrogen excretion that accompanies an increase in dietary protein and may promote calcium absorption."  The Journal of Clinical Endocrinology & Metabolism.  published online December 2, 2008.

Author affiliation:  The Jean Mayer United States Deartment of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, MA. 

Supported by the Agricultural Research Service, the HNRCA is the largest research institution in the world devoted to investigating the relationship between nutrition and aging.