FOREVER YOUNG - chapter five
THE IMPORTANCE OF BONE HEALTH
When I started researching this chapter, I had no idea how radicalized I would become about healthy bones and their crucial function in all aspects of healthy aging and disease prevention. In fact, this is one of the most important chapters in this book because, as you will learn, healthy bones are the very foundation of our immune system, and until now, we did not have the most ideal strategies to ensure that we could prevent bone loss.
Bone formation—the acquisition of bone mineral density (BMD)— peaks between the ages of 20 and 30. After the age of 35, both men and women begin to lose bone mass unless they take action to prevent it. Unfortunately, at that age few of us are thinking about our health, our longevity, or anything in between. By the time we begin to think about our bones, we may have already suffered serious damage. It seems hard to believe that this can happen so early in our lives. Often our conception of age-related bone loss is that of a person of advanced age—seventies or eighties—bent under the burden of the dowager's hump.
You need to protect your bones from an early age. If you are in your twenties or thirties and reading this chapter, you can take active steps to prevent future problems. If you are older, take heart because there are exciting new strategies that can make a significant difference now.
Regular exercise is far and away the single most important action we can take to prevent and help reverse bone loss. Unfortunately, we are raising a generation of couch potatoes and computer/video jockeys who rarely exercise. If you happen to be a small Caucasian female with a penchant for dieting, the risk of bone loss is even greater. But there is good news. According to many studies, a high-intensity exercise program prevents bone loss in early postmenopausal women with low bone density.
The Weighting Game
As many studies affirm, weight-bearing exercises have an extremely beneficial effect on bone mass and bone density. The pressure exerted on the bones during this type of exercise stimulates the building of bone. Ideally, your exercise routines will be complex and will involve the total body; in this way you can achieve the greatest benefits.
A Step in the Right Direction
In conjunction with weight training, I recommend a thirty-minute brisk walk or jog every day. My colleague Harry Preuss, M.D., and I are firm believers in the use of pedometers to encourage an active lifestyle. A pedometer senses your body motion and counts your footsteps. If you are like me, you enjoy a challenge—and a pedometer motivates me to increase my movements. Many of us spend long hours in front of computers, and wearing the pedometer reminds us of just how sedentary our lives have become. If it is 10 a.m. and you glance at the pedometer and see that it is registering a meager 200 steps and your goal is 10,000 per day, it can help spur you into immediate action. I set a goal each day and am always delighted when I exceed it. You need to take 6,000 steps per day for overall good health and as many as 10,000 steps per day for weight loss. It is never too late to start an exercise program, and consistency is always the key. Walking is a great default exercise program in that you don't need a gym; the only equipment you need is a pair of good walking shoes, and, weather permitting, walking is something you can do 365 days a year.
(CHARLES ATLAS EXERCISES NEED NO OUTDOORS, GYM, OR MACHINES - HIS COURSE IS STILL AVAILABLE - Keith Hunt)
Who Is at Risk?
According to information from the National Osteoporosis Foundation posted on the National Institute of Health's Web site (www.osteo.org), the following factors can put you at increased risk for osteoporosis:
History of fracture after age 50.
Current low bone mass.
History of fracture in a close relative.
Being thin and/or having a small frame.
Advanced age (osteoporosis is a major public health threat
for 55 percent of people 50 years of age and older; the older
you are, the greater the risk).
A family history of osteoporosis.
Low lifetime calcium intake.
Vitamin D deficiency.
An inactive lifestyle.
For women only: estrogen deficiency as a result of menopause, especially early or surgically induced. Also, women who stop menstruating before menopause because of conditions such as anorexia or bulimia or because of excessive physical exercise are at greater risk.
For men only: low testosterone levels. For both men and women: use of certain medications to treat chronic medical conditions such as rheumatoid arthritis, endocrine disorders (i.e., an underactive thyroid, which can be helped by coconut oil), seizure disorders, and gastrointestinal diseases may have side effects that can damage bone and lead to osteoporosis.
One class of drugs that has particularly damaging effects on the skeleton is glucocorticoids (a group of steroids that have metabolic and anti-inflammatory-effects). The following drugs can also cause bone loss:
Excessive thyroid hormones
Antacids containing aluminum
These facts notwithstanding, the news is particularly grim for women. It is difficult to overstate the importance of BMD, which is often viewed as the "gold standard" for bone health. Unfortunately, for a variety of reasons, BMD is decreasing in women in the United States. In 2004, Bone Health and Osteoporosis: A Report of the Surgeon General predicted that by 2020 (a scant decade away) half of all American citizens older than 50 will be at risk for fractures from osteoporosis and low bone mass if no immediate action is taken. The report concluded that Americans' bone health is in jeopardy due to increasingly sedentary lifestyles, an absence of current information about bone health (which this chapter will hope to alleviate), and inadequate nutrition. The surgeon general recommended that people of all ages ensure that they get the recommended amounts of calcium and vitamin D, and that supplementation maybe helpful. Pointing out that people are never too young or too old to improve their bone health, the surgeon general issued a "call to action" for the development and evaluation of bone health programs that incorporated three components: (1) improved health literacy, (2) increased physical activity, and (3) improved nutrition. Though this is a vitally important initiative for everyone, women in particular need to be educated on their risks, which pose a significant threat to BMD with the passing years.
Bone loss accelerates after menopause because the female hormone estrogen, needed to maintain bone density, is greatly reduced. The lack of estrogen accelerates a process known as bone remodeling, the process in which small areas of bone are destroyed and subsequently rebuilt. Estrogen deficiency can lead to an imbalance, resulting in more destruction and less formation, which can predispose women to osteoporosis as they age. If a woman's ovaries are surgically removed, even more rapid bone loss may occur because estrogen is made primarily in the ovaries. The most rapid rates of bone loss in women occur during the first five years after menopause, when the decrease in the production of estrogen results in increased bone resorption and decreased calcium absorption. In-fact, according to statistics, women may lose as much as 3 to 5 percent of bone mass per year during the years immediately following menopause, with decreases of less than 1 percent per year after age 65. Two studies are in agreement that increased calcium intake during menopause will not completely offset menopause bone loss. Other studies show that nutritional supplements such as silicon in the form of choline-stabilized ortho silicic acid improves the bone health benefits of both calcium and vitamin D. As you will discover, specially targeted nutrients can not only slow bone loss, they can actually encourage new bone growth.
While there is an extensive and compelling body of research supporting the positive effects of calcium and vitamin D3 on bone health, a review of forty-eight studies on the effects of calcium on bone health concluded that other micronutrients are needed to optimize bone health, including vitamin K2, magnesium, and trace minerals. Vitamin C has also been reported as essential to collagen formation and normal bone development.
Healthy Bones, Healthy Heart
Many of us are familiar with vitamin K (phylloquinone, also known as phytonadione), commonly referred to as vitamin Kl, which is a fat-soluble vitamin found in foods such as cabbage, broccoli, cauliflower, spinach, kale, turnip greens, and other dark leafy greens, cereals, and other vegetables. Vitamin Kl makes up about 90 percent of the vitamin K in a typical Western diet and plays an important role in blood clotting. Because this is a fat-soluble vitamin, it is important to eat these foods dressed with a little extra-virgin olive oil to ensure absorption of the nutrient. Some studies indicate that only 10 percent of the vitamin Kl in foods is absorbed by your body.
Today, emerging evidence in human intervention studies indicate that vitamin Kl at a much lower dose may also benefit bone health, in particular when co-administered with vitamin D. Several mechanisms are suggested by which vitamin K can modulate bone metabolism. Besides the gamma-carboxylation of osteocalcin, a protein believed to be involved in bone mineralization, there is increasing evidence that vitamin K positively affects calcium balance, a key mineral in bone metabolism. The Institute of Medicine has recently increased the dietary reference intakes of vitamin K to 90 micrograms per day for women and 120 micrograms per day for men, which is an increase of approximately 50 percent from previous recommendations.
A new analysis by Joyce McCann, Ph.D., and Bruce Ames, Ph.D., of Children's Hospital Oakland Research Institute of data from hundreds of published articles dating back to the 1970s also advises that the current recommendations for vitamin K intakes be increased.
Current recommendations are based on levels to ensure adequate blood coagulation, but failing to ensure long-term optimal levels of the vitamin may accelerate bone fragility, arterial and kidney calcification, cardiovascular disease, and possibly even cancer.
Vitamin K2: Don't Leave Home Without It!
Though this is good news, the news about vitamin K2 is even better when it comes to both bone and arterial health. Vitamin K2, also known as menaquinones, stays in the body for a significantly longer time than Kl. It makes up about 10 percent of a typical Western diet's vitamin K and can be synthesized in the gut by microflora.
Menaquinones (MK-n) can also be found in the diet: MK-4 can be found in meat; MK-7, MK-8, and MK-9 are found in fermented food products like cheese, and an especially rich source of MK-7 is natto, a popular, centuries-old breakfast dish in Japan made from steamed fermented soybeans. Because of its rather unpleasant—some might call it "slimy"—consistency, natto, said to be the food of samurai warriors, can be a hard sell to the Western palate.
Chairman of the Board Certified
My friend and colleague Stephen Sinatra, M.D., F.A.C.N., C.N.S., is board certified in both internal medicine and cardiology. The buildup of arterial plaque is deadly to the healthy heart, and Dr. Sinatra continually searches for effective strategies to decrease this threat. A number of studies have demonstrated the effectiveness of vitamin K2 in reversing plaque in blood vessels. Vitamin K2 appears to assist in the decalcification of hard plaque formations.
Dr. Sinatra has seen outstanding progress in his patients taking the MK-7 (menaquinone-7) type of vitamin K2, which offers the following unique benefits:
Provides the most active and bioavailable form of vitamin
Helps reduce the level of calcium in the bloodstream
Supports cardiovascular health
Helps strengthen bones
Aids in calcium absorption by bones
Helps increase bone density
I recently met with Dr. Sinatra to learn even more about this remarkable nutrient. Although this is a chapter on bone health, the remarkable discoveries about vitamin K2 demonstrate the holistic nature of the body and how all systems are intrinsically linked—in this instance, bone health and heart health. This makes it difficult to compartmentalize each organ system into a neat little chapter. There is tremendous overlap among bone health, digestive health, the immune system, the cardiovascular system, and so forth. As you will discover, a great bone structure means much more than just getting us on the pages of Vogue.
Dr. Sinatra had impressive news from Dr. Cees Vermeer, a biochemist from Maastricht University in the Netherlands and one of the top vitamin K2 researchers in the world. Two new studies (published in Blood, the journal of the American Society of Hematology) by Dr. Vermeer's team of researchers have reported the following:
The first study showed that vitamin K2 is more absorbable by the body than vitamin Kl, so K2 is able to provide more support for the enzyme process that contributes to bone health—and more protection against osteoporosis. This absorbability puts vitamin K2 at greater risk of interfering with Coumadin, which is a vitamin K antagonist. Vitamin K promotes clotting, and Coumadin is prescribed to keep the blood thin by preventing clotting. According to Dr. Sinatra, new evidence from Europe suggests that Coumadin may also interfere with a vitamin K2 protein system that keeps calcium out of the arterial walls. It now appears that on one hand, Coumadin thins the blood, but on the other, it contributes to arterial calcification. Coumadin causes a deficiency of both vitamin Kl and vitamin K2. It should come as no surprise to learn that Coumadin takers suffer more osteoporosis in conjunction with more abnormal calcium deposits in other areas, such as the heart valves—in fact, twice as much as those not taking the drug. Dr. Sinatra has become extremely cautious about prescribing Coumadin because of these risks, reserving its use for only the highest-risk patients.
(MY DAD WAS ON COUMADIN FOR THE LAST 20 YEARS OF HIS LIFE - HE ALWAYS MADE SURE HE HAD LOTS OF CALCIUM AND "D" EACH DAY - HE LIVED TO BE TWO MONTHS SHORT OF BEING 94 - IF I COULD HAVE GOTTEN HIM TO LOOSE HIS BIG BELLY, I BELIEVE HE WOULD NOT HAVE HAD HIS STROKE AT AGE 91, AND COULD HAVE LIVED TO BE 100 OR MORE - Keith Hunt)
To better understand the role of calcium in the body, consider this:
Normal deposits of calcium occur only in bone and teeth.
Abnormal deposition of calcium in the body occurs in three places:
the intima, the innermost layer or lining of the arteries that causes atherosclerotic plaque; the heart valves; and the medial calcification, which is the muscle layer of the arteries.
Studies also show that people with coronary disease, in conjunction with reduced blood levels of vitamin K2, show more advanced atherosclerotic plaque. It also appears that calcium is an active participant in the buildup of coronary plaque—and not the innocent bystander once supposed!
In a second study, Dr. Vermeer found that a diet high in both vitamins Kl and K2 could prevent and reverse Coumadin-induced arterial calcification in rats. The rat arteries that were studied resembled human arteries affected by common diabetic and age-related sclerosis (hardening of tissues).
Traditionally, calcification has been thought to be an irreversible end-stage process in arterial disease. There is a very real possibility that a vitamin supplement could roll back the sclerosis that destroys the arteries. Imagine what this could mean to individuals with diabetes and heart disease.
Could it be that many detrimental physical processes associated with age are not part of the so-called normal aging process? More and more, the answer is yes, and many of the pillars supporting the "carved in stone" scientific beliefs are toppling. As this information demonstrates, many of these processes can actually be reversed—and, equally important, prevented altogether.
The calcium link between arteries and bone is fascinating to me. One of the biggest tragedies of aging is osteoporosis, which predisposes us to weakness, frailty, and dangerous bone fractures, greatly limiting our mobility. Unfortunately, the calcium that belongs in our bones is transferred to arterial walls, predisposing us to cardiovascular disease and more. Adequate intake of vitamin K2 can stop this from occurring. We now have what appears to be a highly effective strategy to keep bones strong and arteries free of dangerous plaque. As you can see, strategies that can keep bones healthy have significant impact on our cardiovascular systems as well—absolutely critical information for women with each passing decade.
(MY DAD READ AN ARTICLE AT AGE 63 THAT TAKING "LECITHIN" EACH DAY, WOULD KEEP YOUR ARTERIES CLEAN; AT AGE 85 THE DOCTORS AND NURSES COULD NOT BELIEVE HOW CLEAN HIS ARTERIES WERE ON EXAMINATION, AND THEY ASKED HIM WHAT HE HAD BEEN DOING FOR SUCH RESULTS - HE TOLD THEM. I ALSO HAVE BEEN TAKING A LECITHIN TABLET EACH DAY FOR YEARS - Keith Hunt)
Although it is breast cancer that puts the fear of death into women, the fact is that women have a much greater chance of dying of heart disease. Vitamin K2 can greatly reduce your odds of developing this disease. Although heart disease was thought of as a "man's disease" in the past, it is the leading cause of death for both women and men in the United States, and women account for 52.6 percent of the total heart disease deaths. In 2005, heart disease was the cause of death in more than 454,000 females. Heart disease is often perceived as an "older woman's disease," and it is the leading cause of death among women age 65 and older. The fact is that heart disease is the third leading cause of death among women age 25 to 45 and the second leading cause of death among women aged 45 to 64. Remember that many cases of heart disease can be prevented!
The graph below shows how breast cancer compares with other common causes of death in women of all ages.
Diseases of heart 349, 238
Cerebrovascular diseases 86, 993
Lung and bronchus cancer 69, 078
Chronic lower respiratory disease 68, 497
Alzheimer's disease 51, 038
Accidents (unintentional injury) 41, 426
Breast cancer 41, 116
Diabetes melitus 38, 581
Influenza and pneumonia 34, 949
Colorectal cancer 26, 224
0 100,000 200,000 300,000 400,000
Number of Deaths
TOP TEN CAUSES OF DEATH FOR WOMEN IN THE UNITED STATES
Source: Surveillance, Epidemiology, and End Results (SEER) Program (www.seer xancer.gov) SEER*Stat Database: Mortality—All COD, Public-Use with State, Total U.S. (1969-2005), National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released February 2008. Underlying mortality data provided by CDC's National Center for Health Statistics. For more information and facts, visit the CDC's Heart Disease site, http://www.cdc.gov/heartdisease/.
(REMEMBER THIS BOOK WAS WRITTEN IN 2010 - Keith Hunt)
As you can see, you are eight times as likely to die of heart disease than breast cancer. Not to downplay the breast cancer risk, but you are also more likely to die from an accident than you are from breast cancer! I personally find this lack of awareness by many women about their most dire health threat a matter of great concern.
According to the American Heart Association, nearly 37 percent of all female deaths in America occur from cardiovascular disease. Many women simply do not understand the dangers of heart disease and stroke.
TO BE CONTINUED